6 resultados para Score reading introduction


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Losada Iglesias, Daniel; Correa Gorospe, José Miguel (eds.)

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225 p. : il. Texto en español con conclusiones en inglés

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[ES] Este proyecto genera productos adicionales de trabajos también disponibles en el repositori, en concreto:

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Background: Limited information is available about predictors of short-term outcomes in patients with exacerbation of chronic obstructive pulmonary disease (eCOPD) attending an emergency department (ED). Such information could help stratify these patients and guide medical decision-making. The aim of this study was to develop a clinical prediction rule for short-term mortality during hospital admission or within a week after the index ED visit. Methods: This was a prospective cohort study of patients with eCOPD attending the EDs of 16 participating hospitals. Recruitment started in June 2008 and ended in September 2010. Information on possible predictor variables was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up. Main short-term outcomes were death during hospital admission or within 1 week of discharge to home from the ED, as well as at death within 1 month of the index ED visit. Multivariate logistic regression models were developed in a derivation sample and validated in a validation sample. The score was compared with other published prediction rules for patients with stable COPD. Results: In total, 2,487 patients were included in the study. Predictors of death during hospital admission, or within 1 week of discharge to home from the ED were patient age, baseline dyspnea, previous need for long-term home oxygen therapy or non-invasive mechanical ventilation, altered mental status, and use of inspiratory accessory muscles or paradoxical breathing upon ED arrival (area under the curve (AUC) = 0.85). Addition of arterial blood gas parameters (oxygen and carbon dioxide partial pressures (PO2 and PCO2)) and pH) did not improve the model. The same variables were predictors of death at 1 month (AUC = 0.85). Compared with other commonly used tools for predicting the severity of COPD in stable patients, our rule was significantly better. Conclusions: Five clinical predictors easily available in the ED, and also in the primary care setting, can be used to create a simple and easily obtained score that allows clinicians to stratify patients with eCOPD upon ED arrival and guide the medical decision-making process.

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Reinforced concrete structures are introduced in Spain mainly by French influence. This happens in the late nineteenth century, following the scheme operating through proprietary systems prevailing in Europe. Systems initially have poor scientific support reaching, even early twentieth century, an impediment to the development of concrete structures, due to the lack of knowledge shown, as well as due to a series of accidents. Therefore, from the end of the first decade of the past century are enacted a series of regulations in many countries, that will change the design and calculation of reinforced concrete structure. The knowledge of the environment of the patent systems, its beginnings and the circumstances of their application allow us to understand the constraints of the early concrete structures, as presented in the Bilbao wine store (1906).