ABSTRACT
Se describe la experiencia clínica en cuanto al grado de cumplimiento de las guías clínicas en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) atendidos en un servicio de urgencias hospitalario (SUH). Se han revisado las historias de 352 pacientes atendidos por EPOC durante un periodo de 1 año. Se ha observado que la presión arterial se registró en el 92% de los casos, la frecuencia cardiaca en el 74,7%, la frecuencia respiratoria en el 71,9%, la saturación arterial de oxígeno en el 88,4%, la presencia de disnea en reposo en el 25,3% y el uso de musculatura accesoria en el13,4%. De los casos en los que pudo valorarse la antibioticoterapia, ésta se administró sin indicación en el 78,2%, y sólo 117 de los 215 pacientes con criterios de gravedad recibieron corticoides sistémicos (54%). En conclusión, se constata un cumplimiento bajo en la valoración de ítems necesarios para la aplicación de guías clínicas en la EPOC por lo que es necesario buscar herramientas para la mejora en el seguimiento de las recomendaciones de las vías clínicas. (AU)
This study aimed to describe clinical practice in terms of the degree of adherence to practice guidelines for managing chronic obstructive pulmonary disease (COPD) in a hospital emergency department. We reviewed the records of 352patients with COPD treated over a period of 1 year. Blood pressure was recorded in 92% of the cases, heart rate in74.7%, respiratory frequency in 71.9%, arterial blood oxygen saturation in 88.4%, the presence of breathlessness at rest in 25.3%, and accessory muscle recruitment in 13.4%. In cases for which it was possible to assess antibiotic therapy, these drugs were administered without adherence to guideline indications in 78.2%, and only 117 of the 215 patients (54%) with serious exacerbation received systemic corticosteroids. We conclude that the records reveal low adherence to recommendations for recording the signs required to apply practice guidelines for the management of COPD. It is therefore necessary to find tools that improve adherence to the recommended clinical pathways (AU)
Subject(s)
Humans , Emergency Treatment/methods , Pulmonary Disease, Chronic Obstructive/epidemiology , Practice Patterns, Physicians' , Recurrence , Emergency Medical Services/methods , Severity of Illness IndexABSTRACT
Acute liver failure (ALF) is a medical emergency which entails a multisistemic affectation almost always. Twenty cases of ALF have been reviewed in a teaching hospital with active liver transplantation programme. A high percentage of patients with alcohol abuse was observed although these patients did not have previously known hepatic damage. Although microbiological, toxicological and anatomopatological studies were performed in all cases, an important difficulty for establishing the etiologic agent was observed. We observed a worse prognosis in those patients older than 40, those with grade IV encephalophaty and those that did not undergo a liver transplantation. Most patients needed UCI attention and more than half died.
Subject(s)
Liver Failure, Acute/etiology , Adolescent , Adult , Female , Hospitals, Teaching , Humans , Liver Failure, Acute/mortality , Liver Failure, Acute/surgery , Liver Transplantation , Male , Middle Aged , Prognosis , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
El fallo hepático agudo (FHA) es una urgencia médica que conlleva casi siempre una afectación multisistémica. Se han revisado de forma retrospectiva 20 casos de FHA en un hospital universitario con programa de transplante hepático. Observamos un alto porcentaje de enfermos con una ingesta etílica excesiva, aunque sin hepatopatía previa conocida.Apreciamos una manifiesta dificultad para establecer el agente etiológico del proceso a pesar de la realización de estudios microbiológicos, toxicológicos y anatomopatológicos en todos los casos. Constatamos un peor pronóstico de los enfermos mayores de 40 años, los pacientes con encefalopatía grado IV y los no sometidos a transplante hepático. La mayoría de los enfermos precisó atención en UCI y más de la mitad fallecieron. (AU)
Subject(s)
Middle Aged , Adolescent , Adult , Male , Female , Humans , Liver Transplantation , Survival Rate , Treatment Outcome , Prognosis , Retrospective Studies , Hospitals, Teaching , Liver Failure, AcuteSubject(s)
Sexually Transmitted Diseases/therapy , Candidiasis, Vulvovaginal/therapy , Chancroid/therapy , Chlamydia Infections/therapy , Female , Gonorrhea/therapy , Herpes Genitalis/therapy , Humans , Male , Papillomavirus Infections/therapy , Syphilis/therapy , Trichomonas Vaginitis/therapy , Vaginosis, Bacterial/therapySubject(s)
Acne Vulgaris , Acne Vulgaris/diagnosis , Acne Vulgaris/therapy , Adolescent , Adrenal Cortex Hormones/administration & dosage , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Benzoyl Peroxide/therapeutic use , Child , Cryotherapy , Female , Humans , Male , Ointments , Phototherapy , Prognosis , Retinoids/therapeutic useABSTRACT
A group of patients with hypercalciuric renal lithiasis and a group of controls underwent dietary calcium restriction, reinforced by cellulose phosphate, during two weeks. Before and after that intervention, serum levels of 25 OH D, 1.25(OH)2D and PTH, and urinary excretion of cAMP and hydroxyproline were measured. Although the baseline 1.25(OH)2D level was higher in patients with stones, it did not increase with diet as it was the case with controls. Also, the urinary excretion of cAMP was increased in controls but not in patients. 25 OH D, PTH and hydroxyproline were not changed. We conclude that dietary calcium restriction in patients with hypercalciuric renal lithiasis does not appear to induce hormonal changes potentially damaging for the bone.
