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Background: Chronic heart failure (CHF) reduces quality of life and causes hospitalisation and death. Identifying predictive factors of such events may help change the natural history of this condition., Aim: To develop and validate a stratification system for classifying patients with CHF, according to their degree of disability and need for hospitalisation due to any unscheduled cause, over a period of 1 year., Methods and Analysis: Prospective, concurrent, cohort-type study in two towns in the Madrid autonomous region having a combined population of 1 32 851. The study will include patients aged over 18 years who meet the following diagnostic criteria: symptoms and typical signs of CHF (Framingham criteria) and left ventricular ejection fraction (EF)<50% or structural cardiac lesion and/or diastolic dysfunction in the presence of preserved EF (EF>50%).Outcome variables will be(a) Disability, as measured by the WHO Disability Assessment Schedule V.2.0 Questionnaire, and (b) unscheduled hospitalisations. The estimated sample size is 557 patients, 371 for predictive model development (development cohort) and 186 for validation purposes (validation cohort). Predictive models of disability or hospitalisation will be constructed using logistic regression techniques. The resulting model(s) will be validated by estimating the probability of outcomes of interest for each individual included in the validation cohort., Ethics and Dissemination: The study protocol has been approved by the Clinical Research Ethics Committee of La Princesa University Teaching Hospital (PI-705). All results will be published in a peer-reviewed journal and shared with the medical community at conferences and scientific meetings., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: To determine the validity of the Centor score (cervical adenopathy, tonsillar exudate, fever, and absence of catarrh symptoms) in diagnosing streptococcal pharyngitis (gold standard: throat swab)., Design: Descriptive study., Setting: San Fernando 2 Health Centre, Madrid (outer urban area), Spain., Participants: On hundred forty patients over 14 years old who had a "sore throat" as main symptom and attended clinic between 14 February and 12 May, 2005., Main Measurements: Sensitivity, specificity, positive and negative predictive values, and the probability quotients of the Centor score were determined. Pharyngeal throat culture was used as the reference method., Results: Thirty four patients had positive throat culture (24.3%; 95% CI, 17.6%-32.4%). Finding the 4 criteria in the Centor score had a positive predictive value (PPV) of 48.1% (95% CI, 30.7%-66.0%) and a negative predictive value (NPV) of 81.4% (95% CI, 73.3%-87.5%); although only fever (OR, 3.64; 95% CI, 1.40-9.49) and tonsillar exudate (OR, 6.18; 95% CI, 2.08-18.35) were linked to streptococcal aetiology., Conclusions: The high NPV and specificity of the clinical score makes the diagnosis of non-streptococcal pharyngitis very accurate. However, the PPV is low: a high Centor score (3 or 4 criteria) does not mean streptococcal pharyngitis with certainty. What approach to take with patients suspected of streptococcal pharyngitis is not yet resolved (microbiological test, early antibiotic, or postponed antibiotic).

Objectives: (1) To determine the prevalence of joint hypermobility in children aged 4-14 years old without organic disease of the locomotor system; (2) to compare the prevalence of hypermobility in children with and without arthralgia and (3) to analyze the influence of certain variables on the development of arthralgia., Patients and Methods: We performed an observational study in a sample of children aged 4-14 years old living in Area 4 of the Community of Madrid (Spain). Joint hypermobility was evaluated using a goniometer. Hypermobility was defined using Beighton's criteria., Results: A total of 222 subjects were analyzed: 176 in the primary care setting and 46 in the emergency department of a referral hospital. Of the 222 children, 43 reported arthralgia. The prevalence of hypermobility (> or = 4 criteria) was 55 % (123/222), reaching 71 % (49/69) in children aged less than 8 years. No significant differences were found in the prevalence of hypermobility in children with and without arthralgia (65 % and 53 % respectively). Of the variables analyzed (age, sex, country of origin, primary care/emergency department setting) only differences in the absolute number of Beighton criteria present in children with and without arthralgia (4.34 +/- 2.47 and 3.48 +/- 2.35, p = 0.03) were detected, which disappeared when at least four criteria (definition of hypermobility) were required., Conclusions: Fifty-five percent of the population studied and 71 % of those younger than 8 years old met the criteria for joint hypermobility. In the sample analyzed, the presence of joint hypermobility did not seem to favor the development of arthralgias.

Objective: To find how widespread incorrect inhalation techniques are in patients on long-term inhalation treatments, comparing different methods and the health control standard., Design: A descriptive crossover study., Setting: Three Health Centres in Burgos., Patients: People over 15 with at least a month on inhalation treatment., Measurements and Main Results: A questionnaire was composed to find the characteristics of the patients and their illness. Then their inhalation method was qualified as correct, acceptable or incorrect, using a scale based on Newman's classic criteria. Average age was 63.8 +/- 15.6, with 66.5% men. 11.6% of patients were active smokers. The most common diagnosis was COPD (61.6%). 65% of the patients were monitored within primary care (PC). The most common inhalation method was pressurised aerosol (61%); 26.2% of patients used two or more different methods. Only 21.3% of patients correctly performed the technique of inhalation, with better results for patients under specialist care (SC) than PC. 10.5% of patients had never received instruction on an inhalation technique. The method with the best results was the dry dust one, with differences close to statistical significance., Conclusions: There is widespread incorrect use of methods of inhalation. Most people use a pressurised aerosol. There are a large number of patients who have never been shown the correct way to inhale.

To determine how oxygen therapy is being used in general surgery (GS), internal medicine (IM) and pneumology (PN) units of Hospital General Yagüe in Burgos (Spain), as well as to study patient compliance with treatment. Cross-sectional descriptive study. Case histories taken on 2 randomly chosen days one month apart were reviewed. For patients receiving oxygen therapy we analyzed both physician and nursing records on diagnosis, flow, route, form of oxygen administration (continuous-discontinuous), determining the agreement of medical records with what was actually used by the patient. Baseline pulse oximetry readings were available for all patients. One hundred one patients were enrolled in the study. The most frequently recorded diagnosis was chronic obstructive pulmonary disease (COPD). Therapy was prescribed based on gasometric criteria in 62.5% of IM patients, 73.1% of PN patients and 23% of GS patients. The route and flow were recorded mainly in IM and PN wards, but not in GS; form of administration, however, was recorded for only 2 patients. We found agreement between physician and nursing orders in 26.8% in the IM ward, in 60% in the PN unit and in 5.3% of GS cases. The administrative route ordered was that which was actually used in 80% in PN 42.9% in IM and 10.5% in GS. The patients received oxygen fewer days than prescribed (a coefficient of 1 for days ordered/days used in 54.5%).(ABSTRACT TRUNCATED AT 250 WORDS)