Recommendations of the Spanish-Portuguese Internal Medicine services in the fight against climate change and environmental degradation.

Facing the severity of the impact of climate change and environmental degradation on human health, 32 Internal Medicine societies, colleges, and associations of 29 Spanish and Portuguese-speaking countries issue a consensus document in which they call for the implication of doctors and all health professionals in the global fight against the causes of these changes. This commitment requires the cooperation of health-related organizations, elaboration and implementation of good environmental sustainability practices, greater awareness of professionals and population, promotion of education and research in this area, increasing climate resilience and environmental sustainability of health systems, combating inequalities and protecting the most vulnerable populations, adopting behaviors that protect the environment, and claiming Internal Medicine as a core specialty for empowerment of the health system to respond to these challenges.

Análisis bibliométrico de las revistas oficiales de sociedades de medicina interna en Europa / Bibliometric analysis of the official journals of internal medicine societies in Europe

Introducción La bibliometría evalúa la calidad de las revistas biomédicas. El objetivo de este estudio ha sido comparar los principales índices bibliométricos de las revistas oficiales de sociedades científicas de medicina interna en Europa. Material y métodos Se obtuvo información bibliométrica de las bases de datos Web of Science (WoS) y Scopus. Se analizaron tanto métricas de impacto (Journal Impact Factor [JIF], CiteScore) como normalizadas (Journal Citation Indicator [JCI], Normalized Eigenfactor, Source Normalized Impact per Paper [SNIP] y SCImago Journal Rank [SJR]) de las revistas para el año 2022, y se observó su evolución en la última década. Resultados Se evaluaron 23 revistas oficiales de 33 sociedades científicas. Ocho revistas estaban incluidas en WoS y 11 en Scopus. Las revistas mejor posicionadas en 2022 fueron: 1) European Journal of Internal Medicine, que ocupó el primer cuartil (Q1) de las métricas JIF, CiteScore y JCI, superando valores de uno en las métricas Normalized Eigenfactor y SNIP; 2) Internal and Emergency Medicine, en Q1 para las métricas CiteScore y JCI, y con valores >1 en las métricas Normalized Eigenfactor y SNIP; 3) Polish Archives of Internal Medicine, con Q1 en la métrica JCI; 4) Revista Clínica Española, con Q2 para las métricas JIF, CiteScore y JCI; y 5) Acta Medica Belgica, con Q2 en las métricas CiteScore y JCI. Estas revistas incrementaron sus métricas de impacto en los últimos 3 años, coincidiendo con la pandemia COVID. Conclusiones Cinco revistas oficiales de sociedades europeas de medicina interna, entre ellas Revista Clínica Española, cumplen altos estándares de calidad. (AU)

Introduction Bibliometrics evaluates the quality of biomedical journals. The aim of this study has been to compare the main bibliometric indexes of the official journals of scientific societies of internal medicine in Europe. Material and methods Bibliometric information was obtained from the Web of Science (WoS) and Scopus databases. Both impact metrics (Journal Impact Factor [JIF], CiteScore) and normalized metrics (Journal Citation Indicator [JCI], Normalized Eigenfactor, Source Normalized Impact per Paper [SNIP] and SCImago Journal Rank [SJR]) of the journals for the year 2022 were analyzed, and their evolution over the last decade was described. Results Twenty-three official journals from 33 scientific societies were evaluated. Eight journals were included in WoS and 11 in Scopus. The best positioned journals in 2022 were: 1) European Journal of Internal Medicine, which ranked in the first quartile (Q1) for JIF, CiteScore and JCI metrics, exceeding values of 1 in Normalized Eigenfactor and SNIP metrics; 2) Internal and Emergency Medicine, with Q1 for CiteScore and JCI metrics, and with values >1 in Normalized Eigenfactor and SNIP metrics; 3) Polish Archives of Internal Medicine, with Q1 for JCI metrics; 4) Revista Clínica Española, with Q2 for JIF, CiteScore and JCI metrics; and 5) Acta Medica Belgica, Q2 for CiteScore and JCI metrics. These journals increased their impact metrics in the last 3 years, in parallel with the COVID pandemic. Conclusions Five official journals of European Internal Medicine societies, including Revista Clínica Española, meet high quality standards. (AU)

Recomendaciones de los servicios de Medicina Interna hispano-lusos en la lucha contra el cambio climático y la degradación ambiental / Recommendations of the Spanish-Portuguese Internal Medicine services in the fight against climate change and environmental degradation

Ante la gravedad del impacto sobre la salud del cambio climático y la degradación ambiental 32 sociedades, colegios y asociaciones de Medicina Interna de 29 países de habla hispana y lusa divulgan un documento de consenso en que llaman a la implicación de los médicos y todos los profesionales de salud en la lucha global contra las causas de estos cambios. Este compromiso requiere la cooperación de las organizaciones relacionadas con la salud, elaboración e implementación de buenas prácticas de sostenibilidad ambiental, sensibilización de los profesionales de la salud y de la población, promoción de la educación e investigación en esta área, refuerzo de la resiliencia climática y la sostenibilidad ambiental de los sistemas de salud, combatir las desigualdades y proteger a las poblaciones más vulnerables, adopción de comportamientos que protegen el medio ambiente, y defensa de la Medicina Interna como una especialidad central para habilitar al sistema de salud para responder a estos desafíos. (AU)

Facing the severity of the impact of climate change and environmental degradation on human health, 32 Internal Medicine societies, colleges, and associations of 29 Spanish and Portuguese-speaking countries issue a consensus document calling for the implication of doctors and all health professionals in the global fight against the causes of these changes. This commitment requires the cooperation of health-related organizations, elaboration and implementation of good environmental sustainability practices, greater awareness of professionals and population, promotion of education and research in this area, increasing climate resilience and environmental sustainability of health systems, combating inequalities and protecting the most vulnerable populations, adopting behaviors that protect the environment, and claiming Internal Medicine as a core specialty for empowerment of the health system to respond to these challenges. (AU)

Bibliometric analysis of the official journals of internal medicine societies in Europe.

INTRODUCTION: Bibliometrics evaluates the quality of biomedical journals. The aim of this study has been to compare the main bibliometric indexes of the official journals of scientific societies of Internal Medicine in Europe. MATERIAL AND METHODS: Bibliometric information was obtained from the Web of Science (WoS) and Scopus databases. Both impact metrics (Journal Impact Factor [JIF], CiteScore) and normalized metrics (Journal Citation Indicator [JCI], Normalized Eigenfactor, Source Normalized Impact per Paper [SNIP] and SCImago Journal Rank [SJR]) of the journals for the year 2022 were analyzed, and their evolution over the last decade was described. RESULTS: Twenty-three official journals from 33 scientific societies were evaluated. Eight journals were included in WoS and 11 in Scopus. The best positioned journals in 2022 were: 1) European Journal of Internal Medicine, which ranked in the first quartile (Q1) for JIF, CiteScore and JCI metrics, exceeding values of 1 in Normalized Eigenfactor and SNIP metrics; 2) Internal and Emergency Medicine, with Q1 for CiteScore and JCI metrics, and with values >1 in Normalized EigenFactor and SNIP metrics; 3) Polish Archives of Internal Medicine, with Q1 for JCI metrics; 4) Revista Clínica Española, with Q2 for JIF, CiteScore and JCI metrics; and 5) Acta Medica Belgica, with Q2 for CiteScore and JCI metrics. These journals increased their impact metrics in the last 3 years, in parallel with the COVID pandemic. CONCLUSIONS: Five official journals of European Internal Medicine societies, including Revista Clínica Española, meet high quality standards.

Resumen ejecutivo del documento de consenso para la formación y el desarrollo de la ecografía clínica en Medicina Interna: recomendaciones desde el Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna (GTECO-SEMI) / Executive summary of the consensus document for the training and development of clinical ultrasound in internal medicine: Recommendations from the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine (GTECO-SEMI)

Introducción Dada la creciente adopción de la ecografía clínica en medicina, es fundamental estandarizar su aplicación, su formación y su investigación. Objetivos y métodos El propósito de este documento es proporcionar recomendaciones de consenso para responder cuestiones sobre la práctica y el funcionamiento de las unidades de ecografía clínica. Participaron 19 expertos y responsables de unidades avanzadas de ecografía clínica. Se utilizó un método de consenso Delphi modificado. Resultados Se consideraron un total de 137 declaraciones de consenso, basadas en la evidencia y en la opinión experta. Las declaraciones fueron distribuidas en 10 áreas. Un total de 99 recomendaciones alcanzaron consenso. Conclusiones Este consenso define los aspectos más importantes de la ecografía clínica en el ámbito de la Medicina Interna, con el objetivo de homogeneizar y promover este avance asistencial en sus diferentes vertientes. El documento ha sido elaborado por el Grupo de Trabajo de Ecografía Clínica y avalado por la Sociedad Española de Medicina Interna. (AU)

Introduction Given the increasing adoption of clinical ultrasound in medicine, it is essential to standardize its application, training, and research. Objectives and methods The purpose of this document is to provide consensus recommendations to address questions about the practice and operation of clinical ultrasound units. Nineteen experts and leaders from advanced clinical ultrasound units participated. A modified Delphi consensus method was used. Results A total of 137 consensus statements, based on evidence and expert opinion, were considered. The statements were distributed across 10 areas, and 99 recommendations achieved consensus. Conclusions This consensus defines the most important aspects of clinical ultrasound in the field of internal medicine, with the aim of standardizing and promoting this healthcare advancement in its various aspects. The document has been prepared by the Clinical Ultrasound Working Group and endorsed by the Spanish Society of Internal Medicine. (AU)

Resumen ejecutivo del documento de consenso para la formación y el desarrollo de la ecografía clínica en Medicina Interna: recomendaciones desde el Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna (GTECO-SEMI) / Executive summary of the consensus document for the training and development of clinical ultrasound in internal medicine: Recommendations from the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine (GTECO-SEMI)

Introducción Dada la creciente adopción de la ecografía clínica en medicina, es fundamental estandarizar su aplicación, su formación y su investigación. Objetivos y métodos El propósito de este documento es proporcionar recomendaciones de consenso para responder cuestiones sobre la práctica y el funcionamiento de las unidades de ecografía clínica. Participaron 19 expertos y responsables de unidades avanzadas de ecografía clínica. Se utilizó un método de consenso Delphi modificado. Resultados Se consideraron un total de 137 declaraciones de consenso, basadas en la evidencia y en la opinión experta. Las declaraciones fueron distribuidas en 10 áreas. Un total de 99 recomendaciones alcanzaron consenso. Conclusiones Este consenso define los aspectos más importantes de la ecografía clínica en el ámbito de la Medicina Interna, con el objetivo de homogeneizar y promover este avance asistencial en sus diferentes vertientes. El documento ha sido elaborado por el Grupo de Trabajo de Ecografía Clínica y avalado por la Sociedad Española de Medicina Interna. (AU)

Introduction Given the increasing adoption of clinical ultrasound in medicine, it is essential to standardize its application, training, and research. Objectives and methods The purpose of this document is to provide consensus recommendations to address questions about the practice and operation of clinical ultrasound units. Nineteen experts and leaders from advanced clinical ultrasound units participated. A modified Delphi consensus method was used. Results A total of 137 consensus statements, based on evidence and expert opinion, were considered. The statements were distributed across 10 areas, and 99 recommendations achieved consensus. Conclusions This consensus defines the most important aspects of clinical ultrasound in the field of internal medicine, with the aim of standardizing and promoting this healthcare advancement in its various aspects. The document has been prepared by the Clinical Ultrasound Working Group and endorsed by the Spanish Society of Internal Medicine. (AU)

Executive summary of the consensus document for the training and development of clinical ultrasound in Internal Medicine: Recommendations from the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine (GTECO-SEMI).

INTRODUCTION: Given the increasing adoption of clinical ultrasound in medicine, it is essential to standardize its application, training, and research. OBJECTIVES AND METHODS: The purpose of this document is to provide consensus recommendations to address questions about the practice and operation of clinical ultrasound units. Nineteen experts and leaders from advanced clinical ultrasound units participated. A modified Delphi consensus method was used. RESULTS: A total of 137 consensus statements, based on evidence and expert opinion, were considered. The statements were distributed across 10 areas, and 99 recommendations achieved consensus. CONCLUSIONS: This consensus defines the most important aspects of clinical ultrasound in the field of Internal Medicine, with the aim of standardizing and promoting this healthcare advancement in its various aspects. The document has been prepared by the Clinical Ultrasound Working Group and endorsed by the Spanish Society of Internal Medicine.

Estudio multicéntrico sobre multimorbilidad en internados en áreas clínicas / Multicenter Study on Multimorbidity in Patients in Clinical Areas

Introducción: El estudio de la comorbilidad requiere de un enfoque multilateral con vistas a mejorar la calidad de la atención de los enfermos por el sistema de atención. Objetivos: Explorar la magnitud de la comorbilidad de enfermedades crónicas en adultos internados en los hospitales. Métodos: Se realizó un estudio prospectivo-observacional-longitudinal-analítico. Se incluyeron pacientes internados en las Salas de Clínica Médica o pacientes clínicos en Salas de Internación Indiscriminada. Se realizó un estudio multicéntrico en 42 centros en un período de 2 años, con un muestreo consecutivo. Para el estudio se tuvo en cuenta la estadística descriptiva, inferencial y de regresión. Resultados: El total de pacientes en el estudio fue de 5925, masculinos con el 50,3 por ciento de edad 60,66 ± 0,25 años. Principal procedencia desde la guardia el 73 por ciento. La estadía hospitalaria de 12,61 ± 0,24 días, mayormente en pacientes quirúrgicos (15,45 ± 0,67 vs 11,76 ± 0,23; p < 0,00001). El 23 por ciento recibió tratamiento quirúrgico. El principal nivel educativo: secundario completo 21,6 por ciento. Dificultades económicas: 20 por ciento, mortalidad 9,26 por ciento; prevalencia de dislipemia, diabetes e hipertensión: 22,53 por ciento; 28,82 por ciento y 51,86 por ciento con 473 nuevos diagnósticos, IMC: 27,88 ± 0,65, Charlson global 2,09 ± 0,02 y en óbitos 3,84 ± 0,11. La media de patologías por paciente fue de 2,14 ± 0,01 y aumentó con la edad (p valor regresión lineal < 0,00001). Conclusiones: La hipertensión, la diabetes y la dislipemia representaron las entidades más prevalentes en Salas de Internación Clínica, Las enfermedades cardiovasculares, respiratorias, infectológicas, oncológicas, neurológicas, metabólicas y nefrológicas fueron predictores independientes de mortalidad(AU)

Introduction: The study of comorbidity requires a multilateral approach with a view to improving the quality of care for these patients by the care system. Objectives: To explore the magnitude of the comorbidity of chronic diseases in adults admitted to hospitals. Methods: Prospective-observational-longitudinal-analytical study. Patients hospitalized in a medical clinic room or clinical patients in indiscriminate hospitalization rooms are included, Multicenter study in 42 centers, with 2 years of recruitment. Consecutive sampling. Descriptive, inferential and regression statistics. Results: 5925 recruited, male gender 50,3percent, age 60,66 ± 0,25 years, main origin from the guard 73percent, stay 12,61 ± 0,24 days, longer in surgical (15,45 ± 0,67 vs 11,76 ± 0,23, p < 0,00001), 23percent received surgical treatment. Main educational level: complete secondary school 21,6%. Economic difficulties: 20percent, mortality 9,26percent, prevalence of dyslipidemia, diabetes and hypertension: 22,53percent, 28,82percent and 51,86percent with 473 new diagnoses in said pathologies, BMI: 27,88 ± 0,65, Global Charlson 2,09 ± 0,02 and in deaths 3,84 ± 0,11. The average number of pathologies per patient was 2,14 ± 0,01 and increased with age (p value for linear regression < 0,00001). Conclusions: Hypertension, diabetes and dyslipidemia represented the most prevalent entities in the clinical hospitalization room, cardiovascular, respiratory, infectious, oncological, neurological, metabolic and nephrological diseases were independent predictors of mortality(AU)

Jean-Martin Charcot: the polymath / Jean-Martin Charcot: o polímata

Abstract Jean-Martin Charcot, widely regarded as a leading founder of modern neurology, made substantial contributions to the understanding and characterization of numerous medical conditions. His initial focus was on internal medicine, later expanding to include neuropathology, general neurology, and eventually emerging fields such as neuropsychology and neuropsychiatry. Furthermore, Charcot's intellectual pursuits extended beyond medicine, encompassing research in art history, medical iconography, sociology, religious studies, and the arts, solidifying his status as a polymath.

Resumo Jean-Martin Charcot, amplamente considerado como um proeminente fundador da neurologia moderna, fez contribuições substanciais para a compreensão e a caracterização de várias condições médicas. Seu foco inicial era a medicina interna, expandindo-se posteriormente para incluir a neuropatologia, a neurologia geral e, por fim, campos emergentes como a neuropsicologia e a neuropsiquiatria. Além disso, as buscas intelectuais de Charcot foram além da medicina, abrangendo pesquisas em história da arte, iconografia médica, sociologia, estudos religiosos e artes, solidificando seu status de polímata.

Características y tratamiento de los pacientes nonagenarios con enfermedad vascular ingresados en los servicios de medicina interna. Registro NONAVASC-2 / Characteristics and treatment of nonagenarian patients with vascular disease admitted to internal medicine services. NONAVASC-2 registry

Introducción La enfermedad vascular es la causa más frecuente de morbimortalidad, y su prevalencia incrementa con la edad. Los pacientes muy añosos no se encuentran incluidos en los estudios sobre enfermedad vascular, desconociéndose sus características y tratamientos. Objetivo Conocer las características clínicas de los pacientes nonagenarios hospitalizados en servicios de medicina interna con diagnóstico de EV establecida y la adecuación de su manejo farmacológico. Material y métodos El Registro NONAVASC-2 es un estudio observacional, prospectivo y multicéntrico. Se incluyeron pacientes hospitalizados por cualquier causa. La recogida de datos se realizó a través de una base anonimizada online con parámetros sociodemográficos, clínicos, analíticos, terapéuticos y evolutivos. Resultados Se incluyeron 1.049 pacientes con una edad media de 93,14 años (57,8% mujeres). La prevalencia de los factores de riesgo fue muy elevada: hipertensión (84,9%), dislipemia (50,9%) y diabetes mellitus (29,4%). El 33,4% presentaba dependencia grave/total. El 82,9% recibía tratamiento antitrombótico (53,7% antiagregantes, 25,4% anticoagulación y 3,8% doble terapia). Solo el 38,2% recibía estatinas. El porcentaje de dependencia (39,2 vs. 24,1%; p=0,00) y deterioro cognitivo grave (30,8 vs. 13,8%; p=0,00) era significativamente mayor entre los pacientes que no las recibían. El 19% falleció durante el ingreso. Conclusión Los pacientes nonagenarios con EV presentan una elevada comorbilidad, dependencia y mortalidad. A pesar de estar en prevención secundaria, el 17% de ellos no recibía antitrombóticos y solo el 38% estatinas. Esta infraprescripción está condicionada por la situación funcional, entre otros factores, por lo que es necesario realizar más estudios para conocer el impacto sobre su pronóstico (AU)

Introduction Vascular disease is the most frequent cause of morbidity and mortality and its prevalence increases with age. Old patients are not included in studies on vascular disease, their characteristics and treatments being unknown. Objective Know the clinical characteristics of nonagenarian patients hospitalized in Internal Medicine services with a diagnosis of established VD and the adequacy of their pharmacological management. Material and methods The NONAVASC-2 registry is an observational, prospective, multicentre study. Hospitalized patients for any cause were included. Data collection was carried out through an anonymous online database with sociodemographic, clinical, analytical, therapeutic and evolutionary parameters. Results One thousand forty-nine patients with a mean age of 93.14 years (57.8% women) were included. The prevalence of risk factors and VD was high: hypertension (84.9%), dyslipidemia (50.9%) and diabetes mellitus (29.4%). 33.4% presented severe-total dependency. 82.9% received antithrombotic treatment (53.7% antiplatelets, 25.4% anticoagulation and 3.8% double therapy). Only 38.2% received statins. The percentage of severe dependence (39.2% vs 24.1%; p=0.00) and severe cognitive impairment (30.8% vs 13.8%; p=0.00) was significantly higher among patients who did not receive them. 19% died during admission. Conclusions Nonagenarian patients with VD present high comorbidity, dependence and mortality. Despite being in secondary prevention, 17% did not receive antithrombotics and only 38% received statins. The underprescription is conditioned, among other factors, by the functional status. More studies are necessary to determine the impact of this issue on their prognosis (AU)

conTemporary reflectiOns regarding heart failure manaGEmenT - How to ovERcome the PorTuguese barriers (TOGETHER-PT).

INTRODUCTION AND OBJECTIVES: Heart failure (HF) is a complex clinical syndrome that is a significant burden in hospitalisations, morbidity, and mortality. Although a significant effort has been made to better understand its consequences and current barriers in its management, there are still several gaps to address. The present work aimed to identify the views of a multidisciplinary group of health care professionals on HF awareness and literacy, diagnosis, treatment and organization of care, identifying current challenges and providing insights into the future. METHODS: A steering committee was established, including members of the Heart Failure Study Group of the Portuguese Society of Cardiology (GEIC-SPC), the Heart Failure Study Group of the Portuguese Society of Internal Medicine (NEIC-SPMI) and the Cardiovascular Study Group (GEsDCard) of the Portuguese Association of General and Family Medicine (APMGF). This steering committee produced a 16-statement questionnaire regarding different HF domains that was answered to by a diversified group of 152 cardiologists, internists, general practitioners, and nurses with an interest or dedicated to HF using a five-level Likert scale. Full agreement was defined as ≥80% of level 5 (fully agree) responses. RESULTS: Globally, consensus was achieved in all but one of the 16 statements. Full agreement was registered in seven statements, namely 3 of 4 statements for patient education and HF awareness and 2 in 4 statements of both HF diagnosis and healthcare organization, with proportions of fully agree responses ranging from 82.9% to 96.7%. None of the HF treatment statements registered full agreement but 3 of 4 achieved ≥80% of level 4 (agree) responses. CONCLUSION: This document aims to be a call-to-action to improve HF patients' quality of life and prognosis, by promoting a change in HF care in Portugal.

Characteristics and treatment of nonagenarian patients with vascular disease admitted to internal medicine services. NONAVASC-2 registry.

INTRODUCTION: Vascular disease (VD) is the most frequent cause of morbidity and mortality and its prevalence increases with age. Old patients are not included in studies on VD, their characteristics and treatments being unknown. OBJECTIVE: Know the clinical characteristics of nonagenarian patients hospitalized in Internal Medicine services with a diagnosis of established VD and the adequacy of their pharmacological management. MATERIAL AND METHODS: The NONAVASC-2 registry is an observational, prospective, multicentre study. Hospitalized patients for any cause were included. Data collection was carried out through an anonymous online database with sociodemographic, clinical, analytical, therapeutic and evolutionary parameters. RESULTS: One thousand forty-nine patients with a mean age of 93.14 years (57.8% women) were included. The prevalence of risk factors and VD was high: hypertension (84.9%), dyslipidemia (50.9%) and diabetes mellitus (29.4%). 33.4% presented severe-total dependency. 82.9% received antithrombotic treatment (53.7% antiplatelets, 25.4% anticoagulation and 3.8% double therapy). Only 38.2% received statins. The percentage of severe dependence (39.2% vs 24.1%; p = 0.00) and severe cognitive impairment (30.8% vs 13.8%; p = 0.00) was significantly higher among patients who did not receive them. 19% died during admission. CONCLUSIONS: Nonagenarian patients with VD present high comorbidity, dependence and mortality. Despite being in secondary prevention, 17% did not receive antithrombotics and only 38% received statins. The underprescription is conditioned, among other factors, by the functional status. More studies are necessary to determine the impact of this issue on their prognosis.

Estudio transversal sobre la percepción de los factores favorecedores de la actividad investigadora en enfermedades infecciosas / Cross-sectional study on the perception of factors favoring research activity in infectious diseases

Introducción: La implicación de los médicos asistenciales en tareas de investigación clínica presenta grandes diferencias entre las diversas instituciones. Material y método: Estudio transversal basado en una encuesta enviada a los miembros del Grupo de Trabajo de Enfermedades Infecciosas (GTei) de la Sociedad Española de Medicina Interna (SEMI) durante el mes de mayo de 2022. Resultados: De 1.789 miembros del GTei, 169 miembros (9,45%) cumplimentaron la encuesta. La percepción de la conveniencia de participación de cada facultativo en una o varias líneas de investigación fue de 8 puntos (P25:7; P75: 9 puntos). La percepción sobre el estímulo para investigar del sistema sanitario o de la dirección del hospital fue de 2 puntos (1-4), respectivamente. El apoyo a la investigación fue valorado con de 5 (2-7) y 6 (3-7) puntos en relación con el jefe de servicio y los compañeros del departamento, respectivamente. Otros factores evaluados fueron la falta de tiempo por no poder reducir la actividad asistencial (9; 7-10 puntos), la priorización de las actividades de ocio durante el tiempo libre disponible (7; 5-8 puntos), la organización de la carga asistencial (6; 3-9 puntos), las dificultades en la coordinación con otros servicios clínicos o centrales (6; 5-7 puntos y 6; 5-8 puntos, respectivamente). Conclusiones: La investigación clínica es muy bien valorada por los internistas dedicados a la patología infecciosa. Las principales necesidades percibidas son un mayor apoyo institucional y de la dirección del hospital, una mejor organización del departamento, la coordinación interdepartamental y disponer de más tiempo para esta actividad.(AU)

Background: The involvement of attending physicians in clinical research activities differs greatly among institutions. Method: Cross-sectional study based on a survey submitted to the members of the Working Group on Infectious Diseases (GTei) of the Spanish Society of Internal Medicine (SEMI) during the month of May 2022. Results: Out of 1,789 members of the GTei, 169 members (9.45%) completed the survey. The perception of the convenience of participation of each physician in one or more lines of research was 8 points (P25:7; P75: 9 points). The perception of encouragement to do research by the health system or hospital management was 2points (1-4), respectively. Support for research was rated at 5 (2-7) and 6 (3-7) points inrelation to the head of service and colleagues in the department, respectively. Other factors evaluated were the lack of time due to not being able to reduce the care activity (9; 7-10 points), prioritization of leisure activities during available free time (7; 5-8 points), organization of the care load (6; 3-9 points), difficulties in coordinating with other clinical or central services (6; 5-7 points and 6; 5-8 points, respectively). Conclusions: Clinical research is highly valued by internists dedicated to infectious diseases. The main perceived needs are greater institutional and hospital managementsupport, better organization of the department, interdepartmental coordination and more time for this activity. (AU)

Manejo y tratamiento actual de la insuficiencia cardiaca en unidades acreditadas de cardiología y medicina interna en España / Current heart failure disease management and treatment in accredited units from cardiology and internal medicine in Spain

Antecedentes y objetivos La insuficiencia cardiaca (IC) es una patología compleja con una alta prevalencia, incidencia y mortalidad que conlleva un importante coste sanitario. En España existen unidades de IC (UIC) multidisciplinares, lideradas por cardiología y medicina interna. Nuestro objetivo era conocer su organización actual y adherencia a las últimas recomendaciones científicas. Materiales y métodos Un comité científico formado por cardiólogos e internistas elaboró una encuesta a finales de 2021, que fue enviada a 110 UIC. Setenta y tres de cardiología, acreditadas por SEC-Excelente, y 37 de medicina interna, integradas en el programa UMIPIC. Resultados Se recibieron 83 encuestas cumplimentadas (75,5%); 49 de cardiología y 34 de medicina interna. Los resultados mostraron que las UIC están integradas mayoritariamente por un cardiólogo, internista y enfermería especializada (34,9%). El perfil de paciente atendido en las UIC cardiológicas es muy diferente al paciente de las UMIPIC, siendo estos últimos mayores, con fracción de eyección ventricular izquierda conservada y más carga de comorbilidad. La mayoría de UIC actualmente realizan seguimiento mixto, presencial y telemático (73,5%). Los péptidos natriuréticos son los biomarcadores más utilizados (90%). Se titulan los cuatro grupos farmacológicos fundamentales de tratamiento de la IC a la vez mayoritariamente (85%). Solo 24% de las unidades mantienen una comunicación fluida con atención primaria. Conclusiones Los dos modelos de UIC liderados por cardiología y medicina interna son complementarios, disponen de enfermería especializada, y siguen al paciente de forma mixta, con una adherencia farmacológica muy alta a las últimas recomendaciones científicas. El principal punto de mejora es la coordinación con atención primaria (AU)

Background and objectives Heart failure (HF) is a complex disease with high prevalence, incidence and mortality rates leading to high healthcare burden. In Spain, there are multidisciplinary HF units coordinated by cardiology and internal medicine. Our objective was to describe its current organizational model and their adherence to the latest scientific recommendations. Materials and methods In late 2021, a scientific committee (with cardiology and internal medicine specialists) developed a questionnaire that was sent as an online survey to 110 HF units [73 from cardiology (accredited by SEC-Excelente) and 37 from internal medicine (integrated in UMIPIC program)]. Results We received 83 answers (75.5% total: 49 from cardiology and 34 from internal medicine). The results showed that HF units are mostly integrated by specialists from cardiology, internal medicine and specialized nurse practitioners (34.9%). Patient characteristics from HF units are widely different when comparing those in cardiology to UMIPIC, being the latter older, more frequently with preserved ejection fraction and higher comorbidity burden. Most HF units (73.5%) currently use a hybrid face-to-face/virtual model to perform patient follow-up. Natriuretic peptides are the biomarkers most commonly used (90%). All four disease-modifying drug classes are mainly implemented at the same time (85%). Only 24% of HF units hold fluent communication with primary care. Conclusions Both models from cardiology and internal medicine HF units are complementary, they include specialized nursing, they use hybrid approach for patient follow-up and they display a high adherence to the latest guideline recommendations. Coordination with primary care remains as the major improvement area (AU)

Calidad del registro de la historia clínica: autocrítica desde los médicos internistas

Objetivo: Describir la reflexión autocrítica que médicos especialistas en medicina interna hacen de la calidad del registro de la información en la historia clínica electrónica, en el Hospital Pablo Tobón Uribe. Metodología: Estudio cualitativo que aplicó técnicas de la teoría fundamentada, con entrevistas semiestructuradas en profundidad a quince médicos internistas de un hospital de alta complejidad en Medellín, Colombia. El análisis partió de una conceptualización con codificación abierta y, luego, se hizo la agrupación de códigos en categorías descriptivas. Se identificaron propiedades y dimensiones que fueron relacionadas mediante la codificación axial con la matriz del paradigma de la teoría fundamentada, que permitió la emergencia de una categoría más abstracta. Resultados: Los entrevistados manifestaron que la historia clínica guarda información fundamental e invaluable, que contribuye al mejoramiento de la sa¬lud de los pacientes. Relacionaron la calidad del diligenciamiento de la historia clínica con un contexto regulatorio nacional, el cual tiene exigencias administrativas y financieras que ejercen presión de requerimientos externos a la clínica sobre su diligenciamiento. Se reconoce la influencia de la cultura digital y del inmediatismo, debilidades en la formación del diligenciamiento de la historia clínica tanto en pregrado y posgrado. Lo anterior distancia al médico del paciente, genera desmotivación en el ejercicio de su profesión y facilita cometer errores. Conclusiones: Existe una contradicción entre el "deber ser" del diligenciamiento con calidad de la historia clínica y lo que sucede en la práctica, pues su intencionalidad original de ser una herramienta al servicio de la asistencia clínica se desvirtúa, al privilegiar el haberse convertido en un instrumento que responde a otros factores externos del sistema de salud del país.

Objective: to describe the self-critical reflection that internal medicine specialists make on the quality of the information recorded in the electronic medical record in a high complexity hospital. Methodology: qualitative study that applied Grounded Theory techniques, with semi-structured in-depth interviews to fifteen internists of the Pablo Tobón Uribe Hospital in Colombia. The analysis was based on a conceptualization with open coding and then grouping of codes into descriptive categories. Properties and dimensions were identified and related through axial coding with the matrix of the Grounded Theory paradigm, which allowed the emergence of a more abstract category. Results: the interviewees informed the medical records keeps invaluable and fundamental information which contributes to the improvement of patient ́s health. They related the quality of medical records fill out with a national regulatory context, which has administrative and financial challenges that demands external pressure over the completion requirements in the medical assistance. The influence of digital culture and immediacy and insufficiencies skills in undergraduate and postgraduate medical training for a comprehensive fill out medical records, are recognized. The above distances the physician from the patient, generates demotivation in the practice of his profession and makes it easier to make mistakes. Conclusions: there is a contradiction between the "should be" of the quality of the medical records and what happens in practice, since its original intention of being a tool at the service of clinical care is distorted, as it has become a tool that responds to other external factors to the National health system.

Objetivo: Descrever a reflexão autocrítica que os médicos especialistas em medicina interna fazem sobre a qualidade da informação registrada no prontuário eletrônico do Hospital Pablo Tobón Uribe. Metodologia: Estudo qualitativo que aplicou técnicas de teoria fundamentada, com entrevistas semiestruturadas em profundidade com quinze internos de um hospital de alta complexidade em Medellín, Colômbia. A análise partiu de uma conceituação com codificação aberta e, em seguida, foi feito o agrupamento dos códigos em categorias descritivas. Foram identificadas propriedades e dimensões que se relacionaram por meio da codificação axial com a matriz do paradigma da teoria fundamentada, o que permitiu o surgimento de uma categoria mais abstrata. Resultados: Os entrevistados relacionaram a qualidade do preenchimento da história clínica com um contexto regulatório que impõe exigências administrativas e financeiras que exercem pressão de exigências externas à clínica no seu preenchimento. Reconhece-se a influência da cultura digital e do imediatismo, as insuficiências na formação médica graduada e pós-graduada e as limitações dos médicos nas habilidades de comunicação. Isso distancia o médico do paciente, gera desmotivação no exercício de sua profissão e facilita erros. Conclusões: Existe uma contradição entre o "deveria ser" de preencher a anamnese com qualidade e o que ocorre na prática, pois sua intenção original de ser uma ferramenta a serviço do atendimento clínico é desvirtuada, ao privilegiar ter se tornado um instrumento que responde a outros fatores externos ao ato médico e às exigências administrativas do sistema de saúde.

Enfermera de práctica avanzada en Programa de Prehabilitación Quirúrgica / The Advanced Practice Nurse in a Surgical Prehabilitation Program

La rehabilitación multimodal engloba una serie de medidas y estrategias preoperatorias, intraoperatorias y posoperatorias, en la que se incluye la prehabilitación quirúrgica como parte de la fase preoperatoria del proceso quirúrgico. Entre los objetivos del Programa de Prehabillitación Quirúrgica destacan: a) mejorar el estado de salud del paciente, interviniendo sobre parámetros modificables de calidad de vida, funcionalidad y comorbilidades que le permitan afrontar la cirugía en condiciones más óptimas; b) reducir las complicaciones posoperatorias; c) disminuir estancia hospitalaria y reingresos; d) reducir costes sanitarios. Este programa está liderado por una enfermera de práctica avanzada que trabaja, de forma colaborativa e interdisciplinar con un internista, para realizar un abordaje integral del paciente, disminuyendo el número de derivaciones a otros especialistas, y consiguiendo una reducción de los tiempos de atención necesarios para su preparación quirúrgica. El Programa de Prehabilitación Quirúrgica se puso en marcha a mediados de 2019 en el Hospital Infanta Cristina (Madrid, España) con inclusión de 25 pacientes. En 2020 se atendieron 144, en 2021 fueron 276 y en 2022 480 pacientes. En estos años se han registrado resultados clínicos relevantes: mejora de la funcionalidad y calidad de vida; disminución de complicaciones, reingresos, días de estancia y necesidad de concentrados de hematíes; así como un ahorro de aproximadamente 400.000 euros.(AU)

Multimodal rehabilitation encompasses a series of preoperative, intraoperative and postoperative measures and strategies, including Surgical Prehabilitation as part of the preoperative stage in the surgical process. Some of the objectives of the Surgical Prehabilitation Program stand out: a) to improve the health status of the patient, with interventions over modifiable parameters of quality of life, functionality and comorbidity, allowing them to face surgery in optimal conditions: n) to reduce postoperative complications; c) to reduce the hospital stay and re-admissions; d) to reduce healthcare costs. This program is led by an Advanced Practice Nurse, working in a collaborative and interdisciplinary way with an Internal Medicine Specialist, for a comprehensive approach to the patient, reducing the number of referrals to other specialists, and achieving a reduction in the times of care required for their surgical preparation. The Surgical Prehabilitation Program was initiated by mid-2019 at the Hospital Infanta Cristina (Madrid, Spain), and included 25 patients. In 2020, 144 patients were managed, 276 in 2021, and 480 patients in 2022. Relevant clinical results have been registered in these years: an improvement in functionality and quality of life; reduction in complications, readmissions, hospitalization days, and need for packed red blood cells; as well as savings of approximately 400,000 euros.(AU)

Current heart failure disease management and treatment in accredited units from cardiology and internal medicine in Spain.

BACKGROUND AND OBJECTIVES: Heart failure (HF) is a complex disease with high prevalence, incidence and mortality rates leading to high healthcare burden. In Spain, there are multidisciplinary HF units coordinated by cardiology and internal medicine. Our objective is to describe its current organizational model and their adherence to the latest scientific recommendations. MATERIALS AND METHODS: In late 2021, a scientific committee (with cardiology and internal medicine specialists) developed a questionnaire that was sent as an online survey to 110 HF units. 73 from cardiology (accredited by SEC-Excelente) and 37 from internal medicine, (integrated in UMIPIC program). RESULTS: We received 83 answers (75.5% total: 49 from cardiology and 34 from internal medicine). The results showed that HF units are mostly integrated by specialists from cardiology, internal medicine and specialized nurse practitioners (34.9%). Patient characteristics from HF units are widely different when comparing those in cardiology to UMIPIC, being the latter older, more frequently with preserved ejection fraction and higher comorbidity burden. Most HF units (73.5%) currently use a hybrid face-to-face/virtual model to perform patient follow-up. Natriuretic peptides are the biomarkers most commonly used (90%). All four disease-modifying drug classes are mainly implemented at the same time (85%). Only 24% of HF units hold fluent communication with primary care. CONCLUSIONS: Both models from cardiology and internal medicine HF units are complementary, they include specialized nursing, they use hybrid approach for patient follow-up and they display a high adherence to the latest guideline recommendations. Coordination with primary care remains as the major improvement area.

Aumento del síndrome de burnout en los adjuntos de Medicina Interna durante la pandemia de COVID-19 / Burnout syndrome increase during COVID-19 pandemic in attending Internal Medicine physicians

Introducción El burnout es un síndrome psicosocial causado por situaciones estresantes en el ámbito laboral. Afecta al 30-60% de los profesionales médicos. El objetivo de este estudio es realizar un análisis comparativo de su frecuencia antes y después del brote de la COVID-19 en los médicos adjuntos de Medicina Interna españoles. Métodos Se enviaron encuestas por correo electrónico y redes sociales integradas con el Maslach Burnout Inventory a los miembros de la Sociedad Española de Medicina Interna en 2019 y 2020. Resultados Se ha observado un aumento no significativo de burnout (38,0% vs. 34,4%). Sin embargo, sí se constata un aumento en la baja realización personal (66,4% vs. 33,6%; p=0,002), dimensión asociada a la prevención de la morbilidad psiquiátrica, además de otras dos: la fatiga emocional y la despersonalización, que pueden afectar negativamente a la atención del paciente. Conclusiones Es esencial abordar este síndrome individual e institucionalmente (AU)

Introduction Burnout is a psychosocial syndrome caused by stressful situations in the workplace. It affects 30% to 60% of medical professionals. The aim of this study is to carry out a comparative analysis of its frequency before and after the COVID-19 outbreak in Spanish internal medicine attending physicians. Methods Surveys that included the Maslach Burnout Inventory were sent via email and associated social networks to physicians who were members of the Spanish Society of Internal Medicine in 2019 and 2020. Results A non-significant increase in burnout was observed (38.0% vs. 34.4%). However, an increase in low personal fulfilment was observed (66.4% vs. 33.6%; p=0.002), a dimension associated with the prevention of psychiatric morbidity, in addition to two others: emotional fatigue and depersonalization, which can negatively affect patient care. Conclusions It is essential to address this syndrome individually and institutionally (AU)

Burnout syndrome increase during COVID-19 pandemic in attending Internal Medicine physicians.

INTRODUCTION: Burnout is a psychosocial syndrome caused by stressful situations in the workplace. It affects 30%-60% of medical professionals. The aim of this study is to carry out a comparative analysis of its frequency before and after the COVID-19 outbreak in Spanish internal medicine attending physicians. METHODS: Surveys that included the Maslach Burnout Inventory were sent via email and associated social networks to physicians who were members of the Spanish Society of Internal Medicine in 2019 and 2020. RESULTS: A non-significant increase in burnout was observed (38.0% vs. 34.4%). However, an increase in low personal fulfilment was observed (66.4% vs. 33.6%; p = 0.002), a dimension associated with the prevention of psychiatric morbidity, in addition to two others: emotional fatigue and depersonalization, which can negatively affect patient care. CONCLUSIONS: It is essential to address this syndrome individually and institutionally.

Historia de vida del Dr. C. Oscar B. Alonso Chil, ejemplo para la educación médica cubana / Life history of Ph.D. Oscar B. Alonso Chil, a role model for cuban medical education

Introducción: El Dr. C. Oscar B. Alonso Chil (1930-2021) formó parte de los médicos que permanecieron en Cuba después del triunfo de la Revolución. Fue fundador de servicios de asistencia en medicina interna y geriatría, y realizó importantes contribuciones a la docencia médica. Objetivo: Exponer la trayectoria de Oscar B. Alonso Chil como médico y docente de la medicina cubana revolucionaria, a través de su historia de vida. Métodos: Se realizó un estudio de tipo descriptivo y de corte cualitativo, donde se utilizó la técnica de la historia de vida, centrada en el aspecto profesional. Para ello se hizo una entrevista semiestructurada al testimoniante como fuente fundamental de información. Se validó el testimonio oral mediante la revisión de la documentación oficial en su expediente docente y la literatura científica existente relacionada con el tema, además de entrevistas a sus alumnos y compañeros de trabajo. Desarrollo: Se constató que fundó servicios; organizó la actividad docente; realizó tutorías, publicaciones y asesorías; y fue miembro de tribunales y consejos científicos. Cada una de sus actividades las desempeñó con gran compromiso e incondicionalidad a su profesión, lo cual le generó mucha satisfacción con la vida. Llegó a ostentar las más altas distinciones por su trabajo: Especialista de Segundo Grado en Medicina Interna, y Profesor Titular, Consultante y de Mérito de la Universidad de Ciencias Médicas de La Habana. Conclusiones: Oscar B. Alonso Chil contribuyó al desarrollo de la medina interna en Cuba en la etapa revolucionaria. Este profesor representa un modelo para los estudiantes de ciencias médicas por su prestigio profesional y científico(AU)

Introduction: Ph.D. Oscar B. Alonso Chil (b. 1930-d. 2021) was one of the physicians who stayed in Cuba after the triumph of the Revolution. He was a founder of the healthcare services for internal medicine and geriatrics, and made important contributions to medical teaching. Objective: To present the professional career of Oscar B. Alonso Chil as a physician and teacher of revolutionary Cuban medicine, through his life history. Methods: A descriptive and qualitative study was carried out, using the life history technique, focused on the professional aspect. For this purpose, a semistructured interview was conducted with the testimony witness as a fundamental source of information. The oral testimony was validated by reviewing the official documentation in his teaching file and the existing scientific literature related to the subject; in addition to interviews with his students and coworkers. Development: It was observed that he founded services, organized the teaching activity, supervised research, made publications and consultancies, and was a member of scientific boards and councils. He performed each of these activities with great commitment and unconditionality to his profession, which gave him great satisfaction with life. He achieved holding the highest distinctions for his work: second-degree specialist in Internal Medicine, as well as Full Professor, Faculty Consultant and Emeritus Professor of the University of Medical Sciences of Havana. Conclusions: Oscar B. Alonso Chil contributed to the development of internal medicine in Cuba during the revolutionary period. This professor represents a role model for students of medical sciences due to his professional and scientific prestige(AU)