Consenso nacional sobre los contenidos de Grado en Fisioterapia cardiorrespiratoria: estudio Delphi / National consensus on cardiorespiratory physiotherapy curricula in Bachelor's degree programs: A Delphi study

Antecedentes y objetivos El plan de estudios del Grado en Fisioterapia debe dar respuesta a las demandas de los usuarios de Fisioterapia en las principales áreas de su práctica profesional y preparar a los fisioterapeutas para actuar en un entorno complejo y cambiante. El objetivo del presente estudio es elaborar y validar un listado de conocimientos (syllabus) de Fisioterapia cardiorrespiratoria en el título de Grado. Material y métodos Estudio Delphi con tres rondas de consulta realizadas entre febrero y marzo de 2021, mediante encuesta digital. Para ello, se formó un grupo de 14 expertos en Fisioterapia cardiorrespiratoria, de toda España, con diferentes perfiles profesionales. Para establecer el grado de acuerdo en las diferentes rondas se empleó el índice estadístico Free-Marginal Multirater Kappa, siendo necesario al menos un 70% de consenso. Para analizar la estabilidad en las respuestas se empleó el estadístico Kappa de Cohen (K). Resultados Se obtuvieron un 100% de respuestas en las tres rondas de consulta realizadas. Al final del proceso se alcanzó un syllabus formado por 11 bloques temáticos, con 48 ítems, con un porcentaje medio de acuerdo del 90,64%, y una estabilidad en las repuestas de K=0,57 (p<0,001), lo que equivale a una concordancia moderada. Conclusiones El syllabus validado por un grupo de 14 fisioterapeutas expertos y expertas en Fisioterapia respiratoria y cardíaca define los contenidos que deberían formar parte del Grado en Fisioterapia para poder dar respuesta a las necesidades asistenciales en afecciones cardiorrespiratorias, en un contexto complejo y cambiante, acorde a una intervención contemporánea (AU)

Background and objectives The curricula of the Bachelor's degree in physiotherapy must respond to the current demands of physiotherapy clients in the main areas of their professional practice and prepare physiotherapists to act in a challenging and complex context. The aim of this study is to elaborate and validate a list of knowledge (syllabus) about cardiorespiratory physiotherapy in Bachelor's degree programs. Material and methods A digital survey conducted a three-round Delphi study between February and March 2021. A group of 14 experts in cardiorespiratory physiotherapy from all over Spain and with different professional profiles were contacted. To establish the degree of agreement in the consultation rounds, the free-marginal multirater kappa statistical index was used, requiring at least 70% of consensus. Cohen's kappa statistic (K) was used to analyze the responses’ stability. Results Hundred percentage of responses were obtained in the three rounds of consultation conducted with the expert panel. At the end of the process, a syllabus made up of 11 thematic sections and 48 items was reached. An average of 90.64% of agreement and a stability in the responses of K=0.57 (p<0.001), which equates to moderate agreement, was achieved. Conclusions This syllabus validated by 14 respiratory and cardiac physiotherapy experts, determines the contents that should be part of physiotherapy in Bachelor's degree programs. This knowledge is crucial to address the rehabilitation necessities of cardiorespiratory alterations in a challenging and complex context, according to a contemporary approach of physiotherapy (AU)

Physical performance testing in post-COVID-19 patients: protocol for a systematic review of psychometric measurement properties.

INTRODUCTION: COVID-19 is an infectious disease that causes severe acute respiratory syndrome. A large variety of exercise capacity tests are used for the evaluation of post-COVID-19 patients, but the psychometric properties of these exercise tests remain undetermined in this population. This study aims to critically appraise, compare and summarise the psychometric properties (validity, reliability and responsiveness) of all physical performance tests that are used to assess exercise capacity in post-COVID-19 patients. METHODS AND ANALYSIS: This systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. We will include studies with hospitalised adult post-COVID-19 patients (aged 18 years or older and with a confirmed diagnosis of COVID-19). The research will cover randomised controlled trials (RCTs), quasi-RCTs and observational studies published in English and performed in the following settings: hospital, rehabilitation centre, outpatient clinic. We will search the following databases with no date restrictions: PubMed/MEDLINE, EMBASE, SciELO, Cochrane Library, CINAHL and Web of Science. Two authors will independently assess the risk of bias (using the Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of bias checklist) and the certainty of evidence (using the Grading of Recommendations, Assessment, Development and Evaluations). According to the results obtained, data will be meta-analysed or reported narratively. ETHICS AND DISSEMINATION: No ethical approval is required for this publication since it will be based on published data. Results of this review will be disseminated via peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42021242334.

Comparison of different field tests to assess the physical capacity of post-COVID-19 patients.

BACKGROUND: In coronavirus disease (COVID-19), physical capacity is one of the most impaired sequelae. Due to their simplicity and low cost, field tests such as the six-minute walk test (6MWT) are widely used However, in many places it is difficult to perform them and alternatives can be used such as the 1 min sit-to-stand test (1min-STST) or the Chester step test (CST). Therefore, our objective was to compare the 6MWT, 1min-STST and the CST in post-COVID-19 patients. METHODS: We conducted a cross-sectional analysis in post-COVID-19 patients, compared with matched controls (CG). Demographic characteristics and comorbidities were collected. We analysed oxygen saturation (SpO2), heart rate (HR), and the modified Borg scale in the 6MWT, 1min-STST, and CST. Additionally, the correlations between tests were analysed. RESULTS: We recruited 27 post-COVID-19 patients and 27 matched controls. The median age was 48 (IQR 43-59) years old (44% female). The median distance walked in 6MWT was 461 (IQR 415-506) m in post-COVID-patients and 517 (IQR 461-560) m in CG (p = 0.001). In 1min-STST, the repetitions were 21.9 ± 6.7 and 28.3 ± 7.1 in the post-COVID-19 group and CG, respectively (p = 0.001). In the CST, the post-COVID-19 group performed 150 (86-204) steps vs the CG with 250 (250-250) steps (p < 0.001). We found correlations between the 6MWT with the 1min-STST in COVID-19 patients (r = 0.681, p < 0.001) and CG (r = 0.668, p < 0.001), and between the 6MWT and the CST in COVID-19 patients (r = 0.692, p < 0.001). CONCLUSION: The 1min-STST and the CST correlated significantly with the 6MWT in patients post-COVID-19 being alternatives if the 6MWT cannot be performed.

Rehabilitation in adult post-COVID-19 patients in post-acute care with Therapeutic Exercise.

COVID-19 patients may experience disability related to Intensive Care Unit (ICU) admission or due to immobilization. We assessed pre-post impact on physical performance of multi-component therapeutic exercise for post-COVID-19 rehabilitation in a post-acute care facility. A 30-minute daily multicomponent therapeutic exercise intervention combined resistance, endurance and balance training. Outcomes: Short Physical Performance Battery; Barthel Index, ability to walk unassisted and single leg stance. Clinical, functional and cognitive variables were collected. We included 33 patients (66.2±12.8 years). All outcomes improved significantly in the global sample (p<0.01). Post-ICU patients, who were younger than No ICU ones, experienced greater improvement in SPPB (4.4±2.1 vs 2.5±1.7, p<0.01) and gait speed (0.4±0.2 vs 0.2±0.1 m/sec, p<0.01). In conclusion, adults surviving COVID-19 improved their functional status, including those who required ICU stay. Our results emphasize the need to establish innovative rehabilitative strategies to reduce the negative functional outcomes of COVID-19.

Respiratory function in patients post-infection by COVID-19: a systematic review and meta-analysis.

BACKGROUND: Evidence suggests lungs as the organ most affected by coronavirus disease 2019 (COVID-19). The literature on previous coronavirus infections reports that patients may experience persistent impairment in respiratory function after being discharged. Our objective was to determine the prevalence of restrictive pattern, obstructive pattern and altered diffusion in patients post-COVID-19 infection and to describe the different evaluations of respiratory function used with these patients. METHODS: A systematic review was conducted in five databases. Studies that used lung function testing to assess post-infection COVID-19 patients were included for review. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence. RESULTS: Of the 1973 reports returned by the initial search, seven articles reporting on 380 patients were included in the data synthesis. In the sensitivity analysis, we found a prevalence of 0.39 (CI 0.24-0.56, p < 0.01, I2 = 86%), 0.15 (CI 0.09-0.22, p = 0.03, I2 = 59%), and 0.07 (CI 0.04-0.11, p = 0.31, I2 = 16%) for altered diffusion capacity of the lungs for carbon monoxide (DLCO), restrictive pattern and obstructive pattern, respectively. CONCLUSION: Post-infection COVID-19 patients showed impaired lung function; the most important of the pulmonary function tests affected was the diffusion capacity.

Análisis descriptivo de la fisioterapia respiratoria en España / Descriptive analysis of respiratory physiotherapy in Spain

Introducción. La fisioterapia respiratoria (FR) consiste en un conjunto de estrategias destinadas a la prevención, el tratamiento y la estabilización de las alteraciones cardiorrespiratorias en pacientes adultos y pediátricos. El objetivo del presente estudio fue describir la situación de la FR en España en el ámbito asistencial, docente, y de investigación. Métodos. Se diseñó un cuestionario on-line para obtener información sobre la implementación de la FR en España en los ámbitos asistencial, docente, y de investigación. El cuestionario quedó disponible on-line entre octubre de 2010 y enero de 2011 para todos aquellos profesionales interesados en contestarlo. Solo se aceptaron respuestas de fisioterapeutas titulados que vivían y trabajaban en España, a razón de una respuesta por persona. Resultados. Se obtuvieron 793 respuestas válidas a partir de las cuales se determinó que un 67,8% del total de participantes estaban vinculados asistencialmente a la FR. De estos, un 79,3% lo hacían de manera esporádica y solo un 50,4% tenían formación específica. Los tratamientos de FR se realizaban básicamente en hospitales (35,5%), centros privados (31%) o en el domicilio del paciente (16,9%). Un 16,4% de los participantes estaban vinculados a docencia en FR y tenían amplia formación específica. Solo un 11,7% de los encuestados estaban involucrados en proyectos de investigación relacionados con FR, pero generalmente lo hacían de manera esporádica y en combinación con tareas asistenciales o docentes. Conclusiones. La FR en España tiene una baja implementación y dedicación laboral. El nivel de formación específica de los fisioterapeutas que realizan intervenciones de FR es aceptable aunque limitado (AU)

Introduction. Respiratory physiotherapy (RP) consists of a combination of strategies aiming to prevent, treat and stabilize cardiorespiratory disorders in adult and pediatric patients. The aim of this study was to describe RP in Spain in the settings of clinical practice, teaching and research. Methods. An on-line questionnaire was designed to obtain information about the implementation of RP in Spain in settings such clinical practice, teaching and research. The questionnaire was available on-line between October 2010-January 2011 to all professionals interested in completing it. Only responses from graduate physiotherapists living and working in Spain were accepted, at a rate of one answer per person. Results. A total of 793 valid answers were obtained, revealing that 67.8% of the respondents were involved in RP in clinical practice, but that 79.3% of respondents practicing RP did so occasionally and only 50.4% had specific RP training. RP treatments were mostly implemented in hospitals (35.5%), private centers (31%) or at patients’ homes (16.9%). Overall, 16.4% of the participants were involved in RP teaching, and most of them had specific training in RP. Only 11.7% of the respondents were involved in research projects related to RP, and most of this participation was sporadic or combined with clinical or teaching tasks. Conclusions. Respiratory physiotherapy is not widely implemented or practiced in Spain. Professionals providing RP interventions have an acceptable level of training but training is scarce (AU)

Short-term effects of three slow expiratory airway clearance techniques in patients with bronchiectasis: a randomised crossover trial.

OBJECTIVE: To compare the efficacy of three slow expiratory airway clearance techniques (ACTs). DESIGN: Randomised crossover trial. SETTING: Tertiary hospital. PARTICIPANTS: Thirty-one outpatients with bronchiectasis and chronic sputum expectoration. INTERVENTIONS: Autogenic drainage (AD), slow expiration with glottis opened in lateral posture (ELTGOL), and temporary positive expiratory pressure (TPEP). MAIN OUTCOMES: Sputum expectoration during each session (primary endpoint) and in the 24-hour period after each session. Leicester Cough Questionnaire (LCQ) score and spirometry results were recorded at the beginning and after each week of treatment. Data were summarised as median difference [95% confidence interval (CI)]. RESULTS: Median (interquartile range) daily expectoration at baseline was 21.1 (15.3 to 35.6)g. During physiotherapy sessions, AD and ELTGOL expectorated more sputum than TPEP [AD vs TPEP 3.1g (95% CI 1.5 to 4.8); ELTGOL vs TPEP 3.6g (95% CI 2.8 to 7.1)], while overall expectoration in the 24-hour period after each session was similar for all techniques (P=0.8). Sputum clearance at 24hours post-intervention was lower than baseline assessment for all techniques [AD vs baseline -10.0g (95% CI -15.0 to -6.8); ELTGOL vs baseline -9.2g (95% CI -14.2 to -7.9); TPEP vs baseline -6.0g (95% CI -12.0 to -6.1)]. The LCQ score increased with all techniques (AD 0.5, 95% CI 0.1 to 0.5; ELTGOL 0.9, 95% CI 0.5 to 2.1; TPEP 0.4, 95% CI 0.1 to 1.2), being similar for all ACTs (P=0.6). No changes in lung function were observed. CONCLUSIONS: Slow expiratory ACTs enhance mucus clearance during treatment sessions, and reduce expectoration for the rest of the day in patients with bronchiectasis. CLINICAL TRIAL REGISTRATION NUMBER: NCT01854788.

[Pulmonary crackles, what does the clinician hear?]. / Craquements pulmonaires: que perçoit le clinicien ?

INTRODUCTION: The overall duration of a pulmonary crackle is usually less than 20-30 ms but psychoacoustics demonstrates that an acoustical event with a duration of less than 20-40 ms cannot be estimated in terms of pitch and duration. We pose the hypothesis that the main resonant information is contained into the breath sounds following the crackle. METHODS: Eight patients with COPD, viral pneumonia, bronchiectasis, congestive heart failure, hypoproteinemia and fibrosing alveolitis were recruited for this study. Thirty-six crackles were analyzed in time and frequency domains; 12 in each category of low, medium and high frequencies. The acoustic features of the crackles, their segments (initial deflection width, first cycle duration, two cycles duration, decay segment) and the breath sounds following the crackles were compared. RESULTS: The study confirms the differences between the three crackles categories in time and frequency domains. No statistical differences were found between the decay segments and breath sounds in each category. CONCLUSIONS: Breath sounds modified by lung tissue density could be the main resonators determining the fundamental transmission frequencies of crackle signals. Combined acoustic analysis of crackles and breath sounds could replace single analysis of isolated crackles.

Use of air stacking and abdominal compression for cough assistance in people with complete tetraplegia.

STUDY DESIGN: Cross-sectional. OBJECTIVE: To assess cough using air stacking (AS) to assist inspiratory volume with abdominal compression (AC) during expiration in patients with American Spinal Injury Association Impairment Scale (AIS) A. SETTING: Large tertiary hospital in Chile. METHODS: Peak cough flow (PCF) was measured during four different interventions: spontaneous maximal expiratory effort (MEE); MEE while receiving AC (MEE-AC); MEE after AS with a manual resuscitation bag (AS-MEE); and MEE with AS and AC (AS-MEE-AC). RESULTS: Fifteen in-patients with complete tetraplegia (C4-C6) were included. Median age was 33 years (16-56). PCF during the different interventions was PCF for MEE was 183±90 l min(-1); PCF for MEE-AC was 273±119 l min(-1); PCF for AS-MEE was 278±106 l min(-1) and PCF for AS-MEE-AC was 368±129 l min(-1). We observed significant differences in PCF while applying MEE-AC and AS-MEE compared with MEE (P=0.0001). However, the difference in PCF value was greater using the AS-MEE-AC technique (P=0.00001). CONCLUSION: Patients with spinal cord injury (SCI) presented an ineffective cough that constitutes a risk factor for developing respiratory complications. The application of combined techniques (AS-MEE-AC) can reach near normal PCF values. This is a low-cost, simple and easily applied intervention that could be introduced to all patients with tetraplegia.

Effects and barriers to deployment of telehealth wellness programs for chronic patients across 3 European countries.

BACKGROUND: Benefits of cardiopulmonary rehabilitation (CPR) in patients with chronic obstructive pulmonary disease (COPD) are well established, but long-term sustainability of training-induced effects and its translation into healthy lifestyles are unsolved issues. It is hypothesized that Integrated Care Services supported by Information and Communication Technologies (ICS-ICT) can overcome such limitations. In the current study, we explored 3 ICS-ICT deployment experiences conducted in Barcelona, Trondheim and Athens. METHODS: In the 3 sites, a total of 154 patients completed an 8-week supervised CPR program. Thereafter, they were allocated either to an ICS-ICT group or to usual care (CPR + UC) during a follow-up period of at least 12 months with assessment of 6-min walking test (6MWT) as main outcome variable at all time points in the 3 sites. Because real deployment was prioritized, the interventions were adapted to site heterogeneities. RESULTS: In the ICS-ICT group from Barcelona (n = 77), the use of the personal health folder (PHF) was the cornerstone technological tool to empower COPD patients for self-management showing high applicability and user-acceptance. Long-term sustainability of training-induced increase in exercise capacity was observed in ICS-ICT compared to the control group (p = 0.01). Likewise, ICS-ICT enhanced the activities domain of the SGRQ (p < 0.01) and daily physical activity (p = 0.03), not seen in controls. No effects of ICS-ICT were observed in Trondheim (n = 37), nor in Athens (n = 40), due to technological and/or organizational limitations. CONCLUSIONS: The study results suggest the potential of the ICS-ICT Barcelona's approach to enhance COPD management. Moreover, it allowed identification of the factors limiting transferability to the other sites. The research prompts the need for large multicenter trials specifically designed to assess effectiveness, efficiencies and transferability of this type of intervention.

Optimal timing for initiation of highly active antiretroviral therapy in treatment-naïve human immunodeficiency virus-1-infected individuals presenting with AIDS-defining diseases: the experience of the PISCIS Cohort.

In this prospective, multicentre cohort study, we analysed specific prognostic factors and the impact of timing of highly active antiretroviral therapy (HAART) on disease progression and death among 625 human immunodeficiency virus (HIV)-1-infected, treatment-naïve patients diagnosed with an AIDS-defining disease. HAART was classified as early (<30 days) or late (30-270 days). Deferring HAART was significantly associated with faster progression to a new AIDS-defining event/death overall (p 0.009) and in patients with Pneumocystis jiroveci pneumonia (p 0.017). In the multivariate analysis, deferring HAART was associated with a higher risk of a new AIDS-defining event/death (p 0.002; hazard ratio 1.83; 95% CI 1.25-2.68). Other independent risk factors for poorer outcome were baseline diagnosis of AIDS-defining lymphoma, age >35 years, and low CD4(+) count (<50 cells/µL).

Avaliação clínica da capacidade do exercício em pacientes com doença pulmonar obstrutiva crônica: [revisão] / Clinical assessment of exercise capacity in patients with chronic obstructive pulmonary disease: [review]

CONTEXTUALIZAÇÃO: A doença pulmonar obstrutiva crônica (DPOC) se caracteriza por ser uma afecção multissistêmica que leva a uma diminuição na tolerância ao exercício do paciente pneumopata. Atualmente, a Fisioterapia Respiratória dispõe de uma grande variedade de testes validados que tem como característica a sua simplicidade, praticidade e baixo custo. OBJETIVO: Descrever os testes de campo mais utilizados em pacientes com DPOC para avaliar a capacidade de exercício e a atividade física, assim como alguns testes que potencialmente poderiam ser adotados na avaliação clínica destes pacientes. CONCLUSÕES: Para poder justificar a qualidade do trabalho do profissional de Fisioterapia Respiratória, deve-se incorporar os testes utilizados e validados internacionalmente. Além disso, é importante escolher o teste mais adequado para medir a capacidade do exercício e, sobretudo, realizar um seguimento cuidadoso da evolução do paciente.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized as a multisystemic disease that reduces patient's tolerance to exercise. Nowadays, a great variety of validated tests are available for use in Respiratory Physical Therapy that are simple, practical and inexpensive. OBJECTIVE: To describe the tests most used in patients with COPD to evaluate their exercise capacity and physical activity, along with some tests that potentially could be adopted for clinical evaluations in such patients. CONCLUSIONS: To be able to justify the professional quality of the respiratory physical therapists' work, tests that have been used and validated internationally must be incorporated. Moreover, it is important to choose the most appropriate tests for measuring exercise capacity and, above all, to perform a careful follow-up of the patient.

HIV-1 infected patients older than 50 years. PISCIS cohort study.

OBJECTIVE: The aim of this study is to characterize the ways in which older HIV-infected people differ from younger HIV-infected people. METHODS: Prospective cohort study. PISCIS cohort includes newly attended HIV-infected subjects since January 1, 1998. Naive patients were selected. Two groups were defined: G1 (>or=50 years at time of diagnosis, n=493) and G2 (18-49 years, n=4511). Statistical analysis was performed using chi(2), Student's t test, Cox regression and linear mixed models. RESULTS: G1 had different features: males (G1: 84% vs. G2: 75%, p<0.001), sexual transmission (52% vs. 32%, p<0.001), AIDS at first visit (38% vs. 22%, p<0.001). The follow-up was 6 years. Ninety-five percent of patients in G1 and 92% in G2 presented a detectable viral load (>or=500 copies/mm(3)) at the first visit (p=0.016). G1 presented lower CD4 levels with respect to G2 throughout the period but the increase of CD4 in G1 at the end of the study period was 254 cells/mm(3) whereas for G2 it was 196 cells/mm(3) (p<0.001). Mortality was 9% for G1 and 4% for G2 (p<0.001). CONCLUSIONS: HIV-infected people diagnosed at the age of 50 years or older showed different features. They showed good viral and immunological response to HAART.

Objetivos conseguidos del tratamiento hipolipemiante en una unidad de lípidos / Reached objectives in the treatment of hypolipemia in a lipid unit

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Mitochondrial dysfunction in COPD patients with low body mass index.

Patients with chronic obstructive pulmonary disease (COPD) show abnormal adaptations of skeletal muscle redox status after exercise training. Increased skeletal muscle oxidative stress in COPD patients may prompt mitochondrial dysfunction. The present study explores the association between body composition and mitochondrial respiration in seven COPD patients with low body mass index (BMI(L)), eight COPD patients with normal body mass index (BMI(N)) and seven healthy controls. All of them underwent a vastus lateralis biopsy in which muscle structure, in vitro mitochondrial respiratory function, uncoupling protein 3 (UCP3) mRNA expression and glutathione levels in both isolated mitochondria and the whole muscle were determined. Mitochondrial respiratory function (assessed by acceptor control ratio (ACR)) was impaired in BMI(L) (2.2+/-0.6) compared with both BMI(N) (5.3+/-1.3) and controls (8.2+/-1.3). ACR significantly correlated with arterial oxygen tension and with muscle endurance but it showed a negative association with exercise-induced increase in blood lactate levels. UCP3 mRNA expression was reduced in BMI(L) patients. In conclusion, chronic obstructive pulmonary disease patients with low body mass index show electron transport chain dysfunction, which may contribute to low muscle endurance in the current subgroup of patients.

[Hospital mortality in an Internal Medicine service]. / Mortalidad hospitalaria en un Servicio de Medicina Interna.

UNLABELLED: The Internal Medicine service of the Hospital General de Vic (Barcelona) takes part in the mortality committee by revising and discussing in-hospital mortality. BACKGROUND: to establish the characteristics of the deceased, death causes and to revise possible changes in the last six-years time or problems related to the exitus, to evaluate and improve hospitalized patients assistance. METHODOLOGY: Every case was revised following a specific register: demographical data, diagnosis and death cause, hospital death, documentation data, terminal or agonic situation when hospitalized, autopsies and death quality data. Exitus due to hospital problems were analyzed and classified in different groups. The statistical analysis was performed with measures of central tendency and of standard deviation. RESULTS: During the revised six years, there were 819 exitus (5.1%). Global average death age was 79 +/- 1.8 years: 52.5% were men and 47.4% were women; 22.8% died in less than forty-eight hours after hospitalization. The most frequent death causes were cerebrovascular accident (24%), chronic obstructive pulmonary disease (14.4%) and pneumonia (9.6%). There were a small number of autopsies (4.8%). Ratio of exitus due to hospital problems was stable during the six years (0.5%), in which nosocomial infection was the severest problem. CONCLUSIONS: The total percentage of exitus was 5.1%, higher than the common standards. Mortality causes coincide with other series. Ratio of exitus due to hospital problems was according to recommended objectives. The number of autopsies was very small. A correct completing and revision of the clinical recording is indispensable to spot a shortage in the hospitalized patients assistance.

Mortalidad hospitalaria en un Servicio de Medicina Interna / Hospital mortality in an Internal Medicine Service

El Servicio de Medicina Interna del Hospital General de Vic (Barcelona) forma parte del comité de mortalidad revisando y discutiendo los fallecimientos hospitalarios. Fundamento y objetivo: Establecer las características de los fallecidos, causas de muerte y revisar si existen cambios en los últimos 6 años o problemas en relación con el éxitus, para evaluar y mejorar la asistencia de los pacientes ingresados. Sujetos y métodos: Se realizó revisión de cada caso a través de un registro específico con: datos demográficos, diagnóstico y causa de muerte, problemas hospitalarios, datos de documentación, situación terminal/agónica al ingreso, si se realizó autopsia y datos de calidad de muerte. Se analizan los éxitus secundarios a problemas hospitalarios (ESPHS). Para el análisis estadístico se utilizaron las medidas de centralización y dispersión estándar. Resultados: En los 6 años revisados hubieron 819 éxitus (5,1 por ciento), la edad media global fue de 79 ± 1,8 años. el 52,5 por ciento eran varones y el 47,4 por ciento mujeres, el 22,8 por ciento fallecieron en menos de 48 horas de ingreso. las causas más frecuentes de muerte fueron: el accidente vascular cerebral (24 por ciento), la enfermedad pulmonar obstructiva crónica (14,4 por ciento), la pneumonia (9,6 por ciento).el número de autopsias fue muy reducido (4,8 por ciento) los esphs se mantuvieron estables durante los 6 años, con una tasa del 0,5 por ciento siendo la infección nosocomial el problema más importante. Conclusiones: El porcentaje total de éxitus fue del 5,1 por ciento, superior a los estandards aconsejados. Las causas de mortalidad coinciden con otras series. La tasa de ESPHs se ajustó a los objetivos recomendados. El número de autopsias fue muy reducido. La correcta cumplimentación y revisión de la historia clínica es imprescindible para detectar déficits en la asistencia de los pacientes ingresados (AU)

Evaluación de la tolerancia al ejercicio en pacientes con EPOC. Prueba de marcha de 6 minutos / Evaluation exercise tolerance in COPD patients: the 6-minute walking test

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