Revista clinica espanola最新文献

{"title":"Comentario al artículo «Trombosis venosa cerebral en adultos: cohorte de 35 casos de un hospital terciario»","authors":"A. Gil-Díaz","doi":"10.1016/j.rce.2023.09.006","DOIUrl":"https://doi.org/10.1016/j.rce.2023.09.006","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139480013","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}

{"title":"Resumen ejecutivo del documento de consenso para la formación y el desarrollo de la ecografía clínica en Medicina Interna: recomendaciones desde el Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna (GTECO-SEMI)","authors":"Y. Tung-Chen ,&nbsp;G. García de Casasola Sánchez ,&nbsp;S. García Rubio ,&nbsp;L. Beltrán Romero ,&nbsp;M. Bernabéu Wittel ,&nbsp;L.S. Briongos Figuero ,&nbsp;J. Canora Lebrato ,&nbsp;D. García Gil ,&nbsp;S. López Palmero ,&nbsp;D. Luordo Tedesco ,&nbsp;P. Martín Rico ,&nbsp;M. Mateos González ,&nbsp;M. Méndez Bailón ,&nbsp;J.M. Porcel ,&nbsp;G. Serralta ,&nbsp;M. Torres Arrese ,&nbsp;J. Oteiza Olaso ,&nbsp;P. Varela García ,&nbsp;J. Torres Macho","doi":"10.1016/j.rce.2023.11.005","DOIUrl":"https://doi.org/10.1016/j.rce.2023.11.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Given the increasing adoption of clinical ultrasound in medicine, it is essential to standardize its application, training, and research.</p></div><div><h3>Objectives and methods</h3><p>The purpose of this document is to provide consensus recommendations to address questions about the practice and operation of clinical ultrasound units. Nineteen experts and leaders from advanced clinical ultrasound units participated. A modified Delphi consensus method was used.</p></div><div><h3>Results</h3><p>A total of 137 consensus statements, based on evidence and expert opinion, were considered. The statements were distributed across 10 areas, and 99 recommendations achieved consensus.</p></div><div><h3>Conclusions</h3><p>This consensus defines the most important aspects of clinical ultrasound in the field of internal medicine, with the aim of standardizing and promoting this healthcare advancement in its various aspects. The document has been prepared by the Clinical Ultrasound Working Group and endorsed by the Spanish Society of Internal Medicine.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0014256523012973/pdfft?md5=c3fd9a4bd983acbd1abe3e652a8e9fa7&pid=1-s2.0-S0014256523012973-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139480012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Admisiones en los servicios de urgencias y costes económicos relacionados con procesos susceptibles de atención ambulatoria en adultos mayores que viven en centros residenciales","authors":"F.J. Afonso-Argilés ,&nbsp;M. Comas-Serrano ,&nbsp;X. Castells-Oliveres ,&nbsp;I. Cirera-Lorenzo ,&nbsp;D. García-Pérez ,&nbsp;T. Pujadas-Lafarga ,&nbsp;X. Ichart-Tomás ,&nbsp;M. Puig-Campmany ,&nbsp;A.B. Vena-Martínez ,&nbsp;A. Renom-Guiteras ,&nbsp;en nombre del Grupo Caregency que se indica a continuación","doi":"10.1016/j.rce.2023.09.004","DOIUrl":"10.1016/j.rce.2023.09.004","url":null,"abstract":"<div><h3>Objectives</h3><p>To assess the frequency of emergency department admissions (EDAs) for ambulatory care sensitive conditions (ACSC) and non-ACSC among older adults living in care homes (CH), to describe and compare their demographic and clinical characteristics, the outcomes of the hospitalization process and the associated costs.</p></div><div><h3>Method</h3><p>This multicenter, retrospective and observational study evaluated 2444 EDAs of older adults ≥65 years old living in care homes in five emergency departments in Catalonia (Spain) by ACSC and non-ACSC, in 2017. Sociodemographic variables, prior functional and cognitive status, and information on diagnosis and hospitalization were collected. Additionally, the costs related with the EDAs were calculated, as well as a sensitivity analysis using different assumptions of decreased admissions due to ACSC.</p></div><div><h3>Results</h3><p>A total of 2444 ED admissions were analyzed. The patients’ mean (SD) age was 85.9 (7.2) years. The frequency of ACSC-EDA and non-ACSC-EDA was 56.6% and 43.4%, respectively. Severe dependency and cognitive impairment were present in 56.6% and 78%, respectively, with no differences between the two groups. The three most frequent ACSC were falls/trauma (13.8%), chronic obstructive pulmonary disease/asthma (11.4%) and urinary tract infection (7.4%). The average cost per ACSC-EDA was €1408.24. Assuming a 60% reduction of ACSC-EDA, the estimated cost savings would be €1.2 million.</p></div><div><h3>Conclusions</h3><p>Emergency admissions for ACSC from care homes have a significant impact on both frequency and costs. Reducing these conditions through targeted interventions could redirect the avoided costs toward improving care support in residential settings.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135615536","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}

{"title":"Valoración nutricional por ecografía del recto femoral y el tejido adiposo preperitoneal como predictores del riesgo de complicaciones del paciente hospitalizado","authors":"R. Marín-Baselga ,&nbsp;C. Sanz-Ortega ,&nbsp;L. Platero-Dueñas ,&nbsp;R. Sorriguieta-Torre ,&nbsp;S. Palma-Milla ,&nbsp;Y. Tung-Chen","doi":"10.1016/j.rce.2023.09.001","DOIUrl":"10.1016/j.rce.2023.09.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Malnutrition and sarcopenia are associated with increased risk of adverse events and worse outcome in hospitalised patients. Ultrasonography is a useful tool in the assessment of body composition.</p></div><div><h3>Patients and methods</h3><p>Twenty-three patients admitted to a hospital ward were recruited. Ultrasonographic variables of muscle tissue and adipose tissue were collected, as well as their variation during admission. These were correlated with anthropometric, clinical and analytical data.</p></div><div><h3>Results</h3><p>We observed a correlation of ultrasound measurements with length of hospitalisation (maximum preperitoneal fat −0.585, rectus femoris thickness [RF] −0.539, RF area −0.540), frailty (RF −0.599) and dependency (RF 0.628). RF contractile capacity correlated with reported weekly exercise (0.642).</p></div><div><h3>Conclusion</h3><p>RF and preperitoneal fat thickness correlate with the number of days of admission and functional capacity, emerging as prognostic variables.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135515727","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}

{"title":"Nueva era de la medicina basada en las células madre mesenquimales: bases, retos y perspectivas","authors":"F.J. Vizoso ,&nbsp;L.A. Costa ,&nbsp;N. Eiro","doi":"10.1016/j.rce.2023.10.002","DOIUrl":"https://doi.org/10.1016/j.rce.2023.10.002","url":null,"abstract":"<div><p>Stem cells of mesenchymal origin (MSC) arouse special interest due to their regenerative, anti-inflammatory, anti-apoptotic, anti-oxidative stress, antitumor or antimicrobial properties. However, its implementation in the clinic runs into drawbacks of cell therapy (immunological incompatibility, tumor formation, possible transmission of infections, entry into cellular senescence, difficult evaluation of safety, dose and potency; complex storage conditions, high economic cost or impractical clinical use). Considering that the positive effects of MSC are due, to a large extent, to the paracrine effects mediated by the set of substances they secrete (growth factors, cytokines, chemokines or microvesicles), the in vitro obtaining of these biological products makes possible a medicine cell-free regenerative therapy without the drawbacks of cell therapy. However, this new therapeutic innovation implies challenges, such as the recognition of the biological heterogeneity of MSC and the optimization and standardization of their secretome.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138501230","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}

{"title":"Riesgo de hemorragia cerebral en el traumatismo craneal leve y tratamiento antitrombótico","authors":"J.J. Martínez-Rivas ,&nbsp;F. Rodríguez-Lucas ,&nbsp;G. Planells ,&nbsp;D. Corrales ,&nbsp;D. Cocho","doi":"10.1016/j.rce.2023.09.005","DOIUrl":"10.1016/j.rce.2023.09.005","url":null,"abstract":"<div><h3>Introduction</h3><p>The observation time in mild traumatic brain injury (mTBI) is controversial. Our aim was to assess the risk of neurological complications in mTBI with and without antithrombotic treatment.</p></div><div><h3>Method</h3><p>We retrospectively evaluated patients with mTBI seen in the emergency room for 3 years. We considered MTBI those with Glasgow ≥13 at admission. A cranial CT was performed in all cases with <u>&gt;</u>1 risk factor at admission and at 24<!--> <!-->h in those with neurological impairment or initial pathological cranial CT. Complications in the following 3 months were retrospectively reviewed.</p></div><div><h3>Results</h3><p>We evaluated 907 patients with a mean age of 73<!--> <!-->±<!--> <!-->19 years. Ninety-one percent presented risk factors, with 60% on antithrombotic treatment. We detected 11% of initial brain hemorrhage, 0.4% at 24<!--> <!-->h, and no cases at 3 months. Antithrombotic treatment was not associated with an increased risk of brain hemorrhage (9.9% with vs. 11.9% without treatment, <em>P</em>=.3). 39% of the hemorrhages presented neurological symptoms (18% post-traumatic amnesia, 12% headache, 8% vomiting, 1% seizures), with 78.4% having mild symptoms. Of the 4 hemorrhages detected at 24<!--> <!-->h, 3 were asymptomatic and one case that worsened the initial headache. No asymptomatic patient without lesion on initial clinical cranial CT presented at 24<!--> <!-->h.</p></div><div><h3>Conclusions</h3><p>Our study suggests that patients with asymptomatic mTBI, without a lesion on the initial cranial CT, would not require the observation period or CT control regardless of antithrombotic treatment or INR level.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135615280","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}

{"title":"Ecografía clínica en la valoración de la composición corporal: herramienta prometedora y oportunidad para los internistas","authors":"J. Torres Macho ,&nbsp;L.M. Beltrán Romero","doi":"10.1016/j.rce.2023.09.002","DOIUrl":"10.1016/j.rce.2023.09.002","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135509504","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}

{"title":"Ley orgánica de regulación de la eutanasia: conocimiento e implicación de los médicos en España tras un año de su aplicación","authors":"G. Pujol-Fontrodona ,&nbsp;J.M. Domínguez-Roldan ,&nbsp;R. Valero","doi":"10.1016/j.rce.2023.09.003","DOIUrl":"10.1016/j.rce.2023.09.003","url":null,"abstract":"<div><h3>Background and aims</h3><p>The Organic Law Regulating Euthanasia (LORE, for its initials in Spanish) came into force in June 2021. This study aims to examine knowledge of the LORE among physicians licensed in Spain as well as their involvement with and the impact of the law.</p></div><div><h3>Methods</h3><p>This work is a descriptive, cross-sectional study conducted by means of a survey. Information was gathered through a self-administered questionnaire.</p></div><div><h3>Results</h3><p>The survey was answered by 1446 physicians licensed in Spain. The sample's demographic characteristics were as follows: 54.7% were women, the mean age was 52<!--> <!-->±<!--> <!-->14 years, and 66.0% worked in a hospital. Catalonia was the autonomous community with the most participants (44.6%). Regarding specialties, anesthesiology and resuscitation had the highest number of participants (21.9%), followed by family and community medicine (18.5%). The LORE was known in detail by 24.3% of physicians, 58.0% had a positive opinion of it, and 31.1% had direct experience with the euthanasia procedure. Practitioners working in the hospital setting perceived the law more favorably compared to those in the primary care setting (62.3% vs. 47.3%, <em>p</em> <!-->&lt;<!--> <!-->0.01).</p></div><div><h3>Conclusions</h3><p>Most doctors did not have in-depth knowledge of the LORE, although a majority supported its existence, particularly those in hospital medicine. Most physicians who viewed the LORE negatively were male, older, and worked in primary care. A minority of physicians considered registering as conscientious objectors.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135614967","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}

{"title":"Tratamiento del lupus eritematoso sistémico: nuevas opciones terapéuticas","authors":"A. González-García ,&nbsp;I. Cusácovich ,&nbsp;G. Ruiz-Irastorza","doi":"10.1016/j.rce.2023.11.001","DOIUrl":"https://doi.org/10.1016/j.rce.2023.11.001","url":null,"abstract":"<div><p>Systemic lupus erythematosus (SLE) is a systemic autoimmune inflammatory disease of unknown cause, with heterogeneity in its clinical presentation, as well as variability in its clinical course and prognosis. The current goal of treatment is to achieve disease remission or a state of low activity, and thereby improve the patient's quality of life. Biological therapy in lupus, unlike other entities, although it has not been fully established, in recent years it has burst onto the scene with important therapeutic novelties. This review aims to update the therapeutic tools for the treatment of SLE focusing on the new molecules that have achieved the objectives of their clinical trials.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138501221","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}

{"title":"Epidemiología y calidad asistencial de las intoxicaciones agudas en el adulto mayor de 65 años en Alicante, España","authors":"Á. Lirón-García ,&nbsp;J.M. Ramos-Rincón ,&nbsp;B. Valero-Novella ,&nbsp;J. Marín-Aparicio ,&nbsp;R. Sánchez-Martínez ,&nbsp;P. Llorens","doi":"10.1016/j.rce.2023.10.001","DOIUrl":"https://doi.org/10.1016/j.rce.2023.10.001","url":null,"abstract":"<div><h3>Introduction</h3><p>The objective of this study was to examine the epidemiology of acute poisonings in the emergency department (ED) of a tertiary center and to analyze the compliance level with quality indicators (QIs) in patients 65 years and older compared rest of adults.</p></div><div><h3>Materials and methods</h3><p>This was an observational and retrospective study that included diagnosed cases of acute poisoning in patients over 14 years old treated in the ED of a tertiary hospital. Demographic variables, type of toxic substances, and cause of poisoning were collected, along with 19 QIs and patient outcomes, with the main outcome variable being the degree of compliance with the QIs.</p></div><div><h3>Results</h3><p>A total of 1144 cases were recorded, with 10.4% (<em>n</em> <!-->=<!--> <!-->119) being patients 65 years and older. Patients 65 years and older were more likely to be female (72.8% vs. 60.9%; <em>p</em> <!-->=<!--> <!-->0.015), experience more accidental poisonings (37.6% vs. 25.7%; <em>p</em> <!-->=<!--> <!-->0.006), and fewer intentional poisonings (35.0% vs. 49.6%; <em>p</em> <!-->=<!--> <!-->0.003). There were fewer cases of alcohol poisoning (5% vs. 17.8%; <em>p</em> <!-->&lt;<!--> <!-->0.001), and no cases of illegal drug poisoning (<em>p</em> <!-->&lt;<!--> <!-->0.001) in this age group. Most QIs showed a high degree of compliance (&gt;85%) in both patients 65 years and older and rest of adults. However, there were differences in the indication of oxygen therapy in cases of carbon monoxide poisoning (64.2% vs. 40.9%; <em>p</em> <!-->=<!--> <!-->0.005).</p></div><div><h3>Conclusions</h3><p>The epidemiological profile of poisoning in patients 65 years and older differs from that of adult patients, with a similar degree of compliance with QIs. Based on the results obtained, there does not appear to be significant differences in the management of poisoned patients based on their age.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138501229","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}