Frailty as a predictor of clinical problems and events that require elderly patients with heart failure to use health resources.

BACKGROUND: The clinical management of elderly patients with heart failure (HF) is not firmly established. Decision-making should be individualized depending on the biological deterioration of each patient, from aggressive management to a palliative approach. Frailty can serve as the basis for this comprehensive individualized management. Our objective was to evaluate the importance of the main clinical problems, as well as the events that required the use of health resources, based the degree of frailty, in elderly patients with HF. METHODS AND RESULTS: Retrospective observational cohort study. Frailty was defined according to the deficit accumulation construct. A total of 546 patients hospitalized for acute HF were included. The median age (Q1-Q3) was 82 (78-86) years. A total of 454 patients (83%) showed some degree of frailty: 221 (48.7%) mild, 207 (45.6%) moderate and 26 (5.7%) advanced. There was a significant tendency towards polypharmacy from no to severe frailty. Hospital events were recorded for 4 (1-6) patients with mild frailty, 4 (2-6) patients with moderate frailty and 2 ((1-4) patients with advanced frailty (p = 0.045). A total of 204 patients (37.4%) died during follow-up. The median time to death was 11.4 (4-16.8), 6.7 (3.3-11.6), 6.5 (3.4-12.2) and 4.1 (0.8-7.7) months for patients with no, mild, moderate, or advanced frailty, respectively (p = 0.006). CONCLUSIONS: Frailty due to deficit accumulation is a good predictor of clinical problems and events that require the use of health resources; therefore, it can serve as a basis for the management of HF in the elderly.

[Management of congenital adduct clubfoot with the Ponseti technique. Experience at "La Perla" General Hospital]. / Manejo del pie equinovaro aducto congénito con técnica de Ponseti. Experiencia en el Hospital General "La Perla".

UNLABELLED: The purpose of this paper is to present the experience of the hospital using the Ponseti method in patients with congenital adduct clubfoot. MATERIAL AND METHODS: The study was conducted between January 2007 and December 2009. Children of both sexes were included; the Dimeglio classification was applied before surgery and their course was later assessed with the Simons scale when they resumed gait. Patients with postural clubfoot (Dimeglio I) and those with neuromuscular disease (Dimeglio IV) were excluded. Casts were placed as of 15 days of age using the Ponseti technique and then percutaneous tenotomy of the calcaneous tendon was performed in the operating room. RESULTS: Twenty patients (9 girls, 11 boys) and 28 feet were included in the study; they were Dimeglio II (8 children) and III (12 children). Mean age at the time of surgery was 2 months, and mean age at the time of gait assessment was 2 years. Upon applying the Simons scale, 25 feet (89.3%) had satisfactory results and 3 feet (10.7%) unsatisfactory results. Two of the latter underwent percutaneous tenotomy again and in one case the cast was applied again; they evolved properly. CONCLUSIONS: We found in our series that the Ponseti technique is appropriate as definitive treatment for Dimeglio II and III congenital adduct clubfoot.

Diarrea en paciente con sonda de gastrostomía endoscópica percutánea / Diarrhea in patients with percutaneous endoscopic gastrostomy probe

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[The special attention to re-admitted patients can be effective. Cost-benefit analysis of a new health care model]. / La atención especial a los pacientes reingresadores puede ser eficiente. Análisis coste-beneficio de un nuevo modelo asistencial.

BACKGROUND: Patients with chronic conditions are commonly readmitted to hospital. A study was designed to improve their medical care. The cost/benefit analysis is presented to evaluate its efficiency. PATIENTS AND METHODS: Patients attended at the Internal Medicine Department in a hospital area who were readmitted three or more times in a year were included in the study. In a prospective study, patients were attended by means of a specific consultation with upon request care or through telephone care, with the possibility of elective admission. A comparison was made of costs of the new care program with costs of their usual care, and it was correlated with attending results. RESULTS: Patients were followed for 32 months with a 45% decrease in admissions, 50% in visits to the Emergency Department, and 26% in the hospital stay days. The new program involves monthly savings over 5 million pesetas for the attended population. CONCLUSIONS: The proposed health care program decreases the attending needs in these patients and costs derived from hospital care. An efficient alternative is shown.

La atención especial a los pacientes reingresadores puede ser eficiente. Análisis coste-beneficio de un nuevo modelo asistencial / The special attention to re-admitted patients can be effective. Cost-benefit analysis of a new health care model

Fundamento. Los pacientes con patología crónica con gran frecuencia reingresan en el hospital. Se diseñó un estudio con el fin de mejorar su asistencia. Se presenta el análisis coste-beneficio para evaluar su eficiencia. Pacientes y métodos. Se incluyen los enfermos atendidos por el servicio de Medicina Interna de un área hospitalaria que reingresaron tres o más veces en un año. Dentro de un estudio prospectivo se atendieron mediante una consulta específica con atención a demanda y telefónica con la posibilidad de ingreso programado. Se hace una comparación de los costes del nuevo programa asistencial con los costes de su asistencia habitual y se correlaciona con los resultados asistenciales. Resultados. Los pacientes fueron seguidos durante 32 meses con un descenso del 45 por ciento de los ingresos, del 50 por ciento en la frecuentación al servicio de Urgencias y de un 26 por ciento de los días de estancia hospitalaria. El nuevo programa supone un ahorro mensual de más de 5 millones de pesetas para esa población asistida. Conclusiones. El modelo asistencial propuesto disminuye las necesidades asistenciales de estos pacientes y los costes de su asistencia hospitalaria. Se muestra una alternativa eficiente (AU)

[A new model for medical care to multi-admitted patients]. / Un nuevo modelo para la asistencia a los pacientes multiingresadores.

BACKGROUND AND OBJECTIVE: Patients with chronic conditions are often readmitted to hospital. A study was designed to improve health care to these patients. PATIENTS AND METHODS: Patients attended at the Internal Medicine Department of a hospital area who were admitted to hospital at least three times in a year were included in the study. Within a prospective study, patients were attended by means of specific consultation with care upon request and telephone care, with the possibility of programmed admission. RESULTS: Patients were followed for 32 months, with a 45% decrease in the admission rate, 50% in visits to the Emergency Department, and 26% in hospital stay days. CONCLUSIONS: The proposed care model decrease the attending needs for these patients.

Un nuevo modelo para la asistencia a los pacientes multiingresadores / A new model for medical care to multi-admitted patients

Fundamento. Los pacientes con patología crónica con gran frecuencia reingresan en el hospital. Se diseñó un estudio con el fin de mejorar su asistencia. Pacientes y métodos. Se incluyen los enfermos atendidos por el Servicio de Medicina Interna de un área hospitalaria que reingresaron tres o más veces en un año. Dentro de un estudio prospectivo se atendieron mediante una consulta específica con atención a demanda y atención telefónica, con la posibilidad de ingreso programado. Resultados. Los pacientes fueron seguidos durante 32 meses, con un descenso del 45 por ciento de los ingresos, del 50 por ciento en la frecuentación al Servicio de Urgencias y de un 26 por ciento de los días de estancia hospitalaria. Conclusiones. El modelo asistencial propuesto disminuye las necesidades asistenciales de estos pacientes. (AU)

[Rheological and expander effect of hydroxyethyl-starch in intradural anesthesia]. / Efecto reológico y expansor del hidroxietilalmidón en anestesia intradural.

We have evaluated the effect of the infusion of hydroxyethylstarch (HES) on blood viscosity and its usefulness to prevent hypotension associated with intradural anesthetic blockade. The sample consisted of 20 healthy patients scheduled for elective surgery with intradural anesthesia (0.5% hyperbaric bupivacaine), in whom 500 ml of HES were infused in 20 minutes. Blood samples were taken before lumbar puncture and 20 minutes after it and once HES infusion had been finished. Blood viscosity, the erythrocyte and leukocyte mass parameters and biochemical values (total protein, BUN, creatinine, glucose) were measured. Blood pressure (systolic, diastolic, mean) and heart rate were monitored every 5 minutes. During the study time, systolic blood pressure did not show significant changes. Mean and diastolic blood pressure in the minutes 15 and 20 were reduced in less than 10 mmHg (p less than 0.01). Packed red cell volume diminished in 5.7% and the blood viscosity in 0.5-2.3 mPas. It was concluded that HES is a good option for intradural anesthesia because of its plasma volume expanding effect and the hemodilution it induces.