The usefulness of telemedicine in the management of the
(COVID-19) pandemic has not been evaluated.
We conducted a descriptive study of the process of recruitment and follow-up of patients using a ...telemedicine tool (TELEA) in the management of patients at risk, in a rural environment with a dispersed population in Lugo in north western Spain.
A large number of patients diagnosed with COVID-19 infection (N = 545) were evaluated. Of this group, 275 had comorbidities and were enrolled in the program, with a mean age of 57.6 ± 16.3 years, 43.1% male. The risk factors were hypertension (38%), diabetes (16%), asthma (9.5%), heart disease (8.8%), and immunosuppression (5.1%). Patients were followed through the platform with daily control of symptoms and vital signs. Only 8% were admitted to the hospital, 5.1% on a scheduled basis and 2.9% through the emergency room.
The telemedicine tool TELEA is useful for the management of high-risk patients with COVID-19.
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.
Intensive care unit–acquired muscle weakness (ICUAW) has an incidence of 40–46%. Early mobilisation is known to be a protective factor.
The aim of the study was to identify the incidence of ICUAW in ...Spain and to evaluate variables likely to contribute to the development of ICUAW.
A 4-month, prospective observational multicentre cohort study was conducted on patients receiving invasive mechanical ventilation for at least 48 h. Data were collected from ICU day 3 until ICU discharge. The primary outcome was presence of ICUAW (diagnosed using the Medical Research Council MRC scale). The secondary outcome was nurse–patient ratio, physiotherapist availability, analgesia, sedation and delirium management, glycaemic control, and daily level of mobility during the ICU stay as per the ICU Mobility Scale. A logistic regression model was constructed based exclusively on days 3–5 of the ICU stay.
The data of 642 patients were analysed from 80 ICUs, accounting for 35% of all ICUs in Spain. The incidence of ICUAW was 58% (275 of 474 patients; 95% confidence interval CI 53–62). The predictors for ICUAW were older age (odds ratio OR = 1.01; 95% CI 1.00–1.03) and more days with renal replacement therapy (OR = 1.01; 95% CI 1.00–1.02). The protective factors for ICUAW were male gender (OR = 0.58; 95% CI 0.38–0.89), higher Barthel Index (showing prehospital functional independence) (OR = 0.97; 95% CI 0.95–0.99), more days of being awake and cooperative (defined by a feasible MRC assessment) (OR = 0.98; 95% CI 0.97–0.99), presence of delirium (OR = 0.98; 95% CI 0.97–0.99), and more days with active mobilisation (ICU Mobility Scale ≥ 4) (OR = 0.98; 95% CI 0.97–0.99).
The risk factors for ICUAW were functional dependence before admission, female gender, older age, and more days on renal replacement therapy. The protective factors for ICUAW were feasibility of MRC assessment, the presence of delirium, and being actively mobilised during the first 5 days in the ICU.
•Birth-enucleation modifies the spontaneous activity of somatosensory brain areas.•Calcium spike amplitude increases in the thalamus of 1-day-old rats after enucleation.•Calcium spike amplitude ...decreases in the cortex of 1-day-old rats after enucleation.•STCAs development before barrel formation is unaffected by enucleation.
Bilateral eye enucleation at birth (BE) leads to an expansion of the primary somatosensory cortex (S1) in rat pups. Although increased growth of the somatosensory thalamo-cortical afferents (STCAs) in part explains S1 expansion, timing mechanisms governing S1 formation are also involved. In this work, we begin the search of a developmental clock by intending to document the existence of putative clock neurons in the somatosensory thalamus (VPM) and S1 based upon changes of spontaneous spike amplitude; a biophysical property sensitive to circadian regulation; the latter known to be shifted by enucleation. In addition, we also evaluated whether STCAs growth rate and segregation timing were modified, as parameters the clock might time. We found that spontaneous spike amplitude transiently, but significantly, increased or decreased in VPM and S1 neurons of BE rat pups, respectively, as compared to their control counterparts. The growth rate and segregation timing of STCAs was, however, unaffected by BE. These results support the existence of a developmental clock that ticks differently in the VPM and S1 after BE. This observation, together with the fact that STCAs growth rate and segregation timing is unchanged, suggests that S1 expansion in BE rats may in part be controlled at the cortical level.
OBJECTIVETo adapt the ICU Mobility Scale (IMS) to the area of intensive care units (ICU) in Spain and to evaluate the metric properties of the Spanish version of the IMS (IMS-Es). METHODDescriptive ...metric study developed in two phases. Phase 1, adaptation to Spanish of the IMS by a team of nurses and physiotherapists (translation, pilot, backtranslation and agreement). Phase 2, analysis of metric properties (convergent, divergent and predictive validity, interobserver reliability, sensitivity and minimum important difference) of the IMS-Es. Patient characteristics (Barthel, Charlson, BMI, sex), sedation/agitation level (RASS), ICU and hospital stays, survival, quality of life (SF-12), muscle weakness (MRC-SS) and mobility (IMS-Es) were recorded in the patients of the MOviPre national multicentre study. RESULTSAfter obtaining the IMS-Es, it was implemented in 645 patients from 80 Spanish ICUs between April and June 2017. Convergent validity: moderate correlation between IMS-Es and MRC-SS (r=.389; P<.001) and significant comparison between groups with and without ICU-acquired weakness (P<.001). Divergent validity: no correlation between IMS-Es and BMI r (95%CI): -.112 (-.232 to .011), weight r (95%CI): -.098 (-.219 to .026), Charlson r (95%CI): -.122 (-.242 to .001) and Barthel r(95%CI): -.037 (-.160 to .087) and no differences between sexes (P=.587) or BMI categories (P=.412). Predictive validity: moderate and significant correlations with post-ICU hospital stay r (95%CI): -.442 (-.502 to -.377) and physical component of SF-12 (PCS) r (95%CI): .318 (.063 to .534); patients without active mobilisation in ICU increased risk of hospital mortality OR (95%CI): 3.769 (1.428 to 9.947). Interobserver reliability: very good concordance between nurses CCI (95%CI): .987 (.983 to .990) and nurse-physiotherapist CCI (95%CI): .963 (.948 to .974). Sensitivity to change: small effect on discharge from ICU (d=.273) and moderate effect at 3months after hospital discharge (d=.709). Minimal important difference: 2-point difference cut-off point, 91.1% sensitivity and 100.0% specificity. CONCLUSIONSThe IMS-Es is useful, valid and reliable for implementation by ICU nurses and physiotherapists in assessing the mobility of critical patients.
Birth presents a metabolic challenge to cardiomyocytes as they reshape fuel preference from glucose to fatty acids for postnatal energy production
. This adaptation is triggered in part by ...post-partum environmental changes
, but the molecules orchestrating cardiomyocyte maturation remain unknown. Here we show that this transition is coordinated by maternally supplied γ-linolenic acid (GLA), an 18:3 omega-6 fatty acid enriched in the maternal milk. GLA binds and activates retinoid X receptors
(RXRs), ligand-regulated transcription factors that are expressed in cardiomyocytes from embryonic stages. Multifaceted genome-wide analysis revealed that the lack of RXR in embryonic cardiomyocytes caused an aberrant chromatin landscape that prevented the induction of an RXR-dependent gene expression signature controlling mitochondrial fatty acid homeostasis. The ensuing defective metabolic transition featured blunted mitochondrial lipid-derived energy production and enhanced glucose consumption, leading to perinatal cardiac dysfunction and death. Finally, GLA supplementation induced RXR-dependent expression of the mitochondrial fatty acid homeostasis signature in cardiomyocytes, both in vitro and in vivo. Thus, our study identifies the GLA-RXR axis as a key transcriptional regulatory mechanism underlying the maternal control of perinatal cardiac metabolism.
There are no data on the incidence of admissions associated with alcohol withdrawal syndrome (AWS) or about its trend over time in Spain.
To analyze the characteristics, incidence rates and trends ...over time of hospital admissions associated with AWS in Spanish public hospitals.
Analysis from the Spanish public hospitals minimum basic data set of hospital admissions with AWS (CIE9-MC 291.81), alcohol withdrawal delirium (CIE9-MC 291.0) and alcohol withdrawal hallucinosis (CIE9-MC 291.3), since 1999 to 2010.
We identified 56,395 admissions associated with AWS. Mean age was 50.9 (SD 12.5) and 88% were male. The most frequent admission department was Internal Medicine (24.9%). The mean hospital stay was 12.6 days (SD 14.4) and mortality was 4.7%; 62.6% of cases developed AWS during an admission for another reason, mostly due to alcohol-related pathologies. Secondary diagnoses in patients hospitalized for AWS were related to alcohol consumption in more than half of the cases. The incidence rate of admissions associated with AWS in Spain remained stable from 1999 to 2010, with a small decline in the last 3 years of the period. The communities with the highest incidence were the Canary Islands, the Balearic Islands and Galicia.
The incidence rate of admissions associated with AWS in Spanish public hospitals in the period 1999–2010 has remained stable with slight changes. There are differences in the incidence of AWS among the different autonomous communities.
No existen datos acerca de la incidencia de ingresos asociados a síndrome de abstinencia alcohólica (SAA) ni sobre su evolución en los últimos años en España.
Analizar las características, tasas de incidencia y tendencia evolutiva de los ingresos hospitalarios asociados a SAA en hospitales públicos españoles.
Análisis de la base de datos del CMBD de hospitales públicos españoles de los ingresos hospitalarios con SAA (CIE9-MC 291.81), delirio por abstinencia alcohólica (CIE9-MC 291.0) o alucinosis por abstinencia alcohólica (CIE9-MC 291.3), entre los años 1999 y 2010.
Se registraron 56.395 ingresos asociados a SAA. La edad media fue de 50,9 años (DE 12,5) y el 88% eran hombres. El servicio de ingreso más frecuente fue Medicina Interna (24,9%). La estancia media global fue de 12,6 días (DE 14,4) y la mortalidad del 4,7%. El 62,6% desarrollaron SAA durante un ingreso por otro motivo, en su mayoría por enfermedades relacionadas con el alcohol. Los diagnósticos secundarios en pacientes que ingresaron por SAA tenían relación directa o indirecta con el consumo de alcohol en más de la mitad de los casos. La tasa de incidencia de ingresos en España asociados a SAA se mantuvo estable entre 1999 y 2010, con un ligero descenso en los 3 últimos años del periodo. Las comunidades con mayor incidencia fueron Canarias, Baleares y Galicia.
La incidencia de ingresos asociados a SAA en hospitales públicos españoles se ha mantenido estable con pequeñas modificaciones en el periodo 1999–2010. Existen diferencias en la incidencia de ingresos asociados a SAA entre las diferentes comunidades autónomas.
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: 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
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