[Protocols implementing in a university hospital. An assessment of various methods]. / Implantación de protocolos en un hospital universitario. Evaluación de diferentes métodos.

OBJECTIVE: To establish a method for evaluating, in a systematic and periodic way, the degree of compliance with the protocols currently being used in the hospital. MATERIALS AND METHOD: Experts from the hospital designed 6 protocols which were later approved by consensus by several committees and agreed by Medical Direction. The doctors were informed of the new protocols by means of info-sessions and printed materials. In order to evaluate to what extent the protocols were complied with, we carried out a number of longitudinal and cross-sectional studies depending on how often the protocols are used. RESULTS: The study involved 2,190 patients. Cross-sectional studies. Surgical antimicrobial prophylaxis protocol: compliance with the application forms was 83.3% and for surgical interventions it was 64.3%. It should be noted that adherence improved with time. Sliding-scale insulin therapy: compliance improved during the observation period from 54 to 71.1%. Prevention of NSAID induced gastropathy: after 6 months a significant improvement was observed in relation to the previous phase. Pain treatment: of the 117 analgesics prescribed on-demand in the previous phase, 27.3% were administered, as well as 68.4% of a total of 95 fixed prescriptions. In the phases previous to setting up these protocols, adherence ranged from 0 to 68.4%. One year later, adhesion has improved significantly for all the evaluated protocols. Longitudinal studies. Community acquired pneumonia: adhesion was 60.8%, while non significant differences were observed according to severity. Transitory ischemic accident: compliance evaluation showed an adherence value of 81.8%. CONCLUSIONS: When the degree of compliance is high, follow-up studies may be spaced out in time. If not, the reasons for this low compliance must be identified and measures must be taken. Follow-up studies must be carried out more often when protocols have just been set up and less frequently as adherence improves.

Retos del "cañón" de proyección / Challenges of the projection "cannon"

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[Effect of home hospitalization in the reduction of traditional hospitalization and frequency of emergencies in heart failure]. / Efecto de la hospitalización a domicilio en la reducción de la hospitalización convencional y frecuentación de urgencias en la insuficiencia cardíaca.

OBJECTIVE: Medical care to patients with heart failure (HF) entails high needs in health care and social resources. Hospital at home (HH) is a potentially useful care alternative for these patients. MATERIALS AND METHODS: Observational study with 110 elderly patients with non complicated HF admitted to an HH unit. Patients were treated with educational support (clinical, dietetic and pharmacologic) and intensive home follow-up. Conventional hospital admissions and visits to the Emergency Department were analyzed during the 90 days before and after HH. RESULTS: After HH, conventional hospital admissions decreased by 86% and visits to the Emergency Department by 91%. The mean Barthel Index changed from 74 to 77 (p < 0.05, in all cases). Ninety-six percent of patients were satisfied or very satisfied with HH. CONCLUSIONS: In elderly patients with non complicated HF, the intervention of an HH unit reduces conventional hospital admissions and the number of visits to the Emergency Department, the personal satisfaction degree is high and the functional capacity does not worsen.

Efecto de la hospitalización a domicilio en la reducción de la hospitalización convencional y frecuentación de urgencias en la insuficiencia cardíaca / Effect of hospital at home in the reduction of conventional hospitalization and emergency visits in heart failure

Objetivo. La atención de pacientes afectados de insuficiencia cardíaca comporta unas necesidades elevadas de recursos sanitarios y sociales. La hospitalización a domicilio (HaD) es una alternativa asistencial potencialmente útil en estos pacientes. Material y métodos. En este estudio observacional 110 pacientes ancianos con IC no complicada, ingresados en una unidad de HaD se trataron con soporte educacional (clínico, dietético y farmacológico) y seguimiento domiciliario intensivo. Se analizaron los ingresos en hospitalización convencional y la frecuentación del servicio de Urgencias durante los 90 días previos y posteriores a la HaD. Resultados. Tras la HaD, los ingresos en hospitalización convencional se redujeron el 86 por ciento y la frecuentación del servicio de urgencias el 91 por ciento. El índice medio de Barthel pasó de 74 a 77 (p < 0,05 en todos los casos). El 96 por ciento estaban satisfechos o muy satisfechos con la HaD. Conclusiones. En pacientes ancianos con insuficiencia cardíaca no complicada la intervención de una unidad de HaD reduce los ingresos en hospitalización convencional y la frecuentación de urgencias, el grado de satisfacción personal es elevado y no empeora la capacidad funcional (AU)

[Primary renal lymphoma. Apropos of a case]. / Linfoma renal primario. A propósito de un caso.

OBJECTIVE: To describe case of primary renal lymphoma. METHODS/RESULTS: A 76-year-old female patient with a diagnosis of a left renal mass was referred to our service. The patient underwent a radical nephrectomy. Histological analysis of the surgical specimen revealed a non-Hodgkin lymphoma. She received combination chemotherapy with CHOP. CONCLUSIONS: Primary renal lymphoma is a rare clinical entity whose existence has been questioned very often. Its clinical presentation is not unlike that of any other renal tumor and its diagnosis is by histology. Although it is a rare tumor type, it must be taken into account when making the differential diagnosis of any renal mass. Surgical resection in combination with chemotherapy with or without radiotherapy continues to be the widely utilized treatment for primary renal lymphoma.