6 research outputs found
Utilización de recursos sanitarios y costes asociados al diagnóstico y tratamiento de cada episodio de trombosis venosa profunda y sangrado en pacientes intervenidos de cirugía ortopédica de cadera o rodilla
Objective: To determine the use of healthcare resources and costs associated with the diagnosis
and treatment of thrombosis and bleeding patients who have undergone elective hip or knee
replacement surgery, in routine clinical practice conditions.
Patients and methods: This multicentre observational and retrospective study extracted data
from the medical records of three Spanish public hospitals (2010). Patients ≥40 years who had
received prophylaxis-anticoagulation were included. They were randomised into three groups:
(a) control (no hospital complications), (b) bleeding, and (c) thrombosis. General variables, use
of resources and costs were analysed. Statistical analysis: logistic regression and ANCOVA for
model correction (P < .05) was included.
Results: A total of 141 patients (control: 60; bleeding: 60; and thrombosis: 21), with a mean
age 68.7 (SD: 10.4) years, and 68.1% females were identified. Hip arthroplasty was more frequent (71.6%). The bleeding risk was associated with age (OR = 1.1) and thrombosis with COPD
(OR = 1.8); P < .05). The average length of stay for the thrombosis, bleeding and control groups
was 13.9, 11.5 and 7.4 days, respectively; P < .001). The total costs for each group were
D10,484.3; D8766.4 and D6496.1 respectively; P < .05. All grouped results were comparable
between them according to the hospital analysed and the type of replacement. Conclusions: Costs were higher for thrombosis and bleeding patients, respectively. Costs were
associated with length of stay and hospital-acquired infections.Objetivo: Conocer la utilización de recursos sanitarios y los costes asociados al diagnóstico y
tratamiento de la trombosis y sangrado en pacientes intervenidos de artroplastia primaria total
de cadera (ATC) o rodilla (ATR), durante 3 meses de seguimiento.
Pacientes y método: Estudio observacional de carácter multicéntrico y retrospectivo, realizado
a partir de los registros médicos de pacientes pertenecientes a 3 centros hospitalarios-públicos
espanoles ˜ (ano˜ 2010). Se consideraron aleatoriamente 3 grupos de pacientes: a) control (sin
complicaciones hospitalarias); b) sangrado, y c) trombosis. Se incluyeron variables generales, de
utilización de recursos y sus costes. Análisis estadístico: regresión logística y ANCOVA, p < 0,05.
Resultados: Se incluyeron pacientes ≥ 40 anos ˜ y que hubieran recibido profilaxis anticoagulante. Se incluyó un total de 141 pacientes (control: 60; sangrado: 60; y trombosis: 21). La
edad media fue de 68,7 (DE: 10,4) anos ˜ y el 68,1% fueron mujeres. La ATR fue la técnica más
frecuente (71,6%). El riesgo de sangrado se relacionó con la edad (OR = 1,1) y el de trombosis
con la EPOC (OR = 1,8), p < 0,05. El promedio de días de estancia de los grupos de trombosis,
sangrado y control fue de 13,9; 11,5 y 7,4 días, respectivamente, p < 0,001). Los costes totales
fueron: 10.484,3 D; 8.766,4 D, y 6.496,1 D, respectivamente, p < 0,05. Todos los resultados
agrupados fueron comparables entre ellos según el hospital analizado y el tipo de artroplastia.
Conclusiones: Los costes más elevados se producen en los pacientes que habían desarrollado
una trombosis y sangrado, respectivamente. Los costes se relacionaron con la prolongación de
los días de estancia y las infecciones intrahospitalariasMedicin
Early interdisciplinary hospital intervention for elderly patients with hip fractures – functional outcome and mortality
OBJECTIVES: Hip fractures are associated with high levels of co-morbidity and mortality. Orthogeriatric units have been shown to be effective with respect to functional recovery and mortality reduction. The aim of this study is to document the natural history of early multidisciplinary intervention in elderly patients with hip fractures and to establish the prognostic factors of mortality and walking ability after discharge. METHODS: This observational, retrospective study was performed in an orthogeriatric care unit on patients aged >70 years with a diagnosis of hip fracture between 2004 and 2008. This study included 1363 patients with a mean age of 82.7 + 6.4 years. RESULTS: On admission to the unit, the average Barthel score of these patients was 77.2 + 27.8 points, and the average Charlson index score was 2.14 + 2.05. The mean length of stay was 8.9 + 4.26 days, and the readmission rate was 2.3%. The in-hospital mortality rate was 4.7%, and the mortality rates at one, six, and 12 months after discharge were 8.7%, 16.9%, and 25.9%, respectively. The Cox proportional hazards model estimated that male sex, Barthel scale, heart failure, and cognitive impairment were associated with an increased risk of death. With regard to functionality, 63.7% of the patients were able to walk at the time of discharge, whereas 77.4% and 80.1% were able to walk at one month and six months post-discharge, respectively. The factors associated with a worse functional recovery included cognitive impairment, performance status, age, stroke, Charlson score, and delirium during the hospital stay. CONCLUSIONS: Early multidisciplinary intervention appears to be effective for the management of hip fracture. Age, male sex, baseline function, cognitive impairment and previous comorbidities are associated with a higher mortality rate and worse functional recovery
A set of quality and safety indicators for hospitals of the «Agencia Valenciana de Salud»
Objetivos: Elaborar un conjunto de indicadores de calidad y seguridad en el contexto de los
hospitales de la Agencia Valenciana de Salud.
Material y métodos: Se utilizó la técnica Metaplan® para identificar propuestas sobre sostenibilidad y enfermería. Se empleó el catálogo de la Sociedad Espanola ˜ de Calidad Asistencial
como punto de partida para los indicadores clínicos. Utilizando la Técnica Delphi 207 profesionales fueron invitados a participar en el proceso para identificar los indicadores más fiables y
factibles. Finalmente, la propuesta resultante fue validada por los directivos de 12 hospitales,
teniendo en cuenta la variabilidad, objetividad, factibilidad, fiabilidad y sensibilidad de los
indicadores.
Resultados: La tasa de participación osciló entre el 66,67 y 80,71%. De los 159 indicadores
de la propuesta inicial se priorizaron y seleccionaron 68 (21 económicos o de gestión, 22 de
cuidados de enfermería y 25 clínicos). De ellos 3 eran comunes a las 3 categorías y 2 no cumplían los criterios específicos de la fase de validación, por lo que el conjunto final consta de
63 indicadores.
Conclusiones: Se ha elaborado un conjunto de indicadores de calidad y seguridad. El sistema
de información actual permite su monitorización.Objectives: To prepare a set of quality and safety indicators for Hospitals of the «Agencia
Valenciana de Salud».
Material and methods: The qualitative technique Metaplan® was applied in order to gather
proposals on sustainability and nursing. The catalogue of the «Spanish Society of Quality in
Healthcare» was adopted as a starting point for clinical indicators. Using the Delphi technique,
207 professionals were invited to participate in the selecting the most reliable and feasible
indicators. Lastly, the resulting proposal was validated with the managers of 12 hospitals, taking
into account the variability, objectivity, feasibility, reliability and sensitivity, of the indicators.
Results: Participation rates varied between 66.67% and 80.71%. Of the 159 initial indicators,
68 were prioritized and selected (21 economic or management indicators, 22 nursing indicators,
and 25 clinical or hospital indicators). Three of them were common to all three categories and
two did not match the specified criteria during the validation phase, thus obtaining a final
catalogue of 63 indicators.
Conclusions: A set of quality and safety indicators for Hospitals was prepared. They are currently being monitored using the hospital information systems.Medicin
Validation of score in mna scale like nutritional risk factor in institutionalized geriatric patients with moderate and severe cognitive impairment
Introducción: La valoración geriátrica integral incluye
el examen del apartado nutricional debido a la alta prevalencia de desnutrición en este tipo de pacientes; especialmente en los pacientes con deterioro cognitivo asociado.
Las escalas de cribado del estado nutricional presentan
preguntas de autopercepción subjetiva de difícil respuesta en pacientes mayores con demencia.
Objetivo: Estudiar la especificidad, el valor predictivo
positivo y la sensibilidad de la escala MNA para la detección
de malnutrición en pacientes diagnosticados de enfermedad
de Alzheimer con deterioro cognitivo avanzado.
Material y métodos: Se diseñó un estudio descriptivo
poblacional con una muestra de 52 pacientes mayores de
70 años, institucionalizados, con enfermedad de Alzheimer grado moderado y severo. Se estudió la sensibilidad,
especificidad y valor predictivo positivo de la escala MNA
respecto a los parámetros de malnutrición del American
Institute of Nutrition (AIN).
Resultados: Los valores de sensibilidad, especificidad y
valor predictivo positivo son 60%, 94,7% y 93,8% respectivamente. Existe una correlación significativa (p < 0,001)
ente la puntuación obtenida en la escala MNA y la escala de
riesgo de caídas Tinneti (r = 0,577), de función Barthel (r =
0,742), de valoración cognitiva MEC (r = 0,651) y los niveles
de creatinina (r = 0,402). Más del 50% de la muestra presentó al menos un parámetro de malnutrición AIN alterado.
Conclusiones: La escala MNA presenta una menor
sensibilidad y especificidad en estos pacientes. El diseño
de una escala de valoración nutricional sin valoraciones
subjetivas y sólo con parámetros objetivos podría mejorar la eficacia de la misma en ancianos institucionalizados
con deterioro cognitivo moderado y severo.Introduction: comprehensive geriatric assessment
includes examination of the nutritional status given the
high prevalence of hyponutrition in this kind of patients,
particularly in patients with associated cognitive impairment. Scales for screening the nutritional status include
questions on self-perception difficult to answer by
demented elder patients.
Objective: To study the specificity, the positive predictive value, and the sensitivity of the MNA scale to detect
malnutrition in patients diagnosed with Alzheimer’s disease with advanced cognitive impairment.
Material and methods: a population-based descriptive
study with a sample of 52 patients older than 70 years,
institutionalized, and with moderate-severe Alzheimer’s
disease was designed. The sensitivity, specificity, and positive predictive value of MNA scale were studied regarding the parameters on malnutrition of the American
Institute of Nutrition (AIN).
Results: the sensitivity, specificity, and positive predictive values were 60%, 94.7%, and 93.8%, respectively.
There was a significant correlation (p < 0.001) between
the score obtained with the MNA Scale and the Tinneti’s
Risk of Fall Scale (r = 0.577), the Barthel’s function (r =
0.742), the MCT cognitive assessment (r = 0.651), and creatinine levels (r = 0.402). More than 50% of the sample
presented at least one malnutrition parameter altered.
Conclusions: the MNA Scale presents lower sensitivity
and specificity in these patients. Designing a nutritional
assessment scale without subjective evaluations and only
with objective parameters might improve its efficiency in
institutionalized elderly patients with moderate-severe
cognitive impairment.Nutrición humana y dietétic
A daily multidisciplinary assessment of older adults undergoing elective colorectal cancer surgery is associated with reduced delirium and geriatric syndromes
Objectives
Comprehensive geriatric assessment (CGA) has shown to benefit older patients undergoing urological and orthopedic surgery. However, this approach has been scarcely assessed in patients elected for colorectal surgery.
Materials and Methods
Retrospective cohort of patients aged ≥70 years admitted for elective colorectal cancer surgery to a single hospital between 2008 and 2012. Upon admission, patients were assigned to a usual care (UC) plan or a CGA-based care (GS) plan conducted by a multidisciplinary team, according to standard clinical criteria.Analyzed outcomes included the incidence of delirium and other geriatric syndromes during hospital stay, mortality, readmissions, andnumber of perioperative complications.
Results
The cohort included 310 patients, 203 assigned to the GS group and 107 to the UC group. Patients in the GS group had significantly lower Barthel and Lawton scores, higher prevalence of dementia and heart failure, and higher comorbidity burden. Fifty-four (17.5%) patientsexperienced delirium (23 [11.3%] and 31 [29.2%] in the GS and UC groups, respectively; p < .001), and 49 (15.8%) patient experienced other geriatric syndromes (21 [10.3%] and 28 [26.2%] in the GS and UC groups, respectively; p < .001). Serious complications were more frequent in the GS group: 154 (75.9%) vs 60 (56.1%) in the UC group; p < .001. No significant differences were observed between groups regarding readmissions, and in-hospital and post-discharge (1 year follow-up) mortality.
Conclusions
Despite the poorer clinical condition of patients in the GS group, the CGA-based intervention resulted in a lower incidence of delirium and other geriatric syndromes compared with the UC group.Fisioterapi
Severity of cognitive impairment as a prognostic factor for mortality and functional recovery of geriatric patients with hip fracture
Aim
To identify how the severity of dementia influences functional recovery and mortality in elderly
patients hospitalized for hip fracture.
Methods
An observational retrospective study of 1258 patients aged older than 69 years and diagnosed with
hip fracture who received care within an orthogeriatrics unit from 2004 to 2008 was carried out.
During a 12‐month follow‐up period, functional recovery and mortality outcomes were measured.
Results
Dementia was present in 383 (28.1%) patients: it was mild in 183 (48%), moderate in 102 (26.5%)
and severe in 98 (25.5%). Compared with patients with preserved cognitive status, patients with
dementia had the following statistically significant differences (means [standard deviation] or
percentage): older age (preserved, 82.29 years [6.5 years]; mild, 83.63 years [6.1 years]; moderate,
83.47 years [5.9 years]; severe, 84.46 years [6.1 years]; P < 0.001); lower Barthel Index (89.7 [21.6],
72.7 [24.6], 58.9 [28.6], 38.0 [28.1]; P < 0.001); delirium (11.7%, 25.6%, 37.6%, 44.7%; P < 0.001);
less ambulation at 6 months postdischarge (83.9%, 72.8%, 56.9%, 41.7%; P < 0.001); and higher
mortality at discharge (4%, 5.7%, 8.2%, 10.6%; P < 0.001) and 12 months after discharge (21.2%,
32.3%, 46.3%, 53.5%; P < 0.001). Patients with severe dementia had lower probability of functional
recovery at discharge (OR 0.272, 95% CI 0.140–0.526, P < 0.001) and 6 months after discharge (OR
0.439, 95% CI 0.197–0.979, P = 0.04), as well as a greater probability of dying (HR 1.640, 95% CI
1.020–2.635, P = 0.04).
Conclusions
We observed higher 12‐month mortality and less functional recovery with increasing severity of
dementia.Medicin