[Drug prescription in internal medicine: an analysis of the influencing factors]. / Prescripción de medicamentos en medicina interna: análisis de los factores de influencia.

BACKGROUND: The amount and quality of drugs prescribed after hospitalization in Internal Medicine and the factors which influence them have been rarely evaluated in Spain. MATERIAL AND METHODS: We study prospectively drugs prescribed in patients hospitalized in Internal Medicine analyzing amount of drugs before admission (BAD), on discharge (DD), end drugs after temporal drugs were removed (ED), drugs prescribed as chronic treatment (CTD), symptomatic drugs (SD), acute-use drugs (AUD) and low therapeutic utility drugs (LTUD). We also evaluated the sort of drugs and the factors implicated in increase or decrease of prescription volume. RESULTS: Two hundred and eighty-five patients were evaluated [164 males, 121 females, mean age 68.08 (SD 15.27)]. They had mean BAD 3.42(SD 2.67)7 DD 3.92 (SD 2.36) (p < 0.001) and ED 3.65 (SD 2.30) (No differences with BAD). The amount of drugs were higher in patients 65 years old and elder (p < 0.001). LTUD were decreased from 62(22%) patients on admission to 21 (7%) on discharge (p < 0.001). Compounded drugs were reduced from 36 (13%) patients to 17 (6%) (p < 0.05). Age older 65, length of stay greater 7 days, need for intravenous administration of drugs, comorbidities and complications during hospitalization all caused increase in prescription volume on discharge. Logistic-regression analysis showed that CTD and AUD were the main causes of increase of drugs while BAD and LTUD were protective. Drugs reduced in higher proportion were mucolytics (p < 0.005) drugs to treat plant-based hyperplasia benign of prostate (p < 0.05), brain vasodilators (p < 0.001) and peripheral vasodilators (p < 0.01). CONCLUSIONS: Hospitalization in Internal Medicine results in an increase of prescription volume though it is short-term. The higher number of drugs is accumulated in elderly. Factors implicated in increasing are length of stay, need for intravascular access, complications during inpatient, drugs to treat acute diseases and chronic use drugs. Low therapeutic utility drugs are used before admission in outpatients.

Prescripción de medicamentos en Medicina Interna: análisis de los factores de influencia / Drug prescription in internal medicine: analyzing its factors of influence

Fundamento: La cantidad y calidad de los medicamentos prescritos tras la hospitalización en M. Interna y los factores de influencia se ha evaluado en escasas ocasiones. Material y Métodos: Estudio prospectivo de fármacos (F) en pacientes hospitalizados en M. Interna analizando número de F preingreso, al alta, definitivos, F de uso crónico, sintomáticos, de proceso agudo y F de baja utilidad terapéutica y análisis cuantitativo y cualitativo de incremento-reducción de F. Resultados: Analizamos la prescripción de 285 pacientes [(164 varones, 121 mujeres), edad media 68,08 (DE 15,27)]. El número de F preingreso era 3,42 (DE2,67), al alta 3,92 (DE2,36) (p<0,001) y F definitivos una vez retirados F temporales 3,65 (DE2,30) (Sin significación). En los tres apartados el número era mayor en pacientes mayores de 65 años (p<0.001).Los F de baja utilidad terapéutica se redujeron de 62 (22 %) pacientes preingreso a 21(7 %) al alta (p<0,001) y F en asociación de 36 (13 %) pacientes a 17(6 %) (p<0.05). Condicionaron incremento en el volumen de prescripción al alta la edad mayor de 65 años, la estancia media más larga de 7 días, la necesidad de venoclisis, las comorbilidades y la ocurrencia de complicaciones durante la hospitalización. En regresión logística causaron incremento los F de uso crónico y los F para tratar el proceso agudo, sin embargo el mayor volumen de F preingreso y los F de baja utilidad terapéutica fueron factores protectores. Los F con mayor reducción fueron mucolíticos (p<0,005), fitoterapia prostática (p<0,05), vasodilatadores cerebrales (p<0,001) y vasodilatadores periféricos (p<0,01). Conclusiones: El efecto de la hospitalización en M.lnterna es el incremento de fármacos sobre todo por F para tratar el proceso agudo, aunque el tratamiento definitivo no implica cambios en el volumen de prescripción. El mayor número de F se da en pacientes mayores de 65 años. Factores implicados en el incremento de F son la longitud de la estancia media, la necesidad de acceso intravascular, la ocurrencia de complicaciones y los F de uso crónico, y factores protectores son el mayor volumen de F preingreso y los F de baja utilidad terapéutica. Los F en asociación y de baja utilidad terapéutica se utilizan más en el medio ambulatorio (AU)

[The influence of empty-bed days on the median hospital stay in internal medicine]. / Influencia de los días vacíos en la estancia media en hospitalización de Medicina Interna.

BACKGROUND: To evaluate the epidemiology of delays in patients hospitalized in a department of internal medicine in a hospital of third level (high technology, end-stem of Spanish health system), its influences in hospital length of stay and the leading reasons which we named Gap Days. PATIENTS AND METHODS: We studied all patients admitted through emergency ward for internal medicine during Oct 93-June 94. Gap Day was defined as the day passed as inpatient in which no intravenous route, isolation, artificial feeding, fever, impairing of clinic steady-state were needed or waited and any diagnostic tools were used. We counted Gap Day from the second day and from de third day for histopathology that we ordered the explorations. In a nonselected group days of delay to arrive written data were measured while the results were known for personal request. RESULTS: 144 patients had a mean length of stay of 9.52 (SD 5.41) days. Gap Days occurred in 97 (67%) patients (Mean 3.85 SD 2.80) with a mean length of stay 10.71 SD 5.09 days, while patients without Gap Days had a mean length of stay of 7.14 SD 5.29 days (p < 0.001). Patients with higher Gap Days were those with symptoms related to hematological system (p = 0.002), nephrourological system (p = 0.011) and a hematological diagnostic (p = 0.003) on admission. On discharge patients with hematological diagnostic had also higher Gap Days (p = 0.017). They had higher Gap Days also patients with two symptoms or more on admission (3.63 SD 2.96, p = 0.016), patients who lived alone (5.33 SD 3.42, p = 0.050) and patients with no concordance between diagnostic on admission and discharge (4.06 SD 3.41, p < 0.01). In 37 patients written data arrived 2.14 SD 1.06 days later after to know the results for personal request. CONCLUSION: Gap Days are an important factor to prolong the length of stay in internal medicine. They are influenced by number of symptoms on admission, concordance between diagnostics on admission and discharge, hematological diagnostics and some social and functioning hospital factors.

[Mycosis fungoides associated with HIV infection]. / Micosis fungoide asociada a infección por VIH.

The increasing number of cases of HIV-infections made the pathology association wider. Between these pathologies, tumors and lymphoid neoplasias are the most frequent. Large series showed the association between B-cell non-hodgkin lymphomas, and HIV infection, but only exceptional cases of T-cell lymphomas were found. We present a case of T-cell cutaneous lymphoma (mycosis fungoides) in a patient with HIV-infection owing to the fact that very few: cases have been reported, the causal relationship is still unknown.

[The diagnostic spectrum of the general malignancy syndrome]. / Espectro diagnóstico del síndrome general maligno.

The study presents 391 patients with malignant general syndrome (asthenia, anorexia and involuntary weight loss) among the interns in a Internal Medicine Department, and it settles a diagnostic relation. In comparison with other studies it the diagnostic spectrum is very similar to that founded in other countries, in spite of their own characteristics.