Aim: This work aims to evaluate the safety and utility of an at-home telemedicine with telemonitoring program for discharged COVID-19 patients. Methods: This is a retrospective cohort study of all ...patients discharged home in Galicia between 6 March 2020 and 15 February 2021. We evaluated a structured, proactive monitoring program conducted by the ASLAM (Área Sanitaria de Lugo, A Mariña y Monforte de Lemos) Healthcare Area team compared to patients discharged in the rest of the Autonomous Community of Galicia. Results: During the study period, 10,517 patients were hospitalized for COVID-19 and 8601 (81.8%) were discharged. Of them, 738 (8.6%) were discharged in ASLAM and 7863 (91.4%) were discharged in the rest of Galicia. Of those discharged in ASLAM, 475 (64.4%) patients were monitored. Compared to patients in the rest of Galicia, the group monitored via telemedicine had a significantly shorter first hospital stay (p < 0.0001), a lower readmission rate (p = 0.05), and a shorter second hospital stay (p = 0.04), with no differences in emergency department visits or 90-day all-cause mortality. Conclusion: A structured, proactive telemedicine with telemonitoring program for discharged COVID-19 patients is a safe, useful tool that reduces the mean length of hospital stay and readmissions.
We aim to identify patterns of disease clusters among inpatients of a general hospital and to describe the characteristics and evolution of each group.
We used two data sets from the CMBD (Conjunto ...mínimo básico de datos - Minimum Basic Hospital Data Set (MBDS)) of the Lucus Augusti Hospital (Spain), hospitalisations and patients, realising a retrospective cohort study among the 74 220 patients discharged from the Medic Area between 01 January 2000 and 31 December 2015. We created multimorbidity clusters using multiple correspondence analysis.
We identified five clusters for both gender and age. Cluster 1: alcoholic liver disease, alcoholic dependency syndrome, lung and digestive tract malignant neoplasms (age under 50 years). Cluster 2: large intestine, prostate, breast and other malignant neoplasms, lymphoma and myeloma (age over 70, mostly males). Cluster 3: malnutrition, Parkinson disease and other mobility disorders, dementia and other mental health conditions (age over 80 years and mostly women). Cluster 4: atrial fibrillation/flutter, cardiac failure, chronic kidney failure and heart valve disease (age between 70-80 and mostly women). Cluster 5: hypertension/hypertensive heart disease, type 2 diabetes mellitus, ischaemic cardiomyopathy, dyslipidaemia, obesity and sleep apnea, including mostly men (age range 60-80). We assessed significant differences among the clusters when gender, age, number of chronic pathologies, number of rehospitalisations and mortality during the hospitalisation were assessed (p<0001 in all cases).
We identify for the first time in a hospital environment five clusters of disease combinations among the inpatients. These clusters contain several high-incidence diseases related to both age and gender that express their own evolution and clinical characteristics over time.
Objective: To describe the clinical profile of centenarians admitted to galician hospitals.
Method: Review of Discharge Register of the National Health System in the period 2004-2013.
Results: The ...sampled included 1,373 admissions, with mean age of 101.2 ± 1.4.
73.7% were women. The number of admissions per year increased over time (0.31 % in 2004 versus 0.69% in 2013). Ourense and Lugo were the provinces with more admissions in proportion to the reference population. Internal Medicine Services attended more than half of patients. Centenarians were admitted through the emergency department, and the reason for admission was medical in 84.7%, being the most frequent DRG (Diagnosis-Related Group) respiratory infections. There was a higher incidence of respiratory diseases in males, while women had a higher incidence of hip fractures. The mean length of stay was 8.6 ± 7 days, with a mortality of almost 30%. The readmission rate was 7.8%.
Conclusions: There is a progressive increase in the number of centenarians admissions in the lasts years, mainly due to medical conditions. They have a high mortality and are frequently readmitted.
Objetivo: Describir la tendencia temporal y el perfil clínico de los centenarios que ingresan en los hospitales gallegos.
Método: Análisis del Registro de Altas del Sistema Nacional de Salud en el periodo 2004 - 2013.
Resultados: Se registraron 1.373 ingresos, con una edad media de 101,2±1,4. El 73,7% fueron mujeres. El número de ingresos por año se incrementó con el tiempo (0,31% de los ingresos en 2004 versus 0,69% en 2013). Ourense y Lugo fueron las provincias donde hubo más ingresos en proporción con la población atendida. Más de la mitad de los pacientes fueron atendidos por los Servicios de Medicina Interna. Los centenarios ingresaron a través de Servicio de Urgencias, y el motivo de ingreso fue médico en el 84,7%, constituyendo el GRD (Grupos relacionados por el diagnóstico) más frecuente las infecciones respiratorias. En los varones hubo una mayor incidencia de enfermedades respiratorias, mientras que las mujeres presentaron mayor incidencia de fracturas de cadera. La estancia media fue de 8,6±7 días, alcanzando una mortalidad de casi el 30% y la tasa de reingresos al año fue del 7,8%.
Conclusiones: Se observa un incremento progresivo del número de ingresos de pacientes centenarios en los últimos años, fundamentalmente por patología médica. Presentan una mortalidad elevada y reingresan con frecuencia.
Abstract Introduction Patients with multiple hospital admissions represent a small percentage of total hospitalizations but result in a considerable proportion of the healthcare expenditure. There ...are no studies that have analyzed their long-term clinical evolution. Objectives To study the characteristics, temporal patterns of readmissions and clinical evolution of patients with multiple hospital admission in the long term. Methods A retrospective study was conducted of all hospital admissions in the medical area of the Hospital of Lugo (Spain) between January 1, 2000 and December 31, 2012, based on data from the center's minimum basic data set. Results A total of 139,249 hospital admissions for 62,515 patients were studied. Six hospital admissions were recorded for 6.4% of the patients. The overall mortality rate was 16% (9982 patients). The readmissions rate steadily increased with each new admission, from 48% after the first event to 74.6% after the fifth. The rate of hospital readmission before 30 days increased from 18.3% in the second admission to 36.3% in the sixth. The number of chronic diseases increased from 3.1 (SD, 2) in the first hospital admission up to 4.9 (2.8) in the sixth. The Department of Internal Medicine treated a third of all hospital admissions. In the sixth hospitalization, conditions associated with admission in Internal Medicine were CIRS score, age, heart failure, COPD, dementia, diabetes, atrial fibrillation and anemia. Conclusions Patients with multiple hospital admissions are complex patients whose temporal pattern of readmissions changes with time, such that each hospital admission constitutes a factor facilitating the next.
Objective: to assess whether clinical comanagement between vascular surgeons and internists improves the quality of care provided to patients admitted to a vascular surgery service.
Material and ...method: several clinical features related to the clinical care provided to a sample of patients with arterial disease and DVT admitted to the vascular surgery at Lucus Augusti University Hospital of Lugo were analyzed, after implementation of a comanagement model of care involving internists during the year 2013. Data of patients with DVT were compared with historical controls of the year before. Moreover, we conducted a satisfaction survey to the medical staff and nursing of the vascular surgery service about their preferences regarding the model of clinical care.
Results: 50 patients with arterial disease and 75 with DVT (25 cases and 50 controls) were studied. Among the former, mean age was 71.9 years (SD 14), 60% male. They received an average of 8.2 drugs (SD 4.4), the Charlson index was 4.1 (SD 2.7) and the Barthel index 85.9 (SD 20). 70% had anemia at admission and 86% experienced in-hospital complications, with a mortality of 10%.
DVT patients attended by the comanagement model showed a higher frequency of identified risk factors for thrombosis (76% vs 38%, p = 0.002), proper adjustment of the dose of LMWH to weight and renal function (92% vs 18%, p = 0.0001) and complete record of comorbidity (100% vs 50%, P = 0.0001), with no differences in length of hospital stay.
Both medical staff and the nursing preferred the comanagement model with respect to the standard model.
Conclusions: patients with arterial and venous disease have a risk of complications and comorbidity that justify the participation of internists in their clinical care. The comanagement model can improve the quality of care provided, with a high degree of satisfaction among the staff of the surgical team.
Objetivo: valorar si la asistencia clínica compartida entre cirujanos vasculares e internistas mejora la calidad de la atención médica prestada a pacientes ingresados en un servicio de cirugía vascular.
Material y método: se analizaron diversas características clínicas relativas a la atención de una muestra de pacientes con patología arterial y con TVP ingresados en el servicio de cirugía vascular del hospital universitario Lucus Augusti de Lugo, tras la implantación de un modelo de asistencia multidisciplinar con internistas durante el año 2013. Los datos de los enfermos con TVP se compararon con los de controles históricos del año anterior. Por otra parte, se realizó una encuesta de satisfacción al personal sanitario del servicio de cirugía vascular sobre sus preferencias respecto al modelo de atención.
Resultados: se estudiaron 50 pacientes con patología arterial y 75 con TVP (25 casos y 50 controles). Entre los primeros, su edad fue 71.9 años (DE 14), 60% hombres. Recibían una media de 8.2 fármacos (DE 4.4), su índice de Charlson fue 4.1 (DE 2.7) y el índice de Barthel 85.9 (DE 20). El 70% tenía anemia al ingreso y el 86% presentó alguna complicación durante el ingreso, con una mortalidad del 10%.
Los pacientes con TVP atendidos por el modelo de asistencia compartida presentaron una mayor frecuencia de identificación de factores de riesgo de trombosis (76% vs 38%; p=0.002), de ajuste correcto de dosis de HBPM al peso y función renal (92% vs 18%; p=0.0001) y de registro completo de comorbilidad (100% vs 50%; p=0.0001), sin diferencias en la estancia media hospitalaria.
Tanto el personal facultativo como el de enfermería prefirieron el modelo de asistencia compartida con internistas respecto al estándar.
Conclusiones: los enfermos con patología arterial y venosa presentan una comorbilidad y riesgo de complicaciones que justifica la participación de internistas en su atención. El modelo de asistencia compartida puede mejorar la calidad de la asistencia prestada, con un elevado grado de satisfacción entre el personal del equipo quirúrgico
La infección por Streptococcus suis (S. suis) es una zoonosis poco descrita en nuestro país, que se relaciona con la exposición al ganado porcino o su carne. La forma de presentación más frecuente es ...la meningitis, mientras que la afectación de la columna vertebral es rara.
Presentamos 2 casos de infección por S. suis y realizamos una revisión sistemática de los trabajos publicados sobre espondilodiscitis por S. suis entre enero de 1994 y mayo de 2020 con el objetivo de definir las características clínicas, sus factores predisponentes y su evolución.
Se describen 17 casos, el 76,5% varones con una edad media de 57,6 años, generalmente sin enfermedad de base asociada. El enolismo fue un factor presente en casi el 17,6% de los pacientes. Un 70,6% presentaron exposición a ganado porcino o su carne y un 20% heridas en manos. La duración media de los síntomas fue de 10,2 días y el segmento más afectado fue el lumbar. Un 70,6% cursó con meningitis. Todos se trataron con betalactámicos con una duración media de 53,2 días. Hubo una recidiva y ninguno falleció.
Existen pocos casos de espondilodiscitis por S. suis en la literatura. Cuando ocurre, se asocia a otro tipo de infección en la mayoría de los casos. Presentan buena respuesta al tratamiento médico y buen pronóstico.
Streptococcus suis (S. suis) infection is poorly described zoonosis in our country, which is related with exposure to pigs or their meat. The most common clinical presentation is meningitis, while spinés involvement is rare.
We report 2 cases of S. suis infection and perform a systematic review of the articles published on S. suis spondylodiscitis between January 1994 and May 2020 with the aim of defining the clinical characteristics, predisposing factors and evolution.
17 cases are described, 76.5% males with a mean age of 57.6 years, generally without associated underlying disease. Enolism was a factor present in 17.6%. 70.6% had exposure to pigs or their meat and 20% hand injuries. The mean duration of symptoms was 10.2 days and the most affected segment was the lumbar level. 70.6% had meningitis. All were treated with beta-lactams with an average duration of 53.2 days. There was a recurrence and none died.
There are few cases of S. suis spondylodiscitis in the literature. When occurs, it is associated with another type of infection in most cases. They present a good response to medical treatment and a good prognosis.
INTRODUCTION: Multimorbidity, a very frequent and with a big sociosanitary repercussion, is a little studied situation.
PATIENTS AND METHODS: A study of totality of adults hospital discharges in ...medical services between 2000 and 2009 was conducted. The study variables were obtained from hospital records. New variables were created with integration of other medical records and after derivation from the original variables. A descriptive statistical analysis was conducted.
RESULTS: In 10 years-study and 12 adults hospital medical services, 111.123 discharges in 52269 patients (male 55,9%, mean age 68,6 SD 17,2- , accumulated mortality 26,5%) were registered. 51,2% of patients
had at least one of following: coronary ischemic disease (12,4 %), heart failure (15,2%), dementia (9,8 %), cancer (18,1 %) y COPD (16,4 %). Totally, 8597 had at least two of them, generating 30598 discharges,
2818 in-hospital deaths and mean length stay 12,4 (SD 7,1) days. The most frequent association was PD/heart failure (1355 patients, 5330 admissions) and the least all together association (18 patients, 125 admissions).
CONCLUSSION: Multimorbidity is a clinical challenge and a management problem. Our study identifies groups of patients with a great repercussion over hospital activity. It s possible to establish programs to improve quality life and reducing their in-hospital admissions.
INTRODUCCIÓN: La multimorbilidad, a pesar de ser muy frecuente y tener mucha repercusión socio-sanitaria, es un fenómeno poco estudiado.
PACIENTES Y METODOS: Estudio de la totalidad de ingresos hospitalarios en los servicios del área médica de adultos en un Hospital General entre 2000 y 2009. Los datos se obtuvieron de la base de datos general del
centro. Se crearon nuevas variables con la integración de otras bases del servicio y tras el análisis y compactación de los datos existentes. En el análisis estadístico se utilizaron técnicas habituales de la estadística descriptiva.
RESULTADOS: En los 10 años en estudio se registraron 111.123 ingresos correspondientes a 52269 pacientes (varones 55,9%, edad media 68,6 DT 17,2- , mortalidad acumulada 26,5%) distribuidos en 12 servicios hospitalarios. El 51,2% de los pacientes sufrían al menos una de las siguientes patologías: Cardiopatía isquémica (12,4 %), insuficiencia cardiaca (15,2%), Demencia (9,8 %), cáncer (18,1 %) y EPOC (16,4 %). En conjunto, sufrían dos o más de estas patologías 8597 pacientes, sumando 30598 ingresos,
2818 fallecimientos hospitalarios (32,8%) y una estancia media de 12,4(DT 7,1) días. Por asociaciones de patologías la más frecuente fue EPOC/ insuficiencia
cardiaca (1355 pacientes, 5330 ingresos) y la menos habitual la asociación de todas ellas (18 pacientes, 125 ingresos).
CONCLUSIÓN: La multimorbilidad supone un desafío clínico y un importante problema de gestión. Nuestro estudio identifica subgrupos de pacientes que suponen un porcentaje importante de la actividad hospitalaria
y donde es posible establecer programas que mejoren su calidad de vida, reduciendo sus ingresos ospitalarios.
Streptococcus suis (S. suis) infection is poorly described zoonosis in our country, which is related with exposure to pigs or their meat. The most common clinical presentation is meningitis, while ...spinés involvement is rare.
We report 2 cases of S. suis infection and perform a systematic review of the articles published on S. suis spondylodiscitis between January 1994 and May 2020 with the aim of defining the clinical characteristics, predisposing factors and evolution.
17 cases are described, 76.5% males with a mean age of 57.6 years, generally without associated underlying disease. Enolism was a factor present in 17.6%. 70.6% had exposure to pigs or their meat and 20% hand injuries. The mean duration of symptoms was 10.2 days and the most affected segment was the lumbar level. 70.6% had meningitis. All were treated with beta-lactams with an average duration of 53.2 days. There was a recurrence and none died.
There are few cases of S. suis spondylodiscitis in the literature. When occurs, it is associated with another type of infection in most cases. They present a good response to medical treatment and a good prognosis.
Streptococcus suis spondylodiscitis: 2 new cases and a literature review Romay-Lema, Eva-María; Ventura-Valcárcel, Pablo; Iñiguez-Vázquez, Iria ...
Enfermedades infecciosas y microbiologia clinica (English ed.),
February 2022, 2022-Feb, 2022-02-00, 20220201, Letnik:
40, Številka:
2
Journal Article
Recenzirano
Streptococcus suis (S. suis) infection is poorly described zoonosis in our country, which is related with exposure to pigs or their meat. The most common clinical presentation is meningitis, while ...spine’s involvement is rare.
We report 2 cases of S. suis infection and perform a systematic review of the articles published on S. suis spondylodiscitis between January 1994 and May 2020 with the aim of defining the clinical characteristics, predisposing factors and evolution.
17 cases are described, 76.5% males with a mean age of 57.6 years, generally without associated underlying disease. Enolism was a factor present in 17.6%. 70.6% had exposure to pigs or their meat and 20% hand injuries. The mean duration of symptoms was 10.2 days and the most affected segment was the lumbar level. 70.6% had meningitis. All were treated with beta-lactams with an average duration of 53.2 days. There was a recurrence and none died.
There are few cases of S. suis spondylodiscitis in the literature. When occurs, it is associated with another type of infection in most cases. They present a good response to medical treatment and a good prognosis.
La infección por Streptococcus suis (S. suis) es una zoonosis poco descrita en nuestro país, que se relaciona con la exposición al ganado porcino o su carne. La forma de presentación más frecuente es la meningitis, mientras que la afectación de la columna vertebral es rara.
Presentamos 2 casos de infección por S. suis y realizamos una revisión sistemática de los trabajos publicados sobre espondilodiscitis por S. suis entre el enero de 1994 y mayo de 2020 con el objetivo de definir las características clínicas, sus factores predisponentes y su evolución.
Se describen 17 casos, el 76,5% varones con una edad media de 57,6 años, generalmente sin enfermedad de base asociada. El enolismo fue un factor presente en casi el 17.6% de los pacientes. Un 70.6% presentaron exposición a ganado porcino o su carne y un 20% heridas en manos. La duración media de los síntomas fue de 10,2 días y el segmento más afectado fue el lumbar. Un 70.6% cursó con meningitis. Todos se trataron con betalactámicos con una duración media de 53,2 días. Hubo una recidiva y ninguno falleció.
Existen pocos casos de espondilodiscitis porS. suis en la literatura. Cuando ocurre, se asocia a otro tipo de infección en la mayoría de los casos. Presentan buena respuesta al tratamiento médico y buen pronóstico.
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