Polypathological Patients Research Articles

Listeria grayi Meningitis in a Polypathological Patient: A Case Report

Background: The various species of the Listeria genus are frequently isolated from food and drink products. They are classified into two categories according to their pathogenicity. Pathogenic species are frequently incriminated in infections of the elderly, immunocompromised and pregnant women. The Listeria grayi species is rarely isolated as a pathogen in human pathologies. We report a case of L. grayi meningitis in a polypathological patient. Antimicrobial susceptibility testing revealed resistance to ampicillin and susceptibility to Meropenem. Therapeutic failure was recorded despite in vitro sensitivity Methods: Conventional biochemical test and Api Listeria gallery was used for identification of the isolate. Results: We report a case of L. grayi meningitis in a polypathological patient. Antimicrobial susceptibility testing revealed resistance to ampicillin and susceptibility to Meropenem. Therapeutic failure was recorded despite in vitro sensitivity. Conclusion: Given its infrequent reporting, Listeria grayi meningitis warrants consideration, especially in elderly patients with multiple pathologies.

Low Muscle Strength Assessed with Dynamometry in Elderly Polypathological Patients with Acute Heart Failure: PROFUND-IC Registry.

Background: Sarcopenia is a comorbidity associated with heart failure, which aggravates its prognosis. Objectives: To analyze the differential characteristics of polypathological patients with acute heart failure (AHF) based on the presence of low muscle strength, as well as to study whether this condition is associated with a worse prognosis. Methods: An observational study of 377 patients with a diagnosis of acute heart failure from the prospective multicentric PROFUND-IC registry was carried out. The main variable is low muscle strength, which is assessed with dynamometry or prehensile strength. Epidemiological and anthropometric characteristics, as well as associated comorbidities, were analyzed. Likewise, the etiology of the AHF episode, the number of admissions in the previous year, and the NYHA scale were also included. Finally, scores on functionality, treatment established, and mortality and readmission rates were studied. Quantitative variables are described as mean, and standard deviation, and qualitative variables are expressed as absolute numbers and percentages. A descriptive and bivariate analysis was performed according to the presence of low muscle strength (handgrip <27 kg in men and <16 kg in women), using the Welch test for quantitative measures and Chi-square for qualitative variables. In addition, Kaplan-Meier curves of readmission and mortality and a logistic regression analysis were also performed. Results: 377 patients were included (56% female, mean age 83 years). 310 (82.23%) had low muscle strength. Those with low muscle strength were older (84 vs. 78 years, p < 0.001), with more cognitive impairment (11.9% vs. 0%, p = 0.021), worse functional class (p = 0.016), lower scores in the Barthel index and Rockwood scale (p < 0.001), and higher in the PROFUND index (p < 0.001). They had higher rates of readmission and mortality without statistically significant differences. The PROFUND index is significantly associated with low muscle strength (OR 1.19, CI (1.09-1.31), p < 0.001). Conclusions: Elderly polypathological patients with acute heart failure and low muscle strength have a higher PROFUND index and a lower probability of survival per year.

Sodium-Glucose Cotransporter Type 2 Inhibitors Use in Elderly Polypathological Patients with Acute Heart Failure: PROFUND-IC Registry.

Background/Objectives: Heart failure (HF) is a highly prevalent clinical syndrome with serious morbidity and mortality. Furthermore, acute heart failure (AHF) is the main cause of hospital admission in people aged 65 years or more. Sodium-glucose cotransporter type 2 inhibitors (SGLT2is) have been shown to improve the survival and quality of life in patients with HF regardless of left ventricular ejection fraction (LVEF). Our aims were to describe the characteristics of adults with multiple pathologies admitted with acute heart failure as the main diagnosis and of the population treated with SGLT2is, as well as to evaluate if their use was associated with lower readmission and mortality rates. Methods: A prospective study of patients from the PROFUND-IC registry who were admitted with AHF as the main diagnosis was conducted. Clinical and analytical characteristics were analyzed, as well as readmissions and mortality. Descriptive and bivariate analyses of the sample between those taking SGLT2is and those who were not were performed, using the chi-square test for qualitative variables and Welch's test for quantitative measures, as well as the Fisher and Wilcoxon tests as indicated for nonparametric tests. Kaplan-Meier curves were constructed to analyze the readmission and mortality of patients at 12 months based on SGLT2i treatment. Finally, a propensity score matching was performed, guaranteeing that the observed effect of the drug was not influenced by the differences in the characteristics between the groups. Results: There were 750 patients included: 58% were women, and the mean age was 84 years. Functional class II according to the NYHA scale predominated (54%), and the mean LVEF was 51%. SGLT2 inhibitors were prescribed to only 28% of patients. Most of the patients were men (48.6% vs. 39.8%, p = 0.029), they were younger (82 vs. 84 years, p = 0.002), and their LVEF was lower (48% vs. 52%, p < 0.001). Lower mortality was observed in the group treated with SGLT2is, both during baseline admission (2.4% vs. 6.9%, p = 0.017) and at the 12-month follow-up (6.2% vs. 13%, p = 0.023); as well as a lower readmission rate (23.8% vs. 38.9%, p < 0.001). After the propensity score matching, a decrease in the 12-month readmission rate continued to be observed in the group treated with SGLT2is (p = 0.03). Conclusions: SGLT2is use was associated with lower readmission rates at the 12-month follow-up in older adults with multiple pathologies admitted with acute heart failure.

Interprofessional collaboration in primary care: what effect on patient health? A systematic literature review

BackgroundIn a period of change in the organization of primary care, Interprofessional Collaboration (IPC) is presented as one of the solutions to health issues. Although the number of inter-professional interventions grounded in primary care increases in all developed countries, evidence on the effects of these collaborations on patient-centred outcomes is patchy. The objective of our study was to assess the effects of IPC grounded in the primary care setting on patient-centred outcomes.MethodsWe conducted a systematic literature review using the PubMed, Embase, PsycINFO and CINAHL databases from 01/01/1995 to 01/03/2021, according to the PRISMA guidelines. Studies reporting the effects of IPC in primary care on patient health outcomes were included. The quality of the studies was assessed using the revised Downs and Black checklist.ResultsSixty-five articles concerning 61 interventions were analysed. A total of 43 studies were prospective and randomized. Studies were classified into 3 main categories as follows: 1) studies with patients at cardiovascular risk (28 studies)—including diabetes (18 studies) and arterial hypertension (5 studies); 2) studies including elderly and/or polypathological patients (18 studies); and 3) patients with symptoms of mental or physical disorders (15 studies). The number of included patients varied greatly (from 50 to 312,377). The proportion of studies that reported a positive effect of IPC on patient-centred outcomes was as follows: 23 out of the 28 studies including patients at cardiovascular risk, 8 out of the 18 studies of elderly or polypathological patients, and 11 out of the 12 studies of patients with mental or physical disorders.ConclusionsEvidence suggests that IPC is effective in the management of patients at cardiovascular risk. In elderly or polypathological patients and in patients with mental or physical disorders, the number of studies remains very limited, and the results are heterogeneous. Researchers should be encouraged to perform studies based on comparative designs: it would increase evidence on the positive effect and benefits of IPC on patient variables.

Fins de vie et souffrances psychiques en EHPAD

The issues of end-of-life conditions, particularly in nursing homes, are currently at the heart of a societal, legal, political and caregiver debate. These questions highlight the concepts of dignity, of temporality between the lengthy period of dying in geriatric care, which is experienced as an unbearable societal agony, and the will to live of Alzheimer's patients. However, dealing with the end of life, we are necessarily committed to the ethical values of solicitude, listening and knowing how to comfort our very old and polypathological patients who are nearing death. In this study, we will examine the notions of psychic suffering, of the wish to die, of sliding towards death, and the long dying process based on a corpus of patient and caregiver testimonials which are at the heart of a moral code that transitions from stupefaction to consideration.

Increased post-hospital mortality of polypathological patients during COVID-19 pandemic

Increased post-hospital mortality of polypathological patients during COVID-19 pandemic

Sister Marie Joseph Nodule in a Polypathological Patient: Study of an Observation at the Dermatology Hospital of Bamako (Mali)

Summary: Sister Mary Joseph nodule is a metastatic localization with a generally abdominal-pelvic origin and secondary to a primary adenocarcinoma in 90% of cases. We report an observation of Sister Mary Joseph nodule revealing a primary adenocarcinoma of the colon in a young adult with multiple pathologies. Observation: A 57-year-old patient, followed for hepatitis B, HIV1+, and benefiting from a therapeutic regimen (Tenofovir+Lamivudine+Dolutegravir) since 2019 and later a hyperthyroidism of incidental discovery. For one year he has had a firm nodular ulceration measuring 07 cm in its longest axis, with a reddish-pink appearance and whitish deposits, a haemorrhagic ooze on contact, and located at the umbilicus. Also, a tongue laden with whitish coatings that are easily removed with a tongue depressor and the inner surface of the cheeks and palate are erythematous. Bilateral exophthalmos abolished vocal vibrations in both lung bases; two hard left inguinal adenopathies adhering to the deep plane, painless, 3 cm in diameter each. He also described episodes of alternating constipation and diarrhoea accompanied by abdominal pain, coughing, physical asthenia and weight loss (40% loss in 2 years). Anatomopathology of a fragment of the nodule revealed a well-differentiated adenocarcinoma whose tumour cells were of colorectal origin and expressed CK20 and CK8/18. Colonoscopy revealed a multilobed polyploid tumour of the ascending colon and histology concluded that it was a liberkuhnian adenocarcinoma. A chest CT scan revealed pulmonary and abdominal-pelvic metastases and the diagnosis of a Sister Mary Joseph nodule revealing a colonic and metastatic adenocarcinoma was made. The patient was referred to the oncology department for palliative care after the surgical opinion. Conclusion: The nodule of Sister Marie Joseph is a cutaneous metastasis revealing a cancer of the abdominopelvic sphere. This rare and characteristic tumour deserves to be known by practitioners .......

Characterization of Patients with Chronic Diseases and Complex Care Needs: A New High-Risk Emergent Population

Background: To analyze the prevalence and main epidemiological, clinical and outcome features of in-Patients with Complex Chronic conditions (PCC) in internal medicine areas, using a pragmatic working definition. Methods: Prospective study in 17 centers from Spain, with 97 in-hospital, monthly prevalence cuts. A PCC was considered when criteria of polypathological patient (two or more major chronic diseases) were met, or when a patient suffered one major chronic disease plus one or more of nine predefined complexity criteria like socio-familial risk, alcoholism or malnutrition among others (PCC without polypathology). A complete set of baseline features as well as 12-months survival were collected. Then, we compared clinical, outcome variables, and PROFUND index accuracy between polypathological patients and PCC without polypathology. Results: The global prevalence of PCC was 61% (40% of them were polypathological patients, and 21% PCC withouth polypathology) out of the 2178 evaluated patients. Their median age was 82 (59.5% men), suffered 2.3 ± 1.1 major diseases (heart diseases (70.5%), neurologic (41.5%), renal (36%), and lung diseases (26%)), 5.5 ± 2.5 other chronic conditions, met 2.5 ± 1.5 complexity criteria, and presented functional decline (Barthel index 55 (25-90)). Compared to polypathological patients, the subgroup of PCC without polypathology were younger, with a different pattern of major diseases and comorbidities, a better functional status, and lower 12-months mortality rates ((36.2% vs 46.8%; p = .003; OR 0.7(0.48-0.86). The PROFUND index obtained adequate calibration and discrimination power (AUC-ROC 0.67 (0.63-0.69)) in predicting 12-month mortality of PCC. Conclusion: Patients with complex chronic conditions are highly prevalent in internal medicine areas; their clinical pattern has changed in parallel to socio-epidemiological modifications, but their death-risk is still adequately predicted by PROFUND index.

Severe Acute Global Respiratory Failure Treated with Non Invasive Ventilation: Role of Presepsin as an Early Marker of Sepsis

In polypathological patients an early diagnosis of respiratory failure is often difficult. Frequently, polypathology does not allow intubation and intensive care unit (ICU) treatment with invasive mechanical ventilation (IMV). Non-invasive ventilation (NIV) and admission to respiratory intermediate care unit (RICU) may be the only option in these cases. Presepsin, a new predictive marker of systemic infection, appears particularly usefull for early diagnosis, treatment and prognosis of sepsis. 1.2. Case A 73-year-old man with a previous history of ischemic heart disease undergoing coronary artery bypass grafting (CABG), residual constrictive pericarditis, previous multiple hospitalizations for heart failure (CHF), autoimmune hemolytic anemia on chronic steroid therapy and cognitive impairment arrived to the Emergency Department (ED) in acute global respiratory failure with severe acidosis; he was normothermic, radiological imaging showed aspecific diffuse parenchymal thickening and traditional inflammatory markers (white blood cell - WBC - count and serum level of C-reactive protein - CPR - and procalcitonin - PCT) were in normal range, but blood tests revealed a marked elevation in the value of presepsin. Intensivist’s evaluation concluded for a do-not intubate (DNI) status and the patient was admitted to RICU. The combined treatment with NIV, broad-spectrum antibiotics and dopamine resulted in a progressive improvement of the clinical, laboratoristic and radiological parameters and the subsequent discharge of the patient to home in satisfactory general condition. 1.3. Conclusions Elevated presepsin level was found to be an early predictor of severe sepsis, ofter preceding other laboratory or clinical signs of infection. NIV in RICU and medical therapy allowed the successful treatment of a severe global respiratory failure in a DNI patient.

Progress in the risk assessment of hydroxychloroquine in frail elderly people.

Hydroxychloroquine (HCQ) is an antimalarial drug also known to have anti‐inflammatory and antiviral effects. The antiviral action of HCQ has been a point of interest for many researchers because of its mechanism of action and the potential use it could have during the current COVID‐19 pandemic. However, HCQ can cause QT interval prolongation. The current therapies used in COVID‐19 are changing as the pandemic develops. The aim of this article is to promote a validated risk score for QT prolongation in multidimensional assessment of COVID‐19 patients, especially in elderly and polypathological patients.

La saturation de la structure des urgences et le rôle de l'organisation hospitalière : réflexions sur les causes et les solutions

Emergency Department (ED) overcrowding is a silent killer. Thus, several studies in different countries have described an increase in mortality, a decrease in the quality of care and prolonged hospital stays associated with ED overcrowding. Causes are multiple: input and in particular lack of access to lab test and imaging for general practitioners, throughput and unnecessary or time-consuming tasks, and output, in particular the availability of hospital beds for unscheduled patients. The main cause of overcrowding is waiting time for available beds in hospital wards, also known as boarding. Solutions to resolve the boarding problem are mostly organisational and require the cooperation of all department and administrative levels through efficient bed management. Elderly and polypathological patients wait longer time in ED. Internal Medicine, is the ideal specialty for these complex patients who require time for observation and evaluation. A strong partnership between the ED and the internal medicine department could help to reduce ED overcrowding by improving care pathways.

Oxidative Stress, Telomere Shortening, and Apoptosis Associated to Sarcopenia and Frailty in Patients with Multimorbidity.

Background: The presence of oxidative stress, telomere shortening, and apoptosis in polypathological patients (PP) with sarcopenia and frailty remains unknown. Methods: Multicentric prospective observational study in order to assess oxidative stress markers (catalase, glutathione reductase (GR), total antioxidant capacity to reactive oxygen species (TAC-ROS), and superoxide dismutase (SOD)), absolute telomere length (aTL), and apoptosis (DNA fragmentation) in peripheral blood samples of a hospital-based population of PP. Associations of these biomarkers to sarcopenia, frailty, functional status, and 12-month mortality were analyzed. Results: Of the 444 recruited patients, 97 (21.8%), 278 (62.6%), and 80 (18%) were sarcopenic, frail, or both, respectively. Oxidative stress markers (lower TAC-ROS and higher SOD) were significantly enhanced and aTL significantly shortened in patients with sarcopenia, frailty or both syndromes. No evidence of apoptosis was detected in blood leukocytes of any of the patients. Both oxidative stress markers (GR, p = 0.04) and telomere shortening (p = 0.001) were associated to death risk and to less survival days. Conclusions: Oxidative stress markers and telomere length were enhanced and shortened, respectively, in blood samples of polypathological patients with sarcopenia and/or frailty. Both were associated to decreased survival. They could be useful in the clinical practice to assess vulnerable populations with multimorbidity and of potential interest as therapeutic targets.

Simplified medication regimen and survival in polypathological patients

ObjectiveTo determine if a more simplified medication regimen is associated with survival in polypathological patients. MethodsMulticentre cohort study. We included polypathological patients admitted to internal medicine wards between March 1st and June 30rd, 2011. Patients that died during admission and readmissions were excluded. Data were collected about age, gender, home, comorbidity, Charlson, Barthel and Lawton-Brody indexes, Short Portable Mental State Questionnaire, socio-familial Gijón scale, admissions in the previous year, delirium, need of a caregiver and PROFUND index. The therapy complexity was measured with the Medication Regimen Complexity Index (MRCI). The follow-up lasted 4-years. To determine the factors associated with mortality we performed a Cox proportional regression model. ResultsOverall 223 polypathological patients were included, with a mean age of 79.8 (8.6) years. Mean score in MRCI was 32.0 (15.2). After 4 years, 161 (72.2%) patients died, 36 with a more simplified medication regimen. Age, (HR 1.060 95%CI 1.032–1.089; p<.001), neoplasms (HR 2.477 95%CI 1.564–3.923; p<.001), and the number of admissions in the previous year (HR 1.251 95%CI 1.100–1.423; p=.001) were independently associated with 4-year mortality, and Barthel index score (HR .991 95%CI .983–0.998; p<.001) and a more simplified medication regimen (HR 0.634 95%CI 0.414–.970; p=.036) with lower mortality. ConclusionsIn polypathological patients, the more simplified medication regimens are associated with a lower mortality.

Simplification of the Barthel scale for screening for frailty and severe dependency in polypathological patients

ObjectivesTo analyze the sensitivity, specificity and positive predictive (PPV) and negative predictive (NPV) values of each measure of the Barthel index (BI) compared with the full questionnaire for polypathological patients (PPPs). MethodsMulticentre cross-sectional study. We considered 2 cut-off points for the BI (≥90 points for screening frailty and <60 points for diagnosing severe dependence). For each measure and combination of 2 measures, we calculated the sensitivity, specificity, PPV and NPV with respect to the full BI. ResultsThe mean BI of the 1632 included PPPs (mean age, 77.9±9.8years; 53% men) was 69±31 (<90 for 58.7% and <60 for 31.4% of the patients). The “feeding” measure achieved the highest NPV, for a BI≥60 and ≥90 points (87% and 99.6%, respectively). The “walking” and “going up and down stairs” measures achieved the highest PPV, for a BI≥60 and ≥90 (99.2%/99.5% and 81%/92%), respectively. The combination of the 2 measures increased the PPV to 95% and 99.6%, respectively. ConclusionsPPPs in hospital settings have a high rate of functional impairment. The measure for feeding achieved the highest NPV and can therefore be employed for diagnosing severe dependence. The combination of the measures for walking and going up and down stairs achieved the highest PPV and can therefore be employed to propose frailty screening for PPPs.

Simplicidad del régimen de medicación y supervivencia en pacientes pluripatológicos

ObjectiveTo determine if a more simplified medication regimen is associated with survival in polypathological patients. MethodsMulticentre cohort study. We included polypathological patients admitted to internal medicine wards between March 1st and June 30rd, 2011. Patients that died during admission and readmissions were excluded. Data were collected about age, gender, home, comorbidity, Charlson, Barthel and Lawton-Brody indexes, Short Portable Mental State Questionnaire, socio-familial Gijón scale, admissions in the previous year, delirium, need of a caregiver and PROFUND index. The therapy complexity was measured with the Medication Regimen Complexity Index. The follow-up lasted 4-years. To determine the factors associated with mortality we performed a Cox proportional regression model. ResultsOverall 223 polypathological patients were included, with a mean age of 79.8 (8.6) years. Mean score in Medication Regimen Complexity Index was 32.0 (15.2). After 4 years, 161 (72.2%) patients died, 36 with a more simplified medication regimen. Age (HR 1.060, 95%CI 1.032-1.089; P<.001), neoplasms (HR 2.477, 95%CI 1.564-3.923; P<.001), and the number of admissions in the previous year (HR 1.251, 95%CI 1.100-1.423; P=.001) were independently associated with 4-year mortality, and Barthel index score (HR .991, 95%CI .983-0.998; P<.001) and a more simplified medication regimen (HR 0.634 95%CI 0.414-.970; p=.036) with lower mortality. ConclusionsIn polypathological patients, the more simplified medication regimens are associated with a lower mortality.

Advancing in Integrated Care:Results of 4 years of evaluation

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

A multidisciplinary approach for patients with multiple chronic conditions: IMPACTO study

Background and objectiveThe objective of the study was to evaluate the effects of a multidisciplinary intervention on the outcomes of polypathological patients (PP). MethodsA multicenter quasi-experimental pre-post study with a 12-month follow up was performed. In-hospital, at discharge and outpatient clinics patients who met criteria of PP between March 2012 and October 2013 were included. The multidisciplinary approach was defined by 11 interventions performed by general practitioners, internal medicine physicians, team care nurses and hospital pharmacists. The primary outcome was reduction in the number of hospital admissions and days of hospitalization. Secondary outcomes included mortality and the effects of 11 interventions on mortality. Results420 patients were included. Mean patient age was 77.3 (SD: 8.90) and average number of PP defining categories was 2.99 (SD: 1.00). Number of hospital admissions and days of hospitalization decreased significantly after intervention: 1.52 (SD: 1.35) versus 0.82 (SD: 1.29), p<0.001, and 13.77 (SD: 15.20) versus 7.21 (SD: 12.90), p<0.001 respectively. 12-month mortality was 37.7%. PP who failed to receive a structured medical visit from the internal medicine physician and educational workshops from the team care nurses had a higher risk of exitus in the next 12 months, HR: 1.68; 95% CI: 1.15–2.46, p=0.007 and HR: 2.86; 95% CI: 1.92–4.27, p<0.001, respectively. ConclusionsThis multidisciplinary intervention reduced the risk of PP hospital admission and days of hospitalization. Educational workshop programs for PP and their caregivers and structured IM medical visits were associated with improvements of survival.

Comparison between PROFUND and PALIAR indexes in polypathological patients with advanced non-oncologic chronic diseases

Background and objectiveTo compare the discrimination power of PROFUND and PALIAR indexes for predicting mortality in polypathological patients with advanced non-oncologic chronic disease. Material and methodsProspective multicentre cohort study. We included polypathological patients with advanced non-oncologic chronic disease, who were admitted to internal medicine departments between July 1st and December 31st, 2014. Data was collected from each patient on age, sex, categories of polypathology, advanced disease, comorbidity, functional and cognitive assessment, terminal illness symptoms, need for caregiver, hospitalisation in the past three and 12 months and number of drugs. We calculated the PROFUND and PALIAR indexes and conducted a 12-month follow-up. We assessed mortality with the Kaplan–Meier survival curves and the discrimination of indexes with the ROC curves. ResultsWe included 213 patients with a mean (standard deviation) age of 83.0 (7.0) years, 106 (49.8%) of whom were female. Mortality at six months was 40.4% and at 12 months 50.2%. Deceased patients scored higher scores on the PROFUND [11.2(4.2) vs 8.5(3.9); p<0.001] and PALIAR [6.7 (4.6) vs 3.6(3.1); p<0.001] indexes. The discrimination of PALIAR index at six months (under the curve area 0.734 95%CI 0.665–0.803) was higher than of PROFUND, and there was no difference at 12 months. ConclusionsIn polypathological patients with advanced non-oncologic chronic disease, the PALIAR index had better discrimination power than PROFUND index at 66 months and there were no differences at 12 months.

Validation of the PROFUND index to predict early post-hospital discharge mortality.

The PROFUND index (PI) is a prognostic scale for polypathological patients at 12 months. The objective of the study was to validate the PI as a predictor of 1-year mortality in a current cohort of polypathological patients and analyse its prognostic usefulness in the short-term (1 month and 3 months) after discharge from Internal Medicine. We conducted a prospective observational study and all polypathological patients discharged from an Internal Medicine Department between 01 March 2016 and 28 February 2017 were enrolled. The variables recorded for each patient were age, sex, diseases and diagnostic categories defining patients as polypathological patients, PI at discharge, number of hospital admissions, length of stay, vital status at 1 year, and date and place of death if applicable. Follow-up lasted 1 year from the time of enrolment. Six hundred and ten polypathological patients were enrolled. Mortality was 41% and the patients who died were older, their length of stay was longer and their PI was higher compared with those who survived. The discrimination of the PI for predicting mortality was good, with a C-statistic of 0.718 [95% confidence interval (CI) 0.67-0.76]. In addition, a subgroup of patients with early mortality after discharge was identified, with a C-statistic of 0.74 (95% CI 0.67-0.80) at 30 days and 0.73 (95% CI 0.68-0.78) at 90 days. The PI is a valid tool for predicting early and 1-year mortality in polypathological patients after discharge from Internal Medicine.

Assessment of Medico-economic Relevance of Care of Polypathological Patients by a Reinforced Home Nursing Care Services (SSIAD) Device

Assessment of Medico-economic Relevance of Care of Polypathological Patients by a Reinforced Home Nursing Care Services (SSIAD) Device