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Proyecto PROFUND., [ES] Objetivos: Analizar la sensibilidad (S), la especificidad (E) y los valores predictivos positivo (VPP) y negativo (VPN) de cada dimensión del índice de Barthel (IB) con respecto al cuestionario completo en pacientes pluripatológicos (PPP). Métodos: Estudio transversal multicéntrico. Se consideraron dos puntos de corte del IB (≥ 90 puntos para el cribado de fragilidad y < 60 puntos para el diagnóstico de dependencia severa). Para cada dimensión y combinaciones de dos dimensiones se calcularon la S, la E, el VPP y el VPN con respecto al IB completo. Resultados: El IB medio de los 1.632 PPP incluidos (edad media de 77,9 ± 9,8 años, 53% varones) fue 69 ± 31 (< 90 en el 58,7% y < 60 en el 31,4% de pacientes). La dimensión «alimentación» obtuvo los mayores VPN para tener un IB ≥ 60 y ≥ 90 puntos (87% y 99,6%, respectivamente). Las dimensiones «deambular» y «subir y bajar escaleras» obtuvieron el mayor VPP para tener un IB ≥ 60 y ≥ 90 (99,2/99,5% y 81/92%, respectivamente; la combinación de ambas preguntas aumentó el VPP al 95 y al 99,6%, respectivamente. Conclusiones: Los PPP de ámbito hospitalario presentan con elevada frecuencia deterioro funcional. La dimensión referente a alimentarse obtuvo el mayor VPN, por lo que se puede utilizar para el diagnóstico de dependencia severa, mientras que la combinación de deambular y subir y bajar escaleras obtuvo el mayor VPP, pudiendo utilizarse para plantear el cribado de fragilidad de los PPP., [EN] Objectives: To analyse the sensitivity, specificity and positive predictive (PPV) and negative predictive (NPV) values of each measure of the Barthel index (BI) compared with the full questionnaire for polypathological patients (PPPs). Methods: Multicentre cross-sectional study. We considered 2 cut-off points for the BI (≥ 90 points for screening frailty and < 60 points for diagnosing severe dependence). For each measure and combination of 2 measures, we calculated the sensitivity, specificity, PPV and NPV with respect to the full BI. Results: The mean BI of the 1,632 included PPPs (mean age, 77.9 ± 9.8 years; 53% men) was 69 ± 31 (< 90 for 58.7% and < 60 for 31.4% of the patients). The “feeding” measure achieved the highest NPV, for a BI ≥ 60 and ≥ 90 points (87% and 99.6%, respectively). The “walking” and “going up and down stairs” measures achieved the highest PPV, for a BI ≥ 60 and ≥ 90 (99.2%/99.5% and 81%/92%, respectively. The combination of the 2 measures increased the PPV to 95% and 99.6%, respectively. Conclusions: PPPs in hospital settings have a high rate of functional impairment. The measure for feeding achieved the highest NPV and can therefore be employed for diagnosing severe dependence. The combination of the measures for walking and going up and down stairs achieved the highest PPV and can therefore be employed to propose frailty screening for PPPs.

This work aimed to develop an infusion type beverage from Lempira coffee pulp for human consumption. Samples from the Honduran Coffee Institute IHCAFE were used. According to the results obtained from the sensory analysis, it was determined that 70.75% of the evaluators prefer the beverage made with mature grains, given that a balance in taste and acidity is obtained. As for the mass concentration of the packaged content, 60% of the universe of tasters prefer a concentration of 1.6 g of dried pulp per cup. Regarding the type of grinding of the grain, it was determined that 80% of the tasters prefer coarse grinding (701 to 900 µm), describing it as an extremely pleasant product in its flavor and color, with shades of Jamaica, tamarind and nuts. Checking that with this particle size there is a greater release of flavors and maintains a balance in terms of aromas, however in fine particles (350 to 500 µm), their fragrances stand out, but negatively affects their taste and the high sedimentation rate. Therefore, it was concluded that the quality of the infusion drink from coffee pulp is influenced by the type of grinding used for its preparation.

Resumen Fundamento y objetivo Determinar el uso de anticoagulantes orales en pacientes pluripatologicos con fibrilacion auricular y su impacto sobre la mortalidad y el deterioro funcional. Pacientes y metodo Estudio observacional, prospectivo y multicentrico en pacientes pluripatologicos con fibrilacion auricular. Se recogieron datos demograficos, clinicos, funcionales, sociofamiliares, la escala CHADS2, los valores de hemoglobina, albumina y creatinina, y el uso de anticoagulantes orales. Tras un ano de seguimiento se valoro la supervivencia y el estado funcional. Resultados De 1.632 pacientes pluripatologicos, 532 (32,6%) tenian fibrilacion auricular. El riesgo embolico fue alto en 505 (94,9%), moderado en 24 (4,5%) y bajo en 3 (0,6%) pacientes. Se utilizaron anticoagulantes en el 61% de los pacientes con puntuacion ≥ 2 y en el 37,5% con puntuacion 1 en la escala CHADS2. Se hizo menor uso de anticoagulantes en los pacientes de mayor edad y con mas deterioro funcional y cognitivo. La insuficiencia cardiaca era mas frecuente en los pacientes que usaron anticoagulantes. No hubo diferencias segun la presencia de hipertension arterial, diabetes, anemia, insuficiencia renal o ictus. En el analisis multivariante, el uso de anticoagulantes se asocio de forma independiente con menor edad, menor deterioro cognitivo, ausencia de enfermedad hepatica y mayor riesgo embolico. La prescripcion de anticoagulantes se asocio de forma independiente con mayor supervivencia al ano, sin repercutir en el estado funcional de los pacientes pluripatologicos. Conclusiones Los anticoagulantes son infrautilizados en los pacientes pluripatologicos con fibrilacion auricular a pesar de asociarse a mayor supervivencia.

Background: Little is known about the fitness of the available tools in predicting functional decline of polypathological patients (PPs). Our objective was to assess accuracy of the Triage Risk Screening Tool (TRST), the Variable Indicative of Placement risk (VIP) and to develop a specific functional prognostic index adjusted to this population in a multicenter cohort of hospital-based PP. Methods: Prospective 12-month follow-up study of PPs from 36 hospitals. Functional decline was defined as loss of ≥20 points on Barthel’s index (BI). Accuracy of TRST/VIP was assessed by calibration/discrimination tests. Development of the new score was performed by dividing into a derivation cohort (constructing the index by logistic regression), and a validation cohort (in which calibration/discrimination of the index were tested). Results: Nine hundred and fifty-eight patients from the 1632 included survived during follow-up. Basal/12-month BI was 85/70, respectively. Mean fall in BI score was 11.7±24 points [353 (36.8%) fell by ≥20 points]. The activities for daily living that declined most frequently were toilet use, grooming, dressing and bathing. TRST/VIP fitted well but their discrimination power was poor (area under the curve=0.49 and 0.46, respectively). A simplified PROFUNCTION index was derived containing seven items (≥85 years, neurological condition, osteoarticular disease, III–IV functional class of dyspnea, ≥4 polypathology categories, basal BI

To determine the use of oral anticoagulants in polypathological patients with atrial fibrillation and its influence on mortality and loss of functionality.Patients with polypathological patient criteria and atrial fibrillation were included in an observational, prospective and multicenter study. Data on demographic, clinical, functional and sociofamilial characteristics, CHADS2 score, levels of hemoglobin, albumin and creatinine, use of oral anticoagulants and survival and functional status at one year were collected.Five hundred and thirty-two (32.6%) of 1,632 polypathological patients had atrial fibrillation. The stroke risk was high in 505 (94.9%), moderate in 24 (4.5%) and low in 3 (0.6%) patients. Oral anticoagulants were used in 61% of patients with CHADS2 score≥2 and in 37.5% with CHADS2 score=1. Oral anticoagulants were less used in older patients, with more functional and cognitive impairment. Heart failure was associated with more use of oral anticoagulants. There was no difference by the presence of hypertension, diabetes, anemia, renal insufficiency or stroke. In multivariate analysis the use of oral anticoagulants was independently associated with lower age, lower cognitive impairment, absence of hepatic disease and with higher stroke risk. The prescription of oral anticoagulants was independently associated with more survival at one year with no influence on functional status.Oral anticoagulants are underused in polypathological patients with atrial fibrillation despite being associated with more survival.