Trascendencia de la detección precoz del riesgo nutricional en nuestros pacientes. Experiencia en un hospital de media-larga estancia / Transcendence of the early detection of nutritional risk in our patients. Experience at a half-long stay hospital

FUNDAMENTO: El cribado de riesgo nutricional permite detectar el riesgo de desnutrición desde su inicio y antes de su manifestación clínica. OBJETIVO: Evidenciar la utilidad del CONUT en el cribado nutricional al ingreso en un hospital de media-larga estancia. MÉTODOS: Se realizaron dos estudios longitudinales (2014n=121-2018n=155), utilizando CONUT para detectar precozmente el riesgo de desnutrición y evaluar la eficacia de la intervención nutricional. Las variables respuesta fueron el tipo y grado de desnutrición al ingreso y al alta. RESULTADOS: La prevalencia de desnutrición/riesgo nutricional detectada con CONUT al ingreso fue de 85,9%. Con la Valoración Nutricional Completa (VNC), la prevalencia de desnutrición al ingreso fue del 81,0% (5% desnutrición calórica, 17,4% mixta y 58,7% proteica). Un 5% de los pacientes en riesgo detectados mediante CONUT, todavía no podían ser diagnosticados mediante la VNC. Los valores al alta fueron 5% desnutrición calórica, 7,7% mixta y 36,4% proteica. CONUT permitió identificar y seguir la evolución del paciente desnutrido con mayor sensibilidad que los parámetros antropométricos. La intervención nutricional redujo la prevalencia y severidad de la desnutrición, mejorando fundamentalmente a expensas de corregir la desnutrición proteica. Los pacientes desnutridos presentaron mayor número de categorías diagnósticas. Se observaron diferencias significativas entre los perfiles nutricionales de las patologías más prevalentes. CONCLUSIONES: CONUT permitió automatizar eficientemente el cribado nutricional. La aplicación de un protocolo estructurado para la detección, monitorización y tratamiento de la desnutrición permitió identificar pacientes subsidiarios de beneficiarse del soporte nutricional, lo que se reflejó en una mejora del estado nutricional al alta

BACKGROUND: Nutritional risk screening enables the risk of malnutrition to be detected from its beginning and before its clinical expression. OBJECTIVE: To demonstrate the usefulness of CONUT in nutritional screening at admission to a medium-to-long stay hospital. METHODS: Two longitudinal studies (2014n=121-2018n=155) were conducted using CONUT for the early detection of the risk of malnutrition and to evaluate the efficacy of the nutritional intervention. The response variables were the type and degree of malnutrition at admission and discharge. RESULTS: The prevalence of malnutrition/nutritional risk detected with CONUT at admission was 85.9%. With the Comprehensive Nutritional Assessment (CNA), the prevalence of malnutrition at admission was 81.0% (caloric malnutrition 5%, mixed malnutrition 17.4%, and protein malnutrition 58.7%). 5% of the patients at risk detected by CONUT still could not be diagnosed by the CNA. The values at discharge were caloric malnutrition 5%, mixed malnutrition 7.7%, and protein malnutrition 36.4%. CONUT enabled the evolution of the malnourished patient to be identified and followed up with greater sensitivity when compared to the anthropometric parameters. Nutritional intervention reduced the prevalence and severity of malnutrition, essentially improving it upon protein malnutrition correction. Malnourished patients showed a greater number of diagnostic categories. Significant differences were observed among the nutritional profiles of the most prevalent diseases. CONCLUSIONS: CONUT enabled nutritional screening to be efficiently automated. The application of a structured protocol for the detection, monitoring and treatment of malnutrition made it possible to identify subsidiary patients to benefit from nutritional support, which was reflected in an improvement in nutritional status at discharge

Acute circulatory complications in people with diabetes mellitus type 2: How admission varies between urban and rural Victoria.

OBJECTIVE: To identify the extent to which rurality influences the admission and mortality rates for acute circulatory complications among people with type 2 diabetes mellitus. DESIGN: Retrospective study. SETTING: All Victorian hospitals. PARTICIPANTS: State-wide hospital admissions from 1 July 2010 to 30 June 2015 using the Victorian Admitted Episodes Dataset. Data included patients with type 2 diabetes mellitus and diagnosis of acute cardiovascular events, acute cerebrovascular haemorrhage or infarction, acute peripheral vascular events or hypertensive diseases. MAIN OUTCOME MEASURE: Rates of admission and mortality were calculated for local government areas and Department of Health regions. Regression analysis identified the influence between admission rates and various predictor variables. RESULTS: In total, 5785 emergency hospital admissions occurred during the study period, with the highest and lowest mortality and admission rates occurring in rural areas. Moderately high admission rates were identified in urban areas. Cardiovascular events far outnumbered other acute circulatory admissions. Regression analysis identified a number of significant socioeconomic variables, primarily for metropolitan residents. Socioeconomic disadvantage was the only significant factor in rural areas. CONCLUSION: Victorian admission and mortality rates for acute circulatory complications are greatest in rural areas; yet, there is considerable heterogeneity in the admission rates within both rural and metropolitan areas. Furthermore, socioeconomic status is more influential than remoteness in determining emergency admissions. Further research needs to investigate the particular variables that lead to poorer outcomes rurally, investigate socioeconomic disadvantage in rural areas and have greater emphasis on peripheral vascular disease prevention.

Admisiones en la Unidad de Intervención en Crisis del Hospital Psiquiátrico Provincial Luis Ramírez López, Guantánamo 2015-2017 / Internações hospitalares na Unidade de Intervenção de Crise do Hospital Psiquiátrico Provincial Luis Ramírez López, Guantánamo 2015-2017 / Hospital admissions in the Crisis Intervention Unit of the Luis Ramírez López Provincial Psychiatric Hospital, Guantánamo 2015-2017

Introducción: en el Hospital Psiquiátrico Provincial Luis Ramírez López de la provincia Guantánamo no se han caracterizado los pacientes ingresados en la Unidad de Intervención en Crisis (UIC). Objetivo: caracterizar las admisiones hospitalarias en la citada unidad en el periodo comprendido 2015-2017. Método: se realizó un estudio descriptivo y retrospectivo de los pacientes que ingresaron en esta unidad (n=538). Se estudiaron las variables: edad, sexo, procedencia, diagnóstico y estadía. Resultados: la mayor proporción de los pacientes admitidos tenía entre 18 y 23 años (21,9 por ciento), eran del sexo femenino (53,9 por ciento), procedieron del municipio Guantánamo (42,0 por ciento), el diagnóstico más frecuente fue el trastorno de adaptación depresivo (27,9 por ciento) y el 66,4 por ciento tuvo una estadía hospitalaria menor de 7 días. Conclusiones: en la Unidad de Intervención en Crisis se admitieron pacientes en la etapa productiva de la vida, sobre todo mujeres con trastornos depresivos, lo que muestra la pertinencia social de su estudio(AU)

Introduction: the patients admitted to the Crisis Intervention Unit (UIC) have not been characterized in the "Luis Ramírez López" Provincial Psychiatric Hospital of the Guantánamo province. Objective: to characterize hospital admissions in said unit in the period 2015-2017. Method: a descriptive and retrospective study of the patients admitted to this unit was carried out (n=538). The variables were studied: age, sex, origin, diagnosis and stay. Results: the highest proportion of admitted patients was between 18 and 23 years old (21.9 percent), they were female (53.9 percent), they came from the Guantanamo municipality (42.0 percent), the most frequent diagnosis was Depressive adjustment disorder (27.9 percent) and 66.4 percent had a hospital stay of less than 7 days. Conclusions: Patients in the productive stage of life were admitted to the Crisis Intervention Unit, especially women with depressive disorders, which shows the social relevance of their study(AU)

Introdução: os pacientes admitidos na Unidade de Intervenção de Crise (UIC) não foram caracterizados no Hospital Psiquiátrico Provincial "Luis Ramírez López" da Província de Guantánamo. Objetivo: caracterizar internações hospitalares na referida unidade no período 2015-2017. Método: estudo descritivo e retrospectivo dos pacientes admitidos nesta unidade (n=538). As variáveis foram estudadas: idade, sexo, origem, diagnóstico e permanência. Resultados: a maior proporção de pacientes internados foi entre 18 e 23 anos (21,9 por cento), eran do sexo feminino (53,9 por cento), procedentes do município de Guantánamo (42,0 por cento), o diagnóstico mais frequente foi Transtorno de ajuste depressivo (27,9 por cento) e 66,4 por cento tiveram internação hospitalar inferior a 7 dias. Conclusões: pacientes em estágio produtivo de vida foram admitidos na Unidade de Intervenção à Crise, especialmente mulheres com transtornos depressivos, o que mostra a relevância social de seu estudo(AU)

Psychostimulant-related health service demand in an inner-city hospital, 2012-2015.

OBJECTIVE: To analyse routinely collected data from a hospital database of drug health consultation-liaison (CL) assessments. We aimed to investigate changes in psychostimulant-related health service demand in an inner-city hospital to inform the development of locally appropriate models of care. METHODS: We used de-identified drug health CL service data from 2012 to 2015. Psychostimulant-related consultations and admissions were compared with opioid-related consultations and admissions over time, by sex and by ward type (medical units, mental health units or emergency department). RESULTS: The CL service collected information on 8800 consultations and 4405 hospital admissions from 2012 to 2015. Psychostimulant use was responsible for 684 (7.8%) consultations and 372 (8.4%) admissions. Opioids were related to 1914 (21.8%) consultations and 864 (19.6%) admissions. Psychostimulants were the subject of three times more consultations in 2015 than in 2012, and more than twice as many admissions. Time trend analysis showed a significant time effect for consultations and admissions relating to psychostimulants. Conversely, no significant changes were observed in consultations and admissions relating to opioids. CONCLUSION: This study identified a rapid rise in the demand for psychostimulant-related inpatient assessments, suggesting the use of these drugs has increased locally. Because of the impact on the public health system, there is a need to invest in and implement new treatment strategies and services for psychostimulant users.

Poor outcomes among elderly patients hospitalized for influenza-like illness.

BACKGROUND AND OBJECTIVE: Global Influenza Hospital Surveillance Network is a worldwide initiative that aims to document the burden of influenza infections among acute admissions and vaccine effectiveness in particular countries. As a partner of this platform, we aimed to determine the frequency of influenza infections among acute admissions with influenza-like illness and the outcomes of enrolled patients during the 2015-2016 influenza season in selected hospitals in Turkey. PATIENTS AND METHODS: The investigators screened the hospital admission registries, chart review or available records, and screened all patients hospitalized in the previous 24-48 hours or overnight in the predefined wards or emergency room. A total of 1351 patients were screened for enrollment in five tertiary care referral hospitals in Ankara and 774 patients (57.3% of the initial screened population) were eligible for swabbing. All of the eligible patients who consented were swabbed and tested for influenza with real-time polymerase chain reaction (PCR) based methods. RESULTS: Overall, influenza positivity was detected in 142 patients (18.4%). The predominant influenza strain was A H1N1pdm09. Outcomes were worse among elderly patients, regardless of the presence of the influenza virus. Half of the patients over 65 years of age were admitted to the intensive care unit, while one third required any mode of mechanical ventilation and one fourth died in the hospital in that particular episode. CONCLUSION: These findings can guide hospitals to plan and prepare for the influenza season. Effective influenza vaccination strategies, particularly aimed at the elderly and adults with chronic diseases, can provide an opportunity for prevention of deaths due to influenza-like illness.

Demanda asistencial del Servicio de Urgencias del Hospital Distrital de Hernandarias, Alto Paraná, Paraguay. Año 2015 / Assistance request from the Emergency Department of the District Hospital of Hernandarias, Alto Paraná, Paraguay. Year 2015

Una urgencia puede definirse como "una situación clínica que precisa de una atención sanitaria inmediata". Actualmente se observa un aumento desmedido en la utilización de los servicios de urgencias, lo cual afecta a la calidad de la atención y los costes, ya que se ha estimado que el coste de una enfermedad no urgente atendida en el Servicio de Urgencia hospitalario es entre 2,5 y 3 veces mayor que si la misma fuera atendida en una consulta. El objetivo es describir la demanda asistencial del Servicio de Urgencias del Hospital Distrital de Hernandarias (HDH) del año 2015. El estudio fue descriptivo, transversal y retrospectivo, realizado en el HDH, desde 01 de enero al 31 de diciembre del 2015. La fuente de datos, fueron los registros del Departamento de Estadística del HDH, siendo excluidas las consultas extramurales, externas y los casos pediátricos. De acuerdo a la prioridad de atención fueron clasificadas en emergencias, urgencias y consulta normal y los motivos de consulta fueron clasificados por causa médica, quirúrgica y traumas. Fue garantizada la confidencialidad de los pacientes. Durante el 2015 fueron atendidos 95.099 casos, 23.967 registrados como urgencias de adultos. El 70 % (15.815) fueron mujeres. El promedio de edad fue de 41 años. El 95% (22.160) de los pacientes provino de la ciudad de Hernandarias. Los meses con mayor demanda fueron agosto 12% (2930), julio (2701) y setiembre (2540) 11%, enero presento 2% (484). Los días de mayor afluencia fueron los miércoles (17%) y martes (16%). El motivo de consulta fueron Urgencias 71%, 9% Emergencias 9% y Consultas 20%. Los motivos de consultas fueron debidas a casos médicos (85%), traumas 9% y por causas quirúrgicas 6%. El 69% (16.638) fueron internados. Se debe realizar una correcta utilización de los servicios de urgencias para optimizar el servicio.

An urgency can be defined as "a clinical situation that needs immediate health care." There is currently an excessive increase in the use of Emergency Services, which affects the quality of care and costs, since it has been estimated that the cost of a non-urgent case taken care of in the Hospital Emergency Service is between 2.5 and 3 times greater than if the same case was taken care of in a consultation. The objective of this research is to describe the demand of the Emergency Department of the District Hospital of Hernandarias (HDH) of 2015. This study was descriptive, cross-sectional and retrospective, performed in the HDH, from january the 1st to december 31st, 2015. The data source was the records of the HDH Department of Statistics, excluding external consultations and pediatric cases. According to the priority of attention they were classified in emergencies, urgencies and normal consultation. The reasons for consultation were medical, surgical and trauma. Confidentiality of patients was guaranteed. During 2015, 95,099 cases were treated, 23,967 were registered as adult emergencies. 70% (15,815) were male. The average age was 41 years old. 95% (22,160) of the patients came from the city of Hernandarias. The months with the highest demand were August with 12% (2930), July (2701) and September (2540) 11%. January presented 2% of the cases (484). The days of greater affluence were wednesday (17%) and tuesday (16%). The reasons for consultation were 71% urgencies, 9% emergencies 9% and 20% consultations. The motives were due to medical cases (85%), trauma 9% and surgery cases in a 6%. 69% (16,638) were hospitalized. There must be a correct use of Emergencies Services in order to optimize it.

[Health status and access to health services by the population of L'Aquila (Abruzzo Region, Italy) six years after the earthquake]. / Stato di salute e accesso alle prestazioni sanitarie nella popolazione terremotata del comune di L'Aquila. Un bilancio a sei anni dal sisma.

Natural disasters, such as the earthquake that occurred in the province of L'Aquila in central Italy, in 2009, generally increase the demand for healthcare. A survey was conducted to assess perception of health status an d use of health services in a sample of L'Aquila's resident population, five years after the event, and in a comparison population consisting of a sample of the resident population of Avezzano, a town in the same region, not affected by the earthquake. No differences were found in perception of health status between the two populations. Both groups reported difficulties in accessing specialized healthcare and rehabilitation services.

Effects of Air Pollution on Hospital Emergency Room Visits for Respiratory Diseases: Urban-Suburban Differences in Eastern China.

A study on the relationships between ambient air pollutants (PM2.5, SO2 and NO2) and hospital emergency room visits (ERVs) for respiratory diseases from 2013 to 2014 was performed in both urban and suburban areas of Jinan, a heavily air-polluted city in Eastern China. This research was analyzed using generalized additive models (GAM) with Poisson regression, which controls for long-time trends, the "day of the week" effect and meteorological parameters. An increase of 10 µg/m³ in PM2.5, SO2 and NO2 corresponded to a 1.4% (95% confidence interval (CI): 0.7%, 2.1%), 1.2% (95% CI: 0.5%, 1.9%), and 2.5% (95%: 0.8%, 4.2%) growth in ERVs for the urban population, respectively, and a 1.5% (95%: 0.4%, 2.6%), 0.8% (95%: -0.7%, 2.3%), and 3.1% (95%: 0.5%, 5.7%) rise in ERVs for the suburban population, respectively. It was found that females were more susceptible than males to air pollution in the urban area when the analysis was stratified by gender, and the reverse result was seen in the suburban area. Our results suggest that the increase in ERVs for respiratory illnesses is linked to the levels of air pollutants in Jinan, and there may be some urban-suburban discrepancies in health outcomes from air pollutant exposure.

Does Admission to Medicine or Orthopaedics Impact a Geriatric Hip Patient's Hospital Length of Stay?

OBJECTIVES: The aim of our study was to determine the association between admitting service, medicine or orthopaedics, and length of stay (LOS) for a geriatric hip fracture patient. DESIGN: Retrospective. SETTING: Urban level 1 trauma center. PATIENTS/PARTICIPANTS: Six hundred fourteen geriatric hip fracture patients from 2000 to 2009. INTERVENTIONS: Orthopaedic surgery for geriatric hip fracture. MAIN OUTCOME MEASUREMENTS: Patient demographics, medical comorbidities, hospitalization length, and admitting service. Negative binomial regression used to determine association between LOS and admitting service. RESULTS: Six hundred fourteen geriatric hip fracture patients were included in the analysis, of whom 49.2% of patients (n = 302) were admitted to the orthopaedic service and 50.8% (3 = 312) to the medicine service. The median LOS for patients admitted to orthopaedics was 4.5 days compared with 7 days for patients admitted to medicine (P < 0.0001). Readmission was also significantly higher for patients admitted to medicine (n = 92, 29.8%) than for those admitted to orthopaedics (n = 70, 23.1%). After controlling for important patient factors, it was determined that medicine patients are expected to stay about 1.5 times (incidence rate ratio: 1.48, P < 0.0001) longer in the hospital than orthopaedic patients. CONCLUSIONS: This is the largest study to demonstrate that admission to the medicine service compared with the orthopaedic service increases a geriatric hip fractures patient's expected LOS. Since LOS is a major driver of cost as well as a measure of quality care, it is important to understand the factors that lead to a longer hospital stay to better allocate hospital resources. Based on the results from our institution, orthopaedic surgeons should be aware that admission to medicine might increase a patient's expected LOS. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Admission blood glucose predicts mortality and length of stay in patients admitted through the emergency department.

BACKGROUND: Hyperglycaemia has been associated with adverse outcomes in several different hospital populations. AIM: The aim of this study was to investigate the relationship between admission blood glucose level (BGL) and outcomes in all patients admitted through the emergency department. METHODS: This study was a retrospective observational cohort study from an Australian tertiary referral hospital. Patients admitted in the first week of each month from April to October 2012 had demographic data, co-morbidities, BGL, intensive care unit admission, length of stay and dates of death recorded. Factors associated with outcomes were assessed by multi-level mixed-effects linear regression. RESULTS: Admission BGL was recorded for 601 admissions with no diagnosis of diabetes and for 219 admissions diagnosed with type 2 diabetes (T2DM). In patients with no diagnosis of diabetes, admission BGL was associated with in-hospital and 90-day mortality (P < 0.001). After multivariate analysis, BGL greater than 11.5 mmol/L was significantly associated with increased mortality at 90 days (P < 0.05). In patients with T2DM increased BGL on admission was not associated with in-hospital or 90-day mortality but was associated with length of hospital stay (ß: 0.22 days/mmol/L; 95% confidence interval 0.09-0.35; P < 0.001), although this association was lost on multivariable analysis. In patients with T2DM, increased coefficient of variation of BGL was also positively associated with length of hospital stay in an almost dose-dependent fashion (P < 0.001). CONCLUSION: Admission BGL was independently associated with increased mortality in patients with no diagnosis of diabetes. Glycaemic variability was associated with increased length of hospital stay in patients with T2DM.

Reducing costs and avoiding hospital admissions: can mobile working help?

The UK has an increased length of hospital stay in comparison with other European countries, and the need for further investment in community services is required if patients are to truly receive care closer to home. The increase in hospital admissions over the last few years may be attributed to the ageing UK population, as well as poor management of long-term conditions. This may be due to variations in the service provision and availability of case managers and community matrons. The poor working relationships and fragmentation of health and social care services remain a significant issue, despite renewed calls to improve integrated working, which is considered fundamental to achieving a reduction in avoidable hospital admissions. Mobile working was introduced in the NHS to help reform community health-care practice and improve continuity of care. Among other things, it provides clinicians with access to electronic patient records in real time, thus helping to reduce delays in treatment. However, we have to bear in mind that a number of factors could hinder the reduction in hospital admissions.

[Criteria for admitting patients with anorexia nervosa as inpatients to a general hospital; survey among internists]. / Criteria voor opname van volwassenen met anorexia nervosa op een interne afdeling van een algemeen ziekenhuis; enquête onder internisten.

BACKGROUND: Anorexia nervosa (an) is associated with a number of life-threatening complications. Sometimes there are good reasons for admitting an anorexia nervosa patient to a general hospital for treatment as an inpatient. Therefore, there needs to be optimal collaboration between psychiatrists treating the patient and the medical staff at the general hospital. AIM: To obtain insight into the admission criteria and other possible factors that play a role in the physician's decision to admit a patient with anorexia nervosa for inpatient treatment in a general hospital. METHOD: Internists and residents-internal medicine completed a questionnaire about admission criteria and, where applicable, about threshold values for these criteria. The physicians were also asked to judge two case vignettes. In addition, they were questioned about other factors that influenced their views on the admission of patients with anorexia nervosa to a general hospital and about their attitude to this patient-group, their experience of treating patients with anorexia nervosa and their awareness of a need for a guideline. The data were collected at the annual Dutch congress for internists at Maastricht. RESULTS: In total 78 congress attendees responded to the questionnaire; 47% were internist and 53% were resident-in-training. Agreement was greatest with regard to the following admission criteria (top 5): 1. serum potassium (threshold value <2.5 mmol/l was the criterion selected most); 2. arrhythmia; 3. hypoglycemia; 4. heart rate (threshold value <40 bpm was chosen most); 5. prolonged qt interval on an ECG. According to the two fictitious cases, the reason for admitting a patient with anorexia nervosa with milder symptoms was influenced by 'attitude'. Half of the respondents pointed out that the patient's cooperation plays a role in the decision to admit a patient with an eating disorder. CONCLUSION: Respondents reached a consensus regarding several admission criteria but the threshold values they gave varied substantially. Attitude towards the patient-group can sometimes influence the decision to admit a patient with anorexia nervosa to a general hospital. Internists and residents-in-training indicated they require detailed, carefully compiled guidelines which take into consideration the expected results and which emphasise the importance of obtaining the patient's cooperation.

A national study of acute hospital based alcohol health workers.

Alcohol health workers (AHWs) have been identified as an effective means of tackling alcohol-related hospital admissions. However, there is no understanding of the national coverage, or the extent and diversity of the services provided by hospital-based AHWs. Using a cross-sectional questionnaire, this is the first study to explore the current provision and remit of AHWs in acute hospitals across England.The data was analysed using SPSS. Significant differences were found with regards to the extent and diversity of AHW provision across England. This research provides a point of comparison for current and future hospital-based AHW provision.Further research is necessary to examine different 'service types', establish effective ways of working, and determine whether sources of funding could and should more accurately reflect the remit of hospital-based AHW roles.

[Inventory of attendance at Dutch emergency departments and self-referrals]. / Inventarisatie van SEH-bezoeken en zelfverwijzers.

OBJECTIVE: To make an inventory of annual attendance at emergency departments (A&E) in the Netherlands. DESIGN: Inventorisation study in all Dutch A & E departments. METHOD: All A& E departments in the Netherlands that were operational for 24 hours a day, 7 days a week in December 2012 were approached (n = 93) and the following data were collected over 2012: the total number of patients, the number of hospital admissions through the A & E department, and the number of self-referrals. RESULTS: Data were obtained from 96% emergency departments (n = 89) throughout the Netherlands, including all 8 university medical centres and 28 hospitals of the association of tertiary medical teaching hospitals (STZ). In 2012 a total of 1,989,746 people attended the 89 emergency departments. The average percentage of hospital admissions from an A & E department was 32% nationwide (range: 8-54). The average percentage of self-referrals to the emergency departments was 30% nationwide (range: 3-76). CONCLUSION: The number of attendees at A & E, the admission rate through the A & E department and percentage of self-referrals in 2012 showed a range of variation nationwide. The number of people attending A & E has not increased over the last few years and is low in international terms. On average one-third of people attending A & E were admitted. In contrast with prevailing national beliefs,a minority of attendees at A &E departments were self-referrals.

Hospital-based, acute care after ambulatory surgery center discharge.

BACKGROUND: As a measure of quality, ambulatory surgery centers have begun reporting rates of hospital transfer at discharge. This process, however, may underestimate the acute care needs of patients after care. We conducted this study to determine rates and evaluate variation in hospital transfer and hospital-based, acute care within 7 days among patients discharged from ambulatory surgery centers. METHODS: Using data from the Healthcare Cost and Utilization Project, we identified adult patients who underwent a medical or operative procedure between July 2008 and September 2009 at ambulatory surgery centers in California, Florida, and Nebraska. The primary outcomes were hospital transfer at the time of discharge and hospital-based, acute care (emergency department visits or hospital admissions) within 7-days expressed as the rate per 1,000 discharges. At the ambulatory surgery center level, rates were adjusted for age, sex, and procedure-mix. RESULTS: We studied 3,821,670 patients treated at 1,295 ambulatory surgery centers. At discharge, the hospital transfer rate was 1.1 per 1,000 discharges (95% confidence interval 1.1-1.1). Among patients discharged home, the hospital-based, acute care rate was 31.8 per 1,000 discharges (95% confidence interval 31.6-32.0). Across ambulatory surgery centers, there was little variation in adjusted hospital transfer rates (median = 1.0/1,000 discharges [25th-75th percentile = 1.0-2.0]), whereas substantial variation existed in adjusted, hospital-based, acute care rates (28.0/1,000 [21.0-39.0]). CONCLUSION: Among adult patients undergoing ambulatory care at surgery centers, hospital transfer at time of discharge from the ambulatory care center is a rare event. In contrast, the rate of need for hospital-based, acute care in the first week afterwards is nearly 30-fold greater, varies across centers, and may be a more meaningful measure for discriminating quality.

El plan de alta de enfermería y su impacto en la disminución de reingresos hospitalario / The nursing discharge plan and its impact on the reduction of hospital readmissions

En 1984 surgió el plan de alta en enfermería en Estados Unidos. Éste fue incluido dentro del sistema Medicare con el propósito de reducir los costos del sistema de salud, por lo que este se extendió rápidamente a Europa y América Latina. En México existen pocos estudios sobre al plan de alta en enfermería, por lo que es necesario evaluar la trascendencia y el impacto de su aplicación. material y métodos: Se realizó un estudio transversal, descriptivo y cuantitativo en un hospital de tercer nivel. La población de estudio fueron las enfermeras con licenciatura del turno matutino. El instrumento de recolección estuvo dividido en cuatro apartados (datos generales, elaboración y contenido del plan, así como el impacto de su aplicabilidad). Resultados: Las recomendaciones del plan de alta se centran en: los medicamentos, los signos y síntomas de alarma, los cuidados en el hogar y las medidas higiénico-dietéticas con 81%. Los profesionales de enfermería lo aplican de forma oral y escrita en 79%. Más de 50% no registra esta actividad en el expediente clínico. Su aplicación contribuye con el derecho que tienen los pacientes de estar informados, además del impacto en los reingresos hospitalarios. Conclusiones: La aplicación del plan de alta en enfermería es una de las formas para fomentar la reintegración del paciente a la sociedad, ya que nos proporciona una visión completa, rápida y veraz del estado de salud del paciente.

In 1984, there is the nursing discharge plan in the U.S. and this is included in the Medicare system, in order to reduce costs in the health system, so this quickly spread to Europe and Latin America. In Mexico there are few studies on the Nursing discharge plan, so it is necessary to evaluate the significance and impact of the implementation. material and methods: We conducted a cross-sectional, descriptive, quantitative, in a tertiary hospital. The study population consisted of nurses with bachelor’s morning shift. The survey instrument was divided into four sections (general information, preparation and content of the plan and the impact of its applicability. Results: The plan’s recommendations focus on high.

Prevalencia de desnutrición al ingreso en el servicio de medicina interna / Prevalence of undernutrition at admission to the internal medicine unit

Objetivo: determinar la prevalencia de desnutrición de los pacientes a su ingreso en un servicio de medicina interna de un hospital de primer nivel, así como examinar las características del paciente con desnutrición. Material y método: estudio descriptivo transversal en pacientes que ingresaban(estancia de cinco días o más) en servicio de medicina interna de un hospital de agudos comarcal de primer nivel. La muestra se seleccionó de manera consecutiva. Variables estudiadas: sexo, edad, diagnóstico principal al ingreso, estancia, índice de masa corporal (IMC),tipo de dieta pautada al ingreso, estado de la mucosa oral, autonomía del paciente para comer, movilidad durante la estancia y presencia de úlceras por presión. Para definir el grado de desnutrición se utilizó como herramienta el CONUT (control nutricional) que valora los parámetros de albúmina, colesterol y linfocitos totales. Resultados: se estudiaron 197 pacientes. El 18,3% presentaron un estado nutricional normal, el 36,5% desnutrición leve, el 33,5% moderada y un 11,7% grave. Un 53,8% tenían diagnósticas patologías crónicas a su ingreso. Los pacientes desnutridos presentaron valores significativamente más bajos de albúmina, colesterol total y linfocitos. Solamente un 10,3% de los pacientes con un IMC entre 18,5 y 25 tenían un grado de nutrición normal, un 23,2% estaban en un IMC entre 25,1 y 29,9, y un 20% con un IMC de 30 o superior. Conclusión: el estudio refleja una elevada prevalencia de desnutrición. Las determinaciones bioquímicas del método CONUT determinan una mejor detección de la desnutrición que el IMC. A la hora de definir un plan de actuación es importante coordinar un buen seguimiento al alta (AU)

Purpose: Determine the prevalence of patient undernourishment at their admission to an internal medicine unit at a first-level hospital, as well as examining the characteristics of undernourished patients. Material and method: Descriptive cross-sectional study in patients admitted (five-day stay or longer) to an internal medicine unit at a first level district acute-care hospital. The sample was selected consecutively. Variables studied: gender, age, main diagnosis at admission, length of stay, body mass index (BMI), type of diet prescribed at admission, condition of oral mucous lining, patient’s autonomy for eating, mobility during the stay and presence of pressure ulcers. To define the degree of undernourishment, the CONUT (nutrition check) tool, which assesses the parameters of albumin, cholesterol and total lymphocytes was used. Results: This study included 197 patients. A total of 18.3% showed a normal nutritional condition, 36.5% slight undernutrition, 33.5% moderate undernutrition and 11.7% serious undernutrition. A total of 53.8%has chronic disorders diagnosed at admission. The patients suffering from undernutrition showed significantly lower albumin, total cholesterol and lymphocyte levels. Solely 10.3% of the patients with a BMI of 18.5-25 had a normal degree of nutrition, 23.2% having a BMI of 25.1-29.9and 20% with a BMI of 30 or above. Conclusion: This study reflects a high prevalence of undernutrition. The biochemical assays of the CONUT method determine a better detection of undernutrition than the BMI. When setting out a plan for action, it is important to coordinate a good post-release follow-up (AU)

Does childhood attention-deficit/hyperactivity disorder predict risk-taking and medical illnesses in adulthood?

OBJECTIVE: To test whether children with attention-deficit/hyperactivity disorder (ADHD), free of conduct disorder (CD) in childhood (mean = 8 years), have elevated risk-taking, accidents, and medical illnesses in adulthood (mean = 41 years); whether development of CD influences risk-taking during adulthood; and whether exposure to psychostimulants in childhood predicts cardiovascular disease. We hypothesized positive relationships between childhood ADHD and risky driving (in the past 5 years), risky sex (in the past year), and between risk-taking and medical conditions in adulthood; and that development of CD/antisocial personality (APD) would account for the link between ADHD and risk-taking. We report causes of death. METHOD: Prospective 33-year follow-up of 135 boys of white ethnicity with ADHD in childhood and without CD (probands), and 136 matched male comparison subjects without ADHD (comparison subjects; mean = 41 years), blindly interviewed by clinicians. RESULTS: In adulthood, probands had relatively more risky driving, sexually transmitted disease, head injury, and emergency department admissions (p< .05-.01). Groups did not differ on other medical outcomes. Lifetime risk-taking was associated with negative health outcomes (p = .01-.001). Development of CD/APD accounted for the relationship between ADHD and risk-taking. Probands without CD/APD did not differ from comparison subjects in lifetime risky behaviors. Psychostimulant treatment did not predict cardiac illness (p = .55). Probands had more deaths not related to specific medical conditions (p = .01). CONCLUSIONS: Overall, among children with ADHD, it is those who develop CD/APD who have elevated risky behaviors as adults. Over their lifetime, those who did not develop CD/APD did not differ from comparison subjects in risk-taking behaviors. Findings also provide support for long-term safety of early psychostimulant treatment.