Revista clinica espanola最新文献

Objectives: To analyse the structure, activity and results of the Internal Medicine Units (IMUs) of the Spanish National Health System (SNHS). To compare the results of the RECALMIN 2023 survey with previous waves of surveys of the UMIs (2008, 2015, 2017, 2019. 2021) and to analyse trends in the structure, activity and results of the UMIs.

Material and methods: Two data sources: 1) survey on UMI structure and activity; and 2) Hospital discharges of UMIs from the Minimum and Basic Data Set (CMBD) of the SNHS. Cross-sectional descriptive study of the UMIs in acute hospitals of the SNHS with data referring to 2022, comparing them with previous studies.

Results: Over the period 2007-2022, the rate of internists per 100,000 inhabitants increased (IRR: 4.5%; p < 0.001). Inpatient discharges per population and the number of discharges by UMI (IRR: 2.6%; p < 0.005; IRR: 3.5%; p < 0.001, respectively) also increased. The UMIs account for 20% of discharges from general hospitals in the NHS. The SEMI has a database of the CMBD_MIN 2007-2022 with 9,931,401 discharges given by the UMI. The crude in-hospital hospital mortality rate increased in the period 2007-2022 (p < 0.001). From 2020 onwards (SARS-CoV-2 pandemic) overall risk-adjusted and process-adjusted mortality increased (p < 0.001).

Conclusions: UMIs have a central position in SNHS hospital care. The activity of the UMI has grown significantly in the period analysed. The RECALMIN project identifies strengths and opportunities to be strategically addressed by SEMI.

Introduction and objectives: The aim of this study is to assess the safety in a real-world cohort of patients with heart failure with reduced ejection fraction (HFrEF).

Methods: Observational, retrospective and single-center study with patients on vericiguat treatment from the Cardiology and Internal Medicine outpatient clinic of the Valencia General University Hospital Consortium during 2023 year and with minimum follow-up of 6 months. Patients with HFpEF diagnosis and optimized treatment according to the ESC 2021 clinical practice guidelines were included, to whom treatment with vericiguat was started.

Results: We included 123 patients with a mean age of 78 years, mostly men (62%) and with NYHA II functional status (52%). 98 patients completed follow-up after a median follow-up of 162 days (IQR 13-343). The average dose of vericiguat used was 8,3 ± 2,7 mg and 75 patients achieved the target dose of 10 mg (71%). At the end of follow-up, no significant changes were observed in the values of proBNP (pg/mL), CA125, hemoglobin (mg/dl), electrolytes, glomerular filtration rate (mL/min/m²) and systolic blood pressure (mmHg). Of all the patients who completed follow-up, 11 (11%) discontinued treatment due to adverse effects, mostly symptomatic hypotension, digestive symptoms and pruritus; 25 died (20%).

Conclusions: The use of vericiguat is safe, if used according to the technical data sheet, in terms of the established parameters. Further long-term studies are needed to evaluate the impact of vericiguat as a potential disease-modifying treatment.

Acute confusional syndrome (ACS) is a disruption of cognitive function and attention that affects up to 42% of hospitalised patients, most commonly in those over the age of 65. It is typically triggered by one or more precipitating factors in predisposed patients. Point-of-care ultrasound (POCUS) emerges as a tool that could be used to provide quick and accurate information in the diagnosis of patients with ACS, potentially reducing the waiting time for critical interventions, decreasing the need for invasive procedures, and possibly improving clinical outcomes. To date, no articles have been published describing the utility of POCUS in patients with ACS. Therefore, this work presents a review of the utility of POCUS in various pathologies that may be related to the development of ACS. Additionally, we propose an action algorithm that integrates clinical evaluation with bedside ultrasound, which could be useful for allowing quick and accurate identification of the underlying causes of ACS and the guidance of appropriate treatment, although prospective studies are needed to confirm this utility.

Internists must respond to increasingly complex clinical scenarios in a context of progressively increasing life expectancy, techno-scientific development and accelerated demographic and sociocultural changes. Ethical reflection is a useful tool to resolve and prevent value conflicts, which are frequent in clinical practice. The ethical training of internists contributes to professional excellence and can be oriented at two complementary levels: 1) development of skills in all internists for the management of "clinical microethics", which allow the integration of the techno-scientific aspects of medicine in a satisfactory clinical relationship at a human level; 2) specialization for internists who are experts in bioethics, to lead ethics committees (and other consulting models) in a more local setting and participate in bioethical debates and the development of normative ethics in a more general setting.

Background aims: To identify risk factors associated with liver complications in patients with chronic hepatitis B infection in an unselected cohort of hepatitis B patients in southern Spain.

Methods: A prospective open-cohort study was conducted on 437 patients with uncomplicated chronic hepatitis B infection in two hospitals in Málaga, southern Spain. The follow-up time ranged from 0.5 to 31.5 years (mean: 13.8±9.5 years; median: 11.4 years). The aim of this study was to evaluate the occurrence of the initial liver complication during follow-up, which is defined as the emergence of liver cancer or complications resulting from portal hypertension. Survival curves were obtained using a time-to-event method through Kaplan-Meier analysis. Multivariate Cox regression was conducted to estimate the hazard ratios of risk factors associated with complications after adjusting for multiple variables. The follow-up of the patients was carried out under conditions of usual clinical practice. Based on the weighted adjustment of these factors, we developed a Hepatitis B Complication Score (HBCS) from which it was possible to identify patients with low and high risk of complications during follow-up.

Results: 33 out of 437 patients (7.55%) experienced liver complications, 12 (36.3%) were secondary to portal hypertension, and 21 patients (63.7%) developed liver cancer. A Multivariate Cox regression identified the following independent risk factor: Age above 45 years: HR 7.10 (2.9-17.3); low platelet count: HR 4.88 (2.1-10.9); hepatitis C coinfection: HR 4.68 (2.0-10.9); Male gender: HR 4.64 (1.5-14.2); alkaline phosphatase above 147 UI/mL: HR 4.33 (2.0-8.9); and Child score above 5 points: HR 3.83 (1.7-8.4). The Risk of Complications Score (HBCS) was developed with a high predictive capacity AUROC 0.92 (0.87-0.97).

Conclusion: An HBCS score greater than 3.07 points identifies patients at high risk of developing complications and with an increased risk of liver and all-cause mortality.

Objective: To determine the association of HP infection with COPD, assessing its prevalence and influence on symptoms, lung function, quality of life, exacerbations, hospitalizations, mortality, and healthcare costs.

Methods: We performed a systematic review and meta-analysis after conducting a systematic literature search in PubMed, Embase, Cochrane Library, Virtual Health Library, ScienceDirect, Scopus, Researchgate, and GoogleScholar, from database inception to 31/12/2022. We used the Der Simonian-Laird method to calculate pooled HP prevalence, the Mantel-Haenszel model to determine the association of HP with COPD, and the inverse variance method to compare the pulmonary function tests between infected and uninfected patients, always with a fixed-effect model.

Results: Twenty-eight studies included a total of 8647 patients with COPD. The pooled prevalence of HP infection was 29.8% (95%CI 29.0-30.7%). The more severe stage of COPD lesser the prevalence of HP (p < 0.001). HP infection was associated with COPD, estimated odds ratio 1.90 (95%CI 1.71, 2.12), p < 0.001. The mean differences for p%FEV₁, p%FVC and FEV₁/FVC ratio between HP infected and uninfected patients with COPD were -13.06 (95%CI -14.54, -11.58), -3.72 (95%CI -5.64, -1.79) and -0.01 (95%CI -0.02, -0.00) respectively.

Conclusion: Our meta-analysis suggests an appreciable relationship between HP infection and COPD. Further longitudinal studies considerating confounders and investigating causality are required.

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.