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Background and objective The utility of lung ultrasound as a prognostic tool for patients with acute heart failure is well known, but most studies have been conducted in mixed groups of patients with preserved and reduced ejection fraction. While some subgroup analysis suggests that lung ultrasound is useful regardless of ejection fraction, no specific studies have addressed this question. Our objective is to determine the utility of bedside lung ultrasound as a prognostic tool for patients with preserved ejection fraction, acute heart failure. Material and methods Prospective cohort study with 3-month follow-up after bedside lung ultrasound before discharge in patients hospitalized for acute heart failure with preserved ejection fraction. The number of B lines was determined. Two groups were formed: less than fifteen B lines (unexposed) and fifteen B lines or more (exposed). They were compared in terms of readmission and death attributable to worsening heart failure. Results The exposed group was at higher risk of readmission (HR 2.39, 95% CI 1.12–5.12, P = .024), even after multivariable adjustment (HR 2.46, 95% CI 1.11–5.46, P = .03). Differences between groups in terms of mortality were not statistically significant (HR 1.28, 95% CI .23–6.98). Conclusion Subclinical congestion evaluated with lung ultrasound before discharge is associated with worse prognosis in patients with acute heart failure and preserved ejection fraction. Patients with 15 B lines are 2.5 times more likely to be readmitted for acute heart failure than less congestive patients.

Resumen Antecedentes y objetivo La utilidad de la ecografia como herramienta pronostica en pacientes con insuficiencia cardiaca aguda es conocida, pero la mayoria de estudios han sido realizados en grupos mixtos de pacientes con fraccion de eyeccion preservada y reducida. Si bien algunos analisis de subgrupos sugieren ausencia de diferencias en funcion de la fraccion de eyeccion, no existen estudios especificos que lo confirmen. Nuestro objetivo es determinar la utilidad pronostica de la ecografia a pie de cama en pacientes ingresados por insuficiencia cardiaca y fraccion de eyeccion preservada. Material y metodo Estudio de cohortes prospectivo con seguimiento a 3 meses tras realizacion de ecografia pulmonar previa al alta en pacientes ingresados por insuficiencia cardiaca aguda y fraccion de eyeccion preservada. Se determinan las lineas B presentes al alta. Se constituyen dos grupos: con menos de 15 lineas B (no expuestos) y con 15 o mas (expuestos). Se comparan en terminos de reingreso y muerte debidos a insuficiencia cardiaca. Resultados El grupo expuesto tiene mayor riesgo de reingreso (HR: 2,39; IC 95%: 1,12-5,12; p = 0,024), incluso tras ajuste multivariable (HR: 2,46; IC 95%: 1,11-5,46; p = 0,03). No se ha encontrado asociacion con mortalidad por insuficiencia cardiaca (HR: 1,28; IC 95%: 0,23-6,98). Conclusion La congestion subclinica evaluada con ecografia pulmonar al alta se asocia con peor pronostico en pacientes con insuficiencia cardiaca aguda y fraccion de eyeccion preservada. Los pacientes con 15 o mas lineas B tienen un riesgo 2,5 mayor de reingreso que los pacientes menos congestivos.

The incidence of severe manifestations of COVID-19 increases with age with older patients showing the highest mortality, suggesting that molecular pathways underlying aging contribute to the severity of COVID-19. One mechanism of aging is the progressive shortening of telomeres, which are protective structures at chromosome ends. Critically short telomeres impair the regenerative capacity of tissues and trigger loss of tissue homeostasis and disease. The SARS-CoV-2 virus infects many different cell types, forcing cell turn-over and regeneration to maintain tissue homeostasis. We hypothesize that presence of short telomeres in older patients limits the tissue response to SARS-CoV-2 infection. We measure telomere length in peripheral blood lymphocytes COVID-19 patients with ages between 29 and 85 years-old. We find that shorter telomeres are associated to increased severity of the disease. Individuals within the lower percentiles of telomere length and higher percentiles of short telomeres have higher risk of developing severe COVID-19 pathologies.

Introduction. The diagnosis of SARS-CoV-2 infection is crucial for medical and public health reasons, to allow the best treatment of cases and the best control of the pandemic. Serology testing allows for the detection of asymptomatic infections and 19-COVID cases once the virus has been cleared. We analyzed the usefulness of the SARS-CoV-2 rapid test of Autobio and tried to correlate its pattern with the severity of COVID19 infection. Material and methods. We analyzed the accuracy and clinical usefulness of a point-of-care IgM and/or IgG test for SARS-CoV-2 in 35 COVID-19 patients [12 (34.3%) mild-moderate and 23 (65.7%) severe-critical] admitted to a field hospital in Madrid, as well as in 5 controls. Results. The mean time from the first day of symptoms to the antibody test was 28 days (SD: 8.7), similar according to the severity of the disease. All patients with SARS-CoV-2 PCR+ showed the corresponding IgG positivity, while these results were negative in all control individuals. A total of 26 (74%) cases also presented with positive IgM, 19 (83%) were severe-critical cases and 7 (58%) were mild-moderate cases. The IgM response lasted longer in the severe critical cases (mean: 29.7 days; SD: 8.4) compared to the moderate cases (mean: 21.2 days; SD: 2.0). Conclusions. Rapid serology tests are useful for the diagnosis of patients with COVID-19 (mainly IgG detection) and may also be correlated with the severity of the infection (based on IgM detection).

Prior to the appearance of any foot ulcer, there is an increase in the local temperature due to the presence of an underlying inflammatory process. The use of thermometry to identify inflammation could make patients increase preventive measures until the inflammation disappears. We carried out a meta-analysis to determine the effectiveness of the daily measurement of the foot temperature in 6 points to prevent the occurrence of foot ulcers in patients with diabetes. Patients with temperature differences >4°F (2.2°C) between left and right corresponding sites should reduce activity and increase preventive measures until temperature is normalized. We searched the literature in MEDLINE, EMBASE, Cochrane Library, Web of Knowledge, and clinicaltrials.gov. We have only included randomized clinical trials where individuals were assigned to receive enhanced care (temperature measurement and standard care) versus standard care (education, self-care practices, and periodic clinical visits). We found 4 trials comprising 462 patients from the United States and Norway that met our inclusion criteria. The duration of follow-up varied from 4.5 to 15 months. Overall, 18 (7.9%) subjects in the enhanced foot care group and 53 (22.6%) in the standard foot care group developed foot ulcers (pooled risk ratio = 0.37; 95% confidence interval = 0.21-0.66; P = .0008; percentage of heterogeneity [ I2], 25%; P = .26). The number needed to treat was 7 (95% confidence interval = 5-11). The results were robust after analysis by subgroups according to the potential risk of bias in the studies and the duration of follow-up.

Aim: There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound (LUS); however, its role in predicting the prognosis has yet to be explored. The aim of the study was to assess the relationship between lung ultrasound findings with the degree of respiratory failure measured by the PaO2/FiO2 ratio (PaFi) andthe prognosis of these patients: need for non-invasive mechanical ventilation (NIMV), admission to the Intensive Care Unit (ICU) and mortality.Material and method: Prospective, longitudinal and observational study performed in patients with confirmed COVID-19 underwent a LUS examination and laboratory tests.Results: A total of 107 patients were enrolled: 93.4% with bilateral involvement and 73.83% presented at least one consolidation. A good inverse correlation (Rho Spearman coefficient -0.897) between the ultrasound score and PaFi was obtained. The AUC for identification of patients with more severe respiratory failure, a moderate and severe ARDS, was 0.97 (CI 95%: 0.95-1) and a cut-off score of 34.5 showed a sensitivity of 0.94 and a specificity of 0.91. The Kappa index showed a high concordance (0.83) of the classification by ultrasound lunginvolvement and ARDS.Conclusions: The combination of the ultrasound score and the presence of respiratory failure can easily identify patients with a higher risk to present complications.

Background To analyze hospitalization episodes with an ICD-9 diagnosis code of influenza (codes 487 and 488) in any diagnostic position from 2009 to 2015 in the Spanish hospital surveillance system. Methods Information about age, length of stay in hospital, mortality, comorbidity with an influenza diagnosis code between 1 October 2009 and 30 September 2015 was obtained from the National Surveillance System for Hospital Data (Conjunto Mínimo Básico de Datos, CMBD). Results 52,884 hospital admissions were obtained. A total of 24,527 admissions corresponded to diagnoses ICD-9 code 487 (46.4%), and 28,357 (53.6%) corresponded to ICD-9 code 488. The global hospitalization rates were 8.7 and 10.6 per 100,000 people, respectively. Differences between the two diagnostic groups were found for each of the six analyzed seasons. The diagnostic ICD-9-CM 488, male gender, and high-risk patients classified by risk vaccination groups showed direct relationship with inpatient hospital death. Conclusions Influenza diagnosis was present in a significant number of hospital admissions. The code used for diagnosis (ICD-9-CM 488), male sex, age groups and associated risk clinical conditions showed a direct relationship with inpatient hospital fatality.

Objectives To compare the structure, resources and activity of the internal medicine units (IMUs) of the Spanish National Health System (SNHS) in 2013 and 2016. To analyze the differences between IMUs in 2016 by hospital size. Material and methods We conducted a comparison of 2 descriptive cross-sectional studies of IMUs in general acute care hospitals of the Spanish National Health System, with data referring to 2013 and 2016. The variables were collected via an ad hoc questionnaire (RECALMIN survey). Results Between 2013 and 2016, the demand for care increased dramatically (with an annual average of 11% in hospital discharges and 16% in first consultations), and comorbidity slightly increased (2%). During this period, the mean productivity of IMUs increased 16.7% (0.6 ± 0.3 vs. 0.7 ± 0.3; p = .09), and the mean stay decreased 10% (9 ± 2.2 vs. 8.1 ± 2.1 days; p = .001). Progress in implementing good practices and systematic care for complex chronic patients was scarce. Both surveys found variability among IMUs and marked differences among IMUs of hospitals of different sizes. Conclusions IMUs responded to the increased burden of care they supported during 2013–2016 by improving their efficiency and productivity; however, advances in implementing good practices, including care for chronic complex patients, were scare. The significant variability in the indicators of structure, activity and management models found in 2013 remained in 2016.

Resumen Objetivos Comparar la estructura, recursos y actividad de las Unidades de Medicina Interna (UMI) del Sistema Nacional de Salud (SNS) en 2013 y 2016. Analizar las diferencias entre UMI en 2016 por tamano de hospital. Material y metodos Comparativa de 2 estudios descriptivos transversales de UMI en hospitales generales de agudos del Sistema Nacional de Salud con datos referidos a 2013 y a 2016. Las variables fueron recogidas mediante un cuestionario «ad hoc» (encuesta RECALMIN). Resultados Entre 2013 y 2016 aumento notablemente la demanda asistencial (con un promedio anual del 11% en altas de hospitalizacion y del 16% en primeras consultas) y ligeramente la comorbilidad (2%). En el mismo periodo, aumento un 16,7% la productividad media de las UMI (0,6 + 0,3 vs. 0,7 + 0,3; p = 0,09) y la estancia media disminuyo un 10% (9 + 2,2 vs. 8,1 + 2,1 dias; p = 0,001). Los progresos en la implantacion de buenas practicas y de una atencion sistematica al paciente cronico complejo fueron escasos. La variabilidad entre UMI y las notables diferencias entre UMI de hospitales de tamano distinto fueron hallazgos de ambas encuestas. Conclusiones Las UMI respondieron al aumento de la carga asistencial que soportaron en el periodo 2013-2016 mejorando su eficiencia y productividad, pero los avances en la implantacion de buenas practicas, incluyendo la atencion al paciente cronico complejo, fueron escasos. La importante variabilidad en los indicadores de estructura, actividad y modelos de gestion encontrada en 2013 se mantuvo en 2016.

Resumen Objetivos Diabetes mellitus se asocia con un marcado incremento de enfermedad cardiovascular. En el presente estudio analizamos la prevalencia de diabetes mellitus en pacientes hospitalizados en Espana en 2015 y la carga de enfermedad cardiovascular asociada. Metodos Mediante el analisis del conjunto minimo basico de datos (CMBD) del Ministerio de Sanidad del ano 2015, se incluyen todos los pacientes dados de alta con diagnostico de diabetes mellitus. Se describen las caracteristicas epidemiologicas, la distribucion por los diferentes servicios hospitalarios y la presencia de enfermedad cardiovascular. Resultados En el ano 2015 hubo 3.727.583 altas en Espana; de ellas, 619.188 correspondian a diabeticos (16,7%); el 56,8% eran varones y la edad media era de 73,2 anos. La prevalencia de enfermedad cardiovascular fue del 40,8%, distribuida en insuficiencia cardiaca congestiva (20,1%), enfermedad cerebrovascular (10,3%), enfermedad coronaria (9,4%) y enfermedad arterial periferica (9,1%). La mayor parte de pacientes ingresaron en los servicios de medicina interna (34,2%), cardiologia (9,5%) y cirugia general (8,9%). La estancia media global fue de 8,2 dias y los reingresos a 30 dias alcanzaron el 14%. La mortalidad fue del 6,8%. Los pacientes ingresados en medicina interna tienen un grado de severidad mas alto (3-4), 41,9% vs 31,6%, que los ingresados en otros servicios medicos (p Conclusiones La diabetes mellitus es una comorbilidad importante de los pacientes ingresados en medicina interna. Una proporcion significativa de estos pacientes presenta enfermedad cardiovascular, y la mas frecuente es la insuficiencia cardiaca.

Prior to the appearance of any foot ulcer, there is an increase in the local temperature due to the presence of an underlying inflammatory process. The use of thermometry to identify inflammation could make patients increase preventive measures until the inflammation disappears. We carried out a meta-analysis to determine the effectiveness of the daily measurement of the foot temperature in 6 points to prevent the occurrence of foot ulcers in patients with diabetes. Patients with temperature differences >4 degrees F (2.2 degrees C) between left and right corresponding sites should reduce activity and increase preventive measures until temperature is normalized. We searched the literature in MEDLINE, EMBASE, Cochrane Library, Web of Knowledge, and clinicaltrials.gov. We have only included randomized clinical trials where individuals were assigned to receive enhanced care (temperature measurement and standard care) versus standard care (education, self-care practices, and periodic clinical visits). We found 4 trials comprising 462 patients from the United States and Norway that met our inclusion criteria. The duration of follow-up varied from 4.5 to 15 months. Overall, 18 (7.9%) subjects in the enhanced foot care group and 53 (22.6%) in the standard foot care group developed foot ulcers (pooled risk ratio = 0.37; 95% confidence interval = 0.21-0.66; P = .0008; percentage of heterogeneity [I-2], 25%; P = .26). The number needed to treat was 7 (95% confidence interval = 5-11). The results were robust after analysis by subgroups according to the potential risk of bias in the studies and the duration of follow-up.

The use of devices that provide continuous positive pressure in the airway has shown improvement in various pathologies that cause respiratory failure. In the COVID 19 pandemic episode the use of these devices has become widespread, but, due to the shortage of conventional CPAP devices, alternative devices have been manufactured. The objective of this study is to describe the use of these devices, as well as their efficacy.Data are collected from patients admitted for Pneumonia due to COVID 19 at the IFEMA Field Hospital. Data are collected from 23 patients with respiratory failure and need for ventilatory support.Study carried out on a total of 23 patients, dated admission to IFEMA. Alternative CPAP was used in five patients (21.7%), while ventilatory support with a reservoir mask or Ventimask Venturi effect was used in the remaining 18 patients (78.3%). A progressive increase in saturation is observed in those patients in whom alternative CPAP was used (from 94% on average to 98% and 99% on average after 30 and 60 min with the mask, respectively), although this change was not significant (p = 0.058 and p = 0.122 respectively). No significant change in RF was observed at the beginning and end of the measurement in patients who used alternative CPAP (p = 0.423), but among those who did not use alternative CPAP (p = 0.001). A statistically significant improvement in the variable oxygen saturation / fraction inspired by oxygen is observed in patients who used alternative CPAP (p = 0.040).The use of these devices has helped the ventilatory work of several patients by improving their oxygenation parameters. To better observe the evolution of patients undergoing this therapy and compare them with patients with other types of ventilatory support, further studies are necessary.El uso de dispositivos que aportan presión positiva continua en la vía aérea ha demostrado mejoría en diversas patologías que producen insuficiencia respiratoria. En el episodio de pandemia por COVID 19 el uso de estos dispositivos se ha generalizado, pero, debido a la escasez de dispositivos convencionales de CPAP, se han fabricado dispositivos alternativos. El objetivo de este estudio es describir el uso de estos dispositivos, así como su eficacia.Se recogen datos de pacientes ingresados por Neumonía por COVID 19 en el Hospital de campaña de IFEMA. Se recogen datos de pacientes con insuficiencia respiratoria y necesidad de soporte ventilatorio.Estudio realizado sobre un total de 23 pacientes, con fecha ingreso en IFEMA. Se empleó CPAP alternativa en cinco pacientes (21,7%), mientras que en los 18 pacientes restantes (78,3%) se usó soporte ventilatorio con mascarilla reservorio o Ventimask efecto Venturi. Se observa un aumento progresivo de la saturación en aquellos pacientes en los que se empleó CPAP alternativa (de 94% de promedio a 98% y 99% de promedio tras 30 y 60 minutos con la máscara, respectivamente), aunque este cambio no resultó significativo (p = 0,058 y p = 0,122 respectivamente). No se observó un cambio significativo de frecuencia respiratoria al inicio y final de la medición en pacientes que usaron CPAP alternativa (p = 0,423) pero si entre los que no la usaron (p = 0,001). Se observa una mejoría estadísticamente significativa en la variable Saturación de oxigeno / Fracción inspirado de oxígeno en los pacientes que usaron CPAP alternativa (p = 0,040).El uso de estos dispositivos ha ayudado al trabajo ventilatorio de varios pacientes mejorando sus parámetros de oxigenación. Para observar mejor la evolución de los pacientes sometidos a esta terapia y compararlos con pacientes con otro tipo de soporte ventilatorio, son necesarios más estudios en los que se aleatorice su uso.

espanolIntroduccion El uso de dispositivos que aportan presion positiva continua en la via aerea ha demostrado mejoria en diversas patologias que producen insuficiencia respiratoria. En el episodio de pandemia por COVID-19, el uso de estos dispositivos se ha generalizado, pero, debido a la escasez de dispositivos convencionales de presion positiva continua en la via aerea (CPAP), se han fabricado dispositivos alternativos. El objetivo de este estudio es describir el uso de estos, asi como su eficacia. Material y metodos Se recogen datos de pacientes ingresados por neumonia por COVID-19 en el Hospital de Campana de IFEMA, asi como datos de pacientes con insuficiencia respiratoria y necesidad de soporte ventilatorio. Resultados Estudio realizado sobre un total de 23 pacientes, con fecha de ingreso de entre el 24 de marzo y el 28 de abril en IFEMA. Se empleo CPAP alternativa en cinco pacientes (21,7%), mientras que, en los 18 restantes (78,3%) se uso un soporte ventilatorio con mascarilla reservorio o Ventimask efecto Venturi. Se observo un aumento progresivo de la saturacion en aquellos pacientes en los que se empleo CPAP alternativa (de 94% de promedio a 98 y 99% de promedio, tras 30 y 60 minutos con la mascara, respectivamente), aunque este cambio no resulto significativo (p = 0,058 y p = 0,122, respectivamente). De igual manera, no se observo un cambio significativo de frecuencia respiratoria al inicio y al final de la medicion en pacientes que usaron CPAP alternativa (p = 0,423) pero si entre los que no la usaron (p = 0,001). Se observo una mejoria estadisticamente significativa en la variable de saturacion de oxigeno/fraccion inspirado de oxigeno en los pacientes que usaron CPAP alternativa (p = 0,040). Conclusion El uso de estos dispositivos ha ayudado al trabajo ventilatorio de varios pacientes, mejorando sus parametros de oxigenacion. Para observar mejor la evolucion de los pacientes sometidos a esta terapia y compararlos con pacientes con otro tipo de soporte ventilatorio, son necesarios mas estudios en los que se aleatorice su uso. EnglishIntroduction The use of devices that provide continuous positive pressure in the airway has shown improvement in various pathologies that cause respiratory failure. In the COVID-19 pandemic episode the use of these devices has become widespread, but, due to the shortage of conventional continuous positive airway pressure (CPAP) devices, alternative devices have been manufactured. The objective of this study is to describe the use of these devices, as well as their efficacy. Material and methods Data are collected from patients admitted for pneumonia due to COVID-19 at the IFEMA Field Hospital. Data are collected from 23 patients with respiratory failure and need for ventilatory support. Results Study carried out on a total of 23 patients, dated admission to IFEMA. Alternative CPAP was used in five patients (21.7%), while ventilatory support with a reservoir mask or Ventimask Venturi effect was used in the remaining 18 patients (78.3%). A progressive increase in saturation is observed in those patients in whom alternative CPAP was used (from 94% on average to 98 and 99% on average after 30 and 60 minutes with the mask, respectively), although this change was not significant (p = 0.058 and p = 0.122, respectively). No significant change in RF was observed at the beginning and end of the measurement in patients who used alternative CPAP (p = 0.423), but among those who did not use alternative CPAP (p = 0.001). A statistically significant improvement in the variable oxygen saturation / fraction inspired by oxygen is observed in patients who used alternative CPAP (p = 0.040) Conclusion The use of these devices has helped the ventilatory work of several patients by improving their oxygenation parameters. To better observe the evolution of patients undergoing this therapy and compare them with patients with other types of ventilatory support, further studies are necessary.

OBJECTIVE: To evaluate the use of therapy with cardiovascular benefit in patients with type 2 diabetes mellitus admitted to internal medicine departments. METHODS: One day, cross-sectional study of patients with type 2 diabetes mellitus hospitalised in internal medicine departments. We recorded demographic and anthropometric variables, laboratory data and use of antihyperglycaemic drugs. The endpoint was the proportion and determinants of the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA). RESULTS: We included 928 patients belonging to 74 hospitals, with a mean age of 78.9 years (SD, 10.86 years), 50% of whom were men. A total of 557 (60%) patients had ischaemic heart disease, 189 (20.4%) had cerebrovascular disease, 293 (31.6%) had heart failure, 274 (29.5%) had chronic kidney disease, and 129 (13.9%) had peripheral arterial disease. Prior to their hospital admission, the patients were taking sulfonylureas (5.7%), biguanides (49.1%), alpha-glucosidase inhibitors (0.2%), pioglitazone (0%), dipeptidyl peptidase 4 inhibitors (39%), SGLT2i (5.8%), GLP1-RA (2.6%) and basal insulin analogues (24%). An age over 75 years was the main determinant for not taking SGLT2i (adjusted OR, 0.28; 95% CI 0.10-0.74; P=.039) or GLP1-RA (adjusted OR, 0.09; 95% CI 0.02-0.46; P=.006). DISCUSSION: A large proportion of elderly patients with type 2 diabetes mellitus at very high cardiovascular risk are not treated with antihyperglycemic drugs with proven cardiovascular benefit. The most commonly used drugs were metformin and DPP4i. There is room for improvement in the treatment of this very high-risk population.

This document summarizes the concept of focused cardiac ultrasound, the basic technical aspects related to this technique, and its diagnostic objectives. It also defines training requisites in focused cardiac ultrasound. This consensus document has been endorsed by the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of Neurology (SEN), and the Spanish Society of Cardiology (SEC).

Resumen En el presente documento se sintetizan el concepto de ecocardioscopia, los aspectos tecnicos fundamentales relacionados con esta tecnica y sus objetivos diagnosticos. Ademas, se define como deben ser la formacion y la capacitacion en ecocardioscopia. Todo ello, avalado por la Sociedad Espanola de Medicina Interna (SEMI), la Sociedad Espanola de Medicina Familiar y Comunitaria (semFYC), la Sociedad Espanola de Neurologia (SEN) y la Sociedad Espanola de Cardiologia (SEC).

This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting, from its fundamental indications to the recommended training period. There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings (emergencies, hospital ward, general and specific consultations and home care). Ultrasonography has a relevant impact on the practitioner's ability to resolve issues, increasing diagnostic reliability and safety and providing important information on the prognosis and progression. In recent years, ultrasonography has been incorporated as a tool in undergraduate teaching, with excellent results. The use of ultrasonography needs to be widespread. To accomplish this, we must encourage structured training and the acquisition of equipment. This document was developed by the Clinical Ultrasonography Workgroup and endorsed by the Spanish Society of Internal Medicine. (C) 2018 Elsevier Espana, S.L.U. and Sociedad Espanola de Medicina Interna (SEMI). All rights reserved.

Resumen Este documento de posicionamiento describe los aspectos mas importantes de la ecografia clinica en el ambito de la Medicina Interna, desde sus indicaciones fundamentales hasta el periodo de formacion recomendado. Actualmente ya no quedan dudas sobre la gran utilidad de esta herramienta para la practica clinica habitual del internista en multiples escenarios clinicos y ambitos de actuacion (urgencias, planta de hospitalizacion, consulta general y especifica y atencion domiciliaria). Su uso tiene un impacto relevante en la capacidad de resolucion del profesional, al aumentar su fiabilidad y seguridad diagnostica, ademas de proporcionar informacion pronostica y evolutiva importante. Ademas, en los ultimos anos se ha incorporado como una herramienta en la ensenanza pregrado con excelentes resultados. Por tanto, es necesario generalizar su uso y para ello se debe fomentar la formacion estructurada y la adquisicion de equipos. El documento ha sido elaborado por el Grupo de Trabajo de Ecografia Clinica y avalado por la Sociedad Espanola de Medicina Interna.

espanolObjetivos Identificar areas de mejora a partir de una lista local de intervenciones de escasa utilidad diagnostica y terapeutica dirigida a los 5 grupos de diagnostico relacionado y a los 5 diagnosticos principales mas frecuentemente observados en pacientes atendidos en consultas de Medicina Interna. Metodo Revision de la literatura suplementada con un proceso Delphi con 2 rondas. En la primera ronda, los participantes en el proceso de seleccion identificaron las intervenciones de escaso valor en relacion con la patologia mas frecuentemente atendida y en la segunda ronda se seleccionaron aquellas intervenciones con menor utilidad en base a su frecuencia, coste y riesgo para el paciente. Resultados De un total de 100 recomendaciones elaboradas por 19 sociedades cientificas, 23 recibieron el mayor numero de votos en la primera ronda. En la segunda ronda se identificaron 5 recomendaciones para pacientes hospitalizados y 5 recomendaciones para pacientes atendidos en consulta. Conclusiones Hemos descrito un metodo sencillo de elaboracion de una guia local para disminuir el uso de intervenciones medicas innecesarias. EnglishObjectives To identify areas for improvement, using a local list of interventions with low diagnostic and therapeutic usefulness for the 5 Related Diagnostic Groups, as well as the 5 main diagnoses most frequently seen in the hospital outpatient clinic. Method A literature review method was used, supplemented with a Delphi process with 2 rounds. In the first round, participants in the selection process identified low-value interventions in relation to the most frequently observed diagnoses. In the second round, those interventions with lower usefulness were selected based on their frequency, cost, and risk to the patient. Results Out of a total of 100 recommendations made by 19 scientific societies, 23 received the highest number of votes in the first round. In the second round, 5 recommendations were selected for inpatients and 5 recommendations for outpatients. Conclusions A simple method is described for developing a local guide to reduce the use of unnecessary medical interventions.