Cobo M.R.,Parc Sanitari Pere Virgili |
Egea P.T.,University of Barcelona |
Gaju R.T.,Generalitat de Catalonia
Index de Enfermeria | Year: 2015
Nowadays, in the region on Catalonia, there is an opportunity to reform social and health care model in the medium term care hospitals in order to protect and improve the quality of care and its sustainability. Due to financial crisis and limited resources in providing health care attention, nurse managers can focus to analyze their particular government practices in the organizations. So, nurse managers can explore theory of governability in their centre: guarantee transparency, accountability, place in a structure of acute hospitals, and role respecting stakeholders interests. Furthermore, all these principles exposed can be explored, measured and compared their results with level of nursing quality care in the medium term care hospitals in Catalonia. © 2015 Fundación Index.
Rodriguez-Pardo D.,Hospital Universitari Vall dHebron |
Almirante B.,Hospital Universitari Vall dHebron |
Bartolome R.M.,Hospital Universitari Vall dHebron |
Pomar V.,Hospital Of La Santa Creu I Sant Pau |
And 9 more authors.
Journal of Clinical Microbiology | Year: 2013
Prospective hospital-based surveillance for Clostridium difficile-associated disease (CDAD) was conducted in Barcelona (Spain) to describe the epidemiology of this condition and investigate the risk factors for an unfavorable outcome. All patients diagnosed with CDAD during 2009 were included. Using logistic regression modeling, we analyzed the potential risk factors associated with recurrent and complicated CDAD, defined as a need for colectomy or death within 30 days. There were 365 episodes of CDAD, yielding an incidence of 22.5 cases/105 person-years, 1.22 cases/103 hospital discharges, and 1.93 cases/104 patient-days. The main PCR ribotypes identified were 241 (26%), 126 (18%), 078 (7%), and 020 (5%). PCR ribotype 027 was not detected. Among the 348 cases analyzed, 232 (67%) patients were cured, 63 (18%) had a recurrence of CDAD, and 53 (15%) developed complicated CDAD. Predictors of complicated CDAD were continued use of antibiotics following CDAD diagnosis (odds ratio [OR], 2.009; 95% confidence interval [CI], 1.012 to 3.988; P=0.046), Charlson comorbidity index score (OR, 1.265; 95% CI, 1.105 to 1.449; P=0.001), and age (OR, 1.028; 95% CI, 1.005 to 1.053; P=0.019). A leukocyte count of>15×103 cells/ml (OR, 2.277; 95% CI, 1.189 to 4.362; P=0.013), continuation of proton pump inhibitor (PPI) use after CDAD diagnosis (OR, 2.168; 95% CI, 1.081 to 4.347; P=0.029), and age (OR, 1.021; 95% CI, 1.001 to 1.041; P=0.036) were independently associated with higher odds of recurrence. The incidence of CDAD in Barcelona during 2009 was on the lower end of the previously described range for all of Europe. Our analysis suggests that the continuation of non-C. difficile antibiotics and use of PPIs in patients diagnosed with CDAD are associated with unfavorable clinical outcomes. Copyright © 2013, American Society for Microbiology.
Riba-Llena I.,Autonomous University of Barcelona |
Nafria C.,Autonomous University of Barcelona |
Filomena J.,Parc Sanitari Pere Virgili |
Tovar J.L.,Vall dHebron Hospital |
And 7 more authors.
Journal of Cerebral Blood Flow and Metabolism | Year: 2016
High blood pressure accelerates normal aging stiffness process. Arterial stiffness (AS) has been previously associated with impaired cognitive function and dementia. Our aims are to study how cognitive function and status (mild cognitive impairment, MCI and normal cognitive aging, NCA) relate to AS in a community-based population of hypertensive participants assessed with office and 24-hour ambulatory blood pressure measurements. Six hundred ninety-nine participants were studied, 71 had MCI and the rest had NCA. Office pulse pressure (PP), carotid-femoral pulse wave velocity, and 24-hour ambulatory PP monitoring were collected. Also, participants underwent a brain magnetic resonance to study cerebral small-vessel disease (cSVD) lesions. Multivariate analysis-related cognitive function and cognitive status to AS measurements after adjusting for demographic, vascular risk factors, and cSVD. Carotid-femoral pulse wave velocity and PP at different periods were inversely correlated with several cognitive domains, but only awake PP measurements were associated with attention after correcting for confounders (beta = 0.22, 95% confidence interval (CI) 0.41, 0.03). All ambulatory PP measurements were related to MCI, which was independently associated with nocturnal PP (odds ratio (OR) = 2.552, 95% CI 1.137, 5.728) and also related to the presence of deep white matter hyperintensities (OR = 1.903, 1.096, 3.306). Therefore, higher day and night ambulatory PP measurements are associated with poor cognitive outcomes. © The Author(s) 2015.
Geriatric assessment and prognostic factors of mortality in very elderly patients with community-acquired pneumonia [Valoración geriátrica y factores pronósticos de mortalidad en pacientes muy ancianos con neumonía extrahospitalaria]
Calle A.,Parc Sanitari Pere Virgili |
Marquez M.A.,Hospital Del Mar Hospital Of La Esperanza Centro Forum |
Arellano M.,Hospital Del Mar Hospital Of La Esperanza Centro Forum |
Perez L.M.,Parc Sanitari Pere Virgili |
And 2 more authors.
Archivos de Bronconeumologia | Year: 2014
Introduction: To assess the relationship between the parameters obtained in the geriatric assessment and mortality in elderly people with community-acquired pneumonia in an acute care geriatric unit. Methods: Four hundred fifty-six patients (≥. 75. years). Variables: age, sex, referral source, background, consciousness level, heart rate, breathing rate, blood pressure, laboratory data, pleural effusion, multilobar infiltrates, functional status (activities of daily living) prior to admission [Lawton index (LI), Barthel index (BIp)] prior to and at admission (BIa), cognitive status [Pfeiffer test (PT)], comorbidity [Charlson index (ChI)] and nutrition (total protein, albumin). Results: A hundred ten patients died (24.2%) during hospitalization. These patients were older (86.6. ±. 6.4 vs 85.1. ±. 6.4, P<. .04), had more comorbidity (ChI 2.35. ±. 1.61 vs 2.08. ±. 1.38; P<. .083), worse functional impairment [(LI: 0.49. ±. 1.15 vs 1.45. ±. 2.32, P<. .001) (BIp: 34.6. ±. 32.9 vs 54.0. ±. 34.1, P<. .001) (BIa: 5.79. ±. 12.5 vs 20.5. ±. 22.9, P<. .001)], a higher percentage of functional loss at admission (85.9. ±. 23.2 vs 66.4. ±. 28.6; P<. .0001), worse cognitive impairment (PT: 7.20. ±. 3.73 vs 5.10. ±. 3.69, P<. .001) and malnutrition (albumin 2.67. ±. 0.54 vs 2.99. ±. 0.49, P<. .001). Mortality was higher with impaired consciousness [49.2% (. P<. .01)], tachypnea [33.3% (. P<. .01)], tachycardia [44.4% (. P<. .002), high urea levels [31.8 (. P<. .001)], anemia [44.7% (. P<. .02)], pleural effusion [42.9% (. P<. .002)], and multilobar infiltrates [43.2% (. P<. .001)]. In the multivariate analysis, variables associated with mortality were: age ≥. 90. years [OR: 3.11 (95%. CI: 1.31 to 7.36)], impaired consciousness [3.19 (1.66 to 6.15)], hematocrit <. 30% [2.87 (1.19 to 6.94)], pleural effusion [3.77 (1.69 to 8.39)] and multilobar infiltrates [2.76 (1.48 to 5.16)]. Female sex and a preserved functional status prior (LI. ≥. 5) and during admission (BIa. ≥. 40) were protective of mortality [0.40 (0.22 to 0.70), 0.09 (0.01 to 0.81) and 0.11 (0.02 to 0.51)]. Conclusions: Geriatric assessment parameters and routine clinical variables were associated with mortality. © 2013 SEPAR.
PubMed | International University of Catalonia, Biomedical Research Institute Sant Pau, Parc Tauli Sabadell Hospital Universitari and Parc Sanitari Pere Virgili
Type: Journal Article | Journal: Clinical rehabilitation | Year: 2015
To examine the effect of core stability exercises on trunk control, dynamic sitting and standing balance, gait, and activities of daily living in subacute stroke patients.A randomized controlled trial.Inpatient rehabilitation hospital in two centres.Eighty patients (mean of 23.25 (16.7) days post-stroke) were randomly assigned to an experimental group and a control group.Both groups underwent conventional therapy for five days/week for five weeks and the experimental group performed core stability exercises for 15 min/day. The patients were assessed before and after intervention.The Trunk Impairment Scale (Spanish-Version) and Function in Sitting Test were used to measure the primary outcome of dynamic sitting balance. Secondary outcome measures were standing balance and gait as evaluated via Berg Balance Scale, Tinetti Test, Brunel Balance Assessment, Postural Assessment Scale for Stroke (Spanish-Version), and activities of daily living using Barthel Index.The experimental group showed statistically significant differences for all of the total scale scores (P<0.05), except for the sitting section of the Brunel Balance Assessment. The mean (SD) difference between groups in Trunk Impairment Scale total score was 3.40 (4.12) points, and its subscale dynamic sitting balance was 2.28 (3.29). The Berg Balance Scale was 14.54 (18.19) points, and the Barthel Index was 13.17 (25.27) points. Collectively, these results were in favour of the experimental group.Core stability exercises in addition to conventional therapy improves trunk control, dynamic sitting balance, standing balance, gait and activities of daily living in subacute post-stroke patients.
Transferable skills of healthcare professionals in providing homecare in chronically ill patients [Competencias transversales de los profesionales que facilitan atención domiciliaria a pacientes crónicos]
Escarrabill J.,Hospital Clinic |
Cleries X.,Parc Sanitari Pere Virgili |
Sarrado J.J.,Institute Destudis Of La Salut
Atencion Primaria | Year: 2015
Aim To determine the relevance level of non-technical skills of those professionals dedicated to the healthcare of patients with chronic diseases, from an analysis of home care professionals. Design Quantitative and qualitative research conducted in 2 phases: 1. st from November 2010 to March 2011 and 2. nd from December 2012 to August 2013. Setting Health Region of Barcelona city. Participants During the 1. st phase, 30 professionals from homecare teams (3 from Primary Care and 3 from Hospitals). In 2. nd phase, 218 professionals from 50 Primary Healthcare Centres and 7 home care programmes. Method Purposive sampling in was used in the1st phase, and randomized sampling in the 2. nd phase. Likert scales and focus group were used. Results A total of 19 skill categories were identified in the 1. st phase. In the 2. nd phase 3 metacategories were established: comprehensive patient-centered care, interprofessional organization, and inter-health care fields and interpersonal skills. Conclusions It is necessary to improve and secure the professionals relationships between levels of healthcare, continuity of healthcare, biopsychosocial model and holistic attention to patients and relatives, looking at emotions, expectations, feelings, beliefs and values. It is essential to design and implement continuing training in transferable skills in every healthcare centre, through active methodologies. © 2013 Elsevier España, S.L.U. All rights reserved.
PubMed | Hospital Clinic, Parc Sanitari Pere Virgili and Institute Destudis Of La Salut
Type: Journal Article | Journal: Atencion primaria | Year: 2015
To determine the relevance level of non-technical skills of those professionals dedicated to the healthcare of patients with chronic diseases, from an analysis of home care professionals.Quantitative and qualitative research conducted in 2 phases: 1.st from November 2010 to March 2011 and 2.nd from December 2012 to August 2013.Health Region of Barcelona city.During the 1.st phase, 30 professionals from homecare teams (3 from Primary Care and 3 from Hospitals). In 2.nd phase, 218 professionals from 50 Primary Healthcare Centres and 7 home care programmes.Purposive sampling in was used in the1st phase, and randomized sampling in the 2.nd phase. Likert scales and focus group were used.A total of 19 skill categories were identified in the 1.st phase. In the 2.nd phase 3 metacategories were established: comprehensive patient-centered care, interprofessional organization, and inter-health care fields and interpersonal skills.It is necessary to improve and secure the professionals relationships between levels of healthcare, continuity of healthcare, biopsychosocial model and holistic attention to patients and relatives, looking at emotions, expectations, feelings, beliefs and values. It is essential to design and implement continuing training in transferable skills in every healthcare centre, through active methodologies.
Intermediate hospital care for subacute elderly patients as an alternative to prolonged acute hospitalization [Derivación de pacientes geriátricos subagudos a un hospital de atención intermedia como alternativa a la permanencia en un hospital general]
Inzitari M.,Parc Sanitari Pere Virgili |
Inzitari M.,Autonomous University of Barcelona |
Espinosa Serralta L.,Parc Sanitari Pere Virgili |
Perez Bocanegra M.C.,Hospital Universitario Vall dHebron |
And 3 more authors.
Gaceta Sanitaria | Year: 2012
Objective: We evaluated the rapid discharge of older patients with reactivated chronic diseases from an acute general hospital to an intermediate care hospital. Methods: A cohort study was carried out. Compliance with predefined quality standards and patient selection were evaluated. Results: Sixty-eight patients (mean age 82.6 years, 48.5% men) were discharged from the emergency department (69.1%) or medical wards (mean [SD] global length of stay 2.6 [2.9] days in acute wards and 1.5 [1.6] days in the emergency department). Mean post-acute length of stay (SD) was 11.4 (4.2) days. Fifty-six patients (82.4%) were discharged to their previous living situation (home or nursing home), two back to the emergency department, seven to long-term care, and three died. All quality standards were met. In a multivariate analysis, male gender and a higher risk of malnutrition were associated with an increased risk of not returning to the previous living situation (p <0.05). Conclusions: Intermediate care for selected patients with reactivated chronic diseases might represent an alternative to prolonged acute hospitalization. © 2011 SESPAS.
Colprim D.,Parc Sanitari Pere Virgili |
Colprim D.,Autonomous University of Barcelona |
Inzitari M.,Parc Sanitari Pere Virgili |
Inzitari M.,Autonomous University of Barcelona
Journal of the American Medical Directors Association | Year: 2014
Objective: Unplanned acute hospital transfers (AT) from post-acute or long-term care facilities represent critical transitions, which expose patients to negative health outcomes and increase the burden of the emergency departments that receive these patients. We aim at determining incidence and risk factors for AT during the first 30days of admission at an intermediate care and rehabilitation geriatric facility (ICGF). Design and Setting: Prospective cohort study conducted in an ICGF of Barcelona, Spain. Sociodemographics, main diagnostics, and variables of the comprehensive geriatric assessment were recorded at admission. At the moment of AT, suspected diagnostic motivating the transfer was recorded. Multivariable Cox proportional hazard models were used to evaluate the association between admission characteristics and AT. Results: We included 1505 patients (mean age+standard deviation=81.31±7.06, 65.7% women). ATwere 217 (14.4%, 5.64/1000days of stay) resulting in only 81 final hospitalizations (37% of AT), whereas 136 patients returned to ICGF after visiting the emergency department. Principal triggers of AT were cardiovascular, falls/orthopedic, and gastrointestinal problems. Being admitted to ICGF after a general surgery [hazard ratio (HR) 1.88; 95% confidence interval (CI) 1.21-2.94; P<.001], taking 8 or more drugs at admission (HR 1.98; 95% CI 1.37-2.86; P<.001) and living with a partner (HR 1.35; 95% CI 1.01-1.81; P=.05) were independently associated with a higher risk of AT. Conclusions: In our sample, clinical and social characteristics at admission to an ICGF are associated with a higher risk of AT. A relevant proportion of AT is not admitted to the acute hospital, suggesting perhaps some avoidable AT. Identification of risk factors might be relevant to design strategies to reduce AT. © 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
PubMed | Parc Sanitari Pere Virgili, Autonomous University of Barcelona and Complejo Hospitalario Of Navarra Idisna
Type: Journal Article | Journal: Revista espanola de geriatria y gerontologia | Year: 2016
Gait speed (GS), measured at usual pace, is an easy, quick, reliable, non-expensive and informative measurement. With a standard chronometer, like those that currently found in mobile phones, and with two marks on the floor, trained health professionals obtain a more objective and quick measurement compared with many geriatric scales used in daily practice. GS is one of the pillars of the frailty phenotype, and is closely related to sarcopenia. It is a powerful marker of falls incidence, disability and death, mostly useful in the screening of older adults that live in the community. In recent years, the evidence is reinforcing the usefulness of GS in acute care and post-surgical patients. Its use in patients with cognitive impairment is suggested, due to the strong link between cognitive and physical function. Although GS meets the criteria for a good geriatric screening tool, it is not much used in clinical practice. Why? This review has different aims: (i)disentangling the relationship between GS and frailty; (ii)reviewing the protocols to measure GS and the reference values; (iii)reviewing the evidence in different clinical groups (older adults with frailty, with cognitive impairment, with cancer or other pathologies), and in different settings (community, acute care, rehabilitation), and (iv)speculating about the reasons for its poor use in clinical practice and about the gaps to be filled.