RECALMIN. Four years of growth of the internal medicine units of the Spanish National Health System (2013–2016)

ObjectivesTo compare the structure, resources and activity of the internal medicine units (IMUs) of the Spanish National Health System (SNHS) in 2013 and 2016. To analyse the differences between IMUs in 2016 by hospital size. Material and methodsWe conducted a comparison of 2 descriptive cross-sectional studies of IMUs in general acute care hospitals of the Spanish National Health System, with data referring to 2013 and 2016. The variables were collected via an ad hoc questionnaire (RECALMIN survey). ResultsBetween 2013 and 2016, the demand for care increased dramatically (with an annual average of 11% in hospital discharges and 16% in first consultations), and comorbidity slightly increased (2%). During this period, the mean productivity of IMUs increased 16.7% (0.6±0.3 vs. 0.7±0.3; P=.09), and the mean stay decreased 10% (9±2.2 vs. 8.1±2.1 days; P=.001). Progress in implementing good practices and systematic care for complex chronic patients was scarce. Both surveys found variability among IMUs and marked differences among IMUs of hospitals of different sizes. ConclusionsIMUs responded to the increased burden of care they supported during 2013-2016 by improving their efficiency and productivity; however, advances in implementing good practices, including care for chronic complex patients, were scare. The significant variability in the indicators of structure, activity and management models found in 2013 remained in 2016.

RECALMIN. Patient care in the internal medicine units of the Spanish national health system

RECALMIN IV. Evolution in the activity of internal medicine units of the National Health System (2008–2021)

RECALMIN. La atención al paciente en las unidades de Medicina Interna del Sistema Nacional de Salud

RECALMIN IV. Evolución de la actividad de las unidades de medicina interna del Sistema Nacional de Salud (2008-2021)

P115. Analysis of 90-day readmissions across hospital size: Risk factors for readmission in single level anterior cervical discectomy and fusion

RECALMIN V. Evolution in the activity of internal medicine units of the National Health System (2007-2022).

Cost-minimisation analysis of chronic lymphocytic leukemia in Spain in the era of oral targeted therapies

Patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) are often hospitalized in internal medicine units (IMUs), and their management is challenging due to a multiplicity of factors affecting the outcome, such as correct patient classification, appropriate pharmacologic therapy, patient discharge, and follow-up. In this context, a standardized pathway (algorithm) for the management of these patients was designed and tested. Specifically, based on information collected through a survey on the management of COPD patients in IMUs, an initial version of an algorithm was designed by the scientific board and proposed to 45 IMUs for a 6-month period to evaluate its feasibility, usefulness, and critical issues. After this preliminary phase, a second version was released, which was again brought to the attention of the participating centers, leading to the final algorithm. The algorithm reports the steps for the management of patients with severe exacerbations of known or suspected COPD, namely: correct diagnosis, treatment of the acute phase, management of comorbidities, appropriate therapy at discharge, and planning of the follow-up. Focus is given to the shift from systemic therapy in the acute phase to early in-hospital inhalation triple therapy (inhaled corticosteroids/long-acting muscarinic antagonists/long-acting β agonists) and the need for education in the use of the inhaler. The algorithm was considered useful by most of the participating centers. The proposed algorithm is an agile and usable tool for managing the main steps of care of COPD patients in IMUs. The future goal is to make the model available to a wider audience of internists.

ObjectiveThe main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported...

Acute heart failure (AHF) is a leading cause of hospitalizations and mortality worldwide. However, there is limited information regarding its management in general internal medicine units by internal medicine specialists, the usual providers of care for these patients in Argentina. This multicenter study was conducted between January and October 2024, including patients hospitalized for AHF in internal medicine or progressive care units at public and private hospitals. Sociodemographic data, clinical history, complementary studies, pharmacological treatments, and in-hospital outcomes were collected. Thirty-one hospitals participated, enrolling 713 patients (52.6% women) with a median age of 78 years (IQR 65-87). Hypertension was the most prevalent comorbidity (79.7%), followed by diabetes (32.9%) and atrial fibrillation (32.1%). The most frequent cause of decompensation was infection (36.9%). A transthoracic echocardiogram was performed at admission in 46% (n=331) of patients, only seven of which were performed by internists. At discharge, a significant increase in guideline-directed pharmacological prescriptions was observed, particularly sodium-glucose cotransporter-2 inhibitors (SGLT2i), from 8.5% before admission to 24.9% at discharge. In-hospital mortality was 11.9% (n=85). This first Argentine multicenter registry of AHF in patients hospitalized in internal medicine units included older individuals with multiple comorbidities, showing high in-hospital mortality rates comparable to international series. Therapeutic prescriptions at discharge were suboptimal according to current guideline recommendations, underscoring the need to strengthen multidisciplinary approaches and implement strategies to improve quality of care.

The majority of patients hospitalized for heart failure (HF) are admitted to internal medicine (IM) rather than to cardiology (CA) units, but to date few studies have analyzed the characteristics of these two populations. In this snapshot survey, we compared consecutive patients admitted for HF in six IM units vs. one non-intensive CA unit. During the 6-month survey period, 467 patients were enrolled (127 in CA, 27.2% vs. 340 in IM, 72.8%). IM patients were almost 10years older (CA 75 ± 10, IM 82 ± 8years; p < 0.001), more frequently female (CA 39%, IM 55%; p = 0.002) and living at home alone (CA 12%, IM 21%; p = 0.017). The leading cause of hospitalization in both groups was acute worsening of HF (CA 42%, IM 53%; p = 0.031), followed by atrial fibrillation (CA 29%, IM 12%; p < 0.001) and infections (CA 24%, IM 27%; p = 0.563). Ischemic (CA 43%, IM 30%; p = 0.008) and dilated cardiomyopathy patients (CA 21%, IM 12%; p < 0.001) were primarily admitted to CA unit, whereas those with hypertensive heart disease to IM (CA 3%, IM 39%; p < 0.001). Left ventricular ejection fraction (LVEF) was available in 96% of CA patients, but only in 60% of IM patients (p = 0.001). Among patients with LVEF measured, those with LVEF < 40% were predominantly admitted to CA (CA 60%, IM 14%; p < 0.001), whereas those with LVEF ≥ 50% were admitted to IM (CA 21%, IM 33%; p = 0.019); 26% of IM patients were discharged without a known LVEF. Medical treatments also significantly differed, according to patients' clinical and instrumental characteristics in each unit. This study demonstrates important differences between HF patients hospitalized in CA vs. IM, and the need for a greater interaction between these two medical specialties for a better care of HF patients.

Much money and effort today is going into the development of the nation's medical facilities; the Federal government, acting under the Hill-Burton program, is spending a great deal on the construction of general, short-term hospitals (i.e., for an average patient-stay of less than 30 days); and there is an increasing amount of planning for regional health care facilities. The most efficient size for a hospital should be carefully ascertained in order that the available funds be utilized in the best fashion. The question of optimal hospital size becomes especially important as the population becomes more concentrated in urban centers where larger and larger hospitals could be effectively utilized. The purpose of this paper is to explore two aspects of cost variation with respect to hospital size among general, short-term hospitals. Studies comparing the costs of hospitals of different sizes have generally incorporated at least one of two biases. One is a failure to recognize salary and wage differentials due to factors other than hospital size. Such differentials are very large in this nonunionized field. These cost differentials inflate the costs of urban hospitals relative to the costs of hospitals in non-urbanized areas. The other bias stems from the use of adult and pediatric days as a measure of the output of hospitals, without adjustment for auxiliary services, the use and availability of which vary greatly among hospitals of different sizes. The use of the simple patient days measure in cost comparisons tends to inflate the costs of larger hospitals, which generally offer more of the specialized and expensive auxiliary services, relative to the costs of smaller hospitals. Together these two sources of bias tend to exaggerate the differe ce between the costs of large urban hospitals and the costs of small, non-urban hospitals.

IntroductionThe objective of the study was to evaluate the prevalence of Clostridium difficile-associated diarrhoea (CDAD) among hospitalised patients with antibiotic-associated diarrhoea (AAD) in general and by specific types of medical care and hospital units.MethodsA prospective, cross-sectional, non-interventional, multicentre study. The main inclusion criteria were: patient age ≥ 18 years, hospital stay of at least 48 h, current antibiotic therapy or antibiotic therapy within the previous 30 days, loose stools (Bristol stool types 5–7 and stool frequency ≥ 3 within ≤ 24 consecutive hours or exceeding normal for the patient) and signed informed consent form. The stool sample was taken to the local (study site) microbiology laboratory for detection of glutamate dehydrogenase (GDH) and toxins A/B using enzyme immunoassay (EIA) stool test.ResultsFrom April 2016 to April 2017, a total of 1245 patients from 12 large hospitals were enrolled in the study. Data on 81 patients were excluded from the analysis for different reasons. Data on 1164 patients (45.2% males and 54.8% females) with a mean age of 54.9 years (range 18–95 years) were analysed. Length of hospitalisation was 2–188 days (median, 8 days). The EIA stool test showed CDAD-positive results in 21.7% (253/1164) patients. The patients were from surgery units (546/1164), internal medicine units (510/1164) and intensive care units (108/1164). The prevalence of CDAD among patients from surgery, internal medicine and intensive care units was 26.2, 17.8 and 17.6%, respectively. Oncology, gastroenterology, septic surgery, oncohaematology and general medical hospital units accounted for more than 75% of all patients included; the prevalence of CDAD by those hospital units was 11.3, 15.0, 39.2, 17.6, and 27.2%, respectively. The proportion of GDH-positive and toxin A/B-negative patients by the rapid stool test result was 16.8% (196/1164). The prevalence of CDAD varied widely between the hospitals (from 0 to 44.3%).ConclusionsThe prevalence of CDAD among hospitalised patients with AAD in this study was 21.7% (95% confidence interval: 14.8 and 28.7%). The percentage of CDAD varied widely between hospitals and by specific types of medical care and hospital units.

Hospitalisation en médecine interne des nonagénaires. Étude de 150 séjours