Comorbilidad de los pacientes ingresados por insuficiencia cardiaca en los servicios de medicina interna / Morbidity from patients admitted for heart failure in the departaments of internal medicine

Antecedentes y objetivosLos pacientes con insuficiencia cardiaca (IC) presentan con frecuencia patologías asociadas. Se desconoce en toda su extensión la influencia de estas comorbilidades en la mortalidad y otras variables clínicas. Hemos analizado la comorbilidad de los pacientes ingresados por IC en los servicios de medicina interna de hospitales de España y su relación con diversas variables sociodemográficas y clínicas.Pacientes y métodosEstudiamos de forma prospectiva 2.127 pacientes (desde el 1 de octubre del año 2000 al 28 de febrero del año 2001) con IC, ingresados en 51 hospitales de diferentes categorías (comarcales–hospitales universitarios), en los que un internista se ofreció a colaborar. La comorbilidad se calculó con el índice de Charlson.ResultadosLa edad media fue de 77 años (mujeres, el 57%). El 45% había tenido al menos un ingreso en el último año. El 41% tenía una clase funcional iii/iv de la New York Heart Association. La fracción de eyección se halló conservada en el 53% de los enfermos. Se indentificaron patologías asociadas en el 60% de los pacientes (diabetes mellitus, el 39%; enfermedad pulmonar obstructiva crónica, el 31%). El índice de Charlson medio fue de 5,4 puntos (rango: 2–11 puntos). La mortalidad intrahospitalaria global fue del 6,1%. Durante el ingreso hospitalario fallecieron más pacientes en el grupo de mayor comorbilidad (Charlson ≥3 puntos, el 8,4%) que entre los enfermos con menor índice de Charlson (1–2 puntos, el 5,2%; p<0,01). Los tratamientos prescritos fueron similares en ambos grupos. En el análisis multivariante, la comorbilidad se asoció de forma independiente con enfermos del sexo masculino, de edad mayor de 75 años, clase funcional iii/iv de la New York Heart Association y grado de incapacidad física...(AU)

Background and objetivesHeart Failure (HF) patients present frecuently comorbidities. Little is known about the impact of these comorbidities in morbimortality. We analized the comorbidities of HF patients admitted in Spanish internal medicine units and its relation with different socio-demografics and clinical variables.Patients and methodsWe studied prospectivaly 2127 patients (admitted from 01.10.2000–28.02.2001) with HF in 51 Hospitals of different categories (from local hospitals to universitary hospitals) in which an internist was available to collaborate in the study. Comorbidities were estimated by the Charlson index.ResultsMean age was 77 years (women 57%). 45% of patients have had a previous admission in the last year. 41% had a functional stage NYHA iii/iv.ResultsEyection fraction was preserved in 53% of patients. Comorbidities were identified in 60% of patients (diabetes mellitus, 39%; chronic lung disease 31%). The average Charlson index was 5.4 points (range 2–11 points). Global inhospital mortality was 6.1%. During the admission more patients died in the Group with higher comorbidities (Charlson, >3 points; 8.4%) than in the Group with low Charlson index (1–2, 5.2%; p<0.01). Treatments prescribed were similar in both groups. In a multivariant analisis comorbidities was associated independently with masculin gender, age superior to 75 years, functional status NYHA iii/iv and disfunctional physical capacity.ConclusionsComorbidities determined by Charlson index were associated with more frequent admission, longer stay in hospital, higher discapacity and higher mortality. These results enhance the importance of comorbidities in prognosis of heart failure patients admitted in internal medicine units in Spain(AU)

[Morbidity from patients admitted for heart failure in the departments of internal medicine]. / Comorbilidad de los pacientes ingresados por insuficiencia cardiaca en los servicios de medicina interna.

BACKGROUND AND OBJECTIVES: Heart Failure (HF) patients present frequently comorbidities. Little is known about the impact of these comorbidities in morbimortality. We analyzed the comorbidities of HF patients admitted in Spanish internal medicine units and its relation with different socio-demographics and clinical variables. PATIENTS AND METHODS: We studied prospectively 2127 patients (admitted from 01.10.2000-28.02.2001) with HF in 51 Hospitals of different categories (from local hospitals to university hospitals) in which an internist was available to collaborate in the study. Comorbidities were estimated by the Charlson index. RESULTS: Mean age was 77 years (women 57%). 45% of patients have had a previous admission in the last year. 41% had a functional stage NYHA iii/iv. Eyection fraction was preserved in 53% of patients. Comorbidities were identified in 60% of patients (diabetes mellitus, 39%; chronic lung disease 31%). The average Charlson index was 5.4 points (range 2-11 points). Global inhospital mortality was 6.1%. During the admission more patients died in the Group with higher comorbidities (Charlson, >3 points; 8.4%) than in the Group with low Charlson index (1-2, 5.2%; p<0.01). Treatments prescribed were similar in both groups. In a multivariant analysis comorbidities was associated independently with masculine gender, age superior to 75 years, functional status NYHA iii/iv and dysfunctional physical capacity. CONCLUSIONS: Comorbidities determined by Charlson index were associated with more frequent admission, longer stay in hospital, higher discapacity and higher mortality. These results enhance the importance of comorbidities in prognosis of heart failure patients admitted in internal medicine units in Spain.

Prognostic value of serum CA125 levels in diffuse large B-cell lymphoma: potential role of a new sex- and age-adjusted reference value.

CA125, a tumor marker normally used to follow the clinical course of ovarian cancer, also may have a role in lymphoma. All available series were analyzed using the standard reference value 35 U/ml, but age and sex may influence serum CA125 (sCA125) levels. We aim to study the prognostic value of serum CA125 (sCA125) levels in diffuse large B-cell lymphoma (DLBCL), considering the influence of age and sex on sCA125 levels. We investigated the relationship between sCA125 and clinical outcome after treatment in 42 patients with DLBCL, comparing both the standard (35 U/ml) and a new age and sex adjusted (sex/age-adjusted) reference value proposed by our group. We found that patients with elevated sCA125 levels had significantly more adverse prognostic factors at diagnosis, lower CR rates, higher relapse rates and worse survival. In the low-risk IPI categories, the presence of elevated sCA125 defined a particularly high-risk subgroup with poorer 3-year PFS when compared with patients with normal sCA125 levels. The use of a sex/age-adjusted reference value for sCA125 may increase the sensitivity to identify those patients with elevated sCA125 levels truly related to DLBCL activity.

Las sesiones clinicopatológicas en el siglo XXI / No disponible

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[Introducing formative portfolio as a tool for Internal Medicine residents mentoring: review of a pilot project, 2005-2006]. / Introducción del portafolio formativo como instrumento de tutorización de residentes de Medicina Interna: revisión de una experiencia piloto, 2005-2006.

Recent educational projects in our country have been trying to introduce professional portfolios as assessment/learning tools on the undergraduate and specialized post-graduate education levels. The approval of a new formative program for the Internal Medicine specialty in an effort to adapt to the present health care needs offers an opportunity to apply these formative and evaluative methodologies in the learning process of future internists. During the 2005-2006 academic year, the Formative Work Group of the Spanish Internal Medicine Society (SEMI) developed a pilot study on portfolio application as a tool for formative assessment and mentoring. This article describes the project of designing, developing, applying and assessing an electronic portfolio for first year Internal Medicine residents. It presents an analysis of the SEMI Portfolio strengths and weaknesses and finally makes suggestions for future development.

Introducción del portafolio formativo como instrumento de tutorización de residentes de Medicina Interna: revisión de una experiencia piloto, 2005-2006 / Introducing formative portfolio as a tool for Internal Medicine residents mentoring: review of a pilot project, 2005-2006

Experiencias recientes en nuestro país tratan deintroducir los portafolios profesionales comoherramientas de evaluación-aprendizaje, tanto anivel de pregrado como en la formaciónespecializada de posgrado. La aprobación del nuevoprograma de la especialidad de Medicina Interna, enun esfuerzo de adaptación a las necesidades de laatención sanitaria actual, ofrece la oportunidad parala aplicación de estas metodologías docentes y deevaluación formativa del proceso de aprendizaje delos futuros internistas. Durante el curso 2005-2006,el Grupo de Formación de la Sociedad Española deMedicina Interna (SEMI) se propuso desarrollar unaexperiencia piloto demostrativa de la aplicación delportafolio como instrumento para la evaluaciónformativa y la tutorización. Este artículo describedicha experiencia de diseño, desarrollo,implantación y evaluación de un portafolio ensoporte electrónico para residentes de MedicinaInterna de primer año de la especialidad, realiza unanálisis de las fortalezas y las debilidades delPortafolio SEMI y, por último, proponerecomendaciones para su futuro desarrollo

Recent educational projects in our country havebeen trying to introduce professional portfolios asassessment/learning tools on the undergraduate andspecialized post-graduate education levels. Theapproval of a new formative program for theInternal Medicine specialty in an effort to adapt tothe present health care needs offers an opportunityto apply these formative and evaluativemethodologies in the learning process of futureinternists. During the 2005-2006 academic year, theFormative Work Group of the Spanish InternalMedicine Society (SEMI) developed a pilot study onportfolio application as a tool for formativeassessment and mentoring. This article describes theproject of designing, developing, applying andassessing an electronic portfolio for first yearInternal Medicine residents. It presents an analysisof the SEMI Portfolio strengths and weaknesses and finally makes suggestions for future development (AU)

Proposed reference value of the CA 125 tumour marker in men. Potential applications in clinical practice.

INTRODUCTION: CA 125 is a tumour marker usually used to monitor the clinical course of the patients with ovary cancer. The frequently used reference value of this marker is 35 U/mL. However, some arguments to allow us to question us the validity of the classical reference value: i) a second generation of immunoassays, ii) diverse studies related to the factors that influence in the CA 125 serum concentrations and iii) the new applications of CA 125 in pathologies different to the ovary cancer. OBJECTIVES: 1) To propose a reference value of CA 125 in men; 2) To evaluate the CA 125 serum concentration according to different variables, some of which can be altered in pathologies where CA 125 level can be monitored and/ or altered. MATERIAL AND METHODS: 65 healthy men were included (age: 40.21+/-10.60 years). A survey containing different parameters and an analytic that contained a hemogram, hepatic, renal, pancreatic profile, ionogram, thyroid function, tumour markers and NT-Pro-BNP was carried out to exclude the presence of a pathological situation. The percentile 95 (P(95)) was calculated to obtain the reference value. Correlations among the CA 125 and the different variables were analyzed by the Spearman test. RESULTS: The median [ranges] and the P(95) were: 7.50 [3.00-25.00] and 20.17 U/mL, respectively. 78% of the values of CA 125 were < or =10 U/mL, 94% were < or =15 U/mL and 95% were < or =20 U/mL. Furthermore, the studied variables don't seem to influence in the concentrations of this marker. CONCLUSIONS: The proposed reference value obtained in healthy male subjects is significantly lower than the one used in the clinical practice. This value should be kept in mind when extending the use of this marker to other pathologies which was not used up to now.

Factors influencing medical treatment of heart failure patients in Spanish internal medicine departments: a national survey.

BACKGROUND: The medical management of heart failure (HF) in clinical practice varies considerably by country and by medical specialty. AIM: To assess the treatment of HF patients admitted to Internal Medicine departments, and to evaluate out-patient management prior to admission, by specialty. DESIGN: Prospective cross-sectional multi-centre survey. METHODS: Of 55 randomly selected Spanish hospitals, 51 agreed to participate. All patients (n = 2145) consecutively admitted for decompensated HF to the Departments of Internal Medicine of these hospitals, over 5 months, were included. Twenty variables were analysed, including aspects relating to out-patient management prior to admission. RESULTS: Mean +/- SD age was 77.2 +/- 10.5 years, 57.3% were female, 47% had systolic dysfunction. Prescriptions at discharge: loop diuretics 85.6%, spironolactone 29.8%, ACEIs 65.8%, beta-blockers 8.7%, cardiac glycosides 39%. At admission, 86% already had a diagnosis of HF. Of these, 53% (older patients and more women) were being treated on an out-patient basis by primary care physicians. Primary care physicians requested fewer echocardiograms than internists (38% vs. 69%, p<0.001) and prescribed fewer drugs (ACEIs 40% vs. 54%, p<0.001; spironolactone 15% vs. 23%, p<0.05; beta-blockers 6% vs. 13%, p<0.01). The internists treated more incapacitated patients than the cardiologists (p<0.001), prescribed more high-dose ACEIs (20% vs. 13%, p<0.01) and spironolactone (26% vs. 20%, p<0.05), and fewer anticoagulants (32% vs. 39%, p<0.05). DISCUSSION: Patients admitted to medical departments with HF are different to those found in clinical trials. Their management is currently suboptimal. Differences in treatment between internists and cardiologists appear to be accounted for by differences in the patients they treat.