Tratamiento no quirúrgico de la isquemia mesentérica crónica por lesión en la AMS a través de la AMI: una opción a considerar en el paciente frágil / Non-surgical treatment of chronic mesenteric ischemia owing to lesion in the SMA through the SMI: An option for consideration in frail patients

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Predictors of mortality among elderly dependent home care patients.

BACKGROUND: The purpose of this study is to identify which variables--among those commonly available and used in the primary care setting--best predict mortality in a cohort of elderly dependent patients living at home (EDPLH) that were included in a home care program provided by Primary Care Teams (PCT). Additionally, we explored the risk of death among a sub-group of these patients that were admitted to hospital the year before they entered the home care program. METHODS: A one-year longitudinal cohort study of a sample of EDPLH patients included in a home care programme provided by 72 PCTs. Variables collected from each individual patient included health and social status, carer's characteristics, carer's burden of care, health and social services received. RESULTS: 1,001 patients completed the study (91.5%), 226 were admitted to hospital the year before inclusion. 290 (28.9%) died during the one-year follow-up period. In the logistic regression analysis women show a lower risk of death [OR= 0.67 (0.50-0.91)]. The risk of death increases with comorbidity [Charlson index OR= 1.14 (1,06-1.23)], the number of previous hospital admissions [OR= 1,16 (1.03-1.33)], and with the degree of pressure ulcers [ulcers degree 1-2 OR = 2.94 (1.92-4.52); ulcers degree 3-4 OR = 4.45 (1.90-10.92)]. The logistic predictive model of mortality for patients previously admitted to hospital identified male sex, comorbidity, degree of pressure ulcers, and having received home care rehabilitation as independent variables that predict death. CONCLUSIONS: Comorbidity, hospital admissions and pressure ulcers predict mortality in the following year in EDPLH patients. The subgroup of patients that entered home care programs with a previous record of hospital admission and a high score in our predictive model might be considered as candidates for palliative care.

Evaluación de la práctica clínica en pacientes diagnosticados de meningitis infecciosa / Assessment of clinical practice in patients with infectious meningitis

Introducción. La evaluación de la práctica médica en grupos seleccionados de pacientes puede ser útil para mejorar la calidad de la asistencia y disminuir la variabilidad en la práctica clínica. El objetivo de este estudio es evaluar la adecuación de la asistencia y el grado de adecuación con las guías establecidas en pacientes diagnosticados de meningitis mediante indicadores previamente elaborados. Métodos. Basado en las guías de práctica clínica, mediante reuniones de consenso se seleccionaron indicadores de calidad y se diseñó un protocolo de datos que se utilizó de forma retrospectiva en las historias clínicas de los pacientes diagnosticados de meningitis entre 1987 y 2004 en un hospital general básico de 280 camas. Resultados. Se incluyeron 99 episodios. Se comprobó registro de antibioterapia previa en el 94%, antigüedad de los síntomas en el 65%, exploración de fondo de ojo en el 21%, presión del líquido cefalorraquídeo (LCR) en el 5%; el estudio bioquímico y microbiológico de LCR fue adecuado (93-99%) pero no los hemocultivos (73%). De forma global, la realización de tomografía computarizada (TC) craneal fue adecuada en el 52% de los pacientes, pues en muchos casos se realizó sin haber indicación. El tratamiento de los pacientes se realizó según el protocolo del momento en el 53,6% en meningitis bacterianas y el 79,5% en linfocitarias. Fallecieron el 3% de los pacientes. Conclusión. Se observa una infrautilización del fondo de ojo y una sobreutilización de la TC craneal. El tratamiento se ajustó a los protocolos establecidos en algo más de la mitad de las meningitis bacterianas. Este tipo de auditorías son útiles para identificar la variabilidad de la práctica clínica según las guías y diseñar estrategias dirigidas a corregirlas (AU)

Objectives. Medical practice assessments for a specific patient population can be useful for improving health care quality and decreasing the variations in clinical practice. Our aim was to assess compliance with clinical practice guidelines established for patients with meningitis using previously formulated indicators. Methods. The indicators of quality were based on clinical practice guidelines and selected through consensus meetings. A data protocol was designed and applied retrospectively to the medical records of all patients with a diagnosis of meningitis between 1987 and 2004 in a 280-bed general hospital. Results. A total of 99 episodes were included. Information on pre-treatment was recorded in 94%, duration of symptoms in 65%, funduscopic examination in 21%, and cerebrospinal fluid (CSF) pressure in 5% of patients. Biochemical and microbiological CSF study was adequate (93%-99%), but blood culture (73%) was not. Cranial CT scan was adequate in 52% of patients, since in many cases it was performed without an indication for this study. Treatment was given according to the local protocol in 53.6% of patients with suspected bacterial meningitis and 79.5% of those with suspected viral meningitis. Three patients died due to meningitis. Conclusions. The use of funduscopic examination was poor, whereas the use of cranial CT scanning was excessive. Treatment of bacterial meningitis adhered to the established local antibiotic protocol in half the patients. This type of auditing is useful for determining compliance with guidelines and designing strategies to improve health care quality (AU)

Vacunación antigripal en personal sanitario / Flu vaccination in healthcare workers

Fundamento y objetivo. El objetivo es determinar la tendencia en cobertura vacunal antigripal en trabajadores sanitarios. Método. Estudio epidemiológico transversal. Período 1990-2005. Proporciones globales y por categorías profesionales anuales. Análisis: test χ² y test de tendencia lineal Mantel-Haenszel. Resultados. Las mayores coberturas fueron: 2003-2004, 15,9% (IC 95%: 14,8-17) y 2005-2006, 16,3% (IC 95%: 15,3-17,4). Médicos y MIR tienen mayores coberturas, 30,09%. La tendencia fue creciente durante todo el período. Conclusiones. Tendencia creciente de inmunización antigripal en personal sanitario (AU)

Background and objective. The aim of this study was to determine the trends in yearly vaccination coverage in healthcare workers. Method. Cross-sectional epidemiological study over fifteen seasons (1990-2005). Overall vaccination coverage and coverage by professional category was estimated annually. The chi-square test and Mantel-Haenszel test for linear trend were used for the statistical analysis. Results. The greatest vaccination coverage was in the 2003-04 season (15.9%; 95% CI: 14.8-17) and the 2005-06 season (16.3%; 95% CI: 15.3-17.4). The medical staff and residents showed the highest coverage (30.1%). A positive trend was observed along the period. Conclusions. An increasing trend in influenza vaccination coverage has been observed in healthcare workers (AU)

[Assessment of clinical practice in patients with infectious meningitis]. / Evaluación de la práctica clínica en pacientes diagnosticados de meningitis infecciosa.

OBJECTIVES: Medical practice assessments for a specific patient population can be useful for improving health care quality and decreasing the variations in clinical practice. Our aim was to assess compliance with clinical practice guidelines established for patients with meningitis using previously formulated indicators. METHODS: The indicators of quality were based on clinical practice guidelines and selected through consensus meetings. A data protocol was designed and applied retrospectively to the medical records of all patients with a diagnosis of meningitis between 1987 and 2004 in a 280-bed general hospital. RESULTS: A total of 99 episodes were included. Information on pre-treatment was recorded in 94%, duration of symptoms in 65%, funduscopic examination in 21%, and cerebrospinal fluid (CSF) pressure in 5% of patients. Biochemical and microbiological CSF study was adequate (93%-99%), but blood culture (73%) was not. Cranial CT scan was adequate in 52% of patients, since in many cases it was performed without an indication for this study. Treatment was given according to the local protocol in 53.6% of patients with suspected bacterial meningitis and 79.5% of those with suspected viral meningitis. Three patients died due to meningitis. CONCLUSIONS: The use of funduscopic examination was poor, whereas the use of cranial CT scanning was excessive. Treatment of bacterial meningitis adhered to the established local antibiotic protocol in half the patients. This type of auditing is useful for determining compliance with guidelines and designing strategies to improve health care quality.