A Prospective, Observational Study of the Effect of a High-Calorie, High-Protein Oral Nutritional Supplement with HMB in an Old and Malnourished or at-Risk-of-Malnutrition Population with Hip Fractures: A FracNut Study.

BACKGROUND: Hip fractures are prevalent among older people, often leading to reduced mobility, muscle loss, and bone density decline. Malnutrition exacerbates the prognosis post surgery. This study aimed to evaluate the impact of a 12-week regimen of a high-calorie, high-protein oral supplement with ß-hydroxy-ß-methylbutyrate (HC-HP-HMB-ONS) on nutritional status, daily activities, and compliance in malnourished or at-risk older patients with hip fractures receiving standard care. SUBJECTS AND METHODS: A total of 270 subjects ≥75 years of age, residing at home or in nursing homes, malnourished or at risk of malnutrition, and post hip fracture surgery, received HC-HP-HMB-ONS for 12 weeks. Various scales and questionnaires assessed outcomes. RESULTS: During the 12 weeks of follow-up, 82.8% consumed ≥75% of HC-HP-HMB-ONS. By week 12, 62.4% gained or maintained weight (+0.3 kg), 29.2% achieved normal nutritional status (mean MNA score +2.8), and 46.8% improved nutritional status. Biochemical parameters improved significantly. Subjects reported good tolerability (mean score 8.5/10), with 87.1% of healthcare providers concurring. CONCLUSIONS: The administration of HC-HP-HMB-ONS markedly enhanced nutritional status and biochemical parameters in older hip-fracture patients, with high compliance and tolerability. Both patients and healthcare professionals expressed satisfaction with HC-HP-HMB-ONS.

Trasplante de microbiota fecal como tratamiento de la infección por Clostridioides difficile recidivante: a propósito de un caso / Fecal transplantation for the treatment of Clostridioides difficile recurrent infection

No disponible

Improving hip fracture care in Spain: evolution of quality indicators in the Spanish National Hip Fracture Registry.

This study was carried out to analyze the evolution of the quality indicators in the Spanish National Hip Fracture Registry, after disseminating a series of recommendations based on available clinical practice guidelines to the participating hospitals. Six of the seven proposed quality indicators showed a significant improvement. PURPOSE: The Spanish National Hip Fracture Registry (RNFC) arises from the need to know the process and improve the quality of care. Our goal was to analyze the changes in the RNFC's quality indicators after an intervention based on disseminating specific recommendations among the participating hospitals, following available clinical practice guidelines. METHODS: Study comparing before and after performing an intervention in hospitals participating in the RNFC. Data from the hospitals that registered cases in 2017, and that kept registering cases in 2019. Seven quality indicators were chosen, and a standard to be achieved for each indicator was proposed. The intervention consisted in the dissemination of 25 recommendations with practical measures to improve each quality indicator, based on available clinical practice guidelines, by drafting and publishing a scientific paper and sending it via email and printed cards. Fulfilment of each quality indicator was measured after carrying out the intervention. RESULTS: Forty-three hospitals registered 2674 cases between January and May, 2017, and 8037 during 2019. The quality indicators chosen and the degree of compliance were (all with p<0.05): (1) surgery ≤48 h increased from 38.9 to 45.8%; (2) patients mobilised on the first postoperative day increased from 58.9 to 70.3%; (3) patients with anti-osteoporotic medication at discharge increased from 34.5 to 49.8%; (4) patients with calcium supplements at discharge increased from 48.7 to 62.8%; (5) patients with vitamin D supplements at discharge increased from 71.5 to 84.7%; (6) patients developing a grade >2 pressure ulcer during admission decreased from 6.5 to 5.0%; (7) patients able to move on their own at 1 month fell from 58.8 to 56.4%. More than 48% of hospitals improved the proposed indicators. CONCLUSION: Establishing quality indicators and standards and intervening through the dissemination of specific recommendations to improve these indicators achieved an improvement in hospital performance results on a national level.

COVID-19 y fractura por fragilidad de la cadera. Recomendaciones conjuntas de la Sociedad Española de Fracturas Osteoporóticas y la Sociedad Española de Geriatría y Gerontología / COVID-19 and fragility hip fracture. Joint recommendations of the Spanish Society of Osteoporotic Fractures and the Spanish Society of Geriatrics and Gerontology

No disponible

[Spanish National Hip Fracture Registry (RNFC): First-year results and comparison with other registries and prospective multi-centric studies from Spain]. / Registro Nacional de Fracturas de Cadera (RNFC): resultados del primer año y comparación con otros registros y estudios multicéntricos españoles.

OBJECTIVE: The Spanish National Hip Fracture Registry (Registro Nacional de Fracturas de Cadera or RNFC) is a Spanish, prospective, multi- centric registry, commenced in 2017. The goal of this paper is to present the data from the first annual report and to compare them with autonomic registries and recent prospective multi-centric studies performed in Spain. METHODS: We included persons 75 years or older treated for fragility hip fractures in any of the centers participating in the RNFC between January and October 2017. The descriptive statistics of each variable used the mean (and standard deviation) or the median (and interquartile ranges) for the ordinal variables and the percentage for the categoric variables. A descriptive analysis of the casemix was performed and compared with available data from the aforementioned studies. RESULTS: The RNFC included 7.208 patients from 54 hospitals, with a mean age of 86.7 (SD 5.6) years; 75.4% were women, and 36.4% showed cognitive decline. Mean surgical delay was 75.7 (SD 63.6) hours, and length of stay averaged 10.9 (SD 6.7) days. Of the patients who lived at home (75.4%), less than half (37.0%) returned home at discharge. One-month mortality was 7.1%. Comparison with other studies showed important differences, especially regarding patients newly sent to nursing homes (7.7-29.4%) and with antiosteoporotic treatment at discharge (14.5-36.7%). CONCLUSIONS: The RNFC is the largest prospective database to date that offers data regarding the characteristics of patients hospitalized for hip fractures in Spain. Comparison with recent studies showed some important differences.

OBJETIVO: El Registro Nacional de Fracturas de Cadera (RNFC) es un registro español multicéntrico, prospectivo y continuo, que comenzó en 2017. El objetivo de este artículo fue presentar los datos del primer informe anual y compararlos con los registros autonómicos y los estudios multicéntricos realizados recientemente en España. METODOS: Se incluyeron las personas de 75 años o más atendidas con el diagnóstico de fractura de cadera por fragilidad en alguno de los hospitales participantes en el RNFC, entre enero y octubre de 2017. En el análisis estadístico se utilizó la media y desviación estándar o mediana y rangos intercuartílicos para las variables numéricas y los porcentajes para las variables categóricas. Se realizó un análisis descriptivo global de la casuística y se comparó con los datos disponibles de los estudios previos mencionados. RESULTADOS: Se registraron 7.208 personas de 54 hospitales, con una edad media de 86,7 años (DE 5,6). El 75,4% fueron mujeres y el 36,4% presentaron deterioro cognitivo previo. La demora quirúrgica media fue de 75,7 horas (DE 63,6) y la estancia media fue de 10,9 días (DE 6,7). De las personas que vivían en un domicilio antes de la fractura (75,4%), menos de la mitad (37,0%) volvieron a él tras el alta hospitalaria. Al mes, había fallecido el 7,1%. La comparación con los otros estudios mostró algunas diferencias importantes, sobre todo en la ubicación previa, en el porcentaje de pacientes institucionalizados de novo (7,7-29,4%) y en el porcentaje con tratamiento antiosteoporótico al alta (14,5-36,7%). CONCLUSIONES: El RNFC es la mayor base de datos prospectiva que aporta datos sobre el perfil de los pacientes hospitalizados por fractura de cadera en España. La comparación con otros estudios recientes muestra algunas diferencias importantes.

First proposal of quality indicators and standards and recommendations to improve the healthcare in the Spanish National Registry of Hip Fracture / Primera propuesta de indicadores y estándares de calidad y recomendaciones de mejora de la atención en el Registro Nacional de Fractura de Cadera

Background: The Spanish National Hip Fracture Registry (or Registro Nacional de Fractura de Cadera, RNFC) is a database of hip fracture patients admitted to Spanish hospitals. Its goals include assessment and continuous improvement of the care process. Objectives: To (1) establish a series of indicators, (2) evaluate their initial fulfillment, (3) propose quality standards, (4) suggest recommendations to facilitate standards compliance, and (5) monitor the indicators. Method: The indicators fulfilled the criteria of (1) evaluating the process or outcome, (2) being clinically relevant for patients, (3) being modifiable through changes in healthcare practice, and (4) being considered important by the RNFC participants. The first quartile obtained by the group of hospitals in each of the respective variables was proposed as the standard. The Indicators Advisory Committee (IAC) elaborated a list of recommendations for each indicator, based on the available evidence. Results: Seven indicators were chosen. These indicators (its baseline compliance vs. the standard to be reached, respectively) were: the proportion of patients receiving surgery within 48h (44% vs. 63%), mobilized the first postoperative day (56% vs. 86%), with antiosteoporotic medication at discharge (32% vs. 61%), with calcium supplements at discharge (46% vs. 77%), with vitamin D supplements at discharge (67% vs. 92%), who developed pressure ulcers during hospitalization (7.2% vs. 2.1%) and with independent mobility at 30 days (58% vs. 70%). The IAC has established 25 recommendations for improving care. Conclusion: The indicators and standards chosen are presented, as well as the list of recommendations. This process completes the first step to improve quality of care. The results will be evaluated 6 months after implementing the recommendations

Antecedentes: El Registro Nacional de Fractura de Cadera (RNFC) es una base de datos de pacientes con fractura de cadera ingresados en hospitales españoles. Entre sus objetivos se encuentran el conocimiento y la mejora continua del proceso asistencial. Objetivos: 1) establecer una serie de indicadores, 2) evaluar su cumplimiento inicial, 3) proponer unos estándares, 4) sugerir recomendaciones para facilitar el cumplimiento de los estándares y 5) realizar una monitorización de los indicadores. Método: Los indicadores cumplían los criterios de: 1) evaluar proceso o resultados, 2) tener relevancia clínica para los pacientes, 3) ser potencialmente modificables mediante cambios en la práctica asistencial y 4) ser considerados importantes por los participantes del RNFC. Se propuso como estándar el primer cuartil obtenido por el grupo de hospitales en cada una de las variables respectivas. El Comité de Indicadores (CI) elaboró una lista de recomendaciones basadas en la evidencia disponible. Resultados: Se eligieron 7 indicadores. Estos indicadores (con su grado de cumplimiento inicial vs. el estándar a alcanzar, respectivamente) fueron la proporción de pacientes intervenidos en menos de 48h (44 vs. 63%), levantados el primer día del postoperatorio (56 vs. 86%), con tratamiento anti-osteoporótico al alta (32 vs. 61%), con tratamiento de calcio al alta (46 vs. 77%), con tratamiento de vitamina D al alta (67 vs. 92%), que desarrollaron úlceras por presión durante la hospitalización (7,2 vs. 2,1%) y con movilidad independiente a los 30 días (58 vs. 70%). El CI ha establecido una serie de 25 recomendaciones para la mejora asistencial. Conclusión: Se presentan los indicadores y estándares elegidos, así como las recomendaciones. Este proceso completa el primer paso de mejora de calidad asistencial, cuyo resultado deberá ser evaluado tras 6 meses de implementación de las recomendaciones elegidas

Results of an anaemia treatment protocol complementary to blood transfusion in elderly patients with hip fracture / Resultados de un protocolo de tratamiento de anaemia con terapias complementarias a transfusión en anciano con fractura de cadera

Background: Anaemia is a very common condition in elderly patients with hip fracture. The side effects of blood transfusions are well known, and further research on potential alternative therapies is needed. Objectives and design: A non-controlled descriptive study, conducted on 138 patients admitted for hip fracture, aimed at analysing the effects of an anaemia treatment protocol adjunctive to transfusion, based on the use of supra-physiological doses of intravenous iron and erythropoietin (IS/EPOS). The variables collected were, medical history, physical and cognitive status prior to fracture, as well as the need of blood products, medical complications during admission and their functional outcome at three and six months after the fracture were evaluated. Transfusion rates were compared with a historical control group when the only treatment for acute anaemia was transfusion (2011). Results: Almost half (63, 48%) of the patients received blood transfusion, with (91,70%) IS/EPOD. Intravenous iron did not reduce the percentage of transfused patients (56% vs. 44%), but it did reduce the number of blood units required (0.7 units less in IS/EPO group). Patients who required transfusion had a longer hospital stay, (1.7 days; 13.2 vs. 11.5; p<0.005). Patients who received IS had better functional recovery assessed with Barthel index and the Functional Ambulation Categories (FAC scale) at 3 and 6 months after the fracture. Patients with malnutrition or subtrochanteric fracture needed more tabletransfusions (p<0.005). Functional recovery at 3 and 6 months after fracture was better in patients who received intravenous iron. Neither blood transfusions nor intravenous iron were associated with infectious complications or increased mortality. The patient series of this study was compared with a group of patients with hip fracture and similar characteristics seen in 2011, before intravenous iron was available, revealing a 17% reduction in blood transfusion needs (p<0.005). Conclusion: The use of intravenous iron in elderly patients with hip fracture may help to reduce the number of blood units needed for the treatment of anaemia, although a causal relationship cannot be established due to not having a control group. Transfusions were associated with longer hospital stay in elderly patients with hip fracture

Introducción: El síndrome anémico es muy frecuente en el anciano ingresado por fractura de cadera. Los documentados efectos secundarios de la transfusión de hemoderivados hacen necesario investigar otras posibles alternativas terapéuticas. Material y métodos: Estudio descriptivo de 138 pacientes ingresados por fractura de cadera que evalúa el efecto de un protocolo de tratamiento de anemia perioperatoria complementario a transfusión, basado en el empleo de dosis suprafisiológicas de hierro intravenoso y eritropoyetina (FE/EPO). Se trata de un estudio descriptivo sin grupo control. Se evaluaron los antecedentes médicos de los pacientes, y su situación mental y física previas al ingreso, la necesidad de hemoderivados, las complicaciones en el ingreso y su evolución funcional en los 6 meses posteriores a la fractura. Los ratios de transfusión fueron comparados con los de una muestra histórica de similares características sin tratamiento con ferroterapia intravenosa (2011). Resultados: Recibieron transfusión el 48% de los pacientes (63) y ferroterapia parenteral con eritropoyetina (FE/EPO) el 70% (91). La administración de FE/EPO no disminuyó el porcentaje de pacientes hemotransfundidos (56 vs. 44%) de forma significativa, pero sí redujo el número de unidades de sangre requeridas (0,7 unidades menos en grupo de FE/EPO). Los pacientes que recibieron ferroterapia intravenosa tuvieron una estancia hospitalaria de 1,7 días inferior que los transfundidos (11,5 vs. 13,2; p<0,005). La administración de hierro parenteral se relacionó con tendencia a una mejor recuperación de capacidad de autocuidados y deambulación medidos mediante el índice de Barthel (IB) y la escala de deambulación de Holden (FAC) a los 3 y 6 meses de la fractura. La anemia y la malnutrición al ingreso, así como el tipo de fracturas subtrocantérea se relacionaron de forma independiente a mayor necesidad de transfusión (p<0,005). Ni las transfusiones ni el tratamiento con ferroterapia parenteral se asociaron a más complicaciones infecciosas ni a mayor mortalidad. Al comparar la muestra actual con un control histórico de pacientes con fractura de cadera sin disponibilidad de tratamiento con hierro intravenoso, se observa reducción actual del porcentaje de pacientes transfundidos en un 17% (p<0,005). Conclusión: El empleo de ferroterapia intravenosa en pacientes con fractura de cadera puede reducir el número de unidades de hemoderivados necesarias, sí bien no se puede establecerse una relación causal al no ser un estudio controlado. La transfusión se asocia con una prolongación de la estancia hospitalaria en el anciano ingresado por fractura de cadera

First proposal of quality indicators and standards and recommendations to improve the healthcare in the Spanish National Registry of Hip Fracture.

BACKGROUND: The Spanish National Hip Fracture Registry (or Registro Nacional de Fractura de Cadera, RNFC) is a database of hip fracture patients admitted to Spanish hospitals. Its goals include assessment and continuous improvement of the care process. OBJECTIVES: To (1) establish a series of indicators, (2) evaluate their initial fulfillment, (3) propose quality standards, (4) suggest recommendations to facilitate standards compliance, and (5) monitor the indicators. METHOD: The indicators fulfilled the criteria of (1) evaluating the process or outcome, (2) being clinically relevant for patients, (3) being modifiable through changes in healthcare practice, and (4) being considered important by the RNFC participants. The first quartile obtained by the group of hospitals in each of the respective variables was proposed as the standard. The Indicators Advisory Committee (IAC) elaborated a list of recommendations for each indicator, based on the available evidence. RESULTS: Seven indicators were chosen. These indicators (its baseline compliance vs. the standard to be reached, respectively) were: the proportion of patients receiving surgery within 48h (44% vs. 63%), mobilized the first postoperative day (56% vs. 86%), with antiosteoporotic medication at discharge (32% vs. 61%), with calcium supplements at discharge (46% vs. 77%), with vitamin D supplements at discharge (67% vs. 92%), who developed pressure ulcers during hospitalization (7.2% vs. 2.1%) and with independent mobility at 30 days (58% vs. 70%). The IAC has established 25 recommendations for improving care. CONCLUSION: The indicators and standards chosen are presented, as well as the list of recommendations. This process completes the first step to improve quality of care. The results will be evaluated 6 months after implementing the recommendations.

Results of an anaemia treatment protocol complementary to blood transfusion in elderly patients with hip fracture.

BACKGROUND: Anaemia is a very common condition in elderly patients with hip fracture. The side effects of blood transfusions are well known, and further research on potential alternative therapies is needed. OBJECTIVES AND DESIGN: A non-controlled descriptive study, conducted on 138 patients admitted for hip fracture, aimed at analysing the effects of an anaemia treatment protocol adjunctive to transfusion, based on the use of supra-physiological doses of intravenous iron and erythropoietin (IS/EPOS). The variables collected were, medical history, physical and cognitive status prior to fracture, as well as the need of blood products, medical complications during admission and their functional outcome at three and six months after the fracture were evaluated. Transfusion rates were compared with a historical control group when the only treatment for acute anaemia was transfusion (2011). RESULTS: Almost half (63, 48%) of the patients received blood transfusion, with (91,70%) IS/EPOD. Intravenous iron did not reduce the percentage of transfused patients (56% vs. 44%), but it did reduce the number of blood units required (0.7 units less in IS/EPO group). Patients who required transfusion had a longer hospital stay, (1.7 days; 13.2 vs. 11.5; p<0.005). Patients who received IS had better functional recovery assessed with Barthel index and the Functional Ambulation Categories (FAC scale) at 3 and 6 months after the fracture. Patients with malnutrition or subtrochanteric fracture needed more tabletransfusions (p<0.005). Functional recovery at 3 and 6 months after fracture was better in patients who received intravenous iron. Neither blood transfusions nor intravenous iron were associated with infectious complications or increased mortality. The patient series of this study was compared with a group of patients with hip fracture and similar characteristics seen in 2011, before intravenous iron was available, revealing a 17% reduction in blood transfusion needs (p<0.005). CONCLUSION: The use of intravenous iron in elderly patients with hip fracture may help to reduce the number of blood units needed for the treatment of anaemia, although a causal relationship cannot be established due to not having a control group. Transfusions were associated with longer hospital stay in elderly patients with hip fracture.

Registro Nacional de Fracturas de Cadera (RNFC): resultados del primer año y comparación con otros registros y estudios multicéntricos españoles / Spanish National Hip Fracture Registry (RNFC):First-year results and comparison with other registries and prospective multi-centric studies from Spain

OBJETIVO: El Registro Nacional de Fracturas de Cadera (RNFC) es un registro español multicéntrico, prospectivo y continuo, que comenzó en 2017. El objetivo de este artículo fue presentar los datos del primer informe anual y compararlos con los registros autonómicos y los estudios multicéntricos realizados recientemente en España. MÉTODOS: Se incluyeron las personas de 75 años o más atendidas con el diagnóstico de fractura de cadera por fragilidad en alguno de los hospitales participantes en el RNFC, entre enero y octubre de 2017. En el análisis estadístico se utilizó la media y desviación estándar o mediana y rangos intercuartílicos para las variables numéricas y los porcentajes para las variables categóricas. Se realizó un análisis descriptivo global de la casuística y se comparó con los datos disponibles de los estudios previos mencionados. RESULTADOS: Se registraron 7.208 personas de 54 hospitales, con una edad media de 86,7 años (DE 5,6). El 75,4% fueron mujeres y el 36,4% presentaron deterioro cognitivo previo. La demora quirúrgica media fue de 75,7 horas (DE 63,6) y la estancia media fue de 10,9 días (DE 6,7). De las personas que vivían en un domicilio antes de la fractura (75,4%), menos de la mitad (37,0%) volvieron a él tras el alta hospitalaria. Al mes, había fallecido el 7,1%. La comparación con los otros estudios mostró algunas diferencias importantes, sobre todo en la ubicación previa, en el porcentaje de pacientes institucionalizados de novo (7,7-29,4%) y en el porcentaje con tratamiento antiosteoporótico al alta (14,5-36,7%). CONCLUSIONES: El RNFC es la mayor base de datos prospectiva que aporta datos sobre el perfil de los pacientes hospitalizados por fractura de cadera en España. La comparación con otros estudios recientes muestra algunas diferencias importantes

OBJECTIVE: The Spanish National Hip Fracture Registry (Registro Nacional de Fracturas de Cadera or RNFC) is a Spanish, prospective, multi-centric registry, commenced in 2017. The goal of this paper is to present the data from the first annual report and to compare them with autonomic registries and recent prospective multi-centric studies performed in Spain. METHODS: We included persons 75 years or older treated for fragility hip fractures in any of the centers participating in the RNFC between January and October 2017. The descriptive statistics of each variable used the mean (and standard deviation) or the median (and interquartile ranges) for the ordinal variables and the percentage for the categoric variables. A descriptive analysis of the casemix was performed and compared with available data from the aforementioned studies. RESULTS: The RNFC included 7.208 patients from 54 hospitals, with a mean age of 86.7 (SD 5.6) years; 75.4% were women, and 36.4% showed cognitive decline. Mean surgical delay was 75.7 (SD 63.6) hours, and length of stay averaged 10.9 (SD 6.7) days. Of the patients who lived at home (75.4%), less than half (37.0%) returned home at discharge. One-month mortality was 7.1%. Comparison with other studies showed important differences, especially regarding patients newly sent to nursing homes (7.7-29.4%) and with antiosteoporotic treatment at discharge (14.5-36.7%). CONCLUSIONS: The RNFC is the largest prospective database to date that offers data regarding the characteristics of patients hospitalized for hip fractures in Spain. Comparison with recent studies showed some important differences

Intervención geriátrica en el anciano ingresado por fractura de cadera en el Hospital Universitario de Guadalajara: repercusión clínica, asistencial y económica / Geriatric intervention in elderly hip fracture patients admitted to University Hospital of Guadalajara: clincal, healthcare and economical repercussions

Objetivo. Evaluar los resultados asistenciales y la repercusión económica de la intervención geriátrica en pacientes mayores de 75 años con fractura de cadera en fase aguda. Material y métodos. Estudio retrospectivo de los pacientes ingresados por fractura de cadera en el Hospital Universitario de Guadalajara (HUGU). Se evaluaron parámetros asistenciales del total de los pacientes ingresados por fractura de cadera en el HUGU entre los años 2002 y 2013 (n=2.942), tales como número anual de casos, la estancia preoperatoria, la estancia global y la mortalidad. Evaluación del efecto de la intervención geriátrica protocolizada iniciada en 2006 mediante la comparación de datos entre las etapas previa y posterior a su puesta en marcha. Resultados. La intervención geriátrica ha supuesto una reducción progresiva de estancia media y la mortalidad, aunque con una tendencia aumentar la estancia prequirúrgica. Comparando la actividad del 2013 con la del 2006, la estancia media se redujo del 18,5 al 11,2 días (-39,2%) y la mortalidad desde el 8,9 hasta el 6,8% (-23%). Por el contrario, la estancia preoperatoria media se mantuvo en 2,7 días de media en los años postintervención, frente a 2,4 en los años previos. A pesar del incremento anual del precio diario de la hospitalización por factura de cadera, el descenso de la estancia implica una reducción del coste del proceso que supera los 900.000 euros anuales. Conclusiones. La intervención geriátrica contribuye a la reducción observada de la mortalidad y la estancia hospitalaria por fractura de cadera, disminuyendo el coste de la hospitalización (AU)

Objective. To evaluate the healthcare outcomes and economic impact of geriatric intervention in patients over 75 years old with hip fracture in acute phase. Material and methods. Retrospective study of patients admitted to the University Hospital of Guadalajara (HUGU) due to hip fracture. An analysis was made of the number of cases per year, preoperative period, hospital stay, and mortality of all the patients over 75 years admitted to the HUGU due to hip fracture between 2002 and 2013. Results. A total of 2942 patients were included. Comparing the activity of 2013 to that of 2006, the mean hospital stay fell from 18.5 to 11.2 days (-39.2%), and mortality from 8.9% to 6.8% (-23%). In contrast, the mean preoperative stay remained at a mean of 2.7 days versus 2.4 in previous years in the early post-intervention period. Hospital stay decreased, despite a progressive annual increase in the daily cost of hospitalisation due to hip fracture surgery, the reduced stay led to a reduction of the total cost by more than 900,000 euros each year. Geriatric intervention has gradually reduced mean hospital stay and mortality, although with a tendency to increase mean preoperative stay. Conclusions. Geriatric intervention in patients with hip fracture reduces mortality and length of hospital stay, and decreasing costs (AU)

[Geriatric intervention in elderly hip fracture patients admitted to University Hospital of Guadalajara: Clincal, healthcare and economical repercussions]. / Intervención geriátrica en el anciano ingresado por fractura de cadera en el Hospital Universitario de Guadalajara: repercusión clínica, asistencial y económica.

OBJECTIVE: To evaluate the healthcare outcomes and economic impact of geriatric intervention in patients over 75 years old with hip fracture in acute phase. MATERIAL AND METHODS: Retrospective study of patients admitted to the University Hospital of Guadalajara (HUGU) due to hip fracture. An analysis was made of the number of cases per year, preoperative period, hospital stay, and mortality of all the patients over 75 years admitted to the HUGU due to hip fracture between 2002 and 2013. RESULTS: A total of 2942 patients were included. Comparing the activity of 2013 to that of 2006, the mean hospital stay fell from 18.5 to 11.2 days (-39.2%), and mortality from 8.9% to 6.8% (-23%). In contrast, the mean preoperative stay remained at a mean of 2.7 days versus 2.4 in previous years in the early post-intervention period. Hospital stay decreased, despite a progressive annual increase in the daily cost of hospitalisation due to hip fracture surgery, the reduced stay led to a reduction of the total cost by more than 900,000 euros each year. Geriatric intervention has gradually reduced mean hospital stay and mortality, although with a tendency to increase mean preoperative stay. CONCLUSIONS: Geriatric intervention in patients with hip fracture reduces mortality and length of hospital stay, and decreasing costs.

Utilidad de las vías clínicas en el tratamiento del anciano con fractura de cadera / Usefulness of clinical pathways in the treatment of hip fracture in the elderly

No disponible

Tratamiento médico perioperatorio del anciano ingresado por fractura de cadera / Perioperative medical treatment of old patients admitted with hip fracture

No disponible

Diarrea asociada a Clostridium difficile en el anciano: nuevas perspectivas / Diarrhea associated with Clostridium difficile in the elderly: new perspectives

La infección por Clostridium difficile es actualmente la principal causa de enfermedad gastrointestinal de origen nosocomial. Su prevalencia en la población anciana es superior por reunirse en este grupo etario gran cantidad de factores de riesgo como son comorbilidad, frecuente exposición al medio sanitario o residencial, inmunosenescencia y mayor consumo de antibióticos y antiácidos. En los últimos años, las técnicas diagnósticas han mejorado notablemente, lo que podría implicar un incremento de diagnósticos. Las nuevas pautas de consenso de expertos proponen la estratificación de la situación clínica del paciente en el momento del diagnóstico para la elección del tratamiento óptimo. Recientemente se han incluido en las guías clínicas nuevas opciones terapéuticas como la flidaxomicina o el trasplante de materia fecal con resultados alentadores, sobre todo para el control de las frecuentes recurrencias (AU)

Infection due to Clostridium difficile is currently the main cause of hospital acquired gastrointestinal disease. Its prevalence in the elderly population is higher due to there being many associated risk factors in this age group, such as comorbidity, frequent exposure to the healthcare or residential home setting, immunosenescence, greater consumption of antibiotics, and antiacids. The diagnostic techniques have notably improved in the last few years, which could also account for an increase in its diagnosis. The new expert consensus recommendations propose stratifying the clinical situation of the patient in order to choose the treatment option. Therapeutic options have recently been included in the new Clinical Guidelines, such as flidaxomicin or fecal transplants, with encouraging results, particularly for the control of frequent recurrences (AU)

[Diarrhea associated with Clostridium difficile in the elderly: new perspectives]. / Diarrea asociada a Clostridium difficile en el anciano: nuevas perspectivas.

Infection due to Clostridium difficile is currently the main cause of hospital acquired gastrointestinal disease. Its prevalence in the elderly population is higher due to there being many associated risk factors in this age group, such as comorbidity, frequent exposure to the healthcare or residential home setting, immunosenescence, greater consumption of antibiotics, and antiacids. The diagnostic techniques have notably improved in the last few years, which could also account for an increase in its diagnosis. The new expert consensus recommendations propose stratifying the clinical situation of the patient in order to choose the treatment option. Therapeutic options have recently been included in the new Clinical Guidelines, such as flidaxomicin or fecal transplants, with encouraging results, particularly for the control of frequent recurrences.