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In this book, editors Garcia-Sanchez and Faulstich Orellana pull together various studies, that connect, focus, and elevate the cultural and linguistic practices of youth from racially, ethnically ...

In this paper, I examine how liminal spatio-temporal contexts both afford and constrain how immigrant children navigate their social lives in educational settings. Liminal schooling contexts have largely been unexamined in micro-ethnographic approaches to schooling, despite the potential of these contexts for illuminating the educational lives of youth. Shifting the ethnographic lens to the interactions occurring in seemingly liminal schooling contexts (in between ratified activities, in between ratified places, etc.) reveal heightened forms of behavior at the extremes of a continuum ranging from empathy/inclusion to violence/exclusion. On the one hand, liminality can render immigrant youth more vulnerable to racialized bullying, including verbal and physical aggression, since many of the institutional protections that apply in ratified schooling contexts are in abeyance. On the other hand, liminal contexts also allow for displays of support and empathy that can lead to the development of cross-ethnic peer friendships, which can happen when social-ethnic boundaries and hierarchies that are reproduced in more central contexts are relaxed. This paper builds on a linguistic ethnography documenting the social lives of Moroccan immigrant children in a Southwestern Spanish town. Using videoanalysis and ethnographic methods in discourse analysis, I focus on videotaped interactions between immigrant students and their Spanish counterparts taking place in the interstices of school life – when students are walking between buildings, in the fringes/corners of the schoolyard, in between classes … etc. The long-term ethnography allows me to examine the interactions occurring in these liminal contexts in relation to institutional culture and to the relational history between children. This paper calls for examining youth’s schooling experiences more holistically. What happens in liminal contexts is crucial to achieving educational equity in the 21st century: it can, for example, undermine progressive curricular efforts and can have positive/negative implications for immigrant youth’s enduring feelings of belonging and educational enfranchisement.

This paper examines the situated ways in which Moroccan immigrant children in Spain create imagined, alternative life worlds and explore possible forms of identification through an investigation of these children’s hybrid linguistic practices in the midst of play. Drawing on Bakhtin’s (1981, 1986) notions of heteroglossia and hybridity, the analysis focuses on the meanings of codeswitching practices that a group of Moroccan immigrant girls deploy in pretend-play sequences involving dolls to construct female identities; identities that they treat as desirable in the context of Spanish idealizations of femininity, but that are considered transgressional by adults in Moroccan diaspora communities in Spain. Neighborhood peer group play affords Moroccan immigrant girls’ transformations and engagement in subversive tactics, in that these activities take place outside the scrutiny of parents and other adults. The rich verbal and sociocultural environment of Moroccan immigrant children’s peer groups provide us with an excellent window to investigate peer language socialization processes in relation to how immigrant children negotiate, transform, and subvert in the midst of play the different, and often incongruous, socio-cultural and linguistic expectations and constraints that they encounter on a daily basis. Use of Moroccan Arabic and Spanish in this pretend play, in particular, results in a heteroglossic polyphony of voices imbued with moral tensions (Bahktin 1981, 1986). This analysis highlights the importance of these hybrid linguistic practices in immigrant girls’ explorations of alternative processes of gendered identification in multilingual, culturally-syncretic environments. Through surreptitious pretend-play, Moroccan immigrant girls explore imagined transgressional possible identities and moral worlds. In this sense, this research also underscores the implications of children’s language use and language choice in pretend-play for larger processes of cultural continuity and transformation in transnational, diasporic communities undergoing rapid change.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients. (c) 2021 Elsevier Espan tilde a, S.L.U. y SEMICYUC. All rights reserved.

Introduction. 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. Material and 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

Chest x-ray and computed tomography (CT) scans are important pillars for the diagnosis of lung involvement in COVID-19. The radiological image is typically characterized by peripheral, bilateral ground glass opacities (GGO), mainly located in the lower lobes. The limited sensitivity and specificity of these imaging techniques and possible atypical morphological or topographical presentations make it necessary to always rule out other infectious and non-infectious diseases. Therefore, it is fundamental to consider the patient's clinical and analytical data and the epidemiological circumstances.

This article provides a critical review of the theoretical underpinnings of two core concepts in language socialization research: input and communicative competence. We organize our discussion along two major lines of inquiry: ( a) the historical-local and ( b) the language contact–globalization bodies of work. The first part of the article contests the persistent view that input reduces to vocabulary and grammatical structures. To this end, it provides evidence for a more multifaceted approach to input that involves multiparty participant frameworks and multimodality in culturally diverse language socialization ecologies. In this vein, it problematizes language gap studies that are based on middle-class language acquisition models of mother–child dyadic verbal input. The second part of the article challenges monolingual, developmental, and speaker-based models of communicative competence that assume a linear evolution from lesser to greater communicative competence and from more peripheral to more central community membership. It also offers evidence for how communicative competence is socioculturally constructed and, sometimes, interactionally distributed.

El método biográfico narrativo es el foco de esta investigación de corte cualitativo. El objetivo es mostrar la validez de este método como estrategia de formación para futuros docentes. Una estrategia que mejora la capacidad de análisis crítico y con ello de reformulación de los presupuestos de la cultura escolar. La muestra está compuesta por 383 estudiantes del Máster Universitario de Formación del Profesorado de Educación Secundaria de la Universidad de Extremadura (España). Al aplicar este método en los programas de formación del profesorado aparece una alternativa a la investigación tradicional, a la formación y a la acción social. Como resultados, se cultivan tres recursos para capacitar a futuros docentes al mismo tiempo; a medida que los alumnos aprenden el método, realizan un proceso de evaluación, que resulta útil para su formación y competencia futura como profesionales. Por lo tanto, los propios estudiantes adquieren un proceso heurístico y hermenéutico para evaluar y convertirse en investigadores de su propia experiencia y prospectiva profesional.

The collection of papers represented in the Integrative Research Review responds to the question: How can we study children’s/youth’s out of school experiences to inform classroom practices? Using a variety of lenses to address the question, the authors consider how to understand, respond to, and serve children and youth in a variety of contexts. Duke explores a quasi-experimental design showing the potential impact on student achievement and motivation in schools that incorporate literacy practices from children’s lives outside of school compared to the traditional curriculum. Bloome and Faust take a philosophical approach to explore the languaging of the relationship between students’ out-of-school lives and classroom practices and its implications for the construction of personhood by examining one classroom event from a microethnographic discourse analysis perspective. García-Sánchez highlights the methodological features that allow linguistic anthropologists to make visible the agentive and innovative character of immigrant children’s communicative practices in a variety of learning situations. Drawing on the transliteracies approach, Stornaiuolo considers work with a group of young people to study multimodal composing and the development of school makerspaces in a 6-year partnership project with a local innovation high school. Alvermann discusses the papers, pointing out the affordances and challenges of each perspective.

Sedation is necessary in the management of critically ill patients, both to alleviate suffering and to cure patients with diseases that require admission to the intensive care unit. Such sedation should be appropriate to the patient needs at each timepoint during clinical evolution, and neither too low (undersedation) nor too high (oversedation). Adequate sedation influences patient comfort, safety, survival, subsequent quality of life, bed rotation of critical care units and costs. Undersedation is detected and quickly corrected. In contrast, oversedation is silent and difficult to prevent in the absence of management guidelines, collective awareness and teamwork. The Zero Oversedation Project of the Sedation, Analgesia and Delirium Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units aims to offer a practical teaching and collective awareness tool for ensuring patient comfort, safety and management with a view to optimizing the clinical outcomes and minimizing the deleterious effects of excessive sedation. The tool is based on a package of measures that include monitoring pain, analgesia, agitation, sedation, delirium and neuromuscular block, keeping patients pain-free, performing dynamic sedation according to clinical objectives, agreeing upon the multidisciplinary protocol to be followed, and avoiding deep sedation where not clinically indicated.

A photochemical reactor was tested in an undergraduate teaching laboratory through the environmentally friendly aromatization of a 1,4-dihydropyridine, successfully using air as an oxidant, organic...

Objective To know the real clinical practice of Spanish ICUs in relation to analgesia, sedation and delirium, with a view to assessing adherence to current recommendations. Design A descriptive cross-sectional study was carried out based on a national survey on analgesia, sedation and delirium practices in patients admitted to intensive care on 16 November, 2013 and 16 October, 2014. An on-line questionnaire was sent with the endorsement of the SEMICYUC. Setting Spanish ICUs in public and private hospitals. Results A total of 166 ICUs participated, with the inclusion of 1567 patients. The results showed that 61.4% of the ICUs had a sedation protocol, and 75% regularly monitored sedation and agitation – the RASS being the most frequently used scale. Pain was monitored in about half of the ICUs, but the behavioral scales were very little used. Delirium monitoring was implemented in few ICUs. Among the patients on mechanical ventilation, midazolam remained a very commonly used agent. Conclusions This survey is the first conducted in Spain on the practices of analgesia, sedation and delirium. We identified specific targets for quality improvement, particularly concerning the management of sedation and the assessment of delirium.

Resumen Objetivo Conocer la practica clinica real de las UCI espanolas en relacion con la analgosedacion y delirium, y valorar como se ajusta a las recomendaciones actuales. Diseno Estudio transversal descriptivo elaborado mediante encuesta nacional sobre practicas de analgosedacion y delirium de los pacientes ingresados en UCI los dias 16 de noviembre de 2013 y 16 de octubre de 2014. Se envio un cuestionario a traves de Internet con el aval de la SEMICYUC. Ambito UCI tanto publicas como privadas de todo el territorio nacional. Resultados Se incluyeron un total de 166 UCI y a 1.567 pacientes. El 61,4% de las UCI contaban con un protocolo de sedacion. El 75% de las UCI monitorizaban la sedacion y agitacion, con RASS como la escala empleada con mayor frecuencia. El dolor se monitorizaba en algo mas de la mitad de las UCI, pero las escalas conductuales eran de muy baja implantacion. El delirium tambien presentaba un bajo nivel diagnostico. Entre los pacientes en ventilacion mecanica el midazolam continuaba siendo un sedante de muy amplio uso. Conclusiones Esta encuesta es la primera realizada en Espana sobre analgosedacion y delirium y nos muestra una fotografia sobre estas practicas, senala algunos aspectos como los relacionados con la monitorizacion y usos de escalas, junto con el manejo del delirium, en los que los resultados del estudio animan a desarrollar proyectos docentes que acerquen la practica clinica real a las recomendaciones nacionales e internacionales.

An amendment to this paper has been published and can be accessed via the original article.

On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.

Bringing together ethnographic approaches to childhood, linguistic anthropology, and relational–feminist perspectives on care, this review focuses on the role of children as interactional brokers of care, a role that has been underappreciated. Building from the premise that, through language, children perform a fundamental form of other-oriented care—that of mediating another person's ability to express themselves—this review explores the material, political, moral, and affective dimensions of children's interactional care work. Attention to the interactional–relational aspects of children's caregiving shows the extent to which children are involved in facilitating the circulation of care and enabling community care networks, and it opens up new possibilities for how we conceptualize care: It illuminates the processes through which care practices are organized, negotiated, and enacted at the intersection of the local and the global; it reveals care as a reciprocal, distributed interactional achievement; and it helps us transcend dichotomies that have characterized scholarly thinking about care.

22 páginas.-- 6 figuras.-- 115 referencias.-- Additional Supporting Information may be found in the online version of this article: http://dx.doi.org/10.1111/sed.12431, Subsurface granitic environments are scarce and poorly investigated. A multi‐disciplinary approach was used to characterize the abundant moonmilk deposits and associated microbial communities coating the granite walls of the 16th Century Paranhos spring water tunnel in Porto city (north‐west Portugal). It is possible that this study is the first record of moonmilk in an urban subsurface granitic environment. The morphology and texture, mineralogical composition, stable isotope composition and microbial diversity of moonmilk deposits have been studied to infer the processes of moonmilk formation. These whitish secondary mineral deposits are composed of very fine needle‐fibre calcite crystals with different morphologies and density. Calcified filaments of fungal hyphae or bacteria were distinguished by field emission scanning electron microscopy. Stable isotope analysis revealed a meteoric origin of the needle‐fibre calcite, with an important contribution of atmospheric CO2, soil respiration and urn:x-wiley:00370746:media:sed12431:sed12431-math-0001 from weathering of Ca‐bearing minerals. The DNA‐based analyses revealed the presence of micro‐organisms related to urban contamination, including Actinobacteria, mainly represented by Pseudonocardia hispaniensis, Thaumarchaeota and Ascomycota, dominated by Cladosporium. This microbial composition is consistent with groundwater pollution and contamination sources of the overlying urban area, including garages, petrol stations and wastewater pipeline leakage, showing that the Paranhos tunnel is greatly perturbed by anthropogenic activities. Whether the identified micro‐organisms are involved in the formation of the needle‐fibre calcite or not is difficult to demonstrate, but this study evidenced both abiotic and biogenic genesis for the calcite moonmilk in this subsurface granitic environment., The authors acknowledge the Spanish Ministry of Economy, Industry and Competitiveness (MINEICO, project CGL2011-2569) and the Portuguese Foundation for Science and Technology, FCT (UID/GEO/04035/2013, UID/ECI/04028/2013, PEst-OE/CTE/UI0098/2011) and the LABCARGA| ISEP re-equipment program (IPP-ISEP|PAD’2007/ 08) for financial support. AZM thanks MINEICO for the ‘Juan de la Cierva – Incorporación’ postdoctoral contract (IJCI-2014-20443). PMMS thanks the Spanish Ministry of Science and Innovation for his contract associated with the ‘Research Programme in Technologies for the Assessment and Conservation of Cultural Heritage’ (TCP CSD2007-0005

15 páginas.- 5 figuras.- 85 referencias.- The following are available online at http://www.mdpi.com/2079-6412/10/11/1134/s1 .- This article belongs to the Special Issue Biofilms on Cultural Heritage, The Galapagos Islands (Ecuador) have a unique ecosystem on Earth due to their outstanding biodiversity and geological features. This also extends to their subterranean heritage, such as volcanic caves, with plenty of secondary mineral deposits, including coralloid-type speleothems and moonmilk deposits. In this study, the bacterial communities associated with speleothems from two lava tubes of Santa Cruz Island were investigated. Field emission scanning electron microscopy (FESEM) was carried out for the morphological characterization and detection of microbial features associated with moonmilk and coralloid speleothems from Bellavista and Royal Palm Caves. Microbial cells, especially filamentous bacteria in close association with extracellular polymeric substances (EPS), were abundant in both types of speleothems. Furthermore, reticulated filaments and Actinobacteria-like cells were observed by FESEM. The analysis of 16S rDNA revealed the presence of different bacterial phylotypes, many of them associated with the carbon, nitrogen, iron and sulfur cycles, and some others with pollutants. This study gives insights into subsurface microbial diversity of the Galapagos Islands and further shows the interest of the conservation of these subterranean geoheritage sites used as show caves, This research was funded by the Ecuadorian Ministry of Environment (Project PC-65-14 National Park Galapagos), by the Spanish project MINECO CGL2016-75590-P with European Regional Development Fund and the Portuguese Foundation for Science and Technology (Fundação para a Ciência e a Tecnologia-FCT) under the project UID/Multi/04449/2019 for HERCULES/UE. AMGS was supported by a FPU fellowship of the Spanish Ministry of Education, Culture and Sport (AP2010-2052). AZM was supported by a Marie Curie Intra-European Fellowship of the European Commission’s 7th Framework Programme (PIEF-GA-2012-328689-DECAVE) and a CEECIND/01147/2017 contract from FCT. MLC was supported by a CEECIND/00349/2017 contract from FCT. FG was financially supported by the “HIPATIA” research program of the University of Almeria.

Sedation is necessary in the management of critically ill patients, both to alleviate suffering and to cure patients with diseases that require admission to the intensive care unit. Such sedation should be appropriate to the patient needs at each timepoint during clinical evolution, and neither too low (undersedation) nor too high (oversedation). Adequate sedation influences patient comfort, safety, survival, subsequent quality of life, bed rotation of critical care units and costs. Undersedation is detected and quickly corrected. In contrast, oversedation is silent and difficult to prevent in the absence of management guidelines, collective awareness and teamwork. The Zero Oversedation Project of the Sedation, Analgesia and Delirium Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units aims to offer a practical teaching and collective awareness tool for ensuring patient comfort, safety and management with a view to optimizing the clinical outcomes and minimizing the deleterious effects of excessive sedation. The tool is based on a package of measures that include monitoring pain, analgesia, agitation, sedation, delirium and neuromuscular block, keeping patients pain-free, performing dynamic sedation according to clinical objectives, agreeing upon the multidisciplinary protocol to be followed, and avoiding deep sedation where not clinically indicated.

Trichuris trichiura is a nematode considered as the whipworm present in humans and primates. The systematics of the genus Trichuris is complex. Morphological studies of Trichuris isolated from primates and humans conclude that the species infecting these hosts is the same. Furthermore, numerous molecular studies have been carried out so far to discriminate parasite species from humans and Non-Human Primates using molecular techniques, but these studies were not performed in combination with a parallel morphological study. The hypothesised existence of more species of Trichuris in primates opens the possibility to revise the zoonotic potential and host specificity of T. trichiura and other putative new species of whipworms. In the present work, a study of Trichuris Roederer, 1761 (Nematoda:Trichuridae) parasitizing C. g. kikuyensis, P. ursinus, Macaca sylvanus, Pan troglodytes, and Sus scrofa domestica has been carried out using modern morphometric techniques in order to differentiate populations of Trichuris isolated from four species of captive NHP from different geographical regions, and swine, respectively. The results obtained revealed strong support for geometrical morphometrics as a useful tool to differentiate male Trichuris populations. Therefore, morphometrics in combination with other techniques, such as molecular biology analyses, ought to be applied to further the differentiation of male populations. On the other hand, morphometrics applied to female Trichuris species does not seem to contribute new information as all the measurements combinations of obtained from females always showed similar results., Graphical abstract Image 1, Highlights - Geometrical morphometrics is an useful tool to differentiate male Trichuris populations. - Geometrical morphometrics results are in agreement with the molecular biology analysis applied to the adult male samples that allow the identification of different species of Trichuris. - The hypothesised existence of different species of Trichuris in primates opens the possibility to revise the zoonotic potential and host specificity of T. trichiura and other putative new species of whipworms.

To know the real clinical practice of Spanish ICUs in relation to analgesia, sedation and delirium, with a view to assessing adherence to current recommendations.A descriptive cross-sectional study was carried out based on a national survey on analgesia, sedation and delirium practices in patients admitted to intensive care on 16 November, 2013 and 16 October, 2014. An on-line questionnaire was sent with the endorsement of the SEMICYUC.Spanish ICUs in public and private hospitals.A total of 166 ICUs participated, with the inclusion of 1567 patients. The results showed that 61.4% of the ICUs had a sedation protocol, and 75% regularly monitored sedation and agitation - the RASS being the most frequently used scale. Pain was monitored in about half of the ICUs, but the behavioral scales were very little used. Delirium monitoring was implemented in few ICUs. Among the patients on mechanical ventilation, midazolam remained a very commonly used agent.This survey is the first conducted in Spain on the practices of analgesia, sedation and delirium. We identified specific targets for quality improvement, particularly concerning the management of sedation and the assessment of delirium.

Vargas Vila, más allá de la hipérbole

Resumen Objetivo Los pacientes ingresados en el Servicio de Oftalmologia (OFT) estan aumentando su edad, comorbilidad y complejidad, induciendo un incremento de interconsultas a Medicina Interna (MI). Una alternativa a las interconsultas es la asistencia compartida (AC). Estudiamos el efecto de la AC con MI sobre la estancia hospitalaria de los enfermos ingresados en OFT. Metodos Estudio observacional retrospectivo de los pacientes ≥14 anos ingresados desde el 1/1/2009 al 30/06/2013 en OFT; desde mayo de 2011 con AC con MI. Analizamos edad, sexo, tipo de ingreso, si fue operado, peso administrativo asociado a GRD, numero total de diagnosticos al alta, indice de comorbilidad de Charlson (ICh), fallecimiento, reingresos y estancia hospitalaria. Resultados Entre ambos grupos, hubo diferencias estadisticamente significativas en el porcentaje de pacientes operados (odds ratio [OR] 2,3, intervalo de confianza del 95% [IC 95%]: 1,5 a 3,6), peso administrativo (0,1160; IC 95%: 0,0738 a 0,1583) y numero de diagnosticos (0,9; IC 95%: 0,5 a 1,3). Al ajustar, observamos que la AC redujo el 27,8% la estancia en OFT, 0,5 dias (IC 95%: 0,1 a 1). Conclusiones Los enfermos ingresados en OFT estan aumentando su comorbilidad y complejidad. La AC se asocia a una disminucion de la estancia y costes en OFT, similares a los observados en otros servicios quirurgicos.

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.

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.

Resumen Objetivo Una actividad importante y poco estudiada de los servicios de medicina interna (MI) son las interconsultas. Hemos analizado las solicitudes de interconsulta a MI y posibles diferencias entre las consultas de los servicios medicos y quirurgicos. Pacientes y metodos Estudio observacional prospectivo de 8 meses de duracion. Se analizaron variables demograficas, relacionadas con la procedencia de la interconsulta, comorbilidad, estancia y mortalidad hospitalaria, urgencia, demora ingreso-solicitud, adecuacion (no adecuado si otro servicio habia sido consultado por el mismo motivo o porque la enfermedad motivo de consulta era propia del servicio solicitante) y, en los pacientes intervenidos quirurgicamente, si fue solicitada antes o despues de la intervencion. Resultados En el tiempo de estudio se recibieron 215 interconsultas (27 consultas/mes). La edad media fue de 69,8 anos (mujeres 50%). El 30,7% fueron solicitadas por servicios medicos y el 69,3% por servicios quirurgicos. Un 13% de las interconsultas estuvieron duplicadas. El servicio de MI no era el servicio consultado adecuado en el 23,3% (13,0% solicitadas por el mismo motivo a otro servicio y en el 14,3% la enfermedad era propia del servicio solicitante). Los lunes y viernes se formularon mas interconsultas que los jueves (25,1 y 23,7% versus 15,3%; respectivamente, p = 0,03). La demora entre el ingreso y la solicitud de interconsulta fue de 12,6 dias. El 90,7% de las interconsultas solicitadas a pacientes intervenidos se emitieron despues de la intervencion. No hubo diferencias en las caracteristicas de las interconsultas entre los servicios medicos y quirurgicos. Conclusiones Las interconsultas dirigidas a MI con frecuencia son duplicadas, no estan bien dirigidas al servicio adecuado y se aprecia una incorrecta valoracion de su urgencia. Estas caracteristicas son similares para las consultas de los servicios medicos y quirurgicos.