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Disease-related malnutrition (DRM) represents a universal, highly prevalent social and health problem, which is underdiagnosed and undertreated. It complicates the clinical course of the patients, prolongs their hospital staying, and increases the number of early re-admissions with the subsequent increase in health resources usage, increasing the costs. It is estimated that in Europe 33 million people are at risk for malnutrition, representing a cost of € 170 billion. The European Nutrition For Health Alliance (ENHEA) has been created as a lobbying group working with the aim of improving the nutritional care of European patients by actively promoting the implementation of detection of nutritional risk in Europe; public awareness; appropriate reimbursement policies, and heath teams training. In the last years, several initiatives have been developed in neighbor European countries with the implementation of programs and plans to Fight Against Malnutrition. In this manuscript, the Dutch model is reviewed in more detail by analyzing the factors that have made possible its success in a short time after its implementation. Appropriate usage of nutritional resources allows defining ways for saving. Oral supplementation is an active, rather than invasive, therapy in the management of DRM at all health care levels. It improves weight gaining and prevents weight loss in patients at risk for malnutrition. Its usage is directly related with a reduced morbimortality rate in malnourished patients.

Montero Ruiz E.,Hospital Universitario Principe Of Asturias | Monte Secades R.,Hospital Universitario Lucus Augusti
Revista Clinica Espanola | Year: 2015

The inpatient profile is changing towards patients with multiple diseases, the elderly and those with high comorbidity. The growing complexity of their care, the progressive medical superspecialization and the organizational problems that often hinder daily patient follow-up by the same physician have contributed to a progressive increase in the participation of medical departments, especially Internal Medicine, in the care of patients hospitalized in other medical and surgical specialties. The hospital activities that the departments of internal medicine perform outside of their own department do not have well-established definitions and criteria at the organizational level; their assessment and accountability are different in each hospital. In this document, we establish the definitions for shared care, advisory medicine, perioperative medicine and interconsultation, as well as their types in terms of priority, formality, care setting, timeliness, relationship with surgery and other circumstances. © 2014 Elsevier Espana, S.L.U. y Sociedad Espanola de Medicina Interna (SEMI). Todos los derechos reservados.

Albillos A.,University of Alcala | Albillos A.,CIBER ISCIII | Albillos A.,Hospital Universitario Ramon y Cajal | Lario M.,University of Alcala | And 3 more authors.
Journal of Hepatology | Year: 2014

The term cirrhosis-associated immune dysfunction refers to the main syndromic abnormalities of immune function, immunodeficiency and systemic inflammation that are present in cirrhosis. The course of advanced cirrhosis, regardless of its aetiology, is complicated by cirrhosis-associated immune dysfunction and this constitutes the pathophysiological hallmark of an increased susceptibility to bacterial infection, distinctive of the disease. Cirrhosis impairs the homeostatic role of the liver in the systemic immune response. Damage to the reticulo-endothelial system compromises the immune surveillance function of the organ and the reduced hepatic synthesis of proteins, involved in innate immunity and pattern recognition, hinders the bactericidal ability of phagocytic cells. Systemic inflammation, in form of activated circulating immune cells and increased serum levels of pro-inflammatory cytokines, is the result of persistent episodic activation of circulating immune cells from damage-associated molecular patterns, released from necrotic liver cells and, as cirrhosis progresses, from pathogen-associated molecular patterns, released from the leaky gut. Cirrhosis-associated immune dysfunction phenotypes switch from predominantly "pro-inflammatory" to predominantly "immunodeficient" in patients with stable ascitic cirrhosis and in patients with severely decompensated cirrhosis and extra-hepatic organ failure (e.g. acute-on-chronic liver failure), respectively. These cirrhosis-associated immune dysfunction phenotypes represent the extremes of a spectrum of reversible dynamic events that take place during the course of cirrhosis. Systemic inflammation can affect the functions of tissue somatic cells and modify the clinical manifestation of cirrhosis. The best characterized example is the contribution of systemic inflammation to the haemodynamic derangement of cirrhosis, which correlates negatively with prognosis. © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Saez V.P.,Hospital Universitario Principe Of Asturias
Revista Espanola de Anestesiologia y Reanimacion | Year: 2012

Preventive analgesia (administration of a technique or analgesic drug with the aim of reducing postoperative pain, hyperalgesia and allodynia) has shown to be effective in experimental studies. However, the results in patients have been controversial. A review has been made of the clinical trials published during the last 5 years to test the efficacy of preventive analgesia on postoperative pain. A search was made of the published literature in Medline, with the terms ". pre-emptive analgesia", "preventive analgesia" and "postoperative pain", selecting prospective, controlled, randomised and double blind studies that compared analgesic regimens before and after the incision or the same or very similar postoperative conditions. A total of 27 studies were found during the period 2005-2010 that complied with the inclusion criteria. Analgesia measurement variables were analysed, such as postoperative pain, time passed until the first rescue, and total analgesic requirements. Preventive analgesia was effective in 15 of the 27 studies, with pre-incisional epidural drug administration being the most effective (local anaesthetics with or without opioids, clonidine). The possible effectiveness of preventive analgesia in humans is still controversial, partly due to the wide heterogeneity in the inclusion criteria, types of patients, or the analgesia measurement parameters analysed by the studies. More studies are required with common criteria and objectives. © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor.

Montero Ruiz E.,Hospital Universitario Principe Of Asturias
Revista Clinica Espanola | Year: 2016

Surgical departments have increasing difficulties in caring for their hospitalised patients due to the patients' advanced age and comorbidity, the growing specialisation in medical training and the strong political-healthcare pressure that a healthcare organisation places on them, where surgical acts take precedence over other activities. The pressure exerted by these departments on the medical area and the deficient response by the interconsultation system have led to the development of a different healthcare organisation model: Shared care, which includes perioperative medicine. In this model, 2 different specialists share the responsibility and authority in caring for hospitalised surgical patients. Internal Medicine is the most appropriate specialty for shared care. Internists who exercise this responsibility should have certain characteristics and must overcome a number of concerns from the surgeon and anaesthesiologist. © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI).

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