Impacto de la detección de la disfagia en la incidencia de neumonitis por aspiración y en los marcadores bioquímicos de desnutrición, en personas mayores hospitalizadas

La disfagia es un importante problema de salud en las personas mayores, favoreciendo la aparición de neumonías por aspiración e interfiriendo con una nutrición adecuada. Esta tesis analiza si una intervención enfermera estandarizada, la realización de una prueba de agua, disminuye la prevalencia de neumonía aspirativa y previene la desnutrición en pacientes mayores de 70 años, sin antecedentes evidentes de disfagia, que ingresan en un Hospital Universitario. Se estudió una población muy mayor (edad media de 82 años), con una alta prevalencia de desnutrición (el 50 % de los pacientes estaban desnutridos o presentaban riesgo de desnutrición según el MNA) y de disfagia (19 %), considerando como tal la presencia de una prueba del agua positiva. La intervención enfermera no mejoró la tasa de neumonías por aspiración, que fue muy baja (1,4 %), ni la estancia de los pacientes, pero si la mortalidad durante el ingreso (7 % vs 22 %), aunque no a largo plazo. Estos resultados sugieren la utilidad de la realización de intervenciones enfermeras estructuradas para detectar la disfagia

Impacto de la detección de la disfagia en la incidencia de neumonitis por aspiración y en los marcadores bioquímicos de desnutrición, en personas mayores hospitalizadas

La disfagia es un importante problema de salud en las personas mayores, favoreciendo la aparición de neumonías por aspiración e interfiriendo con una nutrición adecuada. Esta tesis analiza si una intervención enfermera estandarizada, la realización de una prueba de agua, disminuye la prevalencia de neumonía aspirativa y previene la desnutrición en pacientes mayores de 70 años, sin antecedentes evidentes de disfagia, que ingresan en un Hospital Universitario. Se estudió una población muy mayor (edad media de 82 años), con una alta prevalencia de desnutrición (el 50 % de los pacientes estaban desnutridos o presentaban riesgo de desnutrición según el MNA) y de disfagia (19 %), considerando como tal la presencia de una prueba del agua positiva. La intervención enfermera no mejoró la tasa de neumonías por aspiración, que fue muy baja (1,4 %), ni la estancia de los pacientes, pero si la mortalidad durante el ingreso (7 % vs 22 %), aunque no a largo plazo. Estos resultados sugieren la utilidad de la realización de intervenciones enfermeras estructuradas para detectar la disfagia

Historical perspective on the concept of health in ancient societies

La vejez es una etapa más del ser humano que ha sido interpretada de forma variable dependiendo del contexto social en el cual se analizara. A la hora de considerar la vejez en la sociedad del siglo XXI, se impone una reflexión sobre la misma a través del espacio y del tiempo, con el fin de entender este complejo fenómeno en la vida del ser humano en su totalidad, como un hecho ligado a la cultura y no sólo biológico.Ageing, one of the stages of human life, has been interpreted differently depending on the social context in which it has been analysed. The consideration of ageing in the 21st century demands a meditation about the concept through space and time, in order to understand wholly this complex phenomenon in human life, as a cultural not only biological fact

Desarrollo de aplicaciones E-health basadas en micro-servicios en una arquitectura de Cloud

En este trabajo se describe una propuesta orientada a los emergentes servicios de eHealth, para ofrecer una mejor prestación en la atención asistencial y hospitalaria. El enfoque propuesto se apoya en el desarrollo de microservicios consistentes en proporcionar una aplicación que contiene a su vez una serie de pequeños y adaptables servicios que se ejecutan de forma autónoma, comunicándose de forma interactiva y continúa. Así, se pretende fortalecer los sistemas de salud tradicionales en los que todavía se carece del Registro Médico Electrónico (RME) y los sistemas de información disponibles presentan una escasa disponibilidad en el acceso y en el procesamiento de sus datos, lo que limita la toma de decisiones clínico-médicas. Se presentan dos sistemas de información desarrollados con este enfoque, con arquitecturas de software que presentan capas estables y modificables, adaptadas a las necesidades de cualquier organización, escalables y replicadas en varios contenedores la infrautilización de recursos informáticos.European Commissio

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Historical view of the concept of ageing from the Middle Ages

La vejez es una etapa más del ser humano que ha sido interpretada de forma variable dependiendo del contexto social en el cual se analizara. A la hora de considerar la vejez en la sociedad del siglo XXI se impone una reflexión sobre la misma a través del espacio y del tiempo, con el fin de entender este complejo fenómeno en la vida del ser humano en su totalidad, como un hecho ligado a la cultura y no solo biológico.Old age is just one more stage for humans, that has been interpreted in different ways depending on me social context from which it was analysed. When it comes to consider ageing in the 21st century, a review through space and time is needed, in order to understand this complex phenomenon in human life as a cultural -not only biological- fact

Machine learning applied to diagnosis of human diseases: a systematic review

Human healthcare is one of the most important topics for society. It tries to find the correct effective and robust disease detection as soon as possible to patients receipt the appropriate cares. Because this detection is often a difficult task, it becomes necessary medicine field searches support from other fields such as statistics and computer science. These disciplines are facing the challenge of exploring new techniques, going beyond the traditional ones. The large number of techniques that are emerging makes it necessary to provide a comprehensive overview that avoids very particular aspects. To this end, we propose a systematic review dealing with the Machine Learning applied to the diagnosis of human diseases. This review focuses on modern techniques related to the development of Machine Learning applied to diagnosis of human diseases in the medical field, in order to discover interesting patterns, making non-trivial predictions and useful in decision-making. In this way, this work can help researchers to discover and, if necessary, determine the applicability of the machine learning techniques in their particular specialties. We provide some examples of the algorithms used in medicine, analysing some trends that are focused on the goal searched, the algorithm used, and the area of applications. We detail the advantages and disadvantages of each technique to help choose the most appropriate in each real-life situation, as several authors have reported. The authors searched Scopus, Journal Citation Reports (JCR), Google Scholar, and MedLine databases from the last decades (from 1980s approximately) up to the present, with English language restrictions, for studies according to the objectives mentioned above. Based on a protocol for data extraction defined and evaluated by all authors using PRISMA methodology, 141 papers were included in this advanced review.Ministerio de Economía y CompetitividadInstituto de Salud Carlos II

Predicting the Appearance of Hypotension during Hemodialysis Sessions Using Machine Learning Classifiers

A patient suffering from advanced chronic renal disease undergoes several dialysis sessions on different dates. Several clinical parameters are monitored during the different hours of any of these sessions. These parameters, together with the information provided by other parameters of analytical nature, can be very useful to determine the probability that a patient may suffer from hypotension during the session, which should be specially watched since it represents a proven factor of possible mortality. However, the analytical information is not always available to the healthcare personnel, or it is far in time, so the clinical parameters monitored during the session become key to the prevention of hypotension. This article presents an investigation to predict the appearance of hypotension during a dialysis session, using predictive models trained from a large dialysis database, which contains the clinical information of 98,015 sessions corresponding to 758 patients. The prediction model takes into account up to 22 clinical parameters measured five times during the session, as well as the gender and age of the patient. This model was trained by means of machine learning classifiers, providing a success in the prediction higher than 80%