Vacunación y eventos supuestamente atribuibles a vacunación o inmunización en estudiantes universitarios

La vacunación es la intervención que mayor impacto ha tenido en la salud después de la potabilización del agua. Las vacunas no están exentas de efectos adversos. Los eventos supuestamente atribuibles a vacunación o inmunización son: todo cuadro clínico que aparece luego de la administración de una vacuna y que eventualmente puede atribuirse a esta. En la Universidad Nacional de San Luis se realizó un Operativo de Vacunación en mayo del 2014. El objetivo fue determinar: vacunas administradas, eventos supuestamente atribuibles a vacunación o inmunización presentados, datos sociodemográficos y conocimiento sobre la notificación de eventos supuestamente atribuibles a vacunación o inmunización. Se realizó una encuesta a 84 personas vacunadas seleccionadas al azar de un total de 285; se incluyeron datos de edad, sexo, vacunas, número, tipo y síntomas de los eventos supuestamente atribuibles a vacunación o inmunización, tratamiento recibido y motivos de la no notificación. Los síntomas se clasificaron como: generales y locales; letales, graves, moderados, leves; y por necesidad de tratamiento o no. Resultados: edad: 18-45 años; sexo: femenino 72, masculino 12; vacunas: antigripal (48%), hepatitis B (24%), triple bacteriana acelular (15%), sarampión rubéola (7%) y doble bacteriana adultos (6%). Eventos supuestamente atribuibles a vacunación o inmunización (39): leves (38) y moderado (1). Síntomas: dolor, hinchazón, induración, malestar general y fiebre. Motivos para no notificar: desconocimiento de la existencia de la notificación (4), dónde y cómo realizar la notificación (7) y pensar que los eventos supuestamente atribuibles a vacunación o inmunización esperables no se deben notificar (28)

Management of post-acute COVID-19 patients in geriatric rehabilitation: EuGMS guidance

PurposeTo describe a guidance on the management of post-acute COVID 19 patients in geriatric rehabilitation.MethodsThe guidance is based on guidelines for post-acute COVID-19 geriatric rehabilitation developed in the Netherlands, updated with recent insights from literature, related guidance from other countries and disciplines, and combined with experiences from experts in countries participating in the Geriatric Rehabilitation Special Interest Group of the European Geriatric Medicine Society.ResultsThis guidance for post-acute COVID-19 rehabilitation is divided into a section addressing general recommendations for geriatric rehabilitation and a section addressing specific processes and procedures. The Sect. “General recommendations for geriatric rehabilitation” addresses: (1) general requirements for post-acute COVID-19 rehabilitation and (2) critical aspects for quality assurance during COVID-19 pandemic. The Sect. “Specific processes and procedures”, addresses the following topics: (1) patient selection; (2) admission; (3) treatment; (4) discharge; and (5) follow-up and monitoring.ConclusionProviding tailored geriatric rehabilitation treatment to post-acute COVID-19 patients is a challenge for which the guidance is designed to provide support. There is a strong need for additional evidence on COVID-19 geriatric rehabilitation including developing an understanding of risk profiles of older patients living with frailty to develop individualised treatment regimes. The present guidance will be regularly updated based on additional evidence from practice and research

La atención hospitalaria al paciente con ictus en Cataluña. Resultados del «Primer Audit Clínic de l’Ictus. Catalunya, 2005/2006»

ResumenObjetivoAnalizar la calidad de la atención hospitalaria al paciente con ictus en los hospitales públicos catalanes antes de la difusión de la Guía de Práctica Clínica (GPC) del ictus, estudiando el grado de adhesión a determinadas recomendaciones de la GPC.MétodosMediante revisión retrospectiva de historias clínicas de pacientes con ictus definidos mediante los códigos CIE-9 431, 433.×1, 434.×1, 436, e ingresados consecutivamente en 48 hospitales públicos catalanes en el primer semestre de 2005, se recogió información sobre distintos indicadores del proceso asistencial al ictus seleccionados según su evidencia científica o su importancia clínica. Los hospitales participantes reclutaron 20, 40 o 60 casos, según el número de ingresos/ año. Se llevó a cabo una auditoría externa en el 9,3% de los casos reclutados en cada centro, tras selección aleatoria, para determinar la calidad de los datos recogidos. Los indicadores se agruparon en 6 perfiles relacionados con diferentes aspectos de la práctica clínica.ResultadosSe incluyeron 1.791 casos, un 53,9% hombres, con una media (desviación estándar) de edad de 75,6 (12,4) años. La concordancia global entre observadores fue de 0,7. El cumplimiento de los perfiles asistenciales (porcentaje medio [intervalo de confianza del 95%]) fue: calidad de la historia clínica, 78,5% (77,5-79,4); estándares de atención básica, 92,4% (91,5-93,2); evaluación neurológica, 38,3% (37,3-39,3); medidas iniciales del tratamiento rehabilitador, 44,9% (43,2-46,7); prevención y manejo de complicaciones, 68,4% (66,9-70), y medidas preventivas iniciales, 78,9% (77,3-80,4).ConclusionesEn 2005 la atención hospitalaria al ictus era mejorable, sobre todo los aspectos relacionados con la evaluación y el seguimiento neurológico del paciente y la rehabilitación.AbstractObjectiveTo determine the quality of in-hospital stroke care in public acute care hospitals in Catalonia before the implementation of a clinical practice guideline (CPG) on stroke by determining adherence to specific recommendations of the CPG.MethodsWe retrospectively reviewed the case notes of consecutive patients with stroke (defined with ICD-9 codes: 431, 433.×1, 434.×1, and 436) admitted to 48 Catalan hospitals within the first half of 2005. Data were collected on indicators of the healthcare process selected on the basis of their scientific evidence and/or clinical relevance. The participating hospitals included 20, 40 or 60 stroke cases according to their annual stroke caseload. After random selection, up to 9.3% of all cases recruited at each study center were externally monitored to assess the quality of the data gathered. Indicators were grouped into six different dimensions related to distinct aspects of clinical practice.ResultsWe analyzed data from 1,791 stroke cases (53.9% men, mean age: 75.6 [12.4] years). Overall inter-observer agreement was 0.7. Compliance with the six dimensions was as follows (mean percentage [95%CI]): quality of medical records, 78.5% (77.5-79.4); initial interventions, 92.4% (91.5-93.2); neurological assessment, 38.3% (37.3-39.3); assessment of rehabilitation needs, 44.9% (43.2-46.7); prevention and management of medical complications, 68.4% (66.9-70), and initial preventive measures, 78.9% (77.3-80.4).ConclusionsIn the first half of 2005, in-hospital stroke care in Catalonia showed room for improvement particularly in aspects related to the neurological assessment and follow-up of patients and their rehabilitation process

Management of post‑acute COVID‑19 patients in geriatric rehabilitation: EuGMS guidance

Key summary points Aim To describe a guidance on the management of post-acute COVID 19 patients in geriatric rehabilitation. Findings This guidance addresses general requirements for post-acute COVID-19 geriatric rehabilitation and critical aspects for quality assurance during the COVID-19 pandemic. Furthermore, the guidance describes relevant care processes and procedures divided in five topics: patient selection; admission; treatment; discharge; and follow-up and monitoring. Message This guidance is designed to provide support to care professionals involved in the geriatric rehabilitation treatment of post-acute COVID-19 patients

First and second waves of coronavirus disease-19: A comparative study in hospitalized patients in Reus, Spain.

Many countries have seen a two-wave pattern in reported cases of coronavirus disease-19 during the 2020 pandemic, with a first wave during spring followed by the current second wave in late summer and autumn. Empirical data show that the characteristics of the effects of the virus do vary between the two periods. Differences in age range and severity of the disease have been reported, although the comparative characteristics of the two waves still remain largely unknown. Those characteristics are compared in this study using data from two equal periods of 3 and a half months. The first period, between 15th March and 30th June, corresponding to the entire first wave, and the second, between 1st July and 15th October, corresponding to part of the second wave, still present at the time of writing this article. Two hundred and four patients were hospitalized during the first period, and 264 during the second period. Patients in the second wave were younger and the duration of hospitalization and case fatality rate were lower than those in the first wave. In the second wave, there were more children, and pregnant and post-partum women. The most frequent signs and symptoms in both waves were fever, dyspnea, pneumonia, and cough, and the most relevant comorbidities were cardiovascular diseases, type 2 diabetes mellitus, and chronic neurological diseases. Patients from the second wave more frequently presented renal and gastrointestinal symptoms, were more often treated with non-invasive mechanical ventilation and corticoids, and less often with invasive mechanical ventilation, conventional oxygen therapy and anticoagulants. Several differences in mortality risk factors were also observed. These results might help to understand the characteristics of the second wave and the behaviour and danger of SARS-CoV-2 in the Mediterranean area and in Western Europe. Further studies are needed to confirm our findings