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La expansión de las áreas de cuidados de intensivos ha sido una de las medidas más significativas en esa obligada adaptación a la evolución de las distintas fases de la pandemia por la COVID-19. El objetivo es evaluar el despliegue de los planes de contingencia en la atención a pacientes ingresados en Unidades de Cuidados Intensivos (UCI) durante el periodo del 19 de marzo al 20 de abril de 2020, en un hospital público, referencia para 300.000 habitantes, perteneciente al Servicio Galego de Saúde. Axencia Galega de Innovación (GAIN, Xunta de Galicia), cofinanciado con fondos FEDER (Unión Europea, «Una manera de hacer Europa» | Ref. IN845D-2020/03

Validation of a questionnaire designed to stratify the level of digital competence in chronic patients.Cross-sectional study, carried out in the Endocrinology and Nutrition Section of the Complejo Asistencial Universitario de León (CAULE). We selected the digital competencies section of the Cambados questionnaire, designed for the identification of digital chronic patient, with a maximum score of 20 points. The questionnaire was completed for validation by patients for whom were prescribed a digital tool for glycemic control. Reliability was assessed by assessing the correct use of the prescribed tool and internal consistency.The questionnaire was completely filled in by 171 patients, with a mean age of 44.36 (SD 17.36). The mean score obtained in the questionnaire was 11.04 (SD 4.74) and a score over 12 was the most appropriate cut-off point to discriminate between patients according to their level of digital competence. 48.54% of the patients made adequate use of the tool. The scale showed good internal consistency with a Cronbach's alpha of 0.77.The results reached in the present study allow us to affirm that the responses obtained from the patients in the digital competency definition questionnaire are a good indicator of the use of digital tools.

The expansion of intensive care areas has been one of the most significant measures in this forced adaptation to the evolution of the different phases of the COVID-19 pandemic. The objective is to evaluate the deployment of contingency plans in the care of patients admitted to intensive care units during the period from March 19 to April 20, 2020, in a public hospital, reference for 300,000 inhabitants belonging to the Galician Health Service.Qualitative research from focus groups, with systematic sampling. Based on the adaptation to the health environment of the 10 measures recommended by Deloitte to face a pandemic, an evaluation was carried out by the quality unit of the Health Area. As outcome indicators, the number of COVID-19 patients, % of patients admitted to hospital, % patients admitted to intensive care units, as well as the number of deaths from COVID-19, were evaluated in seven health areas in the period March 19 to April 20, 2020.The qualitative evaluation identified 2 areas for improvement (communication and risk assessment) of the 10 recommended measures. The Health Area has the lowest relative (2.6%) and absolute (16) rate of deceased patients, as well as the lowest relative (7.9%) and absolute (24) rate of patients admitted to intensive services for COVID-19. The infection rate in professionals has been 4.4%.The simplicity and identification of areas for improvement added to the low consumption of resources are strengths of this proposal. This self-assessment can be helpful in identifying areas for improvement.

1. Colorectal cancer (CRC) is one of the most common types of cancer and a rapid referral pathway (RRP) has been developed in Galicia in order to diminish the time of its diagnosis. Process Mining (PM) helps examining and analyzing the data logs from the electronic medical records. We used PM to study those patients finally diagnosed with CRC in an Integrated Area in Galicia along a 3-years period of time.2. Structured variable data (timestamps and coded data for every activity and event) were extracted from healthcare databases. The moment of extraction of the pathological biopsy was taken as a reference for selecting patients. Process mining analysis was performed to compare processes according to whether or not they were included in the rapid diagnostic pathway.3. From January 2016 to December 2018, we found 444 cases of CRC. 132 (29,7%) were included in the RRP and 312 were not included (70,3%). Referral to RRP came from Primary Care the 38% of events, 10% from the Emergency department and 52% from the Outpatient consultations. The median time from the colonoscopy request was 7 days in RRP vs 34 days in non-RRP cases. We identify two patterns: first, ""from outpatient consultation to colonoscopy"" is repeated 21% in the RRP, compared to 7% of the cases in the non-RRP; another one, “referral from Emergency department“ is the second repeated pattern of the RRP cases (12%), with 20 days of delay until biopsy extraction.4. Process mining analysis makes it possible to describe the complete care process along the time axis without limitations based on levels of care. We have identified the most frequent usage patterns in both rapid and non-rapid referral pathways. It has also helped to know the real performance of the rapid diagnostic pathways, providing new information with the data registered in the digital electronic health information systems. 5. PM advantages in healthcare management are unbounded and applications are several. Most important one: it leads to better medical treatment, more effectiveness.6. We easily identify performance patterns in healthcare assistance of CRC patients in an integrated area analysing structured data of Electronic Health Records with Process mining.7. More long-term studies should be developed to determine the survival and quality of life of patients to determine the impact of PM in RRF in clinical practice and on healthcare related outcomes.8. Next possible step could be the development of a digital algorithm in Electronic Health Records as a clinical decision support system.

O uso de novos sistemas de comunicación dixital entre a poboación de idade avanzada pode facer cambiar o paradigma de atención ao paciente crónico. Neste traballo preténdese definir unha nova categoría de pacientes crónicos baseada nas súas competencias dixitais e a súa relación co sistema sanitario (e- senior chronics). Asímismo, búscase describir as características principais atribuíbles a esa cohorte de pacientes e ponderalas segundo a súa relevancia na definición. El uso de nuevos sistemas de comunicación digital entre la población de edad avanzada puede hacer cambiar el paradigma de atención al paciente crónico. En este trabajo se pretende definir una nueva categoría de pacientes crónicos basada en sus competencias digitales y su relación con el sistema sanitario (e-senior chronics). Asímismo, se busca describir las características principales atribuibles a esa cohorte de pacientes y ponderarlas según su relevancia en la definición. Comunicación presentada en: 21 Congreso Nacional de Hospitales y gestión Sanitaria. Innovación: camino de sostenibilidad. Santiago de Compostela el 8, 9 y 10 de mayo de 2019.

Este Cuaderno de Gestión Sanitaria se estructura de la siguiente forma. Tras la introducción el capitulo 2, aborda las distintas definiciones y dimensiones que se utilizan en relación con la Atención Integrada. En los siguientes capítulos, tras comentar el papel que debería representar el paciente, el capítulo 4, ayuda a construir preguntas poderosas para crear argumentaciones y propuestas de mejora, incluso, diametralmente opuestas a las que pueda tener presente en estos momentos. El capítulo 5 repasa las evaluaciones de áreas integradas, y en el número 6, se citan casos de estudio. Almirall

The objective of this study is to determine the reasons for refusing the flu vaccination in the Primary Care Health Centre of Vilanova de Arousa, Spain, as well as to evaluate the flu vaccination coverage after an educational intervention.A quasi-experimental before and after study was conducted after an educational intervention on a total of 73 people that included those Primary Care Health Centre patients from Vilanova de Arousa who had refused the flu vaccination in 2014, and who did not meet the exclusion criteria (death during 2014 and 2015 campaigns, non-acceptance of participation, vaccine registration mistakes, contraindication or no indication for the vaccine, inability to contact). After a brief educational intervention, vaccination data from those patients in the 2015 and 2016 campaigns were checked. A descriptive analysis of the variables under study was then carried out. Of the 73 patients initially included, 72 completed the study.The main reasons for refusing a vaccination were the concerns about the adverse effects and patient perception of good health. Vaccination coverage was 50.7% in 2015, and 48.6% in 2016.The reasons for refusing vaccination are approachable with a brief intervention since the refusal decreases by half in the long-term.

Previous studies have examined control rates of office blood pressure (BP) in chronic kidney disease (CKD). However, recent evidence suggests major discrepancies between office and 24-hour BP values in hypertensive populations. This study examined concordance/discordance between office- and ambulatory-based BP control in a large cohort of patients with CKD.Cross-sectional.5,693 hypertensive individuals with CKD stages 1-5 from the Spanish ABPM (ambulatory BP monitoring) Registry.Thresholds of 140/90 and 130/80 mm Hg for office BP and 24-hour ambulatory BP, respectively. Age, sex, body mass index, waist circumference, hypertension duration, kidney measures, diabetes, dyslipidemia, target-organ damage, and cardiovascular comorbid conditions.Misclassification of BP control as "white-coat" hypertension (office BP ≥140/90 mm Hg, 24-hour BP130/80 mm Hg) or masked hypertension (office BP140/90 mm Hg, 24-hour BP ≥130/80 mm Hg).Standardized office-based BP and 24-hour ABPM.Mean age was 61.0 ± 13.9 (SD) years and 52.6% were men. The proportion with white-coat hypertension was 28.8% (36.8% of patients with office BP ≥140/90 mm Hg) and that of masked hypertension was 7.0% (but 32.1% of patients with office BP140/90 mm Hg). Female sex, aging, obesity, and target-organ damage were associated with white-coat hypertension; aging and obesity were associated with masked hypertension. Only 21.7% and 8.1% of the CKD population had office BP140/90 and130/80 mm Hg, respectively. In contrast, 43.5% of individuals had average 24-hour BP130/80 mm Hg.Cross-sectional design, longitudinal associations cannot be established.Misclassification of BP control at the office was observed in 1 of 3 hypertensive patients with CKD. Ambulatory-based control rates were far better than office-based rates. Nevertheless, the burden of uncontrolled ambulatory BP and misclassification of BP control at the office constitutes a call for wider use of ABPM to evaluate the success of hypertension treatment in patients with CKD.

Los tumores renales son causantes de hipertension arterial en un bajo porcentaje de casos. El mas frecuentemente implicado es el feocromocitoma, aunque estan descritos otros tumores. Uno de ellos es el hipernefroma, caso que a continuacion se describe y que ademas utilizamos como ejemplo de cronoterapia.

OBJECTIVE: To determine which Short Zarit Interview behaves best for use in establishing caregivers’ burden in primary care. DESIGN: Study of validation of diagnostic tests. LOCATION: Vilaboa Health Centre, Pontevedra, Spain. PARTICIPANTS: Main caregivers of elderly dependent patients who live at home. INTERVENTIONS: Katz Index to determine dependence, Zarit Burden of Care Interview and palliative care version of the Short Zarit Interview, Bédard, Bédard screening version, and the Japanese version. MAIN MEASUREMENTS: Zarit Interview in its 22-item version, with subsequent calculation of the sensitivity (S), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of the various reduced versions. RESULTS: The Short Zarit Interview used in palliative care cases to determine the family giving up has an S of 100%, Sp 90.5%, PPV 95.45%, and NPV 100% in defining caregivers’ burden in primary care. CONCLUSIONS: The scale that behaves best in primary care is the Short Zarit Interview for palliative care.

INTRODUCCIÓN: La población actual evoluciona hacia su envejecimiento progresivo, con un aumento del número de pacientes ancianos dependientes (PAD) que permanecen mayoritariamente en sus domicilios y reciben cuidados de su familia a través de la figura del cuidador principal (CP), que asume el hecho de cuidar con todas sus consecuencias(1). OBJETIVO: Determinar qué variables se relacionan con la sobrecarga del cuidador (SC). DISEÑO: Estudio observacional transversal. EMPLAZAMIENTO: Municipio de Vilaboa (Pontevedra) con una población en 2004 de 5.853 habitantes, de los cuales 834 (14,3%) eran ≥ 70 años, 758 con historia clínica abierta en el centro de salud. PARTICIPANTES: Para definir a los PAD utilizamos la versión numérica del índice de Katz para actividades básicas de la vida diaria(2), definiendo como dependiente al paciente con una puntuación ≥ 2. Para la carga del cuidador utilizamos la escala de sobrecarga del cuidador de Zarit validada en nuestro medio(3), definiendo como CP a la persona que se dedica a ayudar en las necesidades básicas e instrumentales de la vida diaria del paciente dependiente la mayor parte del tiempo. Se establecen los diferentes grados de SC en función de la puntuación obtenida en la escala de Zarit: no SC (≤ 6), SC ligera (47-55) y SC intensa (≥ 56)(3). Son criterios de exclusión la inexistencia de un CP definido, la presencia de más de un CP, el cuidador de más de un paciente dependiente, la duración de los cuidados inferior a 3 meses, la presencia de algún acontecimiento vital estresante en el último mes (ingresos hospitalarios, fallecimiento o ingreso hospitalario de algún conviviente) y la negativa a participar. Quedaron excluidos 18 casos y fallecieron 3 pacientes durante el período de recogida de datos, obteniendo finalmente a una población de 63 parejas CP-PAD. RESULTADOS: En el análisis multivariable se obtienen como variables asociadas independientes la comorbilidad en el CP y la edad, el tratamiento ansiolítico y el uso de pañales en el PAD (tabla 1). El resto de las variables estudiadas no se asocian estadísticamente con la SC. DISCUSIÓN: Dada la multidimensionalidad del concepto de carga, hemos decidido no incluir en el estudio a cuidadores de más de un PAD, por lo difícil que sería evaluar la sobrecarga para cada uno de los pacientes. También excluimos a los PAD con más de un CP porque éstos tendrían repartidas las tareas, pero también la carga. Los casos son similiares a los que nos encontramos habitualmente en atención primaria, con pluripatología y muchas veces sin una causa única de dependencia. Es frecuente encontrar diferentes grados de SC del CP que cuida de un paciente con demencia. En nuestro caso, si bien tiene una puntuación media superior al PAD sin demencia, no se mantiene en el análisis de regresión, obteniéndose odds ratio tanto brutas como ajustadas no significativas. También encontramos asociación con la variable «uso de pañales de incontinencia». Algunos estudios previos la relacionan conla SC, aunque no en una población como la descrita en el presente estudio con diferentes causas de dependencia(4). El tratamiento con ansiolíticos del PAD tiene un efecto protector para la SC en nuestro estudio. Es conocido que las alteraciones de conducta son uno de los motivos de institucionalización precoz y la queja más frecuente entre los cuidadores de pacientes con demencia. También hay estudios que relacionan la SC del CP con la presencia de sintomatología depresiva en el PAD tras un ictus(5). En este sentido, cabe pensar que en una población dependiente tan heterogénea como la nuestra el tratamiento ansiolítico disminuye la carga del CP. Otro factor protector que encontramos es la edad del PAD. Cuanto mayor es el paciente, menor es la SC que provoca en su cuidador. Yaffe et al encuentran mayor grado de institucionalización en pacientes con demencia

The signs predicting radiological healing were studied in 35 bone lesions of 12 children with Langerhans' cell histiocytosis. The earliest and more frequent radiological signs predicting healing were a decrease in size (52%), the change from a non-sclerotic lesion to one with sclerosis (41%) and the loss of distinct margins of the lesions (29%) three months after diagnosis. The first of these signs was statistically significant after three months of follow-up, the last two after 12 months. The trabecular pattern was a late (one case after 2 years) and infrequent (observed in only 24% of lesions) sign of radiological healing.