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Background: Only very few studies have investigated the effect of the COVID-19 pandemic on the pre-hospital stroke code protocol. During the first wave, Spain was one of the most affected countries by the SARS-CoV-2 coronavirus disease pandemic. This health catastrophe overshadowed other pathologies, such as acute stroke, the leading cause of death among women and the leading cause of disability among adults. Any interference in the stroke code protocol can delay the administration of reperfusion treatment for acute ischemic strokes, leading to a worse patient prognosis. We aimed to compare the performance of the stroke code during the first wave of the pandemic with the same period of the previous year., Methods: This was a multicentre interrupted time-series observational study of the cohort of stroke codes of SUMMA 112 and of the ten hospitals with a stroke unit in the Community of Madrid. We established two groups according to the date on which they were attended: the first during the dates with the highest daily cumulative incidence of the first wave of the COVID-19 (from February 27 to June 15, 2020), and the second, the same period of the previous year (from February 27 to June 15, 2019). To assess the performance of the stroke code, we compared each of the pre-hospital emergency service time periods, the diagnostic accuracy (proportion of stroke codes with a final diagnosis of acute stroke out of the total), the proportion of patients treated with reperfusion therapies, and the in-hospital mortality., Results: SUMMA 112 activated the stroke code in 966 patients (514 in the pre-pandemic group and 452 pandemic). The call management time increased by 9% (95% CI: -0.11; 0.91; p value = 0.02), and the time on scene increased by 12% (95% CI: 2.49; 5.93; p value = <0.01). Diagnostic accuracy, and the proportion of patients treated with reperfusion therapies remained stable. In-hospital mortality decreased by 4% (p = 0.05)., Conclusions: During the first wave, a prolongation of the time "on the scene" of the management of the 112 calls, and of the hospital admission was observed. Prehospital diagnostic accuracy and the proportion of patients treated at the hospital level with intravenous thrombolysis or mechanical thrombectomy were not altered with respect to the previous year, showing the resilience of the stroke network and the emergency medical service., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Nicolás Riera-López and Jorge Rodríguez-Pardo de Donlebún have received payments for training courses from the Angels Initiative (Boheringer Ingelheim). The other authors do not report any conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background and Objective: Scientific and technological advances are changing medical practice and transforming hospitals, and both the age and comorbidities of hospitalized patients are rapidly increasing. The increasing complexity of these patients and the scant clinical differences between medical and surgical inpatients calls for changes in the organization and delivery of in-hospital care. Our objective has been to assess differences in age and comorbidity between surgical and medical inpatients., Materials and Methods: Retrospective, observational, descriptive study in patients aged ≥16 years discharged from all medical and surgical services during 2019, except for obstetrics and intensive care. All data were obtained from the hospital's minimum basic data set and analyzed using univariate analysis., Results: The study included 31,264 patients: 16,397 from the medical area and 14,867 from the surgical area. Those in the surgical area were 8 years younger (62.69 years [95% CI 62.4-62.98]), with a slightly higher proportion of women (OR 1.12 [95% CI 1.07-1.17]) compared to the medical area, and fewer non-scheduled admissions (OR 0.11 [95% CI 0.10-0.12]). There were no significant differences in comorbidity burden between study groups., Conclusions: Patients in the surgical area have a high burden of medical comorbidity, similar to those in the medical area. This information is important for surgeons and anesthetists, and should compel hospitals to change the current organizational model., (Copyright © 2021 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Several factors have been associated with the prognosis of prosthetic joint infection (PJI) treated with surgical debridement, antibiotic therapy, and implant retention (DAIR). There is no evidence about the right empirical antibiotic treatment when the causal microorganism is not still identified., Methods: We conducted a retrospective observational study in patients with PJI treated with DAIR between 2009 and 2018 in our center. We analyze the risk factors related with their prognosis and the influence of active empirical antibiotic therapy against causative microorganisms in final outcomes., Results: A total of 80 PJI cases treated with DAIR, from 79 patients (58.7% women, mean age 76.3 years), were included in the study period. Among the cases in which empirical antibiotic therapy were active against the causative microorganisms, the success rate was 46/65 (69.2%) vs 1/15 when not (6.7%, OR 31.5, p = 0.001). Factors related to the success or failure of the DAIR were analyzed with multivariate analysis. We found that active empirical antibiotic treatment remained statistically significant as a good prognostic factor (OR 0.04, p <0.01)., Conclusions: Empirical antibiotic treatment could be an important factor in the prognosis of PJI treated with DAIR. To identify cases at risk of infection by multidrug resistant microorganisms could be useful to guide empirical antibiotic therapy., (©The Author 2021. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

Physicians have long needed and sought out the support and advice of experienced colleagues. This practice, endorse by Hippocrates and Galen, remaining unchanged until the Enlightenment. During that age, cross-consultations boomed. Monographic works were written, the characteristics and qualities that consulting physician had to possess were studied the problems that it could cause were examined, and rules and guidelines to follow during a cross-consultation were established. It remained unchanged until the end of the 19th century, when the emergence of various medical specialties offered the possibility of seeking specialized assistance. This specialization gave rise to a fragmentation of medical care which favored the emergence of the internist as a "universal consultant." In the last quarter of the 20th century, in light of the importance of and problems arising from cross-consultation, it began to be studied on its own, specialized services were created to attend to them, and, finally, comanagement appeared., (Copyright © 2020 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Background and Objective: The age and comorbidity of patients admitted to Otolaryngology are increasing, leading to increased consultations/referrals to Internal Medicine, but do not reach the required effectiveness. An alternative is comanagement. A study is conducted on the effect of comanagement on Otolaryngology., Methods: A retrospective observational study was conducted on patients ≥16 years old admitted in Otolaryngology between 03 December 2017 and 03 December 2019, since 03/12/2018 with comanagement with Internal Medicine since 03 December 2018. An analysis was performed on age, gender, type of admission, and whether the patient had surgery, administrative weight associated with (diagnosis-related group) DRG, total number of diagnoses at discharge, Charlson comorbidity index, deaths, urgent readmissions, and length of stay., Results: Comanaged patients were younger (3.1 years, 95% confidence interval [95% CI] 1.4 to 4.8), but with higher Charlson comorbidity index (0.2; 95% CI; 0.1 to 0.3), number of diagnoses (0.9; 95% CI; 0.6 to 1.2), and administrative weight (0.04; 95% CI; 0 to 0.09). On adjustment, comanagement reduced Otolaryngology length of stay by 26.7%, 0.8 days (95% CI; 0.3 to 1.3), 50% of urgent readmissions, and 60% mortality, both non-significant. The decrease in length of stay implies an Otolaryngology savings of at least € 320,476.5., Conclusions: Patients admitted to Otolaryngology are increasing in age and comorbidity. Comanagement is associated with reduced length of stay and costs similar to those observed in other surgical services., (Copyright © 2020 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Most hospitalized surgical patients have significant medical comorbidity and are treated with a considerable number of drugs and/or experience significant complications. Shared care (SC) is the shared responsibility and authority in managing hospitalized patients. In this article, we discuss whether patients should be selected for SC or not. The various selection criteria are not an exact science nor are they easy to apply. Furthermore, they may leave out many patients who may be good candidates for SC. Perioperative management is essential for preventing postoperative mortality. Failure to rescue (in-hospital mortality secondary to postoperative complications) is the main factor linked to in-hospital surgical mortality and can affect any patient regardless of age, comorbidity, or type of surgery. The component that most reduces failure to rescue is the presence of internists in surgical wards. We believe that all patients hospitalized in surgery departments should receive SC., (Copyright © 2020 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Background and Objectives: Hospitalized surgical patients are increasing in medical complexity, thereby increasing the need for support by internal medicine departments. This support is provided through interconsultations, which present problems that have resulted in the development of shared care (SC). Our objective was to compare the healthcare results achieved by the SC and interconsultation models in Orthopaedic Surgery and Trauma., Materials and Methods: We conducted an observational, prospective, multicentre study of patients hospitalized for emergency Orthopaedic Surgery and Trauma recorded in the REINA-SEMI registry, treated by internal medicine departments through interconsultation or SC. We recorded the demographic characteristics, comorbidity, medical complications, hospital stay and mortality., Results: The study included 697 patients, 415 with SC and 282 with interconsultations. The SC patients were older (78.9 vs. 74.3; P<.001) underwent more operations (89.9 vs. 78.7%; P<.001), had fewer medical complications (50.4 vs. 62.8%; P<.001) and had shorter hospital stays (10 vs. 18 days; P<.001), with no differences in comorbidity or mortality. The following independent factors were associated with stays longer than 15 days: heart failure (OR 3.4; 95% CI 1.8-6.1; P<.001), the male sex (OR 1.9; 95% CI 1.2-3.1; P=.004), electrolyte disorder (OR 2.4; 95% CI 1.3-4.4; P=.003), respiratory infection (OR 1.9; 95% CI 1.04-3.7; P=.035), surgical delay (OR 1.1; 95% CI 1.08-1.2; P<.001) and treatment using the interconsultation on demand model (OR 3.5; 95% CI 2.3-5.4; P<.001)., Conclusions: SC offers better healthcare results than interconsultations for patients hospitalized for emergency Orthopaedic Surgery and Trauma., (Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Introduction: There is a growing increase in prosthetic joint infection (PJI) incidence due to cephalosporin-resistant bacteria, used in surgical prophylaxis. The replacement of these with glycopeptides has not been shown to improve the results, but they have been shown to improve with their combination., Methods: Comparative study of combination of teicoplanin and cefazolin before arthroplasty surgery against cefazolin alone from a previous control group., Results: During the control period, there were 16 PJIs from 585 surgeries, while in the intervention group there were 6 from 579 (incidence 2.7% vs. 1.03%, RR 0.4, P=.04). In control group, 11 of the infections were caused by Gram-positive bacteria versus 4 in the intervention group (1.8% vs. 0.7%, P=.08)., Conclusions: The addition of teicoplanin to cefazolin in the prophylaxis of arthroplasty surgery was associated with a reduction in the incidence of PJI, thanks to a decrease in infections caused by Gram-positive bacteria., (Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Objective: To analyse the activity of interconsultations conducted by internal medicine (IM) departments, their formal aspects and the profile of clinical care required and to quantify the workload they represent., Material and Method: A multicentre, observational prospective study was conducted with consecutive hospitalised patients treated by IM departments using interconsultations between May 15 and June 15, 2016. We estimated the workload related to this activity (1time unit [TU]=10min)., Results: We recorded 1,141 interconsultations from 43 hospitals. The mean age of the patients involved was 69.4 years (SD: 16.2), and 51.2% were men. The mean Charlson index was 2.3 (SD: 2.2). The most common reasons for the consultations were general assessments (27.4%), fever (18.1%), dyspnoea (13.6%), metabolic disorder (9.6%), arterial hypertension (6.3%) and delirium (5.3%). The duration of the first visit was 4 TUs (SD: 5.9) and 7.3 (SD: 21.5) for the sum of all subsequent visits. The surgical patients were older (70.6 [SD, 15.9] vs. 64.4 [SD, 16.3] years; P=.0001) and required more follow-up time (5 [SD, 7.3] vs. 3.5 [SD, 4.2] days; P=.009). The following issues were more common in the interconsultation format performed by medical services: number of regular interconsultations (response >24h), specification of the reason for the interconsultation, minimal data regarding the medical history and agreement on the appropriateness of the time spent with the consultant., Conclusion: The patients treated through interconsultations by the IM departments represented a significant workload. The interconsultations from the medical departments were more in line with the request format., (Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Surgical departments have increasing difficulties in caring for their hospitalised patients due to the patients' advanced age and comorbidity, the growing specialisation in medical training and the strong political-healthcare pressure that a healthcare organisation places on them, where surgical acts take precedence over other activities. The pressure exerted by these departments on the medical area and the deficient response by the interconsultation system have led to the development of a different healthcare organisation model: Shared care, which includes perioperative medicine. In this model, 2 different specialists share the responsibility and authority in caring for hospitalised surgical patients. Internal Medicine is the most appropriate specialty for shared care. Internists who exercise this responsibility should have certain characteristics and must overcome a number of concerns from the surgeon and anaesthesiologist., (Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Medical interconsultation for hospitalised patients is a regular activity among internal medicine specialists. However, despite its growing impact and importance, a model that defines its characteristics, objectives and information has not been established. This study, conducted by the Shared Care and Interconsultations Group of the Spanish Society of Internal Medicine, proposes a number of general recommendations concerning the method for requesting and responding to hospital medical interconsultations, as well as a format for these interconsultations., (Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Introduction and Objectives: Patients admitted to the Department of Otolaryngology (ENT) are increasing in age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. We studied the effect of co-management on length of stay (LoS) in hospital for patients admitted to ENT., Methods: This was a retrospective observational study including patients ≥14 years old discharged from ENT between 1/1/2009 and 30/06/2013, with co-management from May/2011. We analysed age, sex, type of admission, whether the patient was operated, administrative weight associated with DRG, total number of discharge diagnoses, Charlson comorbidity index (CCI), deaths, readmissions and LoS., Results: There were statistically significant differences between both groups in age (4.5 years; 95% confidence interval [95% CI] 2.8-6.3), emergency admissions (odds ratio [OR] 1.4; 95% CI 1.1-1.8), administrative weight (0.3637; 95% CI 0.0710-0.6564), number of diagnoses (1.3; 95% CI 1-1.6), CCI (0.4; 95% CI 0.2-0.6) and deaths (OR 4.1; 95% CI 1.1-15.7). On adjustment, co-management reduced ENT LoS in hospital by 28.6%, 0.8 days (95% CI 0.1-1.6%; P=.038). This reduction represents an ENT savings of at least €165,893., Conclusions: Co-management patients admitted to ENT are increasing in age, comorbidity and complexity. Co-management is associated with reduced LoS and costs in ENT, similar to those observed in other surgical services., (Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.)

Objective: Hospital readmission is considered an adverse outcome, and the hospital readmission ratio is an indicator of health care quality. Published studies show a wide variability and heterogeneity, with large groups of patients with different diagnoses and prognoses. The aim of the study was to analyse the differences between patients readmitted and those who were not, in patients grouped into the diagnosis related group (DRG) 541., Material and Method: A retrospective observational study was conducted on DRG 541 patients discharged in 2010. Readmission is defined as any admission into any hospital department, and for any reason at ≤30 days from discharge. An analysis was performed that included age, sex, day of discharge, month of discharge, number of diagnoses and drugs at discharge, respiratory depressant drugs, length of stay, requests for consultations/referrals, Charlson comorbidity index, feeding method, hospitalisations in the previous 6 months, albumin and haemoglobin levels and medical examinations within 30 days after discharge., Results: Of the 985 patients included in the study, 189 were readmitted. On multivariate analysis, significant variables were: Haemoglobin -0.6g/dl (95% confidence interval [95%CI] -0.9 to -0.3), gastrostomy feeding odds ratio (OR) 5.6 (95%CI: 1.5 to 21.6), hospitalisations in previous 6 months OR 1.9 (95%CI: 1.3 to 2.8), visits to emergency department OR 17.4 (95%CI: 11.3 to 26.8), medical checks after discharge OR 0.4 (95%CI: 0.2 to 0.8)., Conclusions: DRG 541 readmitting patients have some distinctive features that could allow early detection and prevent hospital readmission., (Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.)

Objective: Patients admitted to the Department of Ophthalmology (OPH) are of increasing age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. The effect of co-management on length of hospital stay was studied in patients admitted to OPH., Methods: Retrospective observational study was performed that included patients ≥14 years old discharged from OPH between 1 January 2009 and 30 June 2013, who were co-managed from May 2011. An analysis was made including age, sex, type of admission, whether it was operated on, administrative weight associated with GRD, total number of discharge diagnoses, Charlson comorbidity index (CCI), mortality, readmissions, and LoS., Results: There were statistically significant differences between the groups in operated patients (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 1.5 to 3.6), administrative weight (0.1160; 95% CI 0.0738 to 0.1583), and number of diagnoses (0.9, 95% CI 0.5 to 1.3). On adjustment, co-management reduced LoS in OPH by 27.8%, 0.5 days (95% CI 0.1 to 1)., Conclusions: Patients admitted to OPH have increasing comorbidity and complexity. Co-management is associated with a reduced LoS and costs in OPH, similar to that observed in other surgical services., (Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: A variable percentage of patients admitted to surgical departments are not operated on for several reasons. Our goal is to check if surgeons have more problems in caring for non-operated hospitalized patients than operated ones., Material and Methods: We included all patients aged ≥ 14 years discharged in 2010 from General Surgery, Gynaecology, Urology, and Otolaryngology. The main variables were the length of stay, mortality, readmissions, and number of consultations/referrals requested to medical services. Secondary variables were age, sex, number of emergency admissions, total number of diagnoses, and the Charlson comorbidity index (ICh)., Results: Between 8.7% and 22.8% of patients admitted to these surgical departments are not operated on. The non-operated patients had a significantly higher stay, mortality, readmissions and consultations/referrals requests than operated ones, with significantly higher age (except Urology), number of diagnoses, emergency admissions and ICh (except Urology)., Conclusions: Patients admitted to surgical departments and are not operated on have higher mortality, readmissions and consultation/referrals requests than those operated on, which may be due to their greater medical complexity and urgency of admission. This suggests a greater difficulty in their care by surgeons., (Copyright © 2012 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

The inpatient profile is changing towards patients with multiple diseases, the elderly and those with high comorbidity. The growing complexity of their care, the progressive medical superspecialization and the organizational problems that often hinder daily patient follow-up by the same physician have contributed to a progressive increase in the participation of medical departments, especially Internal Medicine, in the care of patients hospitalized in other medical and surgical specialties. The hospital activities that the departments of internal medicine perform outside of their own department do not have well-established definitions and criteria at the organizational level; their assessment and accountability are different in each hospital. In this document, we establish the definitions for shared care, advisory medicine, perioperative medicine and interconsultation, as well as their types in terms of priority, formality, care setting, timeliness, relationship with surgery and other circumstances., (Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Introduction: Prosthetic joint infection (PJI) is a complication with serious repercussions and its main cause is Staphylococcus aureus. The purpose of this study is to determine whether decolonization of S.aureus carriers helps to reduce the incidence of PJI by S.aureus., Material and Methods: An S.aureus screening test was performed on nasal carriers in patients undergoing knee or hip arthroplasty between January and December 2011. Patients with a positive test were treated with intranasal mupirocin and chlorhexidine soap 5 days. The incidence of PJI was compared with patients undergoing the same surgery between January and December 2010., Results: A total of 393 joint replacements were performed in 391 patients from the control group, with 416 joint replacements being performed in the intervention group. Colonization study was performed in 382 patients (91.8%), of which 102 were positive (26.7%) and treated. There was 2 PJI due S.aureus compared with 9 in the control group (0.5% vs 2.3%, odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.4 to 2.3, P=.04)., Conclusions: In our study, the detection of colonization and eradication of S.aureus carriers achieved a significant decrease in PJI due to S.aureus compared to a historical group., (Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Objective: An important but understudied activity of the departments of internal medicine (IM) is the in-hospital consultations. We analyzed the requests for in-hospital consultation with IM and the potential differences between the consultations of medical and surgical departments., Patients and Methods: This was an 8-month observational prospective study that analyzed demographic variables related to the origin of the interconsultation, comorbidity, length of stay and hospital mortality, emergency, admission-consultation request delay, appropriateness (not appropriate if another department was consulted for the same reason or if the pathology behind the consultation was that of the requesting service) and, for patients who underwent surgery, whether it was requested before or after the surgery., Results: During the study, 215 in-hospital consultations were conducted (27 consultations/month). The mean age of the patients was 69.8 years (women, 50%). Some 30.7% were requested by medical departments and 69.3% by surgical departments. Thirteen percent of the in-hospital consultations were duplicated. The department of IM was not the appropriate department consulted in 23.3% of cases (13.0% of the cases requested consultations for the same reason with another department; in 14.3% of the cases, the pathology was that of requesting department). More in-hospital consultations were conducted on Mondays and Fridays than on Thursdays (25.1% and 23.7% versus 15.3%, respectively; p=.03). The delay between admission and the request for interconsultation was of 12.6 days. Some 90.7% of the in-hospital consultations for patients undergoing surgery were requested after the intervention. There were no differences in the characteristics of the in-hospital consultations between the medical and surgical departments., Conclusions: In-hospital consultations directed at IM are frequently duplicate, are not well directed at the appropriate department and their urgency is incorrectly assessed. These characteristics are similar for the consultations with medical and surgical departments., (Copyright © 2013 Elsevier España, S.L. All rights reserved.)

Objective: Within-hospital medical consultations and referrals (MCR) have many problems, among them are those related to the oral and written transmission of information. Our aim is to analyze problems in the transmission of information related to MCR, and possible differences between medical (MS) and surgical (SS) services., Material and Methods: A prospective, observational study was conducted on the MCR requested to Internal Medicine Service over an 8 month period. The following variables were collected: age, sex, the requester, MCR type, type of admission, comorbidity, hospital stay and mortality, length of MCR, the number of physicians responsible for the patient requesting service during the MCR, MCR repeats, information on the request, available medical records, verbal contact, conflict between doctors, and medical information in the discharge summary., Results: Of the total 215 MCR received, 66 (30.7%) were requested by MS, and 149 (69.3%) per SS. MCR duration was 3 days (standard deviation [SD] 4.8. The number of doctors responsible was 1.7 (SD 1.1), with, Repeats 43 (20%) and Urgent 14 (6.5%). Minimum information on the request, 6 (9.1%) MS and 21 (27.5%) SS. Low availability of medical record, 2 (3%) MS and 50 (33.6%) SS. No verbal contact, 33 (15.4%). Conflict between doctors 13 (6%). Information acceptably good in MCR urgent request 100% MS, and 80% SS. Two out of three MCR were without reference to the discharge report., Conclusions: There are significant losses in the transmission of information during the process of the MCR, which is higher in surgical than in medical departments., (Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.)

Background: Venous thromboembolism (VTE) includes deep vein thrombosis and pulmonary embolism. Although effective prophylaxis exists for medical patients, there is little information outside of clinical trials. We will analyze our experience in the prophylaxis of VTE with enoxaparin in hospitalized medical patients., Material and Methods: We studied all of the patients ≥15 years admitted for emergency care to all of the medical departments of the hospital, except for the Hematology Department, between 1/April/1999 and 31/December/2005. The patients' age, sex, Charlson comorbidity index (CCI), whether they received prophylaxis with enoxaparin or not, dose, VTE, bleeding, thrombocytopenia, and mortality were analyzed., Results: 40,349 patients were included, of which 55.87% were male, with an average age of 67.56, and an average CCI of 4.99. There were 19,834 patients who did not receive prophylaxis for which the rate of incidence of VTE was 0.61%, mortality 8.75%, bleeding 1.38%, and thrombocytopenia 0.04%. Prophylactic enoxaparin was administered to 20,515 patients, for which the rate of incidence of VTE was 0.44%, mortality 10.71%, bleeding 1.1%, and thrombocytopenia 0.04%. The adjusted Odds Ratio (OR) for VTE was 0.65 (95% confidence interval [95% CI] 0.49 to 0.87). The adjusted OR for mortality was 0.84 (95% CI 0.78 to 0.9). With the adjusted data, the number needed to treat (NNT) for VTE was 470.3 (95% CI 278.4 to 1413.3), and the NNT for mortality was 77.2 (95% CI 54.6 to 130.3)., Conclusion: Thromboprophylaxis with enoxaparin in hospitalized medical patients is associated with a lower incidence of VTE and mortality, and is safe., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Introduction: To analyse the long term outcome of the age and comorbidity of patients admitted to Surgical Departments, the number of referrals to Internal Medicine made by these Departments, and to assess whether there are seasonal variations and the call/reject effect., Material and Methods: We compared the age, Charlson Comorbidity Index (CCI), and the number of referrals made by Traumatology, General Surgery and Urology of patients discharged in 2000, with those discharged in 2007. Seasonal variations and the call/reject effect were studied by analysing all the interdepartmental referrals made by all the surgical departments from the year 2000 to 2007., Results: Age increased by 5.6% between 2000 and 2007, the CCI by 5.8%, and interdepartmental referrals by 60%. Interdepartmental referrals decreased in July and August, whilst they increased in January, February, June and October, up to 64% more in January, although with variations of almost 50% in the same month. We detected differences of up to 68.2% in the referrals requested to different physicians., Conclusions: We observed a sharp increase in the requests for referral to Internal Medicine by Surgical Departments of our hospital, which is not explained by the increase in admissions to these Departments, and which could be associated with the increase in age and comorbidity of their patients. Requests for interdepartmental referral have marked monthly variations and also as regards the Consulting Physician., (Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.)

The physician on-call is a fundamental support for modern in-patient care. The majority of the time during which a patient is in the hospital, he/she is under their care. There is almost no information about its clinical aspects. These are greatly influenced by the patient, his/her family, other patients and their relatives, catering services, some special situations, nursing personnel, and the doctor both as the main responsible person for the patient and as the physician on-call. As the doctor on call, he/she should have a clear idea of what the objectives are, achieve good management of the calls received, make the difference corresponding decisions and help the work of the patient's responsible physician. It is necessary to analyze and adapt the amount of work that the physician on-call has.

Pleural effusion (PE) can change the equilibrium between volume of thoracic cavity and volume of intrathoracic structures, and it can disturb the function of respiratory system, heart, and diaphragm. PE alters scanty the pulmonary gas exchange, but it provokes restrictive changes in pulmonary function proportionally to fluid volume, increase thoracic diameters, and decrease lung compliance. PE can originate a syndrome similar to cardiac tamponade. Elevate intrapleural pressure increase intrapericardic pressure and this disturb the cardiac chambers filling, specially right chambers, and decrease cardiac output. Large PE can invert the diaphragm inducing paradoxical movement that origin a reduction of alveolar ventilation. All these alterations improve with drainage of the PE. We think that PE must always be drained, specially if respiratory failure is present.

Background and Objective: To date, no studies have been reported analyzing the prognosis factors related to severe clinical complications in tuberculous pleural effusion (TPE). We studied clinical, biochemical, radiological, and microbiological factors that could help establish the clinical outcome of TPE., Patients and Method: Retrospective study of > or = 15 years old patients diagnosed of TPE along 9 years. Patients were classified in two groups: a group without complications (NCG), and a group with complications (CG) on the basis of residual pleural thickening (RPT) > or = 10 mm, need of surgery or death., Results: Sixty six patients were included, mean age 35.3 years, 53% male, 47 in the NCG group and 19 in the CG (1 died, 4 needed surgery, 14 had RPT). The evolution of clinical symptoms was 20.7 days in the NCG and 45.6 in the CG. 94.7% of the CG patients had loculations (23.4% in the NCG). We observed significant differences in the pH (7.34 vs 7.11), glucose (78 vs 30 mg/dl) and lactic dehydrogenase (925 vs 3,235 U/l)., Conclusions: Severe TPE has similar characteristics to complicated parapneumonic pleural effusion. Loculations, pH < 7.25 and glucose < 50 mg/dl were indicative of a poorly outcome in our study.

Background and Objective: Although surgical units commonly request the collaboration of internists via medical consultation, the efficiency of this system is low and expensive. We studied the effect of the integration of full-time internists in a surgical department., Patients and Method: The study group consisted of the patients admitted during intervention in the Orthopedic Surgery and Traumatology Department. Those patients admitted during the same period of the previous year made up the control group. We analyzed pre-surgical stay, post-surgical stay and total stay. We also studied in-hospital mortality, re-admissions and those patients who were not submitted to surgery (NSS). Control variables were age, sex, type of admission (programmed/emergency) and main diagnosis., Results: 1,216 patients were included, 599 in the control group and 617 in the study group, 48.0% were emergency admissions and 11.7% NSS patients. Study of programmed patients did not suggest any differences between both groups in any of the analyzed variables. In emergency patients, the total stay was decreased in 18.2%, and it was reduced in 40.2% of the NSS. The distribution of the re-admissions was similar in both study and control groups. We observed a decrease in the NSS and a 50% decrease in the deaths of the study group. The obtained saving was 329,170 Euros., Conclusions: The adscription of full-time internists to a surgical service clearly improves the quality of the service it provides, with important hospital savings.

Basis: The medical interconsultation contributes knowledge of a speciality to another one, but implies an important workload. The objective is to define de characteristics of medical interconsultation requested to an Internal Medicine Department and to assess the workload that they involve., Patients and Method: Medical interconsultations requested during 6 months were included. Sex and age of the patient, petitioner department, reason for the interconsultation, follow-up length and referring to other departments were evaluated., Results: 181 medical interconsultation were requested, 53.6% were women. Median age was 68.5 years (17-98), and median follow-up was 6 days (1-76). Surgical departments requested 86.7%. The reason was long pathology in 19.7% and cardiac pathology in 18.9%. There was more than one reason in 53 medical interconsultations. Twelve patients were referred to other departments., Conclusions: Most of medical interconsultations come from the surgical area. The differences among the petitioner departments are due to their different kind of organization and staffing of to the different types of formation or criteria of requestion physicians. Cardiopulmonary pathology predominates, possibly because of high prevalence of this pathology in the hospital. The workload due to medical interconsultation is similar to workload internists endure in their hospitalization area.

Background and Objective: Intrapleural fibrinolysis (IPF) can avoid surgery in patients with loculated pleural effusions. Few clinical trials on IPF for the treatment of empyemas (PEM) and complicated pleural effusions (CPE) have been reported. We describe here our experience with IPF in the treatment of PEM/CPE patients., Patients and Method: 81 patients with PEM/CPE were included. Urokinase, 100000 U, was instilled into the pleural cavity, three times a day. A mean of 12.9 doses of urokinase were administered., Results: The mean of days having a chest tube was 7.7 days and the mean hospital stay was 22.2 days. No radiological sequelae were observed or these were mild in 66 cases (81.5%). There were four deaths and three patients needed surgery., Conclusions: IPF is an efective and reliable method for the treatment of PEM/CPE.