Predictive factors of mortality in severe community-acquired pneumonia: a model with data on the first 24h of ICU admission.

OBJECTIVE: To construct a model of factors predicting mortality in severe community-acquired pneumonia (SCAP) with data on the first 24h after admission to the intensive care unit (ICU). DESIGN: A prospective, observational study was carried out. SETTING: The ICU of a university hospital. PATIENTS: ICU-admitted patients with SCAP were studied prospectively. INTERVENTIONS: Admission pneumonia scores were calculated, and clinical variables were registered during the first 24h. Relationships between predictors of mortality at 28 days were assessed by means of a multivariate logistic regression model. RESULTS: A total number of 242 SCAP patients were evaluated. The SAPS II severity score was 37.2±15.5 points. Bivariate analysis showed high mortality to be more frequent in elderly patients, as well as in patients with high SAPS II scores, neoplastic disease or chronic renal failure. The other prognostic factors related to increased mortality included mechanical ventilation, acute respiratory distress syndrome (ARDS), acute renal failure, bacteremia, and septic shock. Mortality at 28 days was 23.1% (56 patients). Multivariate analysis of the risk factors generated a new predictive model of mortality applicable within the first 24h after ICU admission and comprising 5 main factors: age, CURB severity score 3-4, septic shock, ARDS, and acute renal failure. CONCLUSIONS: Age in years, CURB score 3-4, septic shock, ARDS, and acute renal failure during the first 24h of ICU admission were found to be independent predictors of mortality in SCAP patients.

Application, verification and correction from an elaborate checklist with some of the recommendations («do and do not do¼) of the SEMICYUC working groups. / Aplicación, comprobación y corrección a partir de un checklist elaborado con algunas de las recomendaciones («hacer y no hacer¼) de los grupos de trabajo de la SEMICYUC.

OBJECTIVE: Based on some of the recommendations of the SEMICYUC working groups, we developed a checklist and applied it in 2 periods, analyzing their behavior as a tool for improving safety. DESIGN: A comparative pre- and post-intervention longitudinal study was carried out. SETTING: The Intensive Care Unit (ICU) of a 400-bed university hospital. PATIENTS: Random cases series in 2 periods separated by 6 months. INTERVENTIONS: We developed a checklist with 24 selected indicators that were randomly applied to 50 patients. Verification was conducted by a professional not related to care (prompter). We analyzed the results and compliance index and carried out corrective measures with training. With 6 months of preparation, we again applied the random checklist to 50 patients (post-intervention period) and compared the compliance indexes between the two timepoints. RESULTS: There were no differences in demographic characteristics or evolution between the periods. The compliance index at baseline was 0.86±0.12 versus 0.91±0.52 in the post-intervention period (P=.023). An acceptable compliance index was obtained with the 24 indicators, though at baseline the compliance index was<0.85 for 5 recommendations. These detected non-compliances were worked upon through training in the second phase of the study. The post-intervention checklist evidenced improvement in compliance with the recommendations. CONCLUSIONS: The checklist used to assess compliance with a selection of recommendations of the SEMICYUC applied and moderated by a prompter was seen to be a useful instrument allowing us to identify points for improvement in the management of Intensive Care Unit patients, increasing the quality and safety of care.

Interhospital Sepsis Code in Catalonia (Spain): Territorial model for initial care of patients with sepsis. / Código Sepsis Interhospitalario en Catalunya: modelo organizativo territorial para la atención inicial al paciente con sepsis.

Sepsis is a syndromic entity with high prevalence and mortality. The management of sepsis is standardized and exhibits time-dependent efficiency. However, the management of patients with sepsis is complex. The heterogeneity of the forms of presentation can make it difficult to detect and manage such cases, in the same way as differences in training, professional competences or the availability of health resources. The Advisory Commission for Patient Care with Sepsis (CAAPAS), comprising 7 scientific societies, the Emergency Medical System (SEM) and the Catalan Health Service (CatSalut), have developed the Interhospital Sepsis Code (CSI) in Catalonia (Spain). The general objective of the CSI is to increase awareness, promote early detection and facilitate initial care and interhospital coordination to attend septic patients in a homogeneous manner throughout Catalonia.

Aplicación, comprobación y corrección a partir de un checklist elaborado con algunas de las recomendaciones («hacer y no hacer») de los grupos de trabajo de la SEMICYUC / Application, verification and correction from an elaborate checklist with some of the recommendations («do and do not do») of the SEMICYUC working groups

Objetivo Con algunas de las recomendaciones de los grupos de trabajo de la SEMICYUC elaboramos un checklist y lo aplicamos en 2 periodos. Analizamos su comportamiento como herramienta de mejora en la seguridad. Diseño Estudio longitudinal, comparativo pre- y postintervención. Ámbito Unidad de Cuidados Intensivos de un hospital universitario de 400 camas. Pacientes Serie de casos aleatorios en 2 periodos separados por 6 meses. Intervenciones Elaboramos un checklist con 24 indicadores seleccionados que aplicamos de forma aleatoria a 50 pacientes. La verificación fue conducida por un profesional no relacionado con el cuidado (prompter). Analizamos los resultados y el índice de cumplimiento y realizamos medidas correctoras con formación. Con 6 meses de preparación, aplicamos de nuevo el checklist aleatorio a 50 pacientes (periodo postintervención) y comparamos el índice de cumplimiento entre ambos. Resultados No observamos diferencias en características demográficas ni en la evolución entre periodos. El índice de cumplimiento en el periodo basal fue de 0,86±0,12 y en el periodo de postintervención de 0,91±0,52; p=0,023. Obtuvimos un índice de cumplimiento aceptable de los 24 indicadores, pero en el basal en 5 recomendaciones el índice de cumplimiento fue menor a 0,85. Estos incumplimientos detectados se trabajaron formativamente en la segunda fase. En el checklist postintervención observamos una mejoría en el cumplimiento de las recomendaciones. Conclusiones El checklist utilizado para comprobar el cumplimiento de una selección de recomendaciones de la SEMICYUC aplicado y moderado por un prompter fue un instrumento útil que permitió establecer puntos de mejora en la atención de los pacientes de una unidad de cuidados intensivos, aumentando la calidad y la seguridad. (AU)

Objective Based on some of the recommendations of the SEMICYUC working groups, we developed a checklist and applied it in 2 periods, analyzing their behavior as a tool for improving safety. Design A comparative pre- and post-intervention longitudinal study was carried out. Setting The Intensive Care Unit (ICU) of a 400-bed university hospital. Patients Random cases series in 2 periods separated by 6 months. Interventions We developed a checklist with 24 selected indicators that were randomly applied to 50 patients. Verification was conducted by a professional not related to care (prompter). We analyzed the results and compliance index and carried out corrective measures with training. With 6 months of preparation, we again applied the random checklist to 50 patients (post-intervention period) and compared the compliance indexes between the two timepoints. Results There were no differences in demographic characteristics or evolution between the periods. The compliance index at baseline was 0.86±0.12 versus 0.91±0.52 in the post-intervention period (P=.023). An acceptable compliance index was obtained with the 24 indicators, though at baseline the compliance index was<0.85 for 5 recommendations. These detected non-compliances were worked upon through training in the second phase of the study. The post-intervention checklist evidenced improvement in compliance with the recommendations. Conclusions The checklist used to assess compliance with a selection of recommendations of the SEMICYUC applied and moderated by a prompter was seen to be a useful instrument allowing us to identify points for improvement in the management of Intensive Care Unit patients, increasing the quality and safety of care. (AU)

Recomendaciones para el tratamiento nutrometabólico especializado del paciente crítico: patología abdominal no quirúrgica. Grupo de Trabajo de Metabolismo y Nutrición de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) / Recommendations for specialized nutritional-metabolic treatment of the critical patient: Nonsurgical abdominal disease. Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC)

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Código Sepsis Interhospitalario en Catalunya: modelo organizativo territorial para la atención inicial al paciente con sepsis / Interhospital Sepsis Code in Catalonia (Spain): Territorial model for initial care of patients with sepsis

La sepsis es una entidad sindrómica de elevada prevalencia y mortalidad. Su manejo está estandarizado y tiene una eficacia dependiente del tiempo. Sin embargo, el manejo de los pacientes con sepsis es complejo. La heterogeneidad de las formas de presentación puede dificultar su detección y manejo, así como las diferencias en formación, competencias o disponibilidad de recursos sanitarios. La Comisión Asesora para la Atención al PAciente con Sepsis (CAAPAS), formada por 7 sociedades científicas, el Sistema de Emergencias Médicas (SEM) y el Servei Català de la Salut (CatSalut), han desarrollado en Catalunya el Código Sepsis Interhospitalario (CSI). El objetivo general del CSI es facilitar la detección precoz, la atención inicial y la coordinación interhospitalaria para optimizar el tratamiento de los pacientes con sepsis o shock séptico en formato código de riesgo vital, de forma homogénea a lo largo de todo el territorio catalán

Sepsis is a syndromic entity with high prevalence and mortality. The management of sepsis is standardized and exhibits time-dependent efficiency. However, the management of patients with sepsis is complex. The heterogeneity of the forms of presentation can make it difficult to detect and manage such cases, in the same way as differences in training, professional competences or the availability of health resources. The Advisory Commission for Patient Care with Sepsis (CAAPAS), comprising 7 scientific societies, the Emergency Medical System (SEM) and the Catalan Health Service (CatSalut), have developed the Interhospital Sepsis Code (CSI) in Catalonia (Spain). The general objective of the CSI is to increase awareness, promote early detection and facilitate initial care and interhospital coordination to attend septic patients in a homogeneous manner throughout Catalonia

Testicular tumors in carp-funa hybrid: annual cycle and effect on a wild population.

This study documents the occurrence of testicular tumors in a wild population of carp-funa hybrids. The most prevalent tumor was a dysgerminoma. There were lower prevalences of seminomas, leiomyomas, Sertoli cell tumors, and spermatocytic seminomas. Sex-ratio, gonadosomic index (Gi) and the prevalence of tumors in the monthly catch was analysed for five consecutive reproduction periods (1980 to 1984). Gonadal tumors were found only in males. This may be important to the population dynamics of the carp-funa hybrid, since a high percentage of the fish that die during spawning have these tumors. A schematic model for the reservoir's population is suggested.

Predictive factors of mortality in severe community-acquired pneumonia: A model with data on the first 24h of ICU admission

OBJECTIVE: To construct a model of factors predicting mortality in severe community-acquired pneumonia (SCAP) with data on the first 24h after admission to the intensive care unit (ICU). DESIGN: A prospective, observational study was carried out. SETTING: The ICU of a university hospital. PATIENTS: ICU-admitted patients with SCAP were studied prospectively. INTERVENTIONS: Admission pneumonia scores were calculated, and clinical variables were registered during the first 24h. Relationships between predictors of mortality at 28 days were assessed by means of a multivariate logistic regression model. RESULTS: A total number of 242 SCAP patients were evaluated. The SAPS II severity score was 37.2 ± 15.5 points. Bivariate analysis showed high mortality to be more frequent in elderly patients, as well as in patients with high SAPS II scores, neoplastic disease or chronic renal failure. The other prognostic factors related to increased mortality included mechanical ventilation, acute respiratory distress syndrome (ARDS), acute renal failure, bacteremia, and septic shock. Mortality at 28 days was 23.1% (56 patients). Multivariate analysis of the risk factors generated a new predictive model of mortality applicable within the first 24 h after ICU admission and comprising 5 main factors: age, CURB severity score 3-4, septic shock, ARDS, and acute renal failure. CONCLUSIONS: Age in years, CURB score 3-4, septic shock, ARDS, and acute renal failure during the first 24h of ICU admission were found to be independent predictors of mortality in SCAP patients

OBJETIVO: Construir un modelo de factores predictivos de mortalidad en la neumonía adquirida en la comunidad grave (NACG) utilizando los datos de las primeras 24h de ingreso en la unidad de cuidados intensivos (UCI). DISEÑO: Estudio prospectivo y observacional. Ámbito: UCI de un hospital universitario. PACIENTES: Se estudiaron de forma prospectiva los pacientes ingresados en la UCI con el diagnóstico de NACG. INTERVENCIONES: Se calcularon las escalas de neumonía y se registraron las variables clínicas en las primeras 24h del ingreso en la UCI. Para evaluar los factores predictores de mortalidad a los 28 días, se construyó un modelo multivariado de regresión logística. RESULTADOS: Un total de 242pacientes con NACG fueron analizados. La puntuación de gravedad por el SAPSII fue de 37,2±15,5 puntos. El análisis bivariado mostró una mayor mortalidad en pacientes de edad avanzada, con una puntuación de SAPSII alta, enfermedad neoplásica o insuficiencia renal crónica. Otros factores pronóstico relacionados con el aumento de la mortalidad fueron la ventilación mecánica, el síndrome de distrés respiratorio agudo (SDRA), la insuficiencia renal aguda, y el shock séptico o la bacteriemia. La mortalidad a los 28días fue del 23,1% (56pacientes). El análisis multivariado de los factores de riesgo permitió construir un nuevo modelo predictivo de mortalidad aplicable en las primeras 24h de ingreso en la UCI, que consistió en 5 factores: edad, CURB score 3-4, shock séptico, SDRA e insuficiencia renal aguda. CONCLUSIONES: La edad en años, el CURB score 3-4, el shock séptico, el SDRA y la insuficiencia renal aguda evaluados en las primeras 24h de ingreso en la UCI fueron factores de riesgo independientes de mortalidad en pacientes con NACG

Coma secundario a neurocisticercosis: estudio de 4 casos / No disponible

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Valoración de la realización y mejora de la historia clínica respiratoria del residente de neumología con el sistema Self-Audit / Evaluation of the making and improvement of the respiratory clinical history of the pneumology resident with the Self-Audit system

Objetivo: Analizar el contenido de la historia clínica respiratoria realizada por el residente de neumología y la posibilidad de mejora con el sistema de autoevaluación Self-audit.Métodos: Estudio descriptivo y retrospectivo de 17 historias clínicas respiratorias consecutivas realizadas por un residente de neumología en pacientes hospitalizados, al inicio de la rotación por su especialidad (grupo I) y a partir de 28 variablesestablecidas previamente. El análisis de estas variables se realizó con el mismo residente y fueron comparadas conel registro prospectivo de 20 nuevas historias (grupo II).Resultados: Los pacientes de los grupos I y II tenían una edad y sexo similares. En el grupo I, se registraron correctamente una media de15 variables (desviación estándar DE 4 y rango 9-21) y en el grupo II, 28 (DE 1 y rango 26-29) (p <0,0001). En ningún paciente del grupo I se registraron de forma correcta las 28 variables. En el grupo II, se registraron de forma correcta las 28 variables en 10 (50%) y 27 variables en 5 (25%). El sistema de autoevaluación permitió una mejorasignificativa de los registros de tabaquismo, antecedentes laborales, contacto con animales, broncorrea, sibilancias, hemoptisis, enfermedades pleurales, neoplasia pulmonar, historia de asma, atopia, EPOC, bronquiectasias, radiografía o TC previos, pruebas funcionales respiratorias, ingresos previos o en UCI, oxígeno domiciliario, patología del sueño yotras enfermedades respiratorias.Conclusiones: La historia clínica respiratoria realizada por un residente de neumología al llegar a su especialidad es susceptible de mejora. El sistema de autoevalución Self-audit ha sido muy útil para mejorar su realización

Objective: Analyze the contents of the respiratory clinical history made by pneumonology resident on the possibility of improvement with the self-audit self-evaluation system.Methods: Descriptive and retrospective study of 17 consecutive respiratory clinical histories made by the pneumology resident in hospitalized patients when initiating their rotation in the speciality (group 1) and based on 28 previously establishedvariables. The analysis of these variables were performed with the same resident and compared with the prospective registry of 20 new histories (group 2).Results: The age and gender of the group 1 and 2 patients were similar. In group 1, a measurement of 15 variables (standard deviation - SD - 4 and range 9-21) and in group 2, 28 (SD 1 and range 26.29) were correctly recorded (p < 0.0001).The 28 variables were not recorded correctly in any of the patients of group 1. In group II, the 28 variables were correctly recorded in 10 (50%) and 27 variables in 5 (25%). The self-evaluation system allowed for a significant improvement of the recording of smoking, work background, contact with animals, broncorrhea, high pitched wheezes, hemoptysis, pleural diseases, pulmonary neoplasm, background of asthma, atopy, COPD, bronchiectasis, previous X-ray or CT scan, respiratoryfunction tests, previous admissions or in ICU, domiciliary oxygen, sleep disorder and other respiratory diseases.Conclusions: The respiratory clinical history made by the pneumology resident on arriving to the speciality rotation can be improved. The self-audit self-evaluation system has been very useful to improve its performance