Short- and medium-term complications after emergency department treatment of patients with atrial fibrillation: design and internal validation of the CoSTuM risk scale

OBJECTIVES

To design and validate a clinical risk scale for 90-day adverse events after emergency department (ED) discharge of patients with atrial fibrillation (AF).

MATERIAL AND METHODS

Prospective, observational CoSTuM (Spanish acronym for comorbidity, symptoms, treatments, and poor heart rate control) study of patients with AF. We recorded all adverse events occurring during follow-up and used multivariate logistic regression analysis to identify variables independently associated with the occurrence of any such event. A risk model was developed with data from a random sample of 66% of the patients. Data for the remaining patients were used for internal validation of the model.

RESULTS

We analyzed data for 645 patients (50.2% women; median [interquartile range] age, 76 (67-81 years). At 90 days, at least 1 adverse event had occurred in 165 patients (25.6%); 114 were in the development sample and 51 were in the validation sample. Independent variables associated with risk for adverse events were age 70 years or older; vascular disease; heart failure; chronic obstructive pulmonary disease; kidney disease; obesity; poorly controlled AF symptoms (European Heart Rhythm Association score, III-IV); use of oxygen therapy, digoxin, or other antiarrhythmics in the ED; and poor control of heart rate. The CoSTuM scale based on these variables demonstrated optimal predictive value in both the development sample (c statistic, 0.901; 95% CI, 0.869-0.928; P .001) and the validation sample (c statistic, 0.850, 95% CI, 0.796-0.894; P .001).

CONCLUSION

The CoSTuM risk score was a good predictor of 90-day adverse events after ED discharge of patients treated for AF.

Vaccination of pregnant women in the Valencian Community during the 2014-15 influenza season: a multicentre study

OBJECTIVE

To study influenza vaccination uptake in pregnant women from three Health Departments in the Valencian Community (Spain) during the 2014-15 flu season, to identify degree of knowledge, sources of information and attitudes toward immunization against influenza.

METHODS

Multicentre cross-sectional descriptive study during the 2014-15 vaccination campaign. Vaccine coverage was determined using the Nominal Vaccination Registry (NVR). Subsequently, a telephone survey was carried out on a sample of vaccinated and unvaccinated postpartum women.

RESULTS

The NVR had information on 934 (59.5%) out of 1,569 postpartum women; distribution per Health Departments was: 420 (44.9%), 161 (17.2%) and 353 (37.8%) in La Ribera, Torrevieja and Elx-Crevillent respectively. Vaccine uptake was 27.9% (n = 261). According to the "Country of Origin" variable, 77.5% (n = 724) of women were Spanish, with a vaccination rate of 26.7% (n = 193), compared to 22.5% (n = 210) who were non-Spanish, with a rate of 32.4% (n = 68). The main source of information was midwives for 83.7% (n = 159) of vaccinated pregnant women and for 44.6% (n = 127) of non-vaccinated women. The main reasons for vaccine refusal were lack of awareness (29.5%, n = 84) and not considering it necessary (25.6%, n = 73).

CONCLUSIONS

Despite their high willingness to be vaccinated after receiving information about the flu vaccine, the vaccination coverage in pregnant women studied is still low and can be improved. Health professionals need new information strategies to extend vaccine uptake to a larger number of pregnant women in Spain. Midwife advice plays an essential role in transmitting information on influenza vaccination in pregnant women and has a significant impact on uptake.

Segurança do paciente no centro cirúrgico e qualidade documental relacionadas à infecção cirúrgica e à hospitalização

Objetivo Descrever a qualidade documental de dois registros relacionados à segurança de pacientes no centro cirúrgico e estabelecer as diferenças nas informações relacionadas à infecção cirúrgica e à permanência hospitalar. Métodos Estudo comparativo baseado em dois cortes transversais, realizado com 3.033 pacientes internados há mais de 24 horas, advindos de Cirurgia Ortopédica e Traumatologia. Foram comparados dados sociodemográficos, clínicos e de preenchimento. Mediu-se a infecção pós-cirúrgica como um evento adverso. Resultados Houve correlação significativa entre os dias de hospitalização e o número total de diagnósticos coletados (Pearson=0,328; p<0,001). Quando se agruparam os diagnósticos e a infecção, notou-se um valor significativo entre as fraturas fechadas e a infecção (p=0,001). Conclusão Foram observadas diferenças no grau de preenchimento entre os dois registros. Não houveram diferenças no evento adverso.

[ALEA study. Treatment of chronic wounds infected by the application of silver dressings nanocrystalline combined with dressings hydrocellular]

OBJECTIVE

This study was conducted with the objective to assess, in real clinical conditions in primary care and geriatric centers, application and utility of nanocrystalline silver dressings dressings combined with hydrocellular in relation to the development during 20 shifts dressing or complete healing of the characteristics of the lesions included in the study

MATERIAL AND METHODS

Prospective observational multicenter open, repeated measures. It could include injuries of different etiologies (pressure ulcers stage 11-111, lower limb and traumatic wounds or surgical origin), with clinical signs of local infection (at least three of the following: redness, purulent discharge, heat, edema and pain). Only one wound was included per patient. An analysis of effectiveness by intention to treat all lesions included.

RESULTS

We recruited 103 patients who met the inclusion criteria but were collected in which 77 patients were used for nanocrystalline silver dressings in some phase of the study, They had a median of 80 years of age and 58.4% were women. By type of injury: 53.2% pressure ulcers, 31.2% lower extremity ulcers and 14.3% traumatic or surgical wounds. Over 50% of the lesions was older than eight months and a larger area of 22.75 cm2. At first, 70.1% had redness, purulent discharge 64.9%, 37.7% heat edema 42.9% and 65.8% pain. Remained in the study a median of 42.5 days at a rate of change of dressing every 2.5. During this time in 96.1% of the lesions were removed for clinical signs of local infection in a statistically significant (p < or = 0.001). 27.3% healed from injuries and those not healed, 92.9% experienced improvement, and its healing curves were statistically significant (p < 0.05). 92.2% of clinicians assessed treatment with these products as good or excellent.

CONCLUSION

The use of the products used in this study consistent with the concept and PLH TIME, has proved useful in this type of injury reducing the clinical signs of infection, promoting granulation tissue and necrotic removing the burden being able to manage the exudate of an optimal healing and getting one out of three masses.