Increase in hospital care at the end of life: Retrospective analysis of the last 20 years of life of a cohort of patients.

BACKGROUND: There is an increasing need for end-of-life care due to society's progressive aging. This study aimed to describe how hospitalizations evolve long-term and in the last months life of a cohort of deceased patients. METHODS: The study population were those who died in one year who lived in a district in southern Spain. The number of hospital stays over the previous 20 years and number of contacts with the emergency department, hospitalization, outpatient clinics, and medical day hospital in the last three months of life were determined. The analyses were stratified by age, sex, and pattern of functional decline. RESULTS: The study population included 1773 patients (82.5% of all who died in the district). The hospital stays during the last 20 years of life were concentrated in the last five years (66%) and specially in the last six months (32%). Eighty percent had contact with the hospital during their last three months of life. The older group had the minimun of stays over the last 20 years and contacts with the hospital in the last months of life. CONCLUSIONS: The majority of hospitalizations occur at the end of life and these admissions represent a significant part of an acute-care hospital's activity. The progressive prolongation of life does not have to go necessarily along with a proportional increase in hospital stays.

Ethnicity and Clinical Outcomes in Patients Hospitalized for COVID-19 in Spain: Results from the Multicenter SEMI-COVID-19 Registry.

(1) Background: This work aims to analyze clinical outcomes according to ethnic groups in patients hospitalized for COVID-19 in Spain. (2) Methods: This nationwide, retrospective, multicenter, observational study analyzed hospitalized patients with confirmed COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry) from 1 March 2020 to 31 December 2021. Clinical outcomes were assessed according to ethnicity (Latin Americans, Sub-Saharan Africans, Asians, North Africans, Europeans). The outcomes were in-hospital mortality (IHM), intensive care unit (ICU) admission, and the use of invasive mechanical ventilation (IMV). Associations between ethnic groups and clinical outcomes adjusted for patient characteristics and baseline Charlson Comorbidity Index values and wave were evaluated using logistic regression. (3) Results: Of 23,953 patients (median age 69.5 years, 42.9% women), 7.0% were Latin American, 1.2% were North African, 0.5% were Asian, 0.5% were Sub-Saharan African, and 89.7% were European. Ethnic minority patients were significantly younger than European patients (median (IQR) age 49.1 (40.5−58.9) to 57.1 (44.1−67.1) vs. 71.5 (59.5−81.4) years, p < 0.001). The unadjusted IHM was higher in European (21.6%) versus North African (11.4%), Asian (10.9%), Latin American (7.1%), and Sub-Saharan African (3.2%) patients. After further adjustment, the IHM was lower in Sub-Saharan African (OR 0.28 (0.10−0.79), p = 0.017) versus European patients, while ICU admission rates were higher in Latin American and North African versus European patients (OR (95%CI) 1.37 (1.17−1.60), p < 0.001) and (OR (95%CI) 1.74 (1.26−2.41), p < 0.001). Moreover, Latin American patients were 39% more likely than European patients to use IMV (OR (95%CI) 1.43 (1.21−1.71), p < 0.001). (4) Conclusion: The adjusted IHM was similar in all groups except for Sub-Saharan Africans, who had lower IHM. Latin American patients were admitted to the ICU and required IMV more often.

The role of clinical pharmacists in the optimisation of medication prescription and reconciliation on admission in an emergency department.

OBJECTIVES: To describe a clinical pharmacist's (CP) activity in an emergency department (ED) regarding medication reconciliation and optimisation of pharmacotherapy of patients at hospital admission. METHODS: A 1-year prospective observational study was conducted to analyse the activity of a CP in the ED of a 350-bed hospital in Spain. The CP reviewed home medications and medical prescriptions of patients to perform medication reconciliation if required and intervene if medication errors were detected. RESULTS: The CP reviewed medications and medical orders of 1048 patients. 816 patients had home medication: 440 patients (53.9%) were correctly reconciled by the physician; 136 (16.7%) were reconciled by the physician with unintentional discrepancies; and 240 (29.4%) by the CP, with a higher percentage in patients admitted to surgical departments (χ2:38.698; P<0.001). Following pharmaceutical validation, 434 pharmaceutical interventions were performed. CONCLUSIONS: The presence of a CP in an ED could increase the detection of reconciliation errors and help resolve medication errors.

[Bed rest or early mobilization as treatment of deep vein thrombosis: a systematic review and meta-analysis]. / Reposo en cama o deambulación precoz como tratamiento de la fase aguda de la trombosis venosa profunda: revisión sistemática y metaanálisis.

BACKGROUND AND OBJECTIVE: We aimed to know if treatment of deep vein thrombosis (DVT) with early mobilisation is as safe and effective as bed rest. MATERIAL AND METHOD: MEDLINE, EMBASE, Cochrane library (CCTR), Spanish Medical Index, and MD-Consult Virtual Library databases were searched. We also cross-checked bibliographies of the retrieved articles. The TESEO database of doctoral theses in Spain was also revised. We only searched for clinical trial articles comparing bed rest with early mobilization with respect to the incidence of objectively diagnosed pulmonary embolism (PE) in patients treated for DVT of lower limbs. The concordance coefficient was evaluated by statistical methods. We used relative risk and 95% confidence intervals. Selection bias was evaluated using funnel plot. RESULTS: Only three articles were included in the metaanalysis, with 296 patients randomized from 773 patients initially evaluated, with a follow-up of 9 days to 3 months. Quality rating ranged from 61.4 to 90% and the kappa index of concordance ranged from 0.78 to 0.93. The relative risks of PE between the two groups of treatment (early mobilization versus bed rest) were 1.31 (0.63-2.72), 1.50 (0.17-13.23), and 1.45 (0.56-3.75), respectively, and the global RR was 1.37 (0.78-2.40). CONCLUSIONS: The analyzed studies reveal that the treatment of DVT with early mobilization rather than bed rest neither increases the rate of PE nor increases the complication rate. New well designed, controlled clinical trials are needed to confirm the conclusions of this review.

Reposo en cama o deambulación precoz como tratamiento de la fase aguda de la trombosis venosa profunda: revisión sistemática y metaanálisis / Bed rest or early mobilisation as treatment of deep vein thrombosis: a systematic review and meta-analysis

FUNDAMENTO Y OBJETIVO: Conocer si el tratamiento de la trombosis venosa profunda (TVP) con movilización precoz es tan seguro y efectivo como el reposo en cama. MATERIAL Y MÉTODO: Realizamos una búsqueda en los tesauros MEDLINE, EMBASE, Cochrane Library (CCTR), Índice Médico Español y MD-Consult Virtual Library, así como una búsqueda cruzada de las referencias registradas en los artículos recuperados. También se revisó la base de datos Teseo de tesis doctorales en España. Sólo valoramos los ensayos clínicos que comparaban el reposo en cama frente a la movilización precoz respecto a la incidencia de embolia pulmonar diagnosticada objetivamente en pacientes tratados por TVP. Dos autores extrajeron las características de los estudios y evaluaron su calidad metodológica mediante el sistema de puntuación de Chalmers, y se valoraron los coeficientes de concordancia entre ellos. En el metaanálisis se utilizó el modelo de efectos fijos, dado que el test de heterogeneidad no mostró ninguna disparidad entre los estudios. Se utilizaron el riesgo relativo (RR) y los intervalos de confianza (IC) del 95 por ciento. El sesgo de selección se evaluó mediante funnel plot. RESULTADOS: Sólo se incluyeron 3 artículos en el metaanálisis, con 296 pacientes aleatorizados en total (de 773 valorados inicialmente), seguidos durante un período de 9 días a 3 meses. Los índices de calidad variaron entre el 61,4 y el 90 por ciento, y el índice de concordancia kappa, de 0,78 a 0,93. Los RR de embolia pulmonar entre ambos grupos de tratamiento de movilización precoz frente a reposo en cama fueron 1,31 (IC del 95 por ciento, 0,63-2,72), 1,50 (IC del 95 por ciento, 0,1713,23) y 1,45 (IC del 95 por ciento, 0,56-3,75), respectivamente, y el RR global fue de 1,37 (0,782,40). CONCLUSIONES: De los estudios analizados se desprende que el tratamiento de la TVP con deambulación precoz en lugar de reposo en cama no aumenta las tasas de embolia pulmonar y complicaciones. Se requieren nuevos ensayos clínicos bien diseñados para confirmar las conclusiones de esta revisión (AU)

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