Subject(s)
Humans , Female , Middle Aged , Lymphoma, B-Cell/complications , Lymphoma, B-Cell/diagnosis , Eye Diseases/complications , Eye Diseases/diagnosis , Eye Diseases/therapy , Ocular Motility Disorders/complications , Ophthalmoplegia/complications , Ophthalmoplegia/diagnosis , Eye/pathology , Eye , Eye Diseases/physiopathology , Eye Diseases , Pain/complications , Pain/etiology , Mydriasis/complications , Mydriasis/pathology , Biopsy/methodsSubject(s)
Humans , Male , Female , Anemia/complications , Anemia/diagnosis , Heart Failure/complications , Prognosis , Hemodilution/methods , Iron/metabolism , Erythropoietin/deficiency , Anemia/physiopathology , Hypertension, Pulmonary/complications , Cohort Studies , Hemodilution/trends , HemodilutionABSTRACT
OBJECTIVES: To analyze the epidemiological characteristics of the population admitted to a short-stay medical unit (SSMU) during 2005 due to acute pyelonephritis. To describe and analyze microbiological aspects recorded in these infections and their clinical implication. MATERIAL AND METHOD. A retrospective study was carried out in a cohort of 208 patients admitted in the SSMU during 2005 because of acute pyelonephritis. Epidemiological, clinical and microbiological data were collected. The statistical analysis was done with the SPSS v. 14.0. RESULTS: 208 patients were included, 74% of whom were females. Average age was 43.6 (16-87). Mean length of stay was 4.7+/-1.2 days and 96.6% of patients were discharged successfully from SSMU. Urine culture was valid in 173 patients, 51.4% of which were positive. Escherichia coli was isolated in 93.2% of urine cultures. Blood cultures were valid in 178 cases and in 37 of which were positive. E. coli was isolated in 64.8% of these. In E. coli urine samples, resistance rate to ampicillin was 68.7%, to cotrimoxazole 22.9%, to ciprofloxacin 18.1%; to amoxicillin/clavulanic acid 16.9% and to fosfomycin 2.4. Seven patients were transferred to hospital home care, there being no deaths. CONCLUSIONS: Acute pyelonephritis with admission criteria can be managed successfully in the SSMU with the applicable therapeutics guidelines with regard to the most common microbiological aspects registered and the low incidence of complications.
Subject(s)
Pyelonephritis/diagnosis , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Female , Health Facilities , Humans , Length of Stay , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
Objetivos: Analizar las características epidemiológicas de la población ingresada por pielonefritis aguda en una unidad de corta estancia (UCE) durante el año 2005. Describir y analizar los aspectos microbiológicos registrados en estas infecciones y su implicación clínica. Material y método: Se realizó un estudio retrospectivo de una cohorte de 208 pacientes que ingresaron durante el año 2005 en la UCE de nuestro centro a consecuencia de una pielonefritis aguda (PNA). Se incluyeron datos epidemiológicos, clínicos y microbiológicos. Análisis estadístico: SPSS v.14.0. Resultados: Se incluyeron 208 pacientes, siendo el 74% mujeres, con una edad media de 43,6 (16-87). La estancia media fue de 4,7 ± 1,2 días. El 96,6% fueron dados de alta con éxito desde la UCE. El urocultivo se consideró válido en 173 pacientes, siendo positivo el 51,4%. Escherichia coli representó el 93,2% de los patógenos aislados en la orina. Los hemocultivos válidos fueron 178, siendo positivos en 37 pacientes. E. coli se aisló en el 64,8% de ellos. De las resistencias a antibióticos analizadas para E. coli en urocultivo, el 68,7% fueron para ampicilina; 22,9% para cotrimoxazol; 18,1% para ciprofloxacino; 16,9% para amoxicilina-clavulánico y el 2,4% para fosfomicina. Siete pacientes fueron trasladados a hospitalización domiciliaria y no hubo ningún fallecimiento. Conclusiones: La pielonefritis aguda con criterios de ingreso puede manejarse con éxito en una UCE según las recomendaciones terapéuticas vigentes en nuestro medio, en función de los datos microbiológicos registrados y la baja incidencia de complicaciones (AU)
Objectives: To analyze the epidemiological characteristics of the population admitted to a short-stay medical unit (SSMU) during 2005 due to acute pyelonephritis. To describe and analyze microbiological aspects recorded in these infections and their clinical implication. Material and method: A retrospective study was carried out in a cohort of 208 patients admitted in the SSMU during 2005 because of acute pyelonephritis. Epidemiological, clinical and microbiological data were collected. The statistical analysis was done with the SPSS v. 14.0. Results: 208 patients were included, 74% of whom were females. Average age was 43.6 (16-87). Mean length of stay was 4.7±1.2 days and 96.6% of patients were discharged successfully from SSMU. Urine culture was valid in 173 patients, 51.4% of which were positive. Escherichia coli was isolated in 93.2% of urine cultures. Blood cultures were valid in 178 cases and in 37 of which were positive. E. coli was isolated in 64.8% of these. In E. coli urine samples, resistance rate to ampicillin was 68.7%, to co-trimoxazole 22.9%, to ciprofloxacin 18.1%; to amoxicillin/clavulanic acid 16.9% and to fosfomycin 2.4. Seven patients were transferred to hospital home care, there being no deaths. Conclusions: Acute pyelonephritis with admission criteria can be managed successfully in the SSMU with the applicable therapeutics guidelines with regard to the most common microbiological aspects registered and the low incidence of complications (AU)
Subject(s)
Humans , Male , Female , Adult , Pyelonephritis/diagnosis , Pyelonephritis/epidemiology , /economics , Drug Resistance, Microbial , Pyelonephritis/therapy , Retrospective Studies , Escherichia coli/isolation & purification , Escherichia coli Infections/complications , Comorbidity , Heart RateABSTRACT
Introducción. Evaluar la utilidad de un hospital de día llevado por un equipo multidisciplinar integrado por enfermería especializada en insuficiencia cardíaca (IC), un geriatra y médicos internistas en la reducción de ingresos de pacientes ancianos con IC no preseleccionados por fracción de eyección (FEVI). Material y métodos. Se incluyeron 182 pacientes con una edad media de 76 años con IC descompensada que requirieron ingreso en Medicina Interna y Geriatría. Cincuenta y un pacientes recibieron seguimiento en el hospital de día, donde se realiza educación, optimización del tratamiento, acceso telefónico y tratamiento diurético parenteral ante descompensaciones. Se midió el reingreso por IC a los 3 meses posthospitalización. Se realizó un análisis bivariante usando pruebas paramétricas (p < 0,05) y el análisis de Kaplan Meier. Resultados. El 61% de los pacientes eran mujeres. La clase funcional media de los pacientes según la New York Heart Association (NYHA) fue de 2,75 ± 0,44 y la FEVI era < 45% en el 40% de los casos. La tasa de prescripción de bloqueante beta fue más alta en el grupo de intervención (n = 51) que en el grupo control (93% frente a 24%; p < 0,001), igualmente ocurrió con la prescripción de inhibidores de la enzima convertidora de la angiotensina o antagonistas de los receptores de angiotensina II (96% frente a 72%; p = 0,002). Los pacientes del grupo de intervención tuvieron menor frecuencia de reingreso por IC a los 90 días de seguimiento (28% frente a 11%; p = 0,020). El tiempo libre de reingreso fue superior en estos pacientes que en aquéllos seguidos convencionalmente (85,12 días frente a 76; log rank; p = 0,026). Discusión. La intervención multidisciplinar de enfermeras junto con médicos generalistas en un hospital de día constituye una opción válida en el manejo de pacientes ancianos no preseleccionados por FEVI pues reduce el reingreso hospitalario por IC (AU)
Introduction. To evaluate the utility of a day hospital managed by a multidisciplinary heart failure (HF) team composed of nurses, geriatricians and internal physicians in the reduction of hospital readmission of elderly patients with HF who are not selected by their left ventricular ejection fraction (LVEF). Material and methods. 182 patients with mean age of 76 years and decompensated HP who required admission in internal medicine and geriatric wards were included. A total of 51 patients were followed up in a day hospital, where education, phone access, drug titration and use of parenteral diuretics were performed. Readmission due to HF at 3 months post-hospitalization was measured. A bivariate analysis was performed in both groups using parametrics test (p < 0.05) and a Kaplan Meier analysis using log rank. Results. A total of 61% were women. Mean NYHA class was 2.75 ± 0.44. LVEF < 45% was found in 40%. Prescription rate of beta blockers was significantly higher in the intervention group (93% vs 24%; p < 0.001) as well as ACE-inhibitors and ARB prescription rates (96% vs 72%, p = 0.002). Readmission rate due to HF in the first 90 days after discharge was lower in the intervention group (11% vs 28%; p = 0.020). HF admission free time was longer for these patient than those managed with conventional care (85.12 days versus 76; log rank; p = 0.026). Discussion. Multidisciplinary intervention carried out by generalist physicians and HF nurses in a day hospital is useful to reduce HF admission in elderly patients not selected by their LVEF (AU)
Subject(s)
Male , Female , Aged , Humans , Heart Failure/therapy , Patient Care Team , Day Care, Medical , Outcome and Process Assessment, Health Care , Follow-Up Studies , Prospective StudiesABSTRACT
INTRODUCTION: To evaluate the utility of a day hospital managed by a multidisciplinary heart failure (HF) team composed of nurses, geriatricians and internal physicians in the reduction of hospital readmission of elderly patients with HF who are not selected by their left ventricular ejection fraction (LVEF). MATERIAL AND METHODS: 182 patients with mean age of 76 years and decompensated HP who required admission in internal medicine and geriatric wards were included. A total of 51 patients were followed up in a day hospital, where education, phone access, drug titration and use of parenteral diuretics were performed. Readmission due to HF at 3 months post-hospitalization was measured. A bivariate analysis was performed in both groups using parametrics test (p < 0.05) and a Kaplan Meier analysis using log rank. RESULTS: A total of 61% were women. Mean NYHA class was 2.75 +/- 0.44. LVEF < 45% was found in 40%. Prescription rate of beta blockers was significantly higher in the intervention group (93% vs 24%; p < 0.001) as well as ACE-inhibitors and ARB prescription rates (96% vs 72%, p = 0.002). Readmission rate due to HF in the first 90 days after discharge was lower in the intervention group (11% vs 28%; p = 0.020). HF admission free time was longer for these patient than those managed with conventional care (85.12 days versus 76; log rank; p = 0.026). DISCUSSION: Multidisciplinary intervention carried out by generalist physicians and HF nurses in a day hospital is useful to reduce HF admission in elderly patients not selected by their LVEF.
