Pub Date : 2025-05-01Epub Date: 2025-04-10DOI: 10.1016/j.rce.2024.12.004
S. Sánchez Martínez , J. Solís García del Pozo , L. Cabeza Osorio , J. Gómez Garrido , M. Méndez Bailón , J.J. Alfaro Martínez
Introduction
Despite Internal Medicine's importance in our health system, there has been an impression of a lower demand for the choice of specialty in recent years. Our objective is to know the evolution of the choice of Internal Medicine places between 2001 and 2024 among medical graduates who aspire to specialized training in Spain through new parameters based on quotation and demand.
Material and methods
Based on the data published by the Ministry of Health, we analyze the index and the order of quotation, the order of demand, and the total demand for the period studied.
Results
The Internal Medicine quotation remained relatively stable throughout the period until the years 2022-2024, when it declined. The number of Internal Medicine places awarded when the first specialty is exhausted also remains stable. However, the overall demand has deteriorated in recent years, although it continues to maintain an order of total demand above other medical specialties.
Conclusion
Internal Medicine has maintained a very stable quotation and demand for years despite the development of different specialties, until the last three years when this quotation and demand worsened. It is essential to make medical students aware of the fundamental role that Internal Medicine plays in our health and hospital system to promote the paradigm shift from the disease to the sick person.
{"title":"Análisis de la demanda de la especialidad de Medicina Interna en las plazas MIR a través del índice de cotización entre los años 2001 y 2024","authors":"S. Sánchez Martínez , J. Solís García del Pozo , L. Cabeza Osorio , J. Gómez Garrido , M. Méndez Bailón , J.J. Alfaro Martínez","doi":"10.1016/j.rce.2024.12.004","DOIUrl":"10.1016/j.rce.2024.12.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite Internal Medicine's importance in our health system, there has been an impression of a lower demand for the choice of specialty in recent years. Our objective is to know the evolution of the choice of Internal Medicine places between 2001 and 2024 among medical graduates who aspire to specialized training in Spain through new parameters based on quotation and demand.</div></div><div><h3>Material and methods</h3><div>Based on the data published by the Ministry of Health, we analyze the index and the order of quotation, the order of demand, and the total demand for the period studied.</div></div><div><h3>Results</h3><div>The Internal Medicine quotation remained relatively stable throughout the period until the years 2022-2024, when it declined. The number of Internal Medicine places awarded when the first specialty is exhausted also remains stable. However, the overall demand has deteriorated in recent years, although it continues to maintain an order of total demand above other medical specialties.</div></div><div><h3>Conclusion</h3><div>Internal Medicine has maintained a very stable quotation and demand for years despite the development of different specialties, until the last three years when this quotation and demand worsened. It is essential to make medical students aware of the fundamental role that Internal Medicine plays in our health and hospital system to promote the paradigm shift from the disease to the sick person.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 102278"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-04-11DOI: 10.1016/j.rce.2025.502281
E. Fuentes , J. Jacob , J. González del Castillo , F.J. Montero-Pérez , A. Alquezar-Arbé , Ò. Miró , en representación del grupo EDEN
Objective
To identify the variables associated with living in a care home in patients aged 65 or older who consult in the emergency department (ED), and to assess their outcomes.
Methods
Patients aged 65 or older who consulted in 52 Spanish ED during one week in April 2019 were included and classified according to whether they lived in a care home or at their family home. The characteristics of these patients and the differences between the two groups were investigated using a logistic regression model and the calculation of the odds ratio (OR) with its 95% confidence interval (CI). Mortality, ED revisits, and hospitalization rates at 30 days and at 1 year after the index episode were evaluated, calculating the hazard ratios (HR) and their 95% CI, as well as the log-rank statistic with Cox regression.
Results
A total of 23,629 patients were analyzed, of which 1,569 (6.6%) lived in a care home. Of the 18 variables explored, several were associated with living in a care home in the multivariate model, with the following showing significant results: inability to ambulate, OR 11.330 (95% CI 8.967-14.314); ambulation with assistance, OR 5.687 (95% CI 4.759-6.796); cognitive impairment, OR 2.802 (95% CI 2.448-3.208); and age over 85 years, OR 2.191 (95% CI 1.821-2.636). Total mortality at 30 days and 1 year was 4.4% and 13.7%, respectively, both being higher in the care home patients, with an adjusted HR of 1.472 (95% CI 1.236-1.753) and 1.421 (95% CI 1.282-1.576), respectively. There were no differences in ED revisits or hospitalization in 30 days and 1 year in the adjusted global model.
Conclusions
Patients aged 65 or older who consult in the ED and live in a care home have a worse baseline condition compared to those living at home. During follow-up at 30 days and 1 year, these patients also have higher overall mortality, although there are no differences in ED revisits or hospitalization.
目的确定65岁及以上急诊科（ED）患者在养老院生活的相关变量，并评估其预后。方法纳入2019年4月一周内在52家西班牙急诊科就诊的65岁及以上患者，并根据他们是住在养老院还是住在家里进行分类。采用logistic回归模型，计算95%可信区间（CI）的优势比（OR），分析两组患者的特征及差异。评估指标发作后30天和1年的死亡率、急诊科复诊率和住院率，计算风险比（HR）及其95% CI，并采用Cox回归进行对数秩统计。结果共分析23629例患者，其中1569例（6.6%）居住在养老院。在研究的18个变量中，有几个变量在多变量模型中与住在养老院有关，以下显示了显著的结果：无法行走，OR 11.330 (95% CI 8.967-14.314)；辅助行走，OR 5.687 (95% CI 4.759-6.796)；认知障碍，OR 2.802 (95% CI 2.448-3.208)；年龄大于85岁，OR 2.191 （95% CI 1.821-2.636）。30天和1年的总死亡率分别为4.4%和13.7%，在养老院患者中均较高，调整后的风险比分别为1.472 （95% CI 1.236-1.753）和1.421 （95% CI 1.282-1.576）。在调整后的全球模型中，30天和1年的ED复诊和住院率没有差异。结论65岁及以上在急诊科就诊并住在养老院的患者基线状况较住在家里的患者差。在30天和1年的随访期间，这些患者的总体死亡率也较高，尽管急诊科复诊或住院率没有差异。
{"title":"Características y resultados evolutivos a corto y largo plazo en los pacientes de 65 o más años que viven en residencia. Estudio EDEN-40","authors":"E. Fuentes , J. Jacob , J. González del Castillo , F.J. Montero-Pérez , A. Alquezar-Arbé , Ò. Miró , en representación del grupo EDEN","doi":"10.1016/j.rce.2025.502281","DOIUrl":"10.1016/j.rce.2025.502281","url":null,"abstract":"<div><h3>Objective</h3><div>To identify the variables associated with living in a care home in patients aged 65 or older who consult in the emergency department (ED), and to assess their outcomes.</div></div><div><h3>Methods</h3><div>Patients aged 65 or older who consulted in 52 Spanish ED during one week in April 2019 were included and classified according to whether they lived in a care home or at their family home. The characteristics of these patients and the differences between the two groups were investigated using a logistic regression model and the calculation of the odds ratio (OR) with its 95% confidence interval (CI). Mortality, ED revisits, and hospitalization rates at 30 days and at 1 year after the index episode were evaluated, calculating the hazard ratios (HR) and their 95% CI, as well as the log-rank statistic with Cox regression.</div></div><div><h3>Results</h3><div>A total of 23,629 patients were analyzed, of which 1,569 (6.6%) lived in a care home. Of the 18 variables explored, several were associated with living in a care home in the multivariate model, with the following showing significant results: inability to ambulate, OR 11.330 (95% CI 8.967-14.314); ambulation with assistance, OR 5.687 (95% CI 4.759-6.796); cognitive impairment, OR 2.802 (95% CI 2.448-3.208); and age over 85 years, OR 2.191 (95% CI 1.821-2.636). Total mortality at 30 days and 1 year was 4.4% and 13.7%, respectively, both being higher in the care home patients, with an adjusted HR of 1.472 (95% CI 1.236-1.753) and 1.421 (95% CI 1.282-1.576), respectively. There were no differences in ED revisits or hospitalization in 30 days and 1 year in the adjusted global model.</div></div><div><h3>Conclusions</h3><div>Patients aged 65 or older who consult in the ED and live in a care home have a worse baseline condition compared to those living at home. During follow-up at 30 days and 1 year, these patients also have higher overall mortality, although there are no differences in ED revisits or hospitalization.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 502281"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-04-12DOI: 10.1016/j.rce.2025.502280
L. Ordieres Ortega , J.L. Modesto dos Santos , P. Parra Caballero , T. Soriano Sánchez , C. Sánchez del Hoyo , E. Coloma Bazán , M. Anta Fernández , M. Martín del Pozo
Introduction
Home hospitalisation (HH) is a safe care modality that reduces costs and risks compared to conventional hospitalisation. Evidence supports the safety of outpatient management in patients with pulmonary embolism (PE).
Objectives and methods
To establish a protocol for the identification and clinical management of patients with PE who are candidates for HH management. This document has been prepared jointly by the Venous Thromboembolic Disease Group (VTD) and the Home Hospitalisation Group (HH) of the Spanish Society of Internal Medicine (SEMI).
Results
A total of 44 statements were considered. Voting was carried out using a Likert scale. A total of 39 recommendations reached consensus.
Conclusions
The SEMI VTD and HH working groups recommend evaluating home treatment of PE in patients with a low risk of complications.
{"title":"Resumen ejecutivo del documento de consenso sobre el tratamiento domiciliario de la embolia pulmonar","authors":"L. Ordieres Ortega , J.L. Modesto dos Santos , P. Parra Caballero , T. Soriano Sánchez , C. Sánchez del Hoyo , E. Coloma Bazán , M. Anta Fernández , M. Martín del Pozo","doi":"10.1016/j.rce.2025.502280","DOIUrl":"10.1016/j.rce.2025.502280","url":null,"abstract":"<div><h3>Introduction</h3><div>Home hospitalisation (HH) is a safe care modality that reduces costs and risks compared to conventional hospitalisation. Evidence supports the safety of outpatient management in patients with pulmonary embolism (PE).</div></div><div><h3>Objectives and methods</h3><div>To establish a protocol for the identification and clinical management of patients with PE who are candidates for HH management. This document has been prepared jointly by the Venous Thromboembolic Disease Group (VTD) and the Home Hospitalisation Group (HH) of the Spanish Society of Internal Medicine (SEMI).</div></div><div><h3>Results</h3><div>A total of 44 statements were considered. Voting was carried out using a Likert scale. A total of 39 recommendations reached consensus.</div></div><div><h3>Conclusions</h3><div>The SEMI VTD and HH working groups recommend evaluating home treatment of PE in patients with a low risk of complications.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 502280"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-04-10DOI: 10.1016/j.rce.2025.502283
J.C. Arévalo-Lorido , F. Alonso Ecenarro , P. Luque-Linero , D. García Calle , J.F. Varona Arche , E. Gañán Moreno , B. Seoane González , J. Carretero Gomez , A. Gullón , L. Castilla Guerra
Aim
To update the profile of patients with atrial fibrillation (AF) who are treated in internal medicine wards according to characteristics implicit in elderly patients.
Material and methods
Multicenter national registry with one-year follow-up that includes adult patients diagnosed with AF. The sample is divided into three groups based on comorbidity and dependency (group 1, functional patients with little comorbidity; group 2, partially dependent patients with comorbidity; group 3, dependent patients with comorbidity) and their characteristics are described, differentiating between inpatients and outpatients.
Results
One thousand two hundred fifteen subjects were analyzed (mean age 81.5 ± 8.7, with 52.1% women). An increase in comorbidities associated with AF is observed compared to previous analyses in the same setting. There is a high rate of frailty (44.4%), and risk of malnutrition (52.9%) with significant differences between the established groups. An increase in baseline anticoagulant therapy was observed with fewer individuals treated in group 3, and a greater use of direct anticoagulants (62.3%) than anti-vitamin K drugs (22.2%), especially in group 3.
Discussion
The current profile of AF patients treated in internal medicine shows an aged but heterogeneous population with a higher rate of baseline anticoagulant therapy than in previous records with a greater use of direct anticoagulants, especially in the more comorbid and dependent population. We observed a high prevalence of frailty and malnutrition with differences between the established groups. This situation could have implications for establishing differentiated approaches.
{"title":"Perfil de los pacientes con fibrilación auricular atendidos en servicios de medicina interna en España. Registro SUMAMOS-FA-SEMI","authors":"J.C. Arévalo-Lorido , F. Alonso Ecenarro , P. Luque-Linero , D. García Calle , J.F. Varona Arche , E. Gañán Moreno , B. Seoane González , J. Carretero Gomez , A. Gullón , L. Castilla Guerra","doi":"10.1016/j.rce.2025.502283","DOIUrl":"10.1016/j.rce.2025.502283","url":null,"abstract":"<div><h3>Aim</h3><div>To update the profile of patients with atrial fibrillation (AF) who are treated in internal medicine wards according to characteristics implicit in elderly patients.</div></div><div><h3>Material and methods</h3><div>Multicenter national registry with one-year follow-up that includes adult patients diagnosed with AF. The sample is divided into three groups based on comorbidity and dependency (group 1, functional patients with little comorbidity; group 2, partially dependent patients with comorbidity; group 3, dependent patients with comorbidity) and their characteristics are described, differentiating between inpatients and outpatients.</div></div><div><h3>Results</h3><div>One thousand two hundred fifteen subjects were analyzed (mean age 81.5<!--> <!-->±<!--> <!-->8.7, with 52.1% women). An increase in comorbidities associated with AF is observed compared to previous analyses in the same setting. There is a high rate of frailty (44.4%), and risk of malnutrition (52.9%) with significant differences between the established groups. An increase in baseline anticoagulant therapy was observed with fewer individuals treated in group 3, and a greater use of direct anticoagulants (62.3%) than anti-vitamin K drugs (22.2%), especially in group 3.</div></div><div><h3>Discussion</h3><div>The current profile of AF patients treated in internal medicine shows an aged but heterogeneous population with a higher rate of baseline anticoagulant therapy than in previous records with a greater use of direct anticoagulants, especially in the more comorbid and dependent population. We observed a high prevalence of frailty and malnutrition with differences between the established groups. This situation could have implications for establishing differentiated approaches.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 502283"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-04-16DOI: 10.1016/j.rce.2025.502286
M.Á. Gómez, F.J. Hermida
Objectives
Some of the monoclonal gammopathy of uncertain significance are transient monoclonal gammopathies, characterized by the appearance of a small serum paraprotein followed by its disappearance after a variable period of time. The aim of the present study is to examine the transient monoclonal gammopathies in our health area by describing their characteristics, as well as the pathology they presented at the time of the development of the monoclonal gammopathy.
Methods
A retrospective study was undertaken, in which all serum protein electrophoresis patterns performed during a 6-month period (January-2024/June-2024) were reviewed. All these serum protein electrophoresis were processed in the clinical analysis service of the Clinical Universitary Hospital of Santiago de Compostela from primary and secondary care of the Sanitary Area of Santiago de Compostela and Barbanza. Only patients without hematologic pathology who presented a serum protein electrophoresis without monoclonal gammopathy and who had previously presented a serum protein electrophoresis with the presence of monoclonal gammopathy were selected.
Results
A total of 80 transient monoclonal gammopathies were identified, of which 68 had a monoclonal pattern (85%) and 12 had an oligoclonal pattern (15%). We found different diagnoses coinciding with the presence of transient monoclonal gammopathy, among which we can highlight: 35 cases (43.7%) were infectious processes, 20 cases (25%) were autoimmune diseases and 12 cases (15%) were transplant patients.
Conclusions
Clinicians should consider the likelihood of a transient paraprotein to avoid unnecessary investigations and invasive procedures, which are used in case of suspected malignancy or persistent monoclonality.
{"title":"Gammapatía monoclonal transitoria: un estudio unicéntrico","authors":"M.Á. Gómez, F.J. Hermida","doi":"10.1016/j.rce.2025.502286","DOIUrl":"10.1016/j.rce.2025.502286","url":null,"abstract":"<div><h3>Objectives</h3><div>Some of the monoclonal gammopathy of uncertain significance are transient monoclonal gammopathies, characterized by the appearance of a small serum paraprotein followed by its disappearance after a variable period of time. The aim of the present study is to examine the transient monoclonal gammopathies in our health area by describing their characteristics, as well as the pathology they presented at the time of the development of the monoclonal gammopathy.</div></div><div><h3>Methods</h3><div>A retrospective study was undertaken, in which all serum protein electrophoresis patterns performed during a 6-month period (January-2024/June-2024) were reviewed. All these serum protein electrophoresis were processed in the clinical analysis service of the Clinical Universitary Hospital of Santiago de Compostela from primary and secondary care of the Sanitary Area of Santiago de Compostela and Barbanza. Only patients without hematologic pathology who presented a serum protein electrophoresis without monoclonal gammopathy and who had previously presented a serum protein electrophoresis with the presence of monoclonal gammopathy were selected.</div></div><div><h3>Results</h3><div>A total of 80 transient monoclonal gammopathies were identified, of which 68 had a monoclonal pattern (85%) and 12 had an oligoclonal pattern (15%). We found different diagnoses coinciding with the presence of transient monoclonal gammopathy, among which we can highlight: 35 cases (43.7%) were infectious processes, 20 cases (25%) were autoimmune diseases and 12 cases (15%) were transplant patients.</div></div><div><h3>Conclusions</h3><div>Clinicians should consider the likelihood of a transient paraprotein to avoid unnecessary investigations and invasive procedures, which are used in case of suspected malignancy or persistent monoclonality.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 502286"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-04-10DOI: 10.1016/j.rce.2025.502282
C. Escorial-Moya , I. Lobo-Matas , E. Calderón-Sandubete , F.J. Medrano-Ortega , J.M. Varela-Aguilar , J. Delgado-Cuesta
Background
Core needle biopsy (CNB) is often the initial test for polyadenopathic syndrome and is usually performed by radiologists. The objectives of this study are to determine the diagnostic yield of ultrasound-guided CNB of lymph nodes performed by internists at a tertiary care hospital, the most frequent etiological diagnoses, and the safety of this technique.
Materials
Observational, descriptive study in which we included all patients over 17 years of age who had undergone ultrasound-guided CNB of lymphadenopathy by a member of the internal medicine service of the Virgen del Rocío University Hospital in Seville from 2021-2023.
Results
A total of 76 patients were included, 49 (64.5%) were male and the median age [IQR] was 64 [42-75] years. The most frequent location of lymphadenopathy was inguinal (38.2%). This test allowed a definitive diagnosis in 71 (93.4%) of the patients. Of the 5 in whom the diagnosis was not reached by the CNB, three required an open biopsy, one was diagnosed with Bartonella henselae by serology and in a fifth the diagnosis was not reached. The median delay for the BAG [IQR] was 1 [0-3] days. No patient had complications. The most frequent diagnosis was lymphoma in 31 (41.8%) patients.
Conclusions
Ultrasound-guided CNB performed by internists is a safe, feasible test with very little delay. These data support the extension of this practice to the rest of the internal medicine services.
{"title":"Alta rentabilidad diagnóstica de la biopsia con aguja gruesa ecoguiada de adenopatías realizada en un servicio de medicina interna","authors":"C. Escorial-Moya , I. Lobo-Matas , E. Calderón-Sandubete , F.J. Medrano-Ortega , J.M. Varela-Aguilar , J. Delgado-Cuesta","doi":"10.1016/j.rce.2025.502282","DOIUrl":"10.1016/j.rce.2025.502282","url":null,"abstract":"<div><h3>Background</h3><div>Core needle biopsy (CNB) is often the initial test for polyadenopathic syndrome and is usually performed by radiologists. The objectives of this study are to determine the diagnostic yield of ultrasound-guided CNB of lymph nodes performed by internists at a tertiary care hospital, the most frequent etiological diagnoses, and the safety of this technique.</div></div><div><h3>Materials</h3><div>Observational, descriptive study in which we included all patients over 17 years of age who had undergone ultrasound-guided CNB of lymphadenopathy by a member of the internal medicine service of the <em>Virgen del Rocío</em> University Hospital in Seville from 2021-2023.</div></div><div><h3>Results</h3><div>A total of 76 patients were included, 49 (64.5%) were male and the median age [IQR] was 64 [42-75] years. The most frequent location of lymphadenopathy was inguinal (38.2%). This test allowed a definitive diagnosis in 71 (93.4%) of the patients. Of the 5 in whom the diagnosis was not reached by the CNB, three required an open biopsy, one was diagnosed with <em>Bartonella henselae</em> by serology and in a fifth the diagnosis was not reached. The median delay for the BAG [IQR] was 1 [0-3] days. No patient had complications. The most frequent diagnosis was lymphoma in 31 (41.8%) patients.</div></div><div><h3>Conclusions</h3><div>Ultrasound-guided CNB performed by internists is a safe, feasible test with very little delay. These data support the extension of this practice to the rest of the internal medicine services.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 502282"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-04-11DOI: 10.1016/j.rce.2025.01.003
J. Ena , J. Carretero Gómez , M. Suárez Tembra , L. Lajara Villar , C. Fernández Peña , A. Rosales Castillo , N. Domínguez Pinilla , F.J. Carrasco Sánchez , A. Bustos Merlo , A. Rabassa Soler , en nombre del Grupo de Trabajo de Diabetes, Obesidad y Nutrición de la Sociedad Española de Medicina Interna
Aim
To determine the prevalence and characteristics of chronic kidney disease (CKD) in a cross-sectional population of people with type 2 diabetes treated at internal medicine clinics in Spain.
Methods
We collected data from 25 hospitals which recruited 354 people with type 2 diabetes in an observational study carried out in May, 2024. Information collected included demographic data, comorbidities, nutritional status, presence of sarcopenia and frailty, as well as laboratory data and therapy administered.
Results
We included a total of 314 subjects, of whom 185 (58.9%; 95% confidence interval: 53.4-64.3%) had CKD. Compared with people with no CKD, those with CKD were older (77.4 ± 9.7 vs. 65.9 ± 12.5 years; P<0.001), more often male gender (53.1 vs. 46.9%; P=0.021), with more prevalence of ischemic heart disease (22.4 vs. 10.9%; P=.006) and longer duration of diabetes disease (14.1 ± 8.6 vs. 10.0 ± 7.0 years; P<0.001). Malnutrition (37.3 vs. 25%; P=0.017), sarcopenia (24.6 vs. 11.2%; P=0.003), and frailty (74.3 vs. 59%; P=0.006) was more often associated in people with CKD compared with those with no CKD.
Conclusion
Internal medicine specialists treat a significant number of people with diabetes and CKD. These people are characteristically elderly, with high proportion of cardiovascular disease showing malnutrition, sarcopenia, and frailty, which could determine the target for metabolic control.
目的确定在西班牙内科诊所接受治疗的2型糖尿病患者中慢性肾脏疾病（CKD）的患病率和特征。方法我们收集了来自25家医院的数据，在2024年5月开展的一项观察性研究中招募了354名2型糖尿病患者。收集的信息包括人口统计数据、合并症、营养状况、肌肉减少症和虚弱的存在，以及实验室数据和给予的治疗。结果共纳入314例受试者，其中185例（58.9%）；95%可信区间：53.4-64.3%)患有CKD。与无CKD患者相比，CKD患者年龄较大(77.4±9.7岁vs 65.9±12.5岁；P<0.001)，男性更常见(53.1 vs. 46.9%；P=0.021)，缺血性心脏病患病率更高(22.4%比10.9%；P= 0.006)，糖尿病病程更长(14.1±8.6∶10.0±7.0年；术中,0.001)。营养不良(37.3% vs. 25%；P=0.017)，肌肉减少症(24.6% vs. 11.2%；P=0.003)和虚弱(74.3 vs 59%；P=0.006)在CKD患者中与无CKD患者相比更常相关。结论内科专家治疗了相当数量的糖尿病和慢性肾病患者。这些人的特点是老年人，心血管疾病的比例高，表现为营养不良、肌肉减少和虚弱，这可以确定代谢控制的目标。
{"title":"Evaluación de la enfermedad renal crónica en las personas españolas con diabetes: un estudio llevado a cabo en las consultas de medicina interna","authors":"J. Ena , J. Carretero Gómez , M. Suárez Tembra , L. Lajara Villar , C. Fernández Peña , A. Rosales Castillo , N. Domínguez Pinilla , F.J. Carrasco Sánchez , A. Bustos Merlo , A. Rabassa Soler , en nombre del Grupo de Trabajo de Diabetes, Obesidad y Nutrición de la Sociedad Española de Medicina Interna","doi":"10.1016/j.rce.2025.01.003","DOIUrl":"10.1016/j.rce.2025.01.003","url":null,"abstract":"<div><h3>Aim</h3><div>To determine the prevalence and characteristics of chronic kidney disease (CKD) in a cross-sectional population of people with type 2 diabetes treated at internal medicine clinics in Spain.</div></div><div><h3>Methods</h3><div>We collected data from 25 hospitals which recruited 354 people with type 2 diabetes in an observational study carried out in May, 2024. Information collected included demographic data, comorbidities, nutritional status, presence of sarcopenia and frailty, as well as laboratory data and therapy administered.</div></div><div><h3>Results</h3><div>We included a total of 314 subjects, of whom 185 (58.9%; 95% confidence interval: 53.4-64.3%) had CKD. Compared with people with no CKD, those with CKD were older (77.4<!--> <!-->±<!--> <!-->9.7 vs. 65.9<!--> <!-->±<!--> <!-->12.5 years; <em>P</em><0.001), more often male gender (53.1 vs. 46.9%; <em>P</em>=0.021), with more prevalence of ischemic heart disease (22.4 vs. 10.9%; <em>P</em>=.006) and longer duration of diabetes disease (14.1<!--> <!-->±<!--> <!-->8.6 vs. 10.0<!--> <!-->±<!--> <!-->7.0 years; <em>P</em><0.001). Malnutrition (37.3 vs. 25%; <em>P</em>=0.017), sarcopenia (24.6 vs. 11.2%; <em>P</em>=0.003), and frailty (74.3 vs. 59%; <em>P</em>=0.006) was more often associated in people with CKD compared with those with no CKD.</div></div><div><h3>Conclusion</h3><div>Internal medicine specialists treat a significant number of people with diabetes and CKD. These people are characteristically elderly, with high proportion of cardiovascular disease showing malnutrition, sarcopenia, and frailty, which could determine the target for metabolic control.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 102279"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-04-11DOI: 10.1016/j.rce.2025.502284
I.M. Parra Salinas , J.A. García Erce , Grupo Español de Aféresis (GEA)
The Spanish Apheresis Group (GEA) presents the second edition of the “Urgent Indications for Therapeutic Apheresis” document, updated 12 years after its initial publication. This revision addresses the need to standardize its application, given the variability observed across different centers and the lack of resources in some provinces. A critical review of the most recent scientific evidence was conducted, including the latest edition of the American Society of Apheresis (ASFA) guidelines and other evidence-based recommendations. Through a methodological review and expert consensus, the list of conditions in which therapeutic apheresis—whether plasma exchange, red blood cell exchange, or cytoreductive apheresis—should be considered an urgent treatment has been redefined. This update introduces new indications and clinical scenarios where apheresis can provide significant therapeutic benefits.
{"title":"Indicaciones urgentes de aféresis terapéutica. Grupo Español de Aféresis (GEA). Segunda edición 2024","authors":"I.M. Parra Salinas , J.A. García Erce , Grupo Español de Aféresis (GEA)","doi":"10.1016/j.rce.2025.502284","DOIUrl":"10.1016/j.rce.2025.502284","url":null,"abstract":"<div><div>The Spanish Apheresis Group (GEA) presents the second edition of the “Urgent Indications for Therapeutic Apheresis” document, updated 12 years after its initial publication. This revision addresses the need to standardize its application, given the variability observed across different centers and the lack of resources in some provinces. A critical review of the most recent scientific evidence was conducted, including the latest edition of the American Society of Apheresis (ASFA) guidelines and other evidence-based recommendations. Through a methodological review and expert consensus, the list of conditions in which therapeutic apheresis—whether plasma exchange, red blood cell exchange, or cytoreductive apheresis—should be considered an urgent treatment has been redefined. This update introduces new indications and clinical scenarios where apheresis can provide significant therapeutic benefits.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 502284"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-04-11DOI: 10.1016/j.rce.2025.502285
L. Porcel , S. Alas , S. Bielsa , J.M. Porcel
Background
Ultrasound-guided biopsy (UGB) is a diagnostic procedure that is usually performed by radiologists; however, its use by internists has been poorly studied. This study evaluated the diagnostic yield, accuracy, and safety of UGB for focal lesions with a high suspicion of malignancy in an internal medicine department.
Method
We retrospectively analyzed 255 UGB in 248 patients between 2021 and 2024. Solid organ biopsies were performed to evaluate diagnostic yield, complications, and factors associated with success.
Results
The overall diagnostic yield was 84% with an accuracy of 83% for malignancy and 89% for benignity. The biopsies predominantly comprised of hepatic, pulmonary, and lymph node specimens. Major complications occurred infrequently (3%). Factors such as sample size and accumulated experience improved the results.
Conclusions
UGBs performed by internists for focal lesions suspected of malignancy are safe and effective. Its implementation can reduce diagnostic time and improve patient care.
{"title":"Rentabilidad de las biopsias de lesiones focales guiadas por ecografía en un servicio de medicina interna","authors":"L. Porcel , S. Alas , S. Bielsa , J.M. Porcel","doi":"10.1016/j.rce.2025.502285","DOIUrl":"10.1016/j.rce.2025.502285","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasound-guided biopsy (UGB) is a diagnostic procedure that is usually performed by radiologists; however, its use by internists has been poorly studied. This study evaluated the diagnostic yield, accuracy, and safety of UGB for focal lesions with a high suspicion of malignancy in an internal medicine department.</div></div><div><h3>Method</h3><div>We retrospectively analyzed 255 UGB in 248 patients between 2021 and 2024<em>.</em> Solid organ biopsies were performed to evaluate diagnostic yield, complications, and factors associated with success.</div></div><div><h3>Results</h3><div>The overall diagnostic yield was 84% with an accuracy of 83% for malignancy and 89% for benignity. The biopsies predominantly comprised of hepatic, pulmonary, and lymph node specimens. Major complications occurred infrequently (3%). Factors such as sample size and accumulated experience improved the results.</div></div><div><h3>Conclusions</h3><div>UGBs performed by internists for focal lesions suspected of malignancy are safe and effective<em>.</em> Its implementation can reduce diagnostic time and improve patient care.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 5","pages":"Article 502285"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2025-03-06DOI: 10.1016/j.rce.2024.12.001
L.S. Pinheiroa
Clinical governance highlights the relevance of the combination of «quality» and «safety» with «excellence» and «improvement». In hospitals, as highly complex organizations the principles and practices of clinical governance are key elements for success. Several angles would be pertinent in the application of clinical governance to the hospital context, and specifically to internal medicine. The length of stay of patients in hospital is frequently used as a quality indicator of clinical activity. Ideally the patient should remain in the hospital during the time in which he has benefit, minimizing inherent risks. With its centrality in the patient, clinical governance, interpreted in the light of the Seven Pillars Model can provide a comprehensive framework for addressing the management of length of stay. We should try to bring to the day-to-day of our organizations the aggregating vision of clinical governance, whose foundational values need to be reinforced and deepened.
{"title":"Gobierno clínico en medicina interna: el desafío de la duración de la estancia hospitalaria","authors":"L.S. Pinheiroa","doi":"10.1016/j.rce.2024.12.001","DOIUrl":"10.1016/j.rce.2024.12.001","url":null,"abstract":"<div><div>Clinical governance highlights the relevance of the combination of «quality» and «safety» with «excellence» and «improvement». In hospitals, as highly complex organizations the principles and practices of clinical governance are key elements for success. Several angles would be pertinent in the application of clinical governance to the hospital context, and specifically to internal medicine. The length of stay of patients in hospital is frequently used as a quality indicator of clinical activity. Ideally the patient should remain in the hospital during the time in which he has benefit, minimizing inherent risks. With its centrality in the patient, clinical governance, interpreted in the light of the Seven Pillars Model can provide a comprehensive framework for addressing the management of length of stay. We should try to bring to the day-to-day of our organizations the aggregating vision of clinical governance, whose foundational values need to be reinforced and deepened.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 4","pages":"Pages 240-243"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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