The effect of weekends and public holidays on the care of acute coronary syndrome in the Spanish National Health System.

INTRODUCTION AND OBJECTIVES: To analyze whether admission on weekends or public holidays (WHA) influences the management (performance of angioplasty, percutaneous coronary intervention [PCI]) and outcomes (in-hospital mortality) of patients hospitalized for acute coronary syndrome in the Spanish National Health System compared with admission on weekdays. METHODS: Retrospective observational study of patients admitted for ST-segment elevation myocardial infarction (STEMI) or for non-ST-segment elevation acute coronary syndrome (NSTEACS) in hospitals of the Spanish National Health system from 2003 to 2018. RESULTS: A total of 438 987 episodes of STEMI and 486 565 of NSTEACS were selected, of which 28.8% and 26.1% were WHA, respectively. Risk-adjusted models showed that WHA was a risk factor for in-hospital mortality in STEMI (OR, 1.05; 95%CI,1.03-1.08; P < .001) and in NSTEACS (OR, 1.08; 95%CI, 1.05-1.12; P < .001). The rate of PCI performance in STEMI was more than 2 percentage points higher in patients admitted on weekdays from 2003 to 2011 and was similar or even lower from 2012 to 2018, with no significant changes in NSTEACS. WHA was a statistically significant risk factor for both STEMI and NSTEACS. CONCLUSIONS: WHA can increase the risk of in-hospital death by 5% (STEMI) and 8% (NSTEACS). The persistence of the risk of higher in-hospital mortality, after adjustment for the performance of PCI and other explanatory variables, probably indicates deficiencies in management during the weekend compared with weekdays.

Prevalence, Treatment, and Associated Factors of Hypertension in Spain: A Comparative Study between Populations.

The prevalence and related factors of hypertensive subjects according to the resident area (rural versus urban) were investigated in two population-based studies from Spain. Medical questionnaires were administered and anthropometrics were measured, using standardized protocols. Hypertension was diagnosed in pharmacology treated subjects or those with blood pressure (BP) ≥140/90 mm Hg. Regarding BP control, it was defined as under control if BP was <140/90 or <140/85 mm Hg in type 2 diabetic subjects. Information on educational status, social class, smoking habit, and alcohol intake was obtained. 3,816 subjects (54.38 % women) were included. Prevalence of diagnosed hypertension was higher in women and showed no differences according to the living area (men: urban 21.88 versus rural 21.92 %, p = 0.986; women: urban 28.73 versus rural 30.01 %, p = 0.540). Women living in rural areas and men with secondary or tertiary education levels had a lower probability of being BP uncontrolled (OR (95 % CI): 0.501 (0.258-0.970)/p=0.040, 0.245 (0.092-0.654)/p=0.005, and 0.156 (0.044-0.549)/p=0.004, respectively). Urban young men (31-45 years) and medium aged women (46-60 years) were less BP controlled than their rural counterparts (41.30 versus 65.79 %/p=0.025 and 35.24 versus 53.27 %/p=0.002, respectively).

Prevalence of Hyponatremia and Its Associated Morbimortality in Hospitalized Patients Receiving Parenteral Nutrition.

BACKGROUND: The objective of the study was to determine the prevalence of hyponatremia (HN) and its associated morbimortality in hospitalized patients receiving parenteral nutrition (PN). METHODS: A retrospective study including 222 patients receiving total PN (parenteral nutrition group [PNG]) over a 7-month period in a tertiary hospital and 176 matched to 179 control subjects without PN (control subjects group [CSG]). Demographic data, Charlson Comorbidity Index (CCI), date of HN detection-(serum sodium or SNa <135 mmol/L)-intrahospital mortality, and hospital length-of-stay (LOS) were registered. In the PNG, body mass index (BMI) and SNa before, during, and after PN were recorded. RESULTS: HN was more prevalent in the PNG: 52.8 vs. 35.8% (p = 0.001), and independent of age, gender, or CCI (OR 1.8 [95% CI 1.1-2.8], p = 0.006). In patients on PN, sustained HN (75% of all intraindividual SNa <135 mmol/L) was associated with a higher mortality rate independent of age, gender, CCI, or BMI (OR 7.38 [95% CI 1.07-50.8], p = 0.042). The absence of HN in PN patients was associated with a shorter hospital LOS (<30 days) and was independent of other comorbidities (OR 3.89 [95% CI 2.11-7.18], p = 0.001). CONCLUSIONS: HN is more prevalent in patients on PN. Sustained HN is associated with a higher intrahospital mortality rate. Absence of HN is associated with a shorter hospital LOS.

Impact of clinical training on supra-aortic duplex and transcranial doppler examination concordance.

Sonographic tests are observer-dependent. With 1,527 consecutive patients, 22 trainees were assessed at baseline and after a hands-on 1:1 program, with a pre-examination median of 76 studies/trainee. We evaluated the required number of supervised examinations to reach a 0.80 kappa index (ki). Statistics included linear and exponential generalized estimating equation models. In the exponential model, 76 studies for carotid-duplex and >102 for vertebral-duplex and transcranial Doppler were needed for a 0.80 ki. "Relevant-categories" after-training ki was 0.80 in carotid-duplex and transcranial Doppler but 0.60 in vertebral-duplex. A fixed training does not guarantee a high ki. Measuring the acquired skills of every trainee would improve quality. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:571-579, 2016.

Producción y repercusión científica de un grupo de urgenciólogos españoles seleccionados por su trayectoria investigadora / No disponible

OBJETIVO: Investigar el comportamiento de distintos indicadores de producción y repercusión científicas en médicos investigadores espańoles que trabajan en el ámbito de la medicina de urgencias y emergencias y definir un patrón global para el conjunto de ellos. MÉTODO: Estudio piloto exploratorio en 24 urgenciólogos. CRITERIOS DE INCLUSIÓN: estar en el comité editorial o el panel de expertos de EMERGENCIAS, experiencia investigadora de al menos 10 ańos y tener 20 trabajos indexados en Science Citation Index Expanded, al menos 5 de ellos en los últimos 3 ańos. Para cada autor, se obtuvieron los ańos de experiencia, el número de trabajos publicados (indicador de producción) y el número de citas y el factor de impacto acumulado y el índice h (indicadores de repercusión).Estos indicadores se calcularon para cada ańo de experiencia de su trayectoria investigadora. Se contrastó esta experiencia y el valor alcanzado en estos indicadores y la evolución temporal de dichos indicadores, tanto individualmente como para todo el colectivo, mediante modelos de regresión lineal y polinomial. RESULTADOS: La experiencia media investigadora fue de 19 ± 7 ańos (rango: 10-35). La relación entre la puntuación alcanzada por los investigadores en los indicadores evaluados y los ańos de experiencia no fue significativa. En cambio, la evolución temporal de estos indicadores se ajustó mejor a un modelo cuadrático que a uno lineal: individualmente, los valores de R2 fueron siempre superiores a 0,90 en todos los indicadores; globalmente, el mejor ajuste se produjo con el índice h (R2 = 0,54). En este último, se distinguía un comportamiento diferenciado para los investigadores de 20 o menos años de experiencia (mejor ajuste, R2 = 0,71, y crecimiento más acelerado) y los de más de 20 años de experiencia (R2 = 0,61). CONCLUSIONES: Es posible describir un modelo de evolución temporal de los distintos indicadores de producción y repercusión científicas para los urgenciólogos investigadores españoles. Esta curva de desarrollo puede utilizarse en el futuro para comparar este comportamiento con el de otros colectivos de investigadores o con el de urgenciólogos investigadores de otros países

OBJECTIVES: To investigate bibliometric indicators of research output, or productivity, and impact of selected Spanish emergency physicians who engage in research and to describe the behaviour of these indicators for this group of researchers as a whole. METHODS: Pilot study exploring indicators for a group of 24 emergency physicians who engage in research. The physicians were elected from among members of the editorial board and peer reviewers of the journal Emergencias. All had been publishing papers for at least 10 years and had authored at least 20 papers, including 5 in the last 3 years. The following information was collected for each author: publications in journals included in Science Citation Index Expanded; duration of career in medical research; number of publications as the output indicator; and number of cites, accumulated impact factor, and h-index as the impact indicators. These indicators were calculated for each year of the physicians' research careers. The results, including change in the indicators over time, were analyzed for individuals and for the group as a whole by means of both linear and polynomial regression models. RESULTS: The physicians had been engaged in research for a mean (SD) of 19 (7) years (range, 10-35 years). The associations between years of experience and the indicators of output and impact were not significant. Polynomial regression models fit the changes in these indicators over time better than linear models. Analyzed individually the R2values were always over 0.90 for all indicators in polynomial modelling; for the group as a whole, the h-index showed the best fit (R2 = 0.54). The h-index behaved differently for researchers with up to 20 years of experience (better fit,R2 = 0.71 as well as accelerated increase) and for those with more than 20 years of experience (R2 = 0.61). CONCLUSIONS: It is possible to model changes in the output and impact factors of Spanish emergency physicians who engage in research. The models can be used in the future to compare the behavior of these research indicators with those of other Spanish research groups or those of emergency physicians engaging in research in other countries

Tuberculosis of the spine. A systematic review of case series.

PURPOSE: The objective of this systematic review was to characterise the methodological issues, as well as clinical, diagnosis, microbiological and treatment characteristics of patients with spinal tuberculosis. METHODS: We conducted a systematic review including prospective or retrospective case series written in English, Spanish, French, German and Italian published in the period from January 1980 to March 2011. RESULTS: Thirty-seven articles were included with a total of 1,997 patients; the median of the percentage of men was 53% (interquartile range [IQR] 48-64) and the median of the patients mean age was 43.4 (IQR 37-55). The most common symptom reported was back pain, and thoracic spine was the most frequent segment involved. Spinal plain radiography was done in 35 studies (94.6%), magnetic resonance imaging (MRI) in 26 (70.2%), computed tomography scan (CT-scan) in 13 (35%) and microbiological diagnosis in 29 (78.3%). Surgical treatment was reported in 28 articles 75.7%; finally, 24 articles reported follow-up, and in 15 of them at least 80% of patients improved. CONCLUSIONS: Spinal TB is still an important public health issue, it must be suspected in the presence of back pain or characteristic images and should be confirmed with microbiological procedures. Chemotherapy treatment is often used; in contrast, there is heterogeneity in the percentage of patients treated by surgery.

Factores de riesgo de infección en procedimientos de derivación de líquido cefalorraquídeo / Risk factors for cerebrospinal fluid shunt infection

Fundamento y objetivo: La infección es una de las complicaciones más serias tras la implantación de una derivación permanente de líquido cefalorraquídeo (LCR). El esfuerzo para solucionar este problema se ha centrado en su tratamiento, identificar posibles factores de riesgo y la prevención primaria. El objetivo de este trabajo es identificar factores de riesgo de infección en pacientes portadores de derivaciones de LCR en nuestro medio. Material y método: Se identificaron retrospectivamente los pacientes sometidos a la implantación de una derivación permanente de LCR en nuestro centro durante el período de estudio considerado. Se excluyeron aquellos procedimientos cuyo seguimiento fue inferior a 90 días. Ciento diecinueve procedimientos fueron incluidos en el análisis final.Resultados: El 8,4% de los procedimientos se infectaron. En el análisis univariable el antecedente de infección del LCR en los 6 meses previos a la implantación de la derivación, el antecedente de derivación previa y la sustitución completa de la derivación se asociaron a mayor riesgo de infección. Tras el análisis multivariable, el antecedente de infección del LCR en los 6 meses anteriores a la implantación de la derivación fue el único factor de riesgo independiente identificado (p=0,011). Conclusión: El antecedente de infección del LCR en los 6 meses anteriores a la implantación de una derivación permanente es un factor de riesgo de infección independiente en nuestro medio. La edad, el sexo, la etiología de la hidrocefalia, el antecedente de derivación previa o el tipo de cirugía realizado no se asociaron a un riesgo incrementado de infección (AU)

Background and objective: Shunt-related infection is a major complication. The effort to face up to this problem has focused on therapy, analysis of risk factors and primary prevention. The aim of this study is to identify risk factors for cerebrospinal fluid shunt infection.Material and method: We retrospectively reviewed all patients who underwent shunt placement at our hospital during the period of study. Procedures followed for less than 90 days were excluded. One hundred and nineteen procedures were included in the final analysis. Results: Infection rate per procedure was 8.4%. Previous cerebrospinal fluid infection, previous shunt andcomplete substitution of the shunt were identified as risk factors for infection in the univariate analysis.However, a multivariate analysis confirmed that previous cerebrospinal fluid infection was the only independent risk factor for shunt-related infection (p = 0.011).Conclusion: Previous cerebrospinal fluid infection is an independent risk factor for shunt-relatedinfection. Other factors such as age, gender, etiology of hydrocephalus, previous shunt or completesubstitution of the shunt were not associated with increased risk of infection (AU)

[Risk factors for cerebrospinal fluid shunt infection]. / Factores de riesgo de infección en procedimientos de derivación de líquido cefalorraquídeo.

BACKGROUND AND OBJECTIVE: Shunt-related infection is a major complication. The effort to face up to this problem has focused on therapy, analysis of risk factors and primary prevention. The aim of this study is to identify risk factors for cerebrospinal fluid shunt infection. MATERIAL AND METHOD: We retrospectively reviewed all patients who underwent shunt placement at our hospital during the period of study. Procedures followed for less than 90 days were excluded. One hundred and nineteen procedures were included in the final analysis. RESULTS: Infection rate per procedure was 8.4%. Previous cerebrospinal fluid infection, previous shunt and complete substitution of the shunt were identified as risk factors for infection in the univariate analysis. However, a multivariate analysis confirmed that previous cerebrospinal fluid infection was the only independent risk factor for shunt-related infection (p=0.011). CONCLUSION: Previous cerebrospinal fluid infection is an independent risk factor for shunt-related infection. Other factors such as age, gender, etiology of hydrocephalus, previous shunt or complete substitution of the shunt were not associated with increased risk of infection.