[Predictive validity of Clinical Risk Groups in chronic patients in primary healthcare]. / Validez predictiva del Clinical Risk Groups en pacientes crónicos en el ambito de la atencion primaria.

OBJECTIVE: To analyse a prediction model for admissions and hospital emergencies based on Clinical Risk Groups, in a population of complex chronic patients demanding primary care. DESIGN: A multicentric retrospective observational study, of a cohort of chronic patients with comorbidity, from January until December 2013. PLACE: The study population was assigned to the Santa Pola and Raval health centres from the Health Department of Elche. PARTICIPANTS: Cohort of chronic patients with comorbidity, from January to December 2013. INTERVENTIONS: Data about the number of admissions, reasons and complexity level associated with the admission were collected by the review of medical records. MAIN MEASURES: To determine the level of complexity, the classification included in the chronicity strategy of the Valencian Community based on Clinical Risk Groups was used. RESULTS: Five hundred and four patients were recruited with a high complexity degree (N3) and 272 with moderate/low complexity (N1-N2). A higher comorbidity was observed in N3 patients with high complexity [Charlson 2.9 (DE 1.8) vs. 1.9 (DE 1.3); P<.001], and higher dependence degree for basic diary activities [Barthel 16.1 (n=81) vs. 7.3 (n=20); P<.001]. Association between the number of admissions [0.4 (DE 0.8) vs. 0.1 (DE 0.5); P<.001] and emergency visits [0.8 (DE 1.5) vs. 0.3 (DE 0.8), P<.001] was significatively higher in patients from N3 group than N1-N2 groups. CONCLUSIONS: The predictive capacity of CRG grouper showed high sensibility for the patient classification with a high degree of complexity. Its specificity and positive predictive value were lower for the association of the N3 complexity stratum.

Perfil epidemiológico de los ingresos involuntarios en el Servicio de Psiquiatría del Hospital Universitario de Gran Canaria Doctor Negrín / Epidemiological profile of involuntary admission in the Psychiatry Service of The University Hospital of Gran Canaria Doctor Negrin

Introducción los ingresos involuntarios por razón de trastorno psíquico se producen con relativa asiduidad en las unidades de internamiento hospitalarias de nuestro país. Este trabajo someterá a estudio las características socio-demográficas y clínicas que se encuentran en relación con este tipo de pacientes, para disponer de más información, tanto clínica como legal, con la que trabajar y desempeñar una mejor función, administración de recursos y desarrollo de habilidades necesarias ante estas situaciones. Material y métodos estudio observacional descriptivo retrospectivo, en el cual se analizarán diferentes variables, seleccionadas previamente, presentes en la población de pacientes psiquiátricos ingresados involuntariamente en el Hospital Doctor Negrín en un período de tiempo de 2 años, 2019 y 2020, determinando así el grado de prevalencia de cada una de ellas. Resultados entre las variables más asociadas al ingreso involuntario se encuentran: ser varón, en la cuarta década de la vida, soltero, sin hijos ni empleo y con un diagnóstico de trastorno psicótico o afectivo mayor que muy probablemente ha abandonado el tratamiento. Discusión sería conveniente hacer un especial seguimiento a los pacientes que cumplan el perfil anteriormente descrito con el objetivo de minimizar la involuntariedad. Es necesario el desarrollo de programas educacionales, de seguimiento y adherencia al alcance de la población de pacientes psiquiátricos para así poder minimizar la necesidad de ingresos involuntarios en nuestro medio. (AU)

Introduction Involuntary admissions due to mental disorders occur with relative regularity in hospital admission units in our country. This work will study the socio-demographic and clinical characteristics found in relation to this type of patients, in order to have more information, both clinical and legal, with which to work and perform a better function, administration of resources and development of necessary skills in these situations. Material and methods Retrospective descriptive observational study, in which different variables will be analyzed, previously selected, present in the population of psychiatric patients involuntarily admitted to the Doctor Negrín Hospital in a period of 2 years, 2019 and 2020, thus determining, the degree of prevalence of each of them. Results Among the variables most associated with involuntary admission are, being a man, in the fourth decade of life, single, without children, or employment, with a diagnosis of major psychotic or affective disorder who has most likely abandoned treatment. Discussion It would be advisable to carry out a special follow-up of patients who meet the profile described above in order to minimize involuntary occurrence. It is necessary to develop educational, follow-up and adherence programs within the reach of the population of psychiatric patients in order to minimize the need for involuntary admissions in our environment. (AU)

Utilidad y seguridad de los ingresos directos a una unidad hospitalaria de agudos de un servicio de geriatría valorados por atención geriátrica en residencias / Utility and safety of direct admission to acute geriatric unit after Nursing Home Geriatric Team assessment

Introducción y objetivo Más de la mitad de los ancianos institucionalizados necesita de una derivación anual a urgencias generando, por su complejidad, un alto uso de recursos y mayor riesgo de eventos adversos. El objetivo del estudio es valorar si la hospitalización directa en una unidad de geriatría de agudos, tras evaluación conjunta del equipo médico de residencia y del geriatra consultor, puede ser una alternativa segura y de utilidad en comparación con la atención en urgencias. Métodos Estudio observacional retrospectivo de los pacientes ingresados en la unidad de geriatría de agudos procedentes de las residencias atendidas por nuestro equipo de atención geriátrica a residencia entre el 01/01/2021 y el 31/12/2021. Se excluyeron los pacientes ingresados de forma programada o con diagnóstico de infección por SARS-CoV-2. Se recogieron variables de la historia clínica (sociodemográficas, clínicas, funcionales, cognitivas). Como variables resultado se registraron mortalidad durante el ingreso, estancia hospitalaria y en urgencias, traslado a urgencias y delirium en las primeras 48h del ingreso, ubicación al alta. Resultados 206 pacientes no COVID ingresaron directamente desde la residencia, 101 derivados desde urgencias (N: 307). Al ingreso el 62,5% presentaba Índice Barthel<40 y el 65% Cruz Roja Mental≥2, con Índice de Charlson ≥3 en el 56,4% de los casos. La mortalidad intrahospitalaria entre los ingresos directos fue del 14,6%, en el grupo derivado de urgencias del 20,8%, p=0,14. La estancia hospitalaria total de los pacientes valorados por atención geriátrica a residencia fue 9,61±6,01 días, mientras en los derivados a urgencias 11,22±5,36 días, p=0,02. Presentaron delirium en las primeras 48h del ingreso, 27,7% de los ingresos directos y 36,6% desde urgencias (p=0,11) (AU)

Background and objective More than half of institutionalized older people need a emergency department visit annually, with high resources consumption and higher risk of adverse events, due to high complexity. Direct admission to Acute Geriatric Unit (AGU), after geriatric consultant and nursing home medical team assessment, could be a safety and effective alternative to emergency department (ED) admission. Methods Retrospective observational study of AGU patients admitted by Nursing Home Geriatric Team between January, 1st and December, 31st, 2021. Planned admissions and SARS-CoV-2 positive patients were excluded. Medical (sociodemographic, clinical, functional and cognitive) records and outcomes data (inpatient mortality, hospital and ED lenght of stay, transfer to ED and delirium within 48h after admission, hospital discharge location) were collected. Results Two hundred and six patients directly admitted, 101 through ED (N 307). 62.5% with Barthel index <40, 65% with dementia, 56.4% with Charlson index ≥3. Inpatient mortality was 14.6% in direct admission, 20.8% in ED referral group, p=0.14. Hospital lenght of stay was 9.61±6.01 days in direct admission, 11.22±5.36 days in ED group, p=0.02. 27.7% of patients with delirium in direct admission and 36.6% in ED group; only one patient was transferred to ED, within 48h after admission. Conclusions Direct admission is a safety and effective alternative to ED referral in institutionalized older people after geriatric assessment, due to no increased mortality, shorter length of stay and hospital cost reduction (AU)

Implantación de un programa de mininefrolitotomía percutánea ambulatoria: presentación del protocolo y resultados iniciales / Initial results of the implementation of an ambulatory mini percutaneous nephrolithotomy program

Objetivo Presentar nuestro protocolo de nefrolitotomía percutánea ambulatoria y evaluar los resultados iniciales del programa. Material y métodos Se analiza la implantación clínica del protocolo con los 30 primeros casos de mininefrolitotomía percutánea ambulatoria realizados en nuestro centro entre abril de 2021 y septiembre de 2022. Se recogen datos demográficos, variables perioperatorias, complicaciones y necesidad de atención médica no planificada, stone-free rate, tipología litiásica y parámetros de satisfacción con el proceso de cirugía mayor ambulatoria. Resultados Con una edad media de 60,2±11,6 años se intervinieron un total de 30 pacientes que cumplían los criterios de inclusión. El tamaño medio de la litiasis fue de 15mm [rango: 5-20]. No se registró ninguna complicación intraoperatoria. Todos los pacientes excepto uno fueron dados de alta el mismo día de la intervención, según lo planificado. El mes posterior al alta, la tasa de complicaciones, reconsulta a urgencias o reingreso hospitalario ha sido del 0%. La stone-free rate a los 3 meses ha sido del 83%. La satisfacción global de todo el proceso perioperatorio, valorada a través del cuestionario EVAN-G, fue de 124,3 puntos sobre un máximo de 150, equivalente a un 78,6% de grado de satisfacción. Conclusión La mininefrolitotomía percutánea en régimen ambulatorio puede instaurarse como una opción de asistencia en centros con experiencia en endourología, una unidad establecida de cirugía mayor ambulatoria y mediante una selección estricta de los pacientes. Nuestros resultados iniciales muestran un perfil de seguridad adecuado y un grado de satisfacción global elevado de los pacientes intervenidos en esta modalidad (AU)

Objective To present our program for ambulatory mini percutaneous nephrolithotomy and evaluate its initial results. Material and methods We analyzed the implementation of the protocol into the clinical practice with the first 30 outpatient mini percutaneous nephrolithotomy cases performed in our center between April 2021 and September 2022. Demographic characteristics, perioperative variables, complications and need for unplanned health care, stone-free rate, stone type and patient satisfaction with the major ambulatory surgery process were collected. Results A total of 30 patients with a mean age of 60.2±11.6 years who met the inclusion criteria underwent surgery. The mean stone size was 15mm [range: 5-20]. No intraoperative complications were recorded. All patients except one were discharged the same day of surgery as planned. In the month following discharge, the rate of complications, emergency department revisits or hospital readmissions rates were 0%. Stone-free-rate at 3 months was 83%. Overall satisfaction with the whole perioperative process was assessed with the EVAN-G questionnaire, obtaining 124.3 points out of a maximum of 150, which is equivalent to a 78.6% level of satisfaction. Conclusion Ambulatory mini percutaneous nephrolithotomy can be implemented as a treatment option in centers with experience in endourology, an established major ambulatory surgery unit, and strictly selected patients. Our initial results show an adequate safety profile and high overall satisfaction perceived by patients undergoing the ambulatory approach (AU)

[Utility and safety of direct admission to acute geriatric unit after Nursing Home Geriatric Team assessment]. / Utilidad y seguridad de los ingresos directos a una unidad hospitalaria de agudos de un servicio de geriatría valorados por atención geriátrica en residencias.

BACKGROUND AND OBJECTIVE: More than half of institutionalized older people need a emergency department visit annually, with high resources consumption and higher risk of adverse events, due to high complexity. Direct admission to Acute Geriatric Unit (AGU), after geriatric consultant and nursing home medical team assessment, could be a safety and effective alternative to emergency department (ED) admission. METHODS: Retrospective observational study of AGU patients admitted by Nursing Home Geriatric Team between January, 1st and December, 31st, 2021. Planned admissions and SARS-CoV-2 positive patients were excluded. Medical (sociodemographic, clinical, functional and cognitive) records and outcomes data (inpatient mortality, hospital and ED lenght of stay, transfer to ED and delirium within 48h after admission, hospital discharge location) were collected. RESULTS: Two hundred and six patients directly admitted, 101 through ED (N 307). 62.5% with Barthel index <40, 65% with dementia, 56.4% with Charlson index ≥3. Inpatient mortality was 14.6% in direct admission, 20.8% in ED referral group, p=0.14. Hospital lenght of stay was 9.61±6.01 days in direct admission, 11.22±5.36 days in ED group, p=0.02. 27.7% of patients with delirium in direct admission and 36.6% in ED group; only one patient was transferred to ED, within 48h after admission. CONCLUSIONS: Direct admission is a safety and effective alternative to ED referral in institutionalized older people after geriatric assessment, due to no increased mortality, shorter length of stay and hospital cost reduction.

Sobrepeso y obesidad en Chile: Consideraciones para su abordaje en un contexto de inequidad social

Con 3 de cada 4 personas viviendo con sobrepeso u obesidad, la prevalencia de IMC elevado en Chile es de las más altas del continente, mostrando un patrón de distribución inequitativo mediado por determinantes estructurales que modelan el comportamiento en salud (seguridad social, nivel socioeconómico, educación, género, entre otros). Las características socioeconómicas del país, nación de ingresos altos con marcada inequidad, son poco comunes y representan un desafío adicional a la hora de diseñar intervenciones en salud. Una alta concentración de riqueza permite ser clasificado como país de ingresos altos aun cuando la mayor parte de la población pertenecería a una clase social vulnerable, cuyos ingresos se ven acompañados de recursos sociales y simbólicos que dificultan doblemente la adopción de un "estilo de vida" saludable. A pesar de las múltiples estrategias nutricionales implementadas, la prevalencia de sobrepeso y obesidad continúa en aumento. Se postula como gran responsable al insistente uso de modelos basados en elección y responsabilidad individual, que buscan modificar factores de riesgo conductuales (sedentarismo y alta ingesta calórica) sin neutralizar los determinantes estructurales que predisponen esa conducta. Favorablemente, la última Política Nacional de Nutrición reconoce la "determinación social de la alimentación", representando un cambio de paradigma que confiere cierto optimismo y cuya eficacia deberá ser evaluada en los próximos años.

With 3 out of 4 people living with overweight or obesity, the national prevalence of high BMI is among the highest on the continent, thus showing an inequitable distribution pattern mediated by structural determinants that shape health behavior (social security, socioeconomic status, education, gender, among others). The socioeconomic features of the country, a high-income nation with marked inequity, are unusual and represent an additional challenge when designing health interventions. A high concentration of wealth allows it to be classified as a high-income country even though most of the population would belong to a vulnerable social class, whose income is accompanied by social and symbolic resources that make it doubly challenging to adopt a healthy "lifestyle". Despite the multiple nutritional strategies implemented, the prevalence of overweight and obesity continues to increase. The insistent use of models based on individual choice and responsibility, which seek to modify behavioral risk factors (sedentary lifestyle and high caloric intake) without neutralizing the structural determinants predisposing this behavior, is postulated as highly responsible. Favorably, the latest National Nutrition Policy recognizes the "social determination of food", representing a paradigm shift that confers some optimism and whose effectiveness has to be evaluated in the coming years.

Capital psicológico que influye a la motivación intrínseca de universitarios del noroeste de México / Psychological capital influences the intrinsic motivation for university students from northwestern Mexico

Resumen El capital psicológico y la motivación, bajo la perspectiva teórica de la psicología positiva y la autodeterminación respectivamente, conducen al ser humano a la obtención de resultados y al éxito del desarrollo profesional y personal. Asimismo, ante situaciones problemáticas, representan recursos para generar estrategias de resolución. Se planteó como hipótesis que el capital psicológico ejerce influencia sobre la motivación intrínseca de estudiantes universitarios. El objetivo fue identificar un modelo empírico compuesto por dos factores en interacción de un grupo de 253 estudiantes universitarios de primer ingreso en la carrera de psicología, con un promedio de edad de 19.64 años (DT = 3.34). Se integró una muestra por conveniencia a la que se aplicó un cuestionario con reactivos de tipo escala valorativa: 29 reactivos midieron motivación con cinco opciones de respuesta y 24 reactivos capital psicológico con seis opciones de respuesta. La recolección de datos se realizó en diversas sesiones que duraron aproximadamente 20 minutos; el cuestionario fue contestado voluntariamente, y los datos recabados fueron analizados con ecuaciones estructurales. Se obtuvo un modelo con bondad de ajuste que identificó la influencia del capital psicológico sobre la motivación intrínseca, lo que representa que los estudiantes poseen fuertes motivadores internos para realizar sus estudios y auguran el desempeño exitoso, según advierten algunos estudios preliminares. De acuerdo con la teoría de la autodeterminación, prevalecen los factores internos para generar acciones que repercuten con diversos comportamientos organizacionales.

Abstract Psychological capital and motivation under the perspective of positive psychology and self-determination lead the human being to obtain results and success of professional and personal development; when faced with problematic situations, they also represent resources to generate resolution strategies. In work environments, psychological capital is considered an important resource as the human capital is in any organization. Currently, the study of the psychological capital is focused on university students, which means that educational institutions have to plan the graduate profile that will characterize future professionals. Psychological capital is a construct composed of personal resources defined as: optimism, hope, resilience, and self-efficacy. The data collected in the work environment indicated that these variables could favorably affect organizational effectiveness and job performance. Also, in the educational field, it has been observed that university students who scored high in psychological capital showed greater academic performance and success in completing their studies than those who obtained low scores. Specifically, some studies have shown a predominance of high hope and resilience scores of students. Psychological capital is an antecedent, mediating, or consequent variable that interacts with motivation, with various organizational behaviors, with academic performance, and success in completing professional studies. Therefore, this article set out to identify the influence that psychological capital exerted on the intrinsic motivation of the group of students included in the sample. The aim of this study was to identify an empirical model capable of showing if psychological capital is linked to intrinsic motivation in a group of 253 university newly admitted students the career of Psychology, with an average age of 19.64 years (DT = 3.34); 199 were female and 54 were male. A convenience sample was integrated, by choosing the participation of a cohort of students who were in groups conformed by the preferences of the students' schedules and the availability of space in each classroom. A questionnaire with rating scale items was applied: 29 items belonged to the Educational Motivation Scale, with five response options; and 24 items belonged to the Psychological Capital Scale, with six response options. The items on both scales demonstrated internal consistency in previous research. A psychologist carried out the data collection in several sessions that lasted approximately 20 minutes. The sample voluntarily answered the questionnaire. Structural equations were used to analyze the data. The confirmatory factor analysis technique was performed, since it allowed testing the hypothesis. The empirical model obtained had practical goodness of fit, since it presented a C2 = 26.51 (13 gl, p = .01). The practical goodness of fit was manifested in the fit values of .97 for BBN, .97 for BBNN and .98 for CFI. The RMSEA was equal to .06. The measurement model obtained was made up of four latent first-order variables (self-efficacy, hope, optimism, and resilience); these variables formed a latent second-order variable called psychological capital that influenced the second-order variable called intrinsic motivation. Intrinsic motivation was integrated by three first-order latent variables (intrinsic motivation to know, intrinsic motivation to accomplish, and intrinsic motivation to experience stimulation). A good-fit model identified the influence of psychological capital on intrinsic motivation, which meant that students had strong internal motivators to carry out their studies and predict successful performance according to some preliminary studies. The empirical model registered also had high factorial weights for hope and resilience. In this study, psychological capital (self-efficacy, hope, optimism, and resilience) was associated with intrinsic motivation (intrinsic motivation to know, intrinsic motivation to accomplish, and intrinsic motivation to experience stimulation). In previous research, the relationship with motivation was more generic. According to the theory of self-determination, internal factors prevail to generate actions that affect several organizational behaviors.

Preliminary results of the implementation of robotic radical prostatectomy in a major ambulatory surgery regimen.

OBJECTIVE: To report our initial experience with robotic radical prostatectomy as an outpatient procedure. MATERIAL AND METHODS: Retrospective analysis of patients who underwent RRP as MAS (Major Ambulatory Surgery) at our center between March 2021 and May 2022. We collected baseline patient characteristics, intraoperative outcomes and postoperative data (need for unplanned medical care and complications at one month after surgery). Oncologic characteristics at disease diagnosis (PSA, staging, ISUP, MRI) and postoperative pathologic outcomes were collected. RESULTS: We identified a total of 35 patients with an average age of 60,8 ± 6,88 years and a BMI of 27 ± 2,9 Kg/m2. All patients had a low anesthetic risk and 25.71% had undergone previous abdominal surgery. The surgical time was 151,66 ± 42,15 min and the average blood loss was 301,2 ± 184,38 mL. Two patients (5.7%) were admitted for one night and 7 patients (20%) consulted the emergency department in the following month, of which 3 (8.57%) were readmitted. We recorded one intraoperative complication, seven mild postoperative complications (Clavien I-II) and one severe complication (Clavien IIIb). The severe complication occurred on the eighth postoperative day and was not related to the procedure being ambulatory. CONCLUSION: The absence of serious complications in the immediate postoperative period supports RRP in MAS as a safe technique for selected patients.

Initial results of the implementation of an ambulatory mini percutaneous nephrolithotomy program.

OBJECTIVE: To present our program for ambulatory mini percutaneous nephrolithotomy (mini-PCNL) and evaluate its initial results. MATERIAL AND METHODS: We analyzed the implementation of the protocol into the clinical practice with the first 30 outpatient mini-PCNL cases performed in our center between April 2021 and September 2022. Demographic characteristics, perioperative variables, complications and need for unplanned health care, stone-free rate (SFR), stone type and patient satisfaction with the major ambulatory surgery (MAS) process were collected. RESULTS: A total of 30 patients with a mean age of 60.2 ±â€¯11.6 years who met the inclusion criteria underwent surgery. The mean stone size was 15 mm [range: 5-20]. No intraoperative complications were recorded. All patients except one were discharged the same day of surgery as planned. In the month following discharge, the rate of complications, emergency department (ED) revisits or hospital readmissions rates were 0%. Stone-free-rate (SFR) at 3 months was 83%. Overall satisfaction with the whole perioperative process was assessed with the EVAN-G questionnaire, obtaining 124.3 points out of a maximum of 150, which is equivalent to a 78.6% level of satisfaction. CONCLUSION: Ambulatory mini-PCNL can be implemented as a treatment option in centers with experience in endourology, an established MAS Unit, and strictly selected patients. Our initial results show an adequate safety profile and high overall satisfaction perceived by patients undergoing the ambulatory approach.

Changes in food habits and food-related satisfaction before and during the COVID-19 pandemic in dual-earner families with adolescents

Introduction: Food habits have been associated with positive outcomes during the COVID-19 pandemic. Family members may share protective factors, but each member may also respond differently to the pandemic. Aim: To examine food habits in different-sex dual-earner parents with adolescents, comparing reports from late 2019 before the pandemic (T1) and mid- 2020 during the pandemic (T2) in Temuco, Chile. Method: A sample of 193 families composed of mother, father, and one adolescent aged 10 to 15 responded to a questionnaire at T1 and T2. Non-parametric tests were used to compare family food-related habits and the satisfaction with food-related life of each family member at T1 and T2. An Actor-Partner Interdependence Model was conducted to explore relations between T1 and T2 variables and between family members. Results: Frequency of family meals increased during the pandemic, and mothers increased their cooking hours. All family members improved their diet quality during the pandemic. Perceived family meal atmosphere and satisfaction with food-related life did not change. T1 food habits were not associated with T2 satisfaction with food-related life. Conclusion: These families changed their food-related habits during the pandemic, but their food-related life assessment was similar before and during the pandemic.

Introducción: Las prácticas alimentarias se han asociado con mayor bienestar durante la pandemia por COVID-19. Aunque en una familia se comparten condiciones de vida, cada miembro puede responder de modo diferente a la pandemia. Objetivo: Examinar las prácticas alimentarias en parejas con doble ingreso e hijos adolescentes, comparando reportes antes de la pandemia (finales de 2019, T1) y durante la pandemia (mediados de 2020, T2) en Temuco, Chile. Método: 193 familias compuestas por madre, padre y un hijo adolescente de 10 a 15 años respondieron un cuestionario en T1 y T2. Se utilizaron pruebas no-paramétricas para comparar hábitos alimentarios y satisfacción con la alimentación para cada miembro de la familia en T1 y T2. Se exploraron las relaciones entre variables en T1 y T2, y entre miembros de la familia usando el modelo de interdependencia de actor-compañero. Resultados: La frecuencia de las comidas familiares y las horas que la madre dedicó diariamente a cocinar aumentaron durante la pandemia. Los tres miembros de la familia mejoraron la calidad de su dieta durante la pandemia. La atmósfera percibida de comidas familiares y la satisfacción con la alimentación no cambiaron. Los hábitos alimentarios del T1 no incidieron en la satisfacción con la alimentación en T2. Conclusión: Los hábitos alimenticios de estas familias cambiaron durante la pandemia, pero la evaluación de su vida alimentaria fue similar antes y durante la pandemia.

Resultados preliminares de la implementación de la prostatectomía radical robótica en régimen de cirugía mayor ambulatoria / Preliminary results of the implementation of robotic radical prostatectomy in a major ambulatory surgery regimen

Objetivo Reportar nuestra experiencia inicial de prostatectomía radical robótica (PRR) en régimen ambulatorio. Material y métodos Análisis retrospectivo de los pacientes intervenidos de PRR en cirugía mayor ambulatoria (CMA) en nuestro centro entre marzo de 2021 y mayo de 2022. Recopilamos las características basales de los pacientes, los resultados intraoperatorios y los datos del postoperatorio (necesidad de asistencia médica no planificada y complicaciones al mes de la cirugía). Se recogieron las características oncológicas al diagnóstico de la enfermedad (PSA, estadificación, ISUP, RMN) y el resultado anatomopatológico tras la intervención. Resultados Identificamos un total de 35 pacientes, con una edad promedio de 60,8 ±6,88 años y un IMC de 27 ±2,9kg/m2. Todos presentaban un riesgo anestésico bajo y un 25,71% tenían alguna cirugía abdominal previa. El tiempo quirúrgico fue de 151,66 ±42,15 minutos y el sangrado promedio fue de 301,2 ±184,38mililitros. Dos pacientes (5,7%) ingresaron la primera noche de la cirugía y 7 pacientes (20%) consultaron en urgencias en el mes siguiente, de los cuales 3 (8,57%) reingresaron. Registramos una complicación intraoperatoria, 7 complicaciones postoperatorias leves (ClavienI-II) y una complicación grave (ClavienIIIb). La complicación grave transcurrió al octavo día postoperatorio y no tuvo relación con la ambulatorización del procedimiento. Conclusión La ausencia de complicaciones graves en el postoperatorio inmediato avala la PRR en régimen de CMA como una técnica segura dirigida a pacientes seleccionados (AU)

Objective To report our initial experience with robotic radical prostatectomy (RRP) as an outpatient procedure. Material and methods Retrospective analysis of patients who underwent RRP as major ambulatory surgery (MAS) at our center between March 2021 and May 2022. We collected baseline patient characteristics, intraoperative outcomes and postoperative data (need for unplanned medical care and complications at one month after surgery). Oncologic characteristics at disease diagnosis (PSA, staging, ISUP, MRI) and postoperative pathologic outcomes were collected. Results We identified a total of 35 patients with an average age of 60,8 ±6,88years and a BMI of 27 ±2,9kg/m2. All patients had a low anesthetic risk and 25.71% had undergone previous abdominal surgery. The surgical time was 151,66 ±42,15minutes and the average blood loss was 301,2 ±184,38milliliters. Two patients (5.7%) were admitted for one night and 7 patients (20%) consulted the emergency department in the following month, of which 3 (8.57%) were readmitted. We recorded one intraoperative complication, 7 mild postoperative complications (ClavienI-II) and one severe complication (ClavienIIIb). The severe complication occurred on the eighth postoperative day and was not related to the procedure being ambulatory. Conclusion The absence of serious complications in the immediate postoperative period supports RRP in MAS as a safe technique for selected patients (AU)

Geração de renda para população em situação de rua: relato de experiência / Income generation for homeless people: an experience report / Generación de ingresos para la población en situación de calle: reporte de experiencia

Uma das demandas centrais das pessoas em situação de rua é a dificuldade de acesso a trabalho e renda, o que tanto pode levá-las a essa circunstância como dificultar sua saída das ruas. Nessa direção, em parceria com o Movimento Nacional da População em Situação de Rua em Natal, Rio Grande do Norte (MNPR/RN), Brasil, realizamos projeto de extensão com os objetivos de fortalecer as ações de geração de renda para os militantes do referido movimento e para o movimento em si e de promover a organização coletiva e política dos militantes do MNPR/RN em torno da pauta trabalho. Baseamo-nos na Economia Solidária para elaborar ações de geração de renda e fortalecimento político, e na Psicologia Social do Trabalho para informar sobre as intervenções realizadas pela equipe extensionista. Como estratégia de ação, foram realizados cinco bazares solidários em 2019, os quais envolveram militantes do MNPR/RN e extensionistas em reuniões preparatórias, arrecadação de materiais e efetivação dos bazares. Avaliou-se que os bazares foram uma ótima estratégia para a arrecadação de fundos para o movimento e a geração de renda imediata para os militantes envolvidos, mas que não garantiram a médio e longo prazo a renda dessas pessoas. Também possibilitaram o fortalecimento da autonomia, da participação ativa como trabalhadores e trabalhadoras e do aprendizado mútuo sobre princípios da Economia Solidária.(AU)

One of the main demands of people living on the streets is the difficulty in accessing work and income, which can either lead them to this circumstance or make it difficult for them to leave the streets. In this direction, in partnership with the National Movement of Homeless Population in Natal, in the state of Rio Grande do Norte (Movimento Nacional População de Rua - MNPR/RN), we carried out an extension project with the objectives of strengthening the actions to generate income for the militants of the referred movement and for the movement itself and to promote the collective and political organization of the MNPR/RN militants around the work agenda. We start with the Solidarity Economy for the elaboration of actions to generate income and political strengthening, and from the Social Psychology of Work to inform about the interventions carried out by the extension team. As an action strategy, five solidarity bazaars were held in 2019, involving MNPR/RN militants and extension workers in preparatory meetings, collection of materials, and holding the bazaars. The bazaars were considered an excellent strategy for raising funds for the movement and generating immediate income for the activists involved, but that they could not guarantee the income of these people in the medium and long term. It also allowed for the strengthening of autonomy, active participation as a female or male worker, and mutual learning on the principles of Solidarity Economy.(AU)

Una de las principales demandas de las personas en situación de calle es la dificultad para acceder al trabajo y a los ingresos, lo que puede llevarlos a esta situación o dificultarles su salida de la calle. En este sentido, en colaboración con el Movimiento Nacional de Población en Situación de Calle en Natal/RN (MNPR/RN), realizamos un proyecto de extensión con los objetivos de fortalecer las acciones de generación de ingresos para los activistas del referido movimiento y para el movimiento en sí y de promover la organización colectiva y política de los activistas del MNPR/RN en torno a las normas del trabajo. Partimos de la economía solidaria para desarrollar acciones de generación de ingresos y de fortalecimiento político, y desde la Psicología Social del Trabajo para informar de las intervenciones que realiza el equipo de extensión. Como estrategia de acción, en el 2019 se realizaron cinco ferias solidarias, en las cuales participaron activistas y grupos de extensión del MNPR/RN en reuniones preparatorias, recolección de materiales y realización de las ferias. Se consideró que las ferias son una excelente estrategia para recaudar fondos para el movimiento y generar ingresos inmediatos para los activistas involucrados, pero no pueden garantizar los ingresos de estas personas a mediano y largo plazo. También permiten fortalecer la autonomía, la participación activa como trabajador y trabajadora, y el aprendizaje mutuo sobre los principios de la economía solidaria.(AU)

O papel da herança cultural nos processos de ingresso na carreira diplomática brasileira entre 1995-2015 / El papel del patrimonio cultural en los exámenes de admisión a la carrera diplomática brasileña entre 1995-2015 / The role of cultural heritage in the admission exams for the Brazilian diplomatic career between 1995-2015

Resumo A seleção de novos membros para ocupar cargos na estrutura burocrática federal brasileira mudou progressivamente durante a segunda metade da década de 1990. Se a orientação inicial foi marcada pela retomada quantitativa dos concursos públicos federais (1995-2002), após 2003 a tendência foi de buscar atrair uma maior diversidade de setores sociais nas carreiras públicas - e a seleção de diplomatas não ficou alheia a este processo. A análise qualitativa de fontes primárias (documentos) e fontes secundárias (revisão de literatura) permitiu verificar que, juntamente com iniciativas já reconhecidas na literatura - aumento do número de vagas e da remuneração, isenção de inscrição, entre outras -, a própria modificação das questões formuladas nas provas aplicadas entre 1995 e 2015 pode ser entendida como uma medida com o objetivo de alteração do perfil dos ingressantes na carreira diplomática. Entre 1995 e 2004, a prova avaliou e selecionou os candidatos mediante questões de "cultura geral", que privilegiavam uma certa "herança cultural" reputada como sinal de distinção social e associada a um perfil social pretensamente sofisticado. No entanto, entre 2004 e 2015 parece ter havido uma padronização das novas questões, que, afastando-se das exigências tácitas de refinamento cultural, dariam preferência a outros perfis de candidatos.

Resumen La selección de nuevos miembros para ocupar los cargos públicos federales brasileños cambió progresivamente durante la segunda mitad de la década de 1990. Si la orientación inicial estuvo marcada por la reanudación cuantitativa de los concursos públicos federales (1995-2002), en el período posterior a 2003 esta tendencia buscó atraer una mayor diversidad de sectores sociales a las carreras públicas - y la selección de diplomáticos no quedó ajena a este proceso. El análisis cualitativo de fuentes primarias (documentos) y fuentes secundarias (revisión bibliográfica) permitió constatar que, junto a iniciativas ya reconocidas en la literatura - aumento del número de vacantes y remuneración, exención de registro, entre otras -, se puede entender la modificación de las preguntas formuladas en los exámenes aplicados entre 1995 y 2015 como una medida hacia la alteración del perfil de quienes ingresan a la carrera diplomática. Entre 1995 y 2004 la prueba evaluó y seleccionó a los candidatos a través de preguntas de "cultura general", que privilegiaron un "patrimonio cultural" reputado como signo de distinción social y asociado a un perfil social supuestamente sofisticado. Sin embargo, entre 2004 y 2015 parece haberse producido una estandarización de las nuevas preguntas, que, alejándose de las exigencias tácitas del refinamiento cultural, darían preferencia a otros perfiles de candidatos.

Abstract The selection of new members to occupy positions in the Brazilian federal bureaucratic framework changed progressively during the second half of the 1990s. If the initial orientation was characterized by the quantitative resumption of federal public tenders (1995-2002), post-2003, this trend sought to attract a greater diversity of social sectors in public careers — and the selection of diplomats was not alien to this process. The qualitative analysis of primary sources (documents) and secondary sources (literature review) showed that, along with initiatives already recognized in the literature — increase in the number of vacancies and remuneration, exemption from registration, among others — the very modification of questions formulated in the exams applied between 1995 and 2015 can be understood as a measure toward the alteration of the profile of those entering the diplomatic career. Between 1995 and 2004, the test evaluated and selected the candidates through questions of "general culture," which privileged a certain "cultural heritage" reputed as a sign of social distinction and associated with an allegedly sophisticated social profile. However, between 2004 and 2015, there seems to have been a standardization of the new questions, which, moving away from the tacit requirements of cultural refinement, gave preference to other candidate profiles.

Evaluación del grado de congestión clínica y hemodinámica como predictores de mortalidad en pacientes ambulatorios con insuficiencia cardíaca de edad avanzada / Assessment of clinical and hemodynamic congestion as predictors of mortality in elderly outpatients with heart failure

Introducción El objetivo del estudio fue evaluar si la exploración física y la determinación de la fracción N-terminal del propéptido natriurético cerebral pueden predecir un peor pronóstico en pacientes ambulatorios con insuficiencia cardíaca. Pacientes y métodos Estudio retrospectivo llevado a cabo entre 2010 y 2018, en 238 pacientes diagnosticados de insuficiencia cardíaca. Al inicio, se evaluó la presencia de crepitantes pulmonares y edema de miembros inferiores (congestión clínica) junto con la fracción N-terminal del propéptido natriurético cerebral≥1500pg/mL (congestión hemodinámica). Los pacientes se clasificaron en 4 grupos en función del patrón congestivo: sin congestión (G1) (n=50); con congestión clínica (G2) (n=43); con congestión hemodinámica (G3) (n=73) y con congestión clínica y hemodinámica (G4) (n=72). El objetivo primario fue la muerte por cualquier causa al año de seguimiento. Resultados Se analizaron un total de 238 pacientes, edad media 82 años, 61,8% mujeres, y 20,7% con fracción de eyección del ventrículo izquierdo reducida. Treinta pacientes (12,6%) fallecieron en el primer año de seguimiento. Después de ajustar por variables de confusión (sexo, alta hospitalaria reciente por insuficiencia cardíaca, filtrado glomerular estimado, y fracción de eyección del ventrículo izquierdo), el riesgo de muerte en cada grupo,al compararlos con el grupo de referencia G1, fue: G2, HR 4,121 (IC95% 1,131–15,019); G3, HR 2,511 (IC95% 1,007-6,263), y; G4, HR 7,418 (IC95% 1,630-33,763). Conclusión La congestión en pacientes ambulatorios con insuficiencia cardíaca se correlaciona con el pronóstico. Los pacientes con congestión clínica y hemodinámica tuvieron el mayor riesgo de muerte global al año (AU)

Introduction This work aims to evaluate whether a clinical examination and measurement of N-terminal pro-brain natriuretic peptide can predict poor prognosis in outpatients with heart failure. Patients and methods We carried out a retrospective study from 2010 to 2018 in 238 patients diagnosed with heart failure. At baseline, we evaluated the presence of pulmonary rales and bilateral leg edema (clinical congestion) together with N-terminal pro-brain natriuretic peptide≥1500 pg/mL (hemodynamic congestion). Patients were classified into 4 groups depending on their congestion pattern: no congestion (G1) (n=50); clinical congestion (G2) (n=43); hemodynamic congestion (G3) (n=73); and clinical and hemodynamic congestion (G4) (n=72). The primary outcome was all-cause mortality at one year of follow-up. Results A total of 238 patients were included. The mean age was 82 years, 61.8% were women, and 20.7% had reduced left ventricular ejection fraction. Thirty patients died in the first year of follow-up (12.6%). After controlling for confounding variables (sex, recent discharge for heart failure, estimated glomerular filtration rate, and left ventricular ejection fraction), the independent risk of death in each group compared to G1 as the reference group was: G2: HR 4.121 (95%CI 1.131-15.019); G3: HR 2.511 (95%CI 1.007-6.263); and G4: HR 7.418 (95%CI 1.630-33.763). Conclusion Congestion in outpatients with heart failure correlates with prognosis. Patients with both clinical and hemodynamic congestion had the highest risk of all-cause death at one year (AU)

[Influence of medical outliers in patients with femoral neck fracture]. / Influencia del ingreso hospitalario ectópico en pacientes con fractura del cuello femoral.

OBJECTIVES: The objective is to describe and analyze how outlier admission influences hospital stay and the appearance of complications in patients with a femoral neck fracture treated with arthroplasty. MATERIAL AND METHOD: A historical cohort study was carried out in which the group of patients with a displaced fracture of the femoral neck who had an outlier admission was defined as an exposed cohort, that is, they were admitted to a hospitalization area not belonging to the Orthopedic Surgery and Traumatology department, unlike the unexposed cohort, that included patients admitted to a hospitalization area assigned to the Orthopedic Surgery and Traumatology department. RESULTS: Outlier admission was a risk factor for requiring a postoperative transfusion (RR 1.52, 95% CI 1.05-2.21; P=.035), to have a postoperative stay longer than 5 days (RR 1.35, 95% CI 1.04-1.74; P=.038) and to suffer general postoperative complications (RR 1.35, 95% CI 1.02-1.78; P=.048). CONCLUSIONS: Outlier admission is a threat to the quality and safety of health care. In patients over 80 years of age, medical outliers is a risk factor for postoperative transfusion and systemic postoperative complications.

Model to predict risk for hospital admission and indicate the safety of reverse triage in a hospital emergency department: a prospective validation study. / Validación prospectiva de un modelo predictivo de ingreso y orientar la seguridad de la derivación inversa desde el triaje de los servicios de urgencias hospitalarios.

OBJECTIVES: To prospectively validate a model to predict hospital admission of patients given a low-priority classification on emergency department triage and to indicate the safety of reverse triage. MATERIAL AND METHODS: Single-center observational study of a prospective cohort to validate a risk model incorporating demographic and emergency care process variables as well as vital signs. The cohort included emergency visits from patients over the age of 15 years with priority level classifications of IV and V according to the Andorran-Spanish triage system (Spanish acronym, MAT-SET) between October 2018 and June 2019. The area under the receiver operating characteristic curve (AUC) of the model was calculated to evaluate discrimination. Based on the model, we identified cut-off points to distinguish patients with low, intermediate, or high risk for hospital admission. RESULTS: A total of 2110 emergencies were included in the validation cohort; 109 patients (5.2%) were hospitalized. The median age was 43.5 years (interquartile range, 31-60.3 years); 55.5% were female. The AUC was 0.71 (95% CI, 0.64-0.75). The model identified 357 patients (16.9%) at low risk of hospitalization and 240 (11.4%) at high risk. A total of 15.8% of the high-risk patients and 2.8% of the low-risk patients were hospitalized. CONCLUSION: The validated model is able to identify risk for hospitalization among patients classified as low priority on triage. Patients identified as having high risk of hospitalization could be offered preferential treatment within the same level of priority at triage, while those at low risk of admission could be referred to a more appropriate care level on reverse triage.

OBJETIVO: Validar prospectivamente un modelo predictivo de ingreso hospitalario para los pacientes atendidos en el servicio de urgencias hospitalario (SUH) con baja prioridad de visita y determinar la capacidad predictiva del modelo para realizar con seguridad la derivación inversa. METODO: Estudio observacional unicéntrico de una cohorte prospectiva de validación de un modelo predictivo basado en variables demográficas, de proceso y las constantes vitales (modelo 3). Se incluyeron los episodios de pacientes >15 años con prioridades IV y V MAT-SET atendidos entre octubre 2018 y junio 2019. Se evaluó la discriminación mediante el área bajo la curva de la característica operativa del receptor (ABC). Para determinar la capacidad de discriminación se crearon 3 categorías de riesgo: bajo, intermedio y alto. RESULTADOS: Se incluyeron 2.110 episodios, de los cuales 109 (5,2%) ingresaron. La mediana de edad fue de 43,5 años (RIC 31-60,3) con un 55,5% de mujeres. El ABC fue de 0,71 (IC 95%: 0,64-0,75). Según el modelo predictivo, 357 episodios (16,9%) puntuaron de bajo riesgo de ingreso y 240 (11,4%) de alto riesgo. El porcentaje de ingreso observado de los pacientes clasificados de alto riesgo fue de 15,8% mientras que el de los pacientes de bajo riego fue de 2,8%. CONCLUSIONES: El modelo predictivo validado permite estratificar el riesgo de ingreso de los pacientes con baja prioridad de visita. Los pacientes con alto riesgo de ingreso se les podría ofrecer una atención preferente dentro del mismo nivel de prioridad, mientras que los de bajo riesgo podrían ser redirigidos al recurso asistencial más adecuado (derivación inversa).

Impacto de la Pandemia por SARS-CoV-2 en el Perfil de Ingreso y Egreso de una Unidad de Cuidados Intensivos según Escala de Categorización Kinesiológica / Impact of the SARS-CoV-2 Pandemic on the Admission and Discharge Profile of an Intensive Care Unit according to the Kinesiological Categorization Scale

Introducción. La pandemia por coronavirus trajo consigo una modificación y una reestructuración de las unidades de cuidados intensivos(UCI). Además se produjo un cambio en el perfil de pacientes que ingresan y egresan en estas unidades. Objetivo. Valorar el impacto de la presente pandemia en el perfil de ingreso y egreso de pacientes en UCI según escala de categorización kinesiológica de la unidad. Métodos. Estudio observacional descriptivo que incluyó 50 sujetos de UCI que contaran con escala de categorización kinesiológica (ECK) al ingreso y egreso de la unidad. La ECK contemplo 3 item de evaluación: Función ventilatoria, manejod e secreciones, grado de cooperación y nivel de actividad. El registro de la ECK se planteó de manera retrospectiva para los periodos Julio-agosto 2018 (prepandemia) y Julio - Agosto 2020 (pandemia). Se utilizó estadística descriptiva, utilizando porcentaje y/o promedio para cada variable según corresponda. Resultados. Al observar la función ventilatoria, el requerimiento de soporte ventilatorio varió de un 64% a un 16% pre ­ pandemia, y de un 100% a un 88% durante la pandemia. Respecto al manejo de secreciones, se observó que los sujetos con tos efectiva varío desde un 60% a un 22% en el periodo pandemia Por otra parte, los pacientes que requirieron succión traqueal de manera constante en pandemia, se mantuvo. entre un 88% a un 92% durante la estadía en UCI. En relación al grado de cooperación, un 78% de los pacientes con COVID-19 ingresó con una dependencia severa o nula cooperación, y al momento del egreso de UCI un 54% se mantenía en la misma condición. Respecto al nivel de actividad, durante el periodo pandemia, un 100% de los ingresos y un 96% de los egresos presentó dependencia total. Conclusión. La pandemia causada por SARS-CoV-2 ha influido directamente en el perfil de ingreso y egreso de pacientes UCI, lo cual enfrentó al personal de salud a un aumento considerable en la carga de trabajo.

Introduction. The coronavirus led to a modification and a building of new intensive care units (ICU). In addition, there was a change in the profile of patients admitted and discharged from these units. Objetive. Assess the impact of this pandemy on the admission and discharge profile of patients in the ICU according to a kinesiological categorization scale of the unit. Methods. Descriptive observational study that included 50 ICU subjects who had a Kinesiology Categorization Scale (ECK) at admission and discharge from the unit. The ECK contemplates 3 evaluation elements: ventilatory function, management and secretions, degree of cooperation and level of activity. The ECK registry was considered retrospectively for the periods July-August 2018 (pre-pandemy) and July-August 2020 (pandemy). Descriptive statistics was developed, using percentage and/or average for each variable as appropriate. Results: Looking at ventilatory function, the requirement for ventilatory support varied from 64% to 16% pre-pandemic, and from 100% to 88% during the pandemic. Regarding the management of secretions, it was shown that the subjects with effective cough varied from 60% to 22% in the pandemic period. On the other hand, the patients who required tracheal suctioning constantly in the pandemic were maintained. between 88% and 92% during the ICU stay. Regarding the degree of cooperation, 78% of the patients with COVID-19 were admitted with a severe dependency or no cooperation, and at the time of discharge from the ICU, 54% were pressed in the same condition. Regarding the level of activity, during the pandemic period, 100% of income and 96% of expenses presented total dependency. Conclusion. The pandemy caused by SARS-CoV-2 has directly influenced the admission and discharge profile of ICU patients, which confronted health personnel with a considerable increase in workload.

Impacto del abandono de la lactancia materna exclusiva sobre la salud de los lactantes / Impact of exclusive breastfeeding withdrawal on the health of babies

Introducción: El abandono de la lactancia materna es uno de los problemas que enfrenta el Sistema Nacional de Salud en Cuba por las consecuencias desfavorables que representa para la salud de los lactantes. Objetivo: Identificar la relación entre el abandono de la lactancia materna exclusiva y las afectaciones en la salud de los lactantes. Material y Métodos: Se realizó un estudio descriptivo, retrospectivo de corte transversal, en 105 lactantes del Policlínico Aleida Fernández Chardiet nacidos en 2019, cuyas madres dejaron de utilizar la lactancia materna exclusiva antes del sexto mes. Las variables utilizadas fueron edad materna, tiempo de duración de la lactancia materna exclusiva, las enfermedades más frecuentes diagnosticadas en el niño y la necesidad de ingresos hospitalarios. Se aplicó la prueba no paramétrica de independencia Chi Cuadrado para demostrar la relación entre variables. Resultados: Predominó el abandono de la lactancia materna exclusiva antes de los 3 meses y no se encontró relación estadísticamente significativa entre esta y las afecciones más frecuentes de los lactantes (las IRA en 40 por ciento y las EDA en 23,8 por ciento). El 55,2 por ciento necesitó ingreso hospitalario antes del sexto mes y la relación con el abandono precoz de la lactancia materna exclusiva fue estadísticamente significativa. Conclusiones: El abandono precoz de la lactancia materna exclusiva afecta la salud de los lactantes y aunque las afecciones no tuvieron una relación estadísticamente significativa con aquella sí tienen una elevada frecuencia en estos niños de tan corta edad(AU)

Introduction: Breastfeeding withdrawal is one of the challenges faced by the Cuban National Health System due to its adverse consequences on the health of babies. Objective: To identify the relationship between exclusive breastfeeding withdrawal and health disorders in babies. Material and Methods: A descriptive, retrospective, cross-sectional study was carried out on 105 breastfed babies from "Aleida Fernández Chardiet" Policlinic who were born in 2019 and were precociously weaned from exclusive breastfeeding before the sixth month. The variables used were: maternal age, duration of exclusive breastfeeding, most frequent diseases diagnosed in the child, and need for hospital admission. The chi-squared non-parametric independence test was used to show the relationship among variables. Results: Exclusive breastfeeding withdrawal before the third month was predominant (71, 4 percent); the most frequent diseases diagnosed were respiratory diseases and diarrheas (40 percent and 23,8 percent, respectively); about half the babies required hospital admission (55,2 percent) before the sixth month; the relationship with early withdrawal of breastfeeding was statistically significant. Conclusions: Early withdrawal of breastfeeding has negative effects on the health of babies. Although the illnesses did not have a statistically significant relationship with it, a high frequency of their incidence was found in such young babies(AU)

Validación prospectiva de un modelo predictivo de ingreso y orientar la seguridad de la derivación inversa desde el triaje de los servicios de urgencias hospitalarios / Model to predict risk for hospital admission and indicate the safety of reverse triage in a hospital emergency department: a prospective validation study

Objetivo. Validar prospectivamente un modelo predictivo de ingreso hospitalario para los pacientes atendidos en el servicio de urgencias hospitalario (SUH) con baja prioridad de visita y determinar la capacidad predictiva del modelo para realizar con seguridad la derivación inversa. Método. Estudio observacional unicéntrico de una cohorte prospectiva de validación de un modelo predictivo basado en variables demográficas, de proceso y las constantes vitales (modelo 3). Se incluyeron los episodios de pacientes >15 años con prioridades IV y V MAT-SET atendidos entre octubre 2018 y junio 2019. Se evaluó la discriminación mediante el área bajo la curva de la característica operativa del receptor (ABC). Para determinar la capacidad de discriminación se crearon 3 categorías de riesgo: bajo, intermedio y alto. Resultados. Se incluyeron 2.110 episodios, de los cuales 109 (5,2%) ingresaron. La mediana de edad fue de 43,5 años (RIC 31-60,3) con un 55,5% de mujeres. El ABC fue de 0,71 (IC 95%: 0,64-0,75). Según el modelo predictivo, 357 episodios (16,9%) puntuaron de bajo riesgo de ingreso y 240 (11,4%) de alto riesgo. El porcentaje de ingreso observado de los pacientes clasificados de alto riesgo fue de 15,8% mientras que el de los pacientes de bajo riego fue de 2,8%. Conclusiones. El modelo predictivo validado permite estratificar el riesgo de ingreso de los pacientes con baja priori- dad de visita. Los pacientes con alto riesgo de ingreso se les podría ofrecer una atención preferente dentro del mismo nivel de prioridad, mientras que los de bajo riesgo podrían ser redirigidos al recurso asistencial más adecuado (derivación inversa).

Objectives. To prospectively validate a model to predict hospital admission of patients given a low-priority classification on emergency department triage and to indicate the safety of reverse triage. Methods. Single-center observational study of a prospective cohort to validate a risk model incorporating demographic and emergency care process variables as well as vital signs. The cohort included emergency visits from patients over the age of 15 years with priority level classifications of IV and V according to the Andorran–Spanish triage system (Spanish acronym, MAT-SET) between October 2018 and June 2019. The area under the receiver operating characteristic curve (AUC) of the model was calculated to evaluate discrimination. Based on the model, we identified cut-off points to distinguish patients with low, intermediate, or high risk for hospital admission. Results. A total of 2110 emergencies were included in the validation cohort; 109 patients (5.2%) were hospitalized. The median age was 43.5 years (interquartile range, 31-60.3 years); 55.5% were female. The AUC was 0.71 (95% CI, 0.64-0.75). The model identified 357 patients (16.9%) at low risk of hospitalization and 240 (11.4%) at high risk. A total of 15.8% of the high-risk patients and 2.8% of the low-risk patients were hospitalized. Conclusions. The validated model is able to identify risk for hospitalization among patients classified as low priority on triage. Patients identified as having high risk of hospitalization could be offered preferential treatment within the same level of priority at triage, while those at low risk of admission could be referred to a more appropriate care level on reverse triage.