[Factors associated with a significant functional gain and new institutionalisation in rehabilitated patients admitted to a long term care unit]. / Factores asociados a mejoría funcional y nueva institucionalización en enfermos con intervención rehabilitadora en una unidad de media-larga estancia.

BACKGROUND AND OBJECTIVES: To determine which factors are associated with a functional gain above 19 on Barthel's index (CSFG) and also factors associated with a new post-discharge institutionalisation (NPDI) in patients who a underwent rehabilitation intervention whilst admitted to a medium long term care unit. PATIENTS AND METHODS: Prospective study of patients admitted between 2000 and 2005 who underwent a rehabilitation intervention. Demographic, mind-body and laboratory data were collected. RESULTS: 153 patients were selected for the first aim and 148 for the second. 53.3% of the patients achieved a CSFG. The incidence of NPDI was of 23.7%. The following factors were associated with a CSFG in the multivariate analysis: age (OR: 0.95), female gender (OR: 0.35), rehabilitation objective at admission (OR: 7.43), infectious disease as primary diagnosis (OR: 10.35), mild dependence at admission (OR: 0.09), absence of malnutrition (OR: 3.12), high comorbidity (OR: 0.31), need of wound care (OR: 0.36) and ansiolitic intake at admission (OR: 9.11). Likewise, the following factors were associated with the occurrence of a NPDI: age (OR: 1.12), long-term care objective at admission (OR: 7.84), chronic lung disease (OR: 0.29), number of drug prescriptions at admission (OR: 0.82), neuroleptic intake at admission (OR: 7.42), living with relatives (OR: 0.29) and nosocomial infection during the hospital stay (OR: 2.99). CONCLUSIONS: Several factors have been associated to CSFG and NPDI and they would be useful to optimise rehabilitation resources and to plan post-discharge institutional transfer.

Factores asociados a mejoría funcional y nueva institucionalización en enfermos con intervención rehabilitadora en una unidad de media-larga estancia / Factors associated with a significant functional gain and new institutionalisation in rehabilitated patients admitted to a long term care unit

Fundamento y objetivoDeterminar qué factores se asocian con una ganancia funcional clínicamente relevante (GFCR) superior a 19 en el índice de Barthel y con nueva institucionalización al alta (NIA) en pacientes con intervención rehabilitadora.Pacientes y métodoEstudio prospectivo en pacientes con intervención rehabilitadora ingresados entre 2000 y 2005 en una unidad de media-larga estancia. Se recogieron datos demográficos, biopsicosociales y de laboratorio.ResultadosParticiparon en el estudio 153 pacientes para el primer objetivo y 148 para el segundo. Alcanzó una GFCR el 53,3% de los pacientes. La incidencia de NIA fue del 23,7%. En el análisis multivariante se relacionaron con una GFCR los siguientes factores: edad (OR: 0,95), sexo femenino (OR: 0,35), objetivo de remisión rehabilitador (OR: 7,43), diagnóstico principal infeccioso (OR: 10,35), dependencia moderada al ingreso (OR: 0,09), ausencia de desnutrición (OR: 3,12), alta comorbilidad (OR: 0,31), necesidad de curas al ingreso (OR: 0,36) y uso de ansiolíticos al ingreso (OR: 9,11). Asimismo, se relacionaron con NIA: edad (OR: 1,12), remisión para larga estancia (OR: 7,84), enfermedad pulmonar crónica (OR: 0,29), número de fármacos al ingreso (OR: 0,82), neurolépticos al ingreso (OR: 7,42), vivir con familiares (OR: 0,29) e infección nosocomial (OR: 2,99).ConclusionesSe ha detectado un conjunto de variables asociadas a una GFCR y al riesgo de NIA, que podrían ser utilizadas tanto para optimizar los recursos rehabilitadores como para planificar la necesidad de un recurso residencial al alta(AU)

Background and objectivesTo determine which factors are associated with a functional gain above 19 on Barthel's index (CSFG) and also factors associated with a new post-discharge institutionalisation (NPDI) in patients who a underwent rehabilitation intervention whilst admitted to a medium long term care unit.Patients and methodsProspective study of patients admitted between 2000 and 2005 who underwent a rehabilitation intervention. Demographic, mind-body and laboratory data were collected.Results153 patients were selected for the first aim and 148 for the second. 53.3% of the patients achieved a CSFG. The incidence of NPDI was of 23.7%. The following factors were associated with a CSFG in the multivariate analysis: age (OR: 0.95), female gender (OR: 0.35), rehabilitation objective at admission (OR: 7.43), infectious disease as primary diagnosis (OR: 10.35), mild dependence at admission (OR: 0.09), absence of malnutrition (OR: 3.12), high comorbidity (OR: 0.31), need of wound care (OR: 0.36) and ansiolitic intake at admission (OR: 9.11). Likewise, the following factors were associated with the occurrence of a NPDI: age (OR: 1.12), long-term care objective at admission (OR: 7.84), chronic lung disease (OR: 0.29), number of drug prescriptions at admission (OR: 0.82), neuroleptic intake at admission (OR: 7.42), living with relatives (OR: 0.29) and nosocomial infection during the hospital stay (OR: 2.99).ConclusionsSeveral factors have been associated to CSFG and NPDI and they would be useful to optimise rehabilitation resources and to plan post-discharge institutional transfer(AU)

Hidratación en el contexto de sedación paliativa en agonía: una perspectiva multidimensional / No disponible

Antecedentes: los médicos se enfrentan a aspectos éticos en su práctica clínica que producen perplejidad, exigen mucho tiempo y les implican emocionalmente. No sólo la vertiente clínica influye en la decisión, sino que interactúan otros factores como las creencias religiosas derivadas de la doctrina católica, en nuestro caso, y los aspectos legales. Las convicciones religiosas influyen en la forma de ver la vida y la muerte. Algunas familias, basándose en la creencia de que la doctrina católica apoya la hidratación hasta el final de la vida, demandan el mantenimiento de la misma a pesar de que ello puede prolongar el sufrimiento de su familiar agónico. Los aspectos legales de la cuestión preocupan sobre todo en relación a la problemática del encarnizamiento terapéutico, que puede derivarse del temor del personal sanitario a hipotéticas demandas legales. Todo ello plantea una disyuntiva. Este trabajo surge como una reflexión acerca del dilema ético planteado a los sanitarios en la toma de decisiones sobre la práctica de la hidratación en la sedación paliativa en agonía. Objetivo: revisar la literatura especializada relacionada con aspectos clínicos, antropológicos, doctrinales de la Iglesia Católica y médico-legales, según la legislación española e internacional, sobre la hidratación en el contexto de la sedación paliativa en la agonía. Material y método: una revisión narrativa de la literatura utilizando el buscador general Google y la base de datos Pubmed. Capítulos de libros sobre temas de medicina paliativa, antropología y legislación, los números anteriores de Medicina Paliativa y documentos tanto de la Sociedad Española de Cuidados Paliativos (SECPAL) como de la Iglesia Católica. La revisión se hizo en los idiomas español e inglés. Se seleccionaron aquellos artículos en los que la hidratación y/o la sedación paliativa en la agonía se trataban de manera relevante o aportaban algún dato significativo al tema. Resultados: se seleccionaron 8 capítulos de 7 libros de texto, 10 artículos, 11 documentos, compendios de legislación, 1 Acta del Senado, 1 sentencia judicial y 1 artículo de un periódico de información general. Se eligieron por sus referencias a la valoración de aspectos: a) clínico-antropológicos; b) doctrinales católicos; y c) médico-legales respecto a la hidratación en los últimos días de vida, con especial énfasis en las consideraciones éticas de cada apartado. Conclusión: desde el punto de vista clínico existe controversia sobre la hidratación en la agonía, siendo necesario individualizar cada situación y conjugarla con las creencias, actitudes y valores del paciente y su familia. Aunque la doctrina católica propugna la hidratación y la nutrición como cuidados debidos a todos los enfermos, considera lícito suprimirlas o no iniciarlas si resultan gravosas para el paciente. Desde el punto de vista legal, la hidratación parenteral en la agonía es opcional, siendo aconsejable razonar el proceso de toma de decisiones en la historia clínica

Background: physicians have to face ethical issues in their clinical practice that may induce perplexity, be time-consuming, and emotionally involve them. Not only clinical aspects influence decision making, but also other factors like religious beliefs (in our setting, mainly the Catholic point of view) or even Legal regulations. The way of perceiving life and death is influenced by religious faith; some families request hydration for their terminally ill relatives, even though this may lengthen their suffering. That is because they believe that Catholic doctrine endorses hydration to the end of life. The legal aspects of these questions derive from the fear of healthcare professionals to hypothetic claims, which could drive them to therapeutic obstinacy. This paper attempts to reflect on the ethical dilemma that we often face up in palliative care regarding decision making on sedation and hydration for terminally-ill patients. Objective: a review of the specialized literature related to clinical, anthropological, Catholic Church, and medico-legal aspects (domestic and international legislation) concerning hydration in the context of palliative sedation at the end of life. Material and method: a narrative review of the literature using Google and the Pubmed database. Book chapters on palliative medicine, anthropology and legislation, former issues of Medicina Paliativa, and documents from not only Sociedad Española de Cuidados Paliativos (SECPAL), but also the Catholic Church. The review was carried out in both Spanish and English. Papers dealing with hydration and/or palliative sedation at the end of life, or providing any significant information thereupon, were selected. Results: eight chapters from 7 textbooks, 10 articles, 11 documents and legislation compendia, 1 Senate committee decision, 1 judicial sentence, and 1 general newspaper’s opinion article were selected. They were chosen because of their references to clinical-anthropological, Catholic doctrinal, and medical-legal aspects about hydratation at the end of life, with special emphasis in the ethical regards of each source. Conclusion: from a clinical point of view there is controversy about hydration at the end of life, and decisions should be made on an individual basis considering patient and family attitudes and values. While the Catholic doctrine endorses hydration and nutrition for all patients, it also allows their discontinuation or absence should these measures be ultimately grievous. From a legal point of view, artificial hydration at the end of life is optional, but the rationale of a decision for or against it should be included in the patient’s medical record

Etiologic role of unapparent exposure in cat allergy.

To determine the importance of unnoticed exposure to cat, we studied 20 patients with a history of respiratory allergy. All the patients had a positive prick test to cat dander extract, and none of them kept cats as pets. The prick test was carried out with a dander extract from cat at a concentration of 100 BU/ml. The specific IgE was determined by the commercially available Pharmacia CAP System. We carried out a conjunctival challenge test. The concentration of Fel d 1 was quantified in dust samples from the patients' homes by a commercially available method. The patients were reassessed in order to establish a relation between exposure and symptoms, and concealed allergen sources. Sixteen patients showed significant levels of Fel d 1 in their homes (mean of 3.35 micrograms/g of dust). The conjunctival challenge test was positive in 15 patients. These patients showed an exposure mean of 0.4 microgram/g of dust. The mean levels of specific serum IgE were higher in those patients with a positive challenge than in those with a negative challenge (P = 0.0145). In nine reassessed patients, a relation was established between natural exposure and the onset of the symptoms. A possible hidden allergen source was established in 11 patients.(ABSTRACT TRUNCATED AT 250 WORDS)