Conjunto mínimo básico de datos al alta hospitalaria [Recurso electrónico] : grupos relacionados por el diagnóstico (GRDs) : hospitales concertados 2010

En la port.: Dirección General de Planificación e Innovación Sanitaria, Servicio de Conciertos Sanitarios

Influencia de la angina preinfarto en la semana previa en la morbimortalidad cardiovascular tardía tras el alta hospitalaria.

The occurrence of angina in the week preceding myocardial infarction is associated with a reduction in cardiovascular complications in the acute phase. However, little is known about it relationship with prognosis after hospitalization (e.g., cardiovascular death and the development of heart failure or ischemic cardiomyopathy). The study included 290 consecutive patients admitted for a first myocardial infarction: 107 (36.9%) had preceding angina while 183 did not. Those with a history of ischemic cardiomyopathy of more than 1 week or structural cardiopathy were excluded. There was no difference in baseline characteristics between the two groups. Moreover, there was no difference in the rates of cardiovascular complications after hospital discharge: cardiovascular death (7% vs. 12.6%; P=.3), heart failure (7.4% vs. 11.6%; P=.2), and myocardial ischemia, including myocardial infarction and unstable angina, requiring hospitalization (41.2% vs. 31.3%; P=.3). The occurrence of angina in the week before a first myocardial infarction did not influence cardiovascular complications after hospital discharge (odds ratio = 0.75 [0.51-1.11]; P=.15).

Changes in health related quality of life 3 months after an acute coronary syndrome

BACKGROUND The aim of the study was to identify the changes in Health Related Quality of Life (HRQL) 3 months after discharge from hospital, in patients who have had an acute coronary episode, and to determine the clinical and sociodemographic variables that explain those changes. METHODS HRQL was assessed in 132 patients while they were admitted to the hospital and at 3 months after discharge, using the SF-36 health questionnaire. To identify the variables associated with the change, multiple linear regression models were constructed for two summary dimensions of the SF-36 (PCS and MCS) taking the change in the score of the dimension as dependent variable. RESULTS There were no significant differences between the patients who completed the monitoring (n = 76) and those who were dropped out. After three months, a significant decrease was observed in the dimensions of physical functioning, general health, vitality, and Physical Summary Component (PCS). The variables revascularisation, age, and the interaction between previous history of coronary heart disease (CHD) and the presence of one or more risk factors explained 16.6% of the decrease in the PCS. The decrease in the PCS was 6.4 points less in the patients who had undergone revascularisation, 0.2 points less for each year of age, and 4.7 points less in the patients who had antecedents of the illness as well as one or more risk factors. CONCLUSION The dimensions most affected at three months after an acute coronary episode were those related to the physical component. Undergoing revascularisation improved the PCS in patients, but in the younger patients and those without personal antecedents or risk factors, the PCS was affected more, perhaps due to greater expectations for recovery in these patients.

Relación entre la edad, el índice de masa corporal, el grado de dependencia y la calidad de vida en pacientes con desnutrición tras un alta hospitalaria.

Introduction: The quality of life assessment means investigating how patients perceive their disease. Malnutrition-specific characteristics make patients more vulnerable, so it is important to know how these factors impaction patients’ daily life. Aim: To assess the quality of life in malnourished patients who have had hospital admission, and to determine the relationship of the quality of life with age, body mass index, diagnosis of malnutrition, and dependency. Method: Multicenter transversal descriptive study in 106 malnourished patients after hospital admission. The quality of life (SF-12 questionnaire), BMI, functional independency (Barthel index), morbidity, and a dietary intake evaluation were assessed. The relationship between variables was tested by using the Spearman correlation coefficient Results: The patients of the present study showed a SF-12 mean of 38.32 points. The age was significantly correlated with the SF-12 (r= -0.320, p= 0.001). The BMI was correlated with the SF-12 (r= 0.251, p= 0.011) and its mental component (r= 0.289, p= 0.03). It was also reported a significant correlation between the Barthel index and the SF-12 (r= 0.370, p< 0.001). Conclusions: The general health perception in malnourished patients who have had a hospital admission was lower than the Spanish mean. Moreover, the quality of life in these patients is significantly correlated with age, BMI and functional independency.

Estrategia para la seguridad del paciente en el SSPA 2011-2014

En soporte papel, está acompañada por el "Análisis de la implementación de la Estrategia para la Seguridad del Paciente en el SSPA 2006-2010."

Análisis de la implementación de la estrategia para la seguridad del paciente en el SSPA 2006-2010

Es la evaluación del desarrollo de la implantación de la "Estrategia para la Seguridad del Paciente 2006-2010" en Andalucía.En soporte papel, acompaña a la "Estrategia para la seguridad del paciente en el SSPA 2011-2014".

Atención al paciente pluripatológico : proceso asistencial integrado. 2ª ed

Publicado en la página web de la Consejería de Salud: www.juntadeandalucia.es/salud (Consejería de Salud / Profesionales / Nuestro Compromiso por la Calidad / Procesos Asistenciales Integrados)

Dietoterapia en paciente con linfangiectasia intestinal primaria y ascitis quilosa de repetición.

OBJECTIVES Primary intestinal lymphangiectasia is a lymphatic system's disorder, where lymphatic drainage is blockaged. Clinically it produces malabsorption, protein-losing enteropathy, hypogammaglobulin in blood, and several degrees of malnutrition. Its treatment is not easy and includes dietetic-therapy and drugs. MATERIAL AND METHOD A 35-year-old-woman case report is exposed. She has recurrent chylosa ascites, requiring several admissions and evacuatory paracentesis. After food-fat was replaced by medium-chain triacyl-glicerol-enriched diet, a clinical, analytical and anthropometric improvement was demonstrated. CONCLUSIONS The major way of treatment in intestinal lymphangiectasia in this case is the employement of specific-diet and adaptaded-basic-food. It's difficult and high collaboration of the patient is required, being necessary medical revisions during the whole life, due to the not well known evolution of this long-standing disease.

Resistencia de la hiperhomocisteinemia del paciente renal al tratamiento con dosis suprafisiológicas de ácido fólico parenteral

Hemodialysis patients present an increase in plasma homocysteine (Hcy) due to methylation impairment caused by uremia and the deficiency of the co-factors needed (vitamin B, folic acid). This correlates with a more common development of premature vascular disease. There is no consensus on the therapy, with a poor response to oral administration of conventional doses of folic acid. In this work, we assessed the response of hyperhomocysteinemia in 73 regular hemodialysis patients after the administration of 50 mg of parenteral folinic acid for 18 months. Plasma homocysteine of the patients at the time of the study beginning presented mean values of 22.67 (micromol/L). During the first year of supplementation the mean value was kept at 20 micromol/L. From the first year to the end of the 18-months observation period the mean homocysteine levels were 19.58 micromol/L. Although we found a clear trend towards a decrease in plasma homocysteine levels during the treatment period, there were no significant differences. Homocysteine levels did not come back to normal in none of the patients treated.

Comunicación paciente-médico y toma de decisiones en salud en Andalucía. Expectativas de pacientes crónicos del Sistema Sanitario Público Andaluz

The purpose of the study was to know about the expectations had by chronic patients within th e Public Healthcare System in Andalusi a, concerning commu nication and making deci sions with the med ical professionals who take care of them duri ng the entire treatment process. A qualitative study was carried out in Andalusia, based on 19 i n-depth interviews and 17 focus groups with 15 4 chronic patients and their relatives, suffering from seven different types of illness, of which the content was later analyzed based on the type of disease (pathologies), and the level of care (Primary, Sp eci aliz ed or Em ergen cy Ser vices). The study shows that patients i ncl uded in all healthcare processes want information about their illness. In Primary Care, they value continued attention, closeness and trust as well as being referred to a proper specialist. In Specialized Care, they expect to receive trustworthy information, proper tests and a correct diagnosis, friendly treatment and to be listened to. In the Emergency Room, lack of tim e and overcrowding d i sru pt proper communic ation. The type of chronic illne ss i nfluenc es patients’ expectations in terms of communication and decisionmaking. Communic ation between patients and medical personnel and the decision-making process related to chronic illness are crucial for the improvement of the qualit y o f healthcare. The type of chr onic disease marks diffe rent expectation s about the communication and decision-making. The communication and the decision making in the chronic assistance is a priority to improve the quality of the assistance

Recepción, clasificación según escala Manchester y atención sanitaria inicial al paciente que acude a un Dispositivo de Cuidados Críticos y Urgencias (DCCU) con motivo de consulta “Diabetes”: Posibilidad de intervención finalista de la enfermera en la consulta de triage (Triage Avanzado) ante la hipoglucemia. Colaboración multidisciplinar y criterios de derivación

The Andalusian Public Health System (SSPA) is considering the last time an attempt urgent process management through triage consultation, both hospital and primary care environment and tables situations in which the nurse responsible for these consultations can carry out a final statement of which only she is directly responsible through their independent intervention and referral (Triage Advanced). Pose, at once and consistently to the idea of teamwork, where they can be the limits to that intervention finalist and the circuits to follow. This paper proposes a definition line of one of those situations through triage concepts universally tested, and takes full advantage of advanced practice profile offered by nurses Device Critical Care (DCCU) of the SSPA and any the emerging legal and regulatory framework in terms of standardized collaborative prescription, us know legitimate receivers. This work stems from the vision of professionals and our contribution to that line of institutional work that must be consensus.

Paciente transferido desde Equipo Móvil de Dispositivo de Cuidados Críticos y Urgencias (EM DCCU) a sistema de helitransporte sanitario (HEMS): Guía de actuación

Assistance and transfer of critical patients often takes place in an environment in which the medium response time, playing against an appropriate and definitive treatment at a center useful. The relationship in this sense arises between the resources of the level of primary care and the medical helicopter transport system (HEMS), is caused by the need to shorten those response times and referral in areas where initial care is taken to DCCU out by, despite being timedependent pathology that requires a fast transfer can not be offered by them with the possibility of optimization. The support in this sense of HEMS is essential: The knowledge of the environment and the establishment of policy guidance are necessary.