BACKGROUND
The increasing incidence of osteoporotic hip fracture (HF) has raised the requirements of red blood cell (RBC) transfusions, whereas this scarce resource may cause morbidity and mortality.
...STUDY DESIGN AND METHODS
This study was a multicenter, randomized, double‐blind, clinical trial that aimed to assess efficacy of ferric carboxymaltose (FCM) with or without erythropoietin (EPO) in reducing RBC transfusion in the perioperative period of HF. Participants (patients > 65 years admitted with HF and hemoglobin Hb levels of 90‐120 g/L) were randomly assigned to receive a preoperative single dose of 1 g of FCM (short intravenous IV infusion over 15 min), plus 40,000 IU of subcutaneous EPO (EPOFE arm); versus 1 g of IV FCM plus subcutaneous placebo (FE arm); and versus IV and subcutaneous placebo (placebo arm). Primary endpoint was the percentage of patients who received RBC transfusion, and secondary endpoints were the number of RBC transfusions per patient, survival, hemoglobinemia, and health‐related quality of life (HRQoL; by means of Short Form 36 Version 2 questionnaire).
RESULTS
A total of 306 patients (85% women, mean age 83 ± 6.5 years) were included. A total of 52, 51.5, and 54% of patients required RBC transfusion in the EPOFE, FE, and placebo arms, respectively, with no significant differences in the number of RBC transfusions per patient, survival, HRQoL, and adverse events among treatment groups. A significant increase in Hb levels was achieved at discharge (102 g/L vs. 97 g/L) and 60 days after discharge (125 g/L vs. 119 g/L) in the EPOFE arm with respect to placebo arm; in addition, a higher rate of patients recovered from anemia in the EPOFE arm with respect to the placebo arm (52% vs. 39%), 60 days after discharge.
CONCLUSION
Preoperative treatment with FCM alone or in combination with EPO improved recovery from postoperative anemia, but did not reduce the needs of RBC transfusion in patients with HF.
The centenarian population is gradually increasing, so it is becoming more common to see centenarians in clinical practice. Electrocardiogram abnormalities in the elderly have been reported, but ...several methodological biases have been detected that limit the validity of their results. The aim of this study is to analyse the ECG abnormalities in a prospective study of the centenarian population and to assess their impact on survival.
We performed a domiciliary visit, where a medical history, an ECG and blood analysis were obtained. Barthel index (BI), cognitive mini-exam (CME) and Charlson index (ChI) were all determined. Patients were followed up by telephone up until their death.
A total of 80 centenarians were studied, 26 men and 64 women, mean age 100.8 (SD 1.3). Of these, 81% had been admitted to the hospital at least once in the past, 81.3% were taking drugs (mean 3.3, rank 0-11). ChI was 1.21 (SD 1.19). Men had higher scores both for BI (70 -SD 34.4- vs. 50.4 -SD 36.6-, P = .005) and CME (16.5 -SD 9.1- vs. 9.1 -SD 11.6-, P = .008); 40.3% of the centenarians had anaemia, 67.5% renal failure, 13% hyperglycaemia, 22.1% hypoalbuminaemia and 10.7% dyslipidaemia, without statistically significant differences regarding sex. Only 7% had a normal ECG; 21 (26.3%) had atrial fibrillation (AF), 30 (37.5%) conduction defects and 31 (38.8%) abnormalities suggestive of ischemia, without sex-related differences. A history of heart disease was significantly associated with the presence of AF (P = .002, OR 5.2, CI 95% 1.8 to 15.2) and changes suggestive of ischemia (P = .019, OR 3.2, CI 95% 1.2-8.7). Mean survival was 628 days (SD 578.5), median 481 days. Mortality risk was independently associated with the presence of AF (RR 2.0, P = .011), hyperglycaemia (RR 2.2, P = .032), hypoalbuminaemia (RR 3.5, P < .001) and functional dependence assessed by BI (RR 1.8, P = .024).
Although ECG abnormalities are common in centenarians, they are not related to sex, functional capacity or cognitive impairment. The only abnormality that has an impact on survival is AF.
Around one third to one half of patients with hip fractures require red-cell pack transfusion. The increasing incidence of hip fracture has also raised the need for this scarce resource. ...Additionally, red-cell pack transfusions are not without complications which may involve excessive morbidity and mortality. This makes it necessary to develop blood-saving strategies. Our objective was to assess safety, efficacy, and cost-effictveness of combined treatment of i.v. ferric carboxymaltose and erythropoietin (EPOFE arm) versus i.v. ferric carboxymaltose (FE arm) versus a placebo (PLACEBO arm) in reducing the percentage of patients who receive blood transfusions, as well as mortality in the perioperative period of hip fracture intervention.
Multicentric, phase III, randomized, controlled, double blinded, parallel groups clinical trial. Patients > 65 years admitted to hospital with a hip fracture will be eligible to participate. Patients will be treated with either a single dosage of i.v. ferric carboxymaltose of 1 g and subcutaneous erythropoietin (40.000 IU), or i.v. ferric carboxymaltose and subcutaneous placebo, or i.v. placebo and subcutaneous placebo. Follow-up will be performed until 60 days after discharge, assessing transfusion needs, morbidity, mortality, safety, costs, and health-related quality of life. Intention to treat, as well as per protocol, and incremental cost-effectiveness analysis will be performed. The number of recruited patients per arm is set at 102, a total of 306 patients.
We think that this trial will contribute to the knowledge about the safety and efficacy of ferric carboxymaltose with/without erythropoietin in preventing red-cell pack transfusions in patients with hip fracture. CLINICALTRIALS.GOV IDENTIFIER: NCT01154491.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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.
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
To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19.
A prospective observational study of patients with COVID-19 diagnosis by ...positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least 11a day.
313 patients (52.4% female) with a total average age of 60.9 (DE 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions; 18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study.
Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way.
Galicia Clínica. Informe de los editores Monte Secades, Rafael; Díaz Díaz, José Luis; Rabuñal Rey, Ramón
Galicia-clinica,
12/2012, Letnik:
73, Številka:
4
Journal Article
Odprti dostop
En el año 2008, la revista Galicia Clínica retomó su actividad, interrumpida en 1996 después de 65 años de vida editorial. La Sociedad Gallega de Medicina Interna (SOGAMI), en su XXV aniversario, ...planteó la recuperación de la revista, con la que los internistas habían mantenido una estrecha relación en su prime-ra etapa, a nivel particular como medio de formación continuada, e institucional al servir de vehículo para la publicación de comunicaciones a sus congresos.
Introduccion y objetivo: Existe poca informacion sobre el curso temporal del sindrome de abstinencia alcoholica en el ambito de un hospital general. El objetivo de este estudio es saber que ...manifestaciones son atribuibles a la abstinencia y en que momento de su evolucion, asi como sus implicaciones pronosticas. Material y metodo: estudio de cohortes sobre los enfermos diagnosticados de sindrome de abstinencia alcoholica en el Hospital Xeral de Lugo entre 1987 y 2003, segun criterios del manual DSM IV-TR. Para cada caso se registraron datos clinicos y de seguimiento, con especial atencion a los intervalos temporales de aparicion y duracion de sus manifestaciones. Resultados: Se estudiaron 539 episodios en 436 pacientes: 156 casos de sindrome de abstinencia no complicado y 383 casos de delirium tremens. El tiempo medio de abstinencia hasta el diagnostico de sindrome de abstinencia alcoholica fue 54,4 horas (D.T. = 31,1). Las crisis comiciales aparecieron 35 horas (D.T. = 23,3) desde el cese de la ingesta. La duracion del sindrome de abstinencia no complicado desde el diagnostico fue 46,4 horas (D.T. = 23,1). Cuando evolucionaron a delirium tremens, este se diagnostico a las 40,2 horas (D.T. = 29,4), y se prolongo durante 73,9 horas (D.T. = 41,5). Cuando fue preciso el traslado a la UCI, este se produjo a las 40,8 horas (D.T. = 60) desde el diagnostico de sindrome de abstinencia. Los enfermos en los que el sindrome de abstinencia alcoholica complico un ingreso por otro motivo, presentaron manifestaciones clinicas mas prolongadas que los que ingresaron por abstinencia. Conclusiones: las manifestaciones clinicas del sindrome de abstinencia alcoholica siguen una pauta evolutiva claramente reconocible. Su conocimiento puede ayudar a una mejor planificacion de su atencion y tratamiento. Palabras clave: abstinencia alcoholica, delirium tremens, evolucion, hospitalizacion. Course of alcohol withdrawal syndrome in a general hospital Introduction and objective: There is little information available regarding the course of alcohol withdrawal syndrome in a general hospital. The aim of this study was to analyse the timing of the most important clinical features attributed to alcohol withdrawal, as well as their prognostic implications. Material and method: A cohort study of patients with a diagnosis of alcohol withdrawal syndrome was carried out at the Xeral Hospital in Lugo (Spain) between 1987 and 2003, in accordance with DSM IV-TR criteria. Data on clinical characteristics and course were collected, with special attention to the timing of significant events. Results: A total of 539 episodes were studied in 436 patients: 156 cases of alcohol withdrawal syndrome and 383 of alcohol withdrawal delirium. Mean time of abstinence until the diagnosis of alcohol withdrawal syndrome was 54 hours (D.T. = 31.1). Seizures occurred at 35 hours (D.T. = 23.3) after abstinence. The alcohol withdrawal syndrome lasted for 46.4 hours (D.T. = 23.1) after diagnosis. In cases in which delirium tremens developed, this occurred at 46.4 hours (D.T. = 23.1), and lasted 73.9 hours (D.T. = 41.5). Patients needing intensive care were admitted to the ICU 40.8 hours (D.T. = 60) after the diagnosis of alcohol withdrawal syndrome. The clinical features of alcohol withdrawal syndrome tended to be more prolonged in patients admitted with a medical or surgical diagnosis other than withdrawal syndrome than in those admitted because of withdrawal syndrome itself. Conclusions: The natural history of alcohol withdrawal syndrome in a general hospital setting and the timings of its principal events follow a clearly recognizable pattern. This knowledge can help to provide better assessment in relation to the monitoring and treatment of these patients. Key Words: alcohol withdrawal, delirium tremens, timing, hospitalization
Unidades de ortogeriatría Rafael Monte Secades
Galicia-clinica,
12/2017, Letnik:
78, Številka:
4
Journal Article
Odprti dostop
El aumento progresivo de la esperanza de vida ligada a la mejora de las condiciones higiénicas, socioeconómicas y de la asistencia sanitaria ha conducido a un incremento constante de la población ...anciana en los últimos años en nuestro país.
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