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Resumen Introduccion La conceptualizacion de la conducta suicida es muy compleja y constituye un problema de salud mundial. Su etiologia es multifactorial y, en muchos casos, prevenible. Suicidio y enfermedad neurodegenerativa coinciden en algunos factores de riesgo como la depresion, los sentimientos de desesperanza y el aislamiento social. Objetivo Conocer si los pacientes con enfermedad de Parkinson (EP), esclerosis multiple (EM), enfermedad de Alzheimer (EA), esclerosis lateral amiotrofica (ELA) y enfermedad de Huntington (EH) estan mas expuestos a presentar conducta suicida y cuales son los factores de riesgo mas relevantes. Metodo Se realiza una revision bibliografica de articulos cientificos en bases de datos, asi como protocolos y documentos de sitios web nacionales y gubernamentales relacionando la enfermedad neurodegenerativa y el suicidio. Resultados Se ha encontrado una clara relacion entre suicidio y EM, ELA y EH, mientras que los resultados en EP y EA son bastante contradictorios, si bien se ha detectado una serie de factores de riesgo cuya presencia puede predisponer a este comportamiento. Conclusiones Existe mayor riesgo de conducta suicida en pacientes con EM, ELA y EH y a su vez se han encontrado una serie de factores de riesgo relevantes asociados a dicha conducta cuyo conocimiento nos ayuda a detectar signos de alarma y a actuar precozmente.

Introduction The conceptualization of suicidal behavior is very complex and constitutes a worldwide health problem. Its etiology is multifactorial and in many cases preventable. Suicide and neurodegenerative disease have some risk factors in common, such as depression, feelings of hopelessness and social isolation. Objective To find out if patients with Parkinson's disease (PD), multiple sclerosis (MS), Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS) and Huntington's disease (HD) are more likely to present suicidal behavior than the general population and to ascertain the most relevant risk factors. Method A review of scientific articles in databases was carried out, as well as of protocols and documents published on national and government websites linking neurodegenerative disease and suicide. Results A clear relationship was found between suicide and MS, ALS and HD. Results in relation to PD and AD are somewhat contradictory but a series of risk factors were detected, the presence of which could predispose individuals to this behavior. Conclusions There is a greater risk of suicidal behavior in patients with MS, ALS and HD. A series of relevant risk factors associated with this behavior were found, knowledge of which will help us to detect warning signs and take early action.

To compare the prevalence of potentially inappropriate medication (PIM) in the elderly according to the PRISCUS list, STOPP criteria, and Beers criteria. Secondary, to describe the differences using the three criteria focused on the inappropriate prescription of psychotropic drugs in the elderly. A retrospective study was performed at Severo Ochoa University Hospital. The study included 365 patients, aged 80 years and older, living in Madrid, Spain. 93.42% of patients received at least one PIM during hospitalization. Using the PRISCUS list, this changed from 32.6 to 2.7% at discharge. Applying STOPP criteria lowered the percentage from 65.20 to 10.95%, and with Beers criteria from 80.27 to 10.13. Lower Barthel index at admission was associated with an increased relative risk for receiving at least one PIM (OR 1.79, 95% CI 1.15–2.80, p = 0.024) using PRISCUS list as a tool in conjunction with STOPP criteria (OR 1.44, 95% CI 0.89–2.33, p = 0.037). Polypharmacy at admission predicted the presence of PIMs with STOPP criteria (OR 1.74, 95% CI 1.07–2.84, p = 0.001). Regarding psychotropic medicines, 208 patients (56.98%) received at least one psychotropic medicine during hospitalization. A total of 26.30% of patients were treated with psychotropic medicines, detected by the PRISCUS list, and 53.97% and 29.85% with STOPP and Beers, respectively. Explicit criteria are a useful tool for identifying during hospitalization of the elderly patients. As indicated by the results, new research is needed to carry out an adaptation in our country that includes an evaluation of the strengths of the three tools to decrease PIMs and improve prescription in the elderly.

Instituto de Salud Carlos III (Ministry of Economy, Industry and Competitiveness) (PI20/00095) Fundacion para la Investigacion Biomedica del Hospital Universitario Infanta Sofia y del Hospital del Henares (FIIB HUIS HHEN) SERMAS-Fundacion para la Investigacion Biomedica del Hospital 12 de Octubre Universidad Europea de Madrid (UEM20/01) Spanish Society of Paediatrics (Asociacion Espanola de Pediatria) Covid-19 EPICO-AEP 2020 4.056 JCR (2021) Q1, 22/130 Pediatrics 0.922 SJR (2021) Q1, 539/2489 Medicine (Miscellaneous) No data IDR 2021 UEM

Background Chagas disease (CD) has become an emerging global health problem in association with the immigration of individuals from endemic areas (in LatinAmerica) to other countries.Spain is the country in Europe with the highest number of CD cases. Concerning pediatric CD, treatment is not only better tolerated by younger children but also has greater cure possibilities. The aim of this study was to describe clinical and epidemiological aspects of CD in a pediatric population diagnosed of 10 hospitals in the Community of Madrid during the 2004–2018 period, as well as the safety and efficacy of CD treatment on this population. Methodology/Principal findings A multicenter, retrospective, descriptive study was conducted. The studied population included all identified children under the age of 18 with a diagnosis of CD. Diagnosis was performed with a positive parasitological test (with subsequent confirmation) or confirmed persistence of positive serology beyond 9 months, for children younger than one year-old, and with two different positive serological tests, for children older than one. Fifty-one children were included (59% male; 50.9% born in Spain). All mothers were from Latin America. The median age at diagnosis was 0.7 months for those under one year of age, and 11.08 years for those older than one year-old. Only one case presented a symptomatic course (hydrops faetalis, haemodynamic instability at birth, ascites, anaemia). For 94% treatment was completed. Considering patients who received benznidazole (47), AE were recorded in 48,9%. Among the 32 patients older than one year-old treated with benznidazole, 18 (56.25%) had adverse events whereas in the 15 under one year, 5(33,3%) did. Eigtheen (78.2%) of the patients with benznidazole AE were older than one year-old(median age 11.4 years). Of the patients treated with nifurtimox (9), AE were reported in 3 cases (33,3%). Cure was confirmed in 80% of the children under one year-old vs 4.3% in those older (p Conclusions/Significances Screening programs of CD since birth allow early diagnosis and treatment, with a significantly higher cure rate in children treated before one year of age, with lower incidence of adverse events. The high proportion of patients lost to follow-up in this vulnerable population is of concern.

Objectives: To evaluate electrocardiogram markers to predict coronary involvement in patients with Kawasaki disease by assessing measures of ventricular repolarization parameters on the 12-lead electrocardiogram. Study design: This cross-sectional study included 180 Spanish and Japanese patients ≤14 years of age with Kawasaki disease, with or without coronary involvement, from 2011 to 2016. We manually measured the Tp-Te/QT ratio and QTc interval (with Bazett's formula) in 12-lead electrocardiogram in the acute and recovery period and explored their potential association with coronary involvement. Results: No association was found between Tp-Te/QT ratio obtained manually in V5 and V6 leads and coronary involvement in the acute (V5:0.25 [IQR, 0.21-0.27] vs 0.25 [IQR, 0.20-0.27], P = .80; V6:0.24 [IQR, 0.21-0.27] vs 0.25 [IQR, 0.20-0.27], P = .86) or the recovery (V5: 0.23 [IQR, 0.20-0.25] vs 0.23 [IQR, 0.19-0.25], P = .68; V6: 0.23 [IQR, 0.20-0.25] vs 0.23 [IQR, 0.17-0.25], P = .50) period. By contrast, QTc in V5 and V6 was significantly lower in patients with Kawasaki disease and coronary involvement in the acute period (V5: 378 ms [IQR, 364-395 ms] vs 390 ms [IQR, 371-411 ms], P = .04; V6: 377 ms [IQR, 364-392 ms] vs 390 ms [IQR, 371-410 ms], P = .01). A QTc interval of

We conducted a multicenter clinical validity study of the Panbio coronavirus disease 2019 Antigen Rapid Test of nasopharyngeal samples in pediatric patients with coronavirus disease 2019-compatible symptoms of ≤5 days of evolution. Our study showed limited accuracy in nasopharyngeal antigen testing: overall sensitivity was 45.4%, and 99.8% of specificity, positive-predictive value was 92.5%.

Most studies of medication errors are focused only on finding global prevalence by patients, by phases or according to a certain group of medication. It's just a partial view of the problem. To analyze and compare the prevalence of errors in prescription, transcription and administration, and their clinical repercussions in different pharmacological groups in a third-level hospital.Prospective inclusion study with direct observation disguised as medication administration and comparison with prescriptions and transcriptions at history clinical. The ME and its clinical effects were classified by expert consensus. We calculated the different error rates and their repercussions with their confidence intervals at 95%. Then we compared using Chi-square tests.We studied 5,578 prescribed drugs and we observed the administration of 1,879 doses. A total of 117 different pharmacological groups were found, although 50.1% of the prescriptions belonged to only 9 types. We found heparins had a lower prevalence of errors in prescription and transcription and aspirin also had a lower prevalence of prescription errors. On the opposite side, a greater number of errors were obtained in transcription of Paracetamol, Metamizole and Laxatives and a prevalence of errors in the administration phase superior to rest in Paracetamol and in Proton Pump Inhibitors. The impact of medication error increased as medication process progressed, being similar between groups in prescription. In transcription, Heparins and Corticosteroids presented more serious errors. In administration, medication error are more serious for Diuretics and Statins (p0.05).Drugs considered potentially dangerous present fewer errors (Heparins, Corticoids), but more serious. Drugs with the highest prevalence of errors were Paracetamol and Inhibitors of proton pump but had a lower impact.La mayoría de los estudios sobre errores de medicación se centran sólo en hallar prevalencias globales por pacientes, por fases del proceso o según un determinado grupo de fármacos, por lo que se da una visión parcial. El objetivo de este trabajo fue analizar y comparar la prevalencia de errores en prescripción, trascripción y administración y sus repercusiones clínicas en los principales grupos farmacológicos en un hospital de tercer nivel.Estudio de inclusión prospectiva con observación directa disfrazada de la administración de medicamentos y comparación con prescripciones médicas y trascripciones presentes en la historia clínica. Los errores de medicación y sus efectos fueron clasificados por consenso de expertos. Se calcularon las diferentes tasas de errores y sus repercusiones con sus intervalos de confianza al 95% y se compararon utilizando la prueba de Chi cuadrado.Se estudiaron 5578 fármacos prescritos, aunque se observó sólo la administración de 1879 dosis. Se encontraron un total de 117 grupos farmacológicos, donde el 50,1% (2795) de las prescripciones pertenecían sólo a 9 tipos. La prevalencia de errores de prescripción global fue de 4,79%, de trascripción de 14,61% y de administración 9,32%. Por grupos, las Heparinas tuvieron una menor prevalencia de errores en la fase de prescripción y en la de trascripción. Se obtuvo mayor número de errores en trascripción de los Analgésicos como el Paracetamol y el Metamizol y de los Laxantes, y una prevalencia de errores en administración superior al resto en Analgésicos como el Paracetamol y en los Inhibidores de la Bomba de Protones. Las repercusiones clínicas de los errores de medicación en la fase de prescripción fueron parecidas entre grupos farmacológicos. En trascripción Heparinas y Corticoides presentaron errores más graves, mientras que en la administración fueron los IECAS y las Estatinas (p0,05).Los fármacos considerados clásicamente como de alto riesgo presentaron menos errores (Heparinas, Corticoides), pero más graves. Los fármacos con mayor prevalencia de errores fueron los Analgésicos (Paracetamol) y los Inhibidores de la Bomba de Protones, pero tuvieron una menor repercusión clínica.

Medication reconciliation is priority in safety. Between 54% and 67% of hospitalized patients have at least one unintended discrepancies (UDs) between pharmacological treatment of a hospital inpatient and treatment that they were previously taking at home. Quasi-experimental pre-post study performed. The objective is to assess the impact of an intervention aimed at decreasing UDs between medication prescribed on admission and patient’s regular treatment. Patients who were hospitalised for more than 24 hours and were undergoing treatment prior to admission which involved taking three or more medicines were included. The number of patients included was 331 and 3781 medicines were reconciled. The incidence of UDs decreased significantly from 7.24% to 4.18%. Omission was the most common UD, with a significant decrease from 5.8% to 3.4%. Respect to clinical impact, we observed that error type C (error reached patient without causing harm) predominates, how- ever, experienced a statistically significant decrease from 5.3% to 2.4%.

Background Medication reconciliation process has proved to be an effective tool to improve the safety of drug use. The objective of this study was to assess the impact of an intervention aimed to decrease unintended discrepancies between patient's usual treatment and medications prescribed on admission to the Department of Internal Medicine. Methods A quasi-experimental study was carried out from June 2009 to May 2010, analyzing discrepancies between home medication and drugs prescribed in a tertiary care hospital, before (first phase) and after (second phase) an electronic reconciliation tool was introduced at admission. This tool connected patients' usual medication with the electronic prescription program. The research team was made up of two hospital pharmacists, two nurses and three physicians from the Internal and Preventive Medicine Departments. Results During the two phases of the study, 162 patients were included with a total of 1,959 medicines reconciled. The incidence of unintended discrepancies decreased from 3.5% to 1.8% after the intervention (p value 0.03). The proportion of patients with at least one unintended discrepancy was 23.7% in the first phase and 14.6% in the second phase (p value 0.20). Omission was the most common unintended discrepancy. Asthmatic patients showed 6 times higher risk of being affected by an unintended discrepancy (OR 6.37, 95%CI 1.6–25.5; p value 0.009). Conclusions Implementing a computerized tool integrated into the electronic prescribing program could be very helpful to develop a medication reconciliation process. It is essential to involve all hospital staff in this process.

Learning Objectives After completing this course, the reader will be able to: Use patient age as only one consideration, along with tumor status and comorbidities, in deciding on treatment strategies for elderly colorectal cancer patients.Obtain and apply information regarding the medical, functional, mental, and social status of colorectal cancer elderly patients in order to make appropriate therapeutic decisions. CME This article is available for continuing medical education credit at CME.TheOncologist.com Purpose. To analyze differences in the therapeutic approach to and tumor-related mortality of young and elderly colorectal cancer (CRC) patients. Patients and Methods. This was a descriptive study of a retrospective cohort, based on administrative databases, of all patients with CRC diagnosed or treated in our institution. We extracted data on sociodemographic characteristics, comorbidity, type of cancer, type of treatment received, survival time, and cause of death. We compared differences between a young group (YG) (age Results. The study included 503 patients (YG, 320; OG, 183), with mean ages of 63.1 years in the YG and 81.8 years in the OG. No differences were observed between the groups in degree of differentiation, extension, tumor stage, or comorbidity. After adjustment for gender, comorbidity, and tumor localization and extension, YG patients were more likely than OG patients to receive surgery, radiotherapy, and chemotherapy and less likely to receive palliative care. After a median follow-up of 36.5 months, YG patients had a longer tumor-specific survival time than OG patients (36.41 months vs 26.05 months). After further adjustment, the YG had a lower tumor-specific mortality risk (hazard ratio, 0.66) than the OG. Conclusion. In comparison with younger patients, elderly CRC patients are undertreated, mainly because of their age and not because of their tumor type or comorbidity. Elderly patients have a significantly shorter tumor-specific survival time, partially because of this undertreatment.

PurposeHealthcare risk epidemiology identifies medication error as the commonest cause of adverse effects on patients. Medication error can occur at any phase of the complex medication process so prevalence rates need to be estimated at each drug treatment phase: prescription, transcription and administration along with their clinical repercussions. This paper aims to investigate this issue.Design/methodology/approachMedication errors were recorded on an ad hoc sheet and staff were observed handling medications. Recorded errors were later classified and their clinical repercussions determined by experts.FindingsIn total 757 inpatients and 5,466 drug prescriptions were studied. The prescription error rate was 4.79 percent (95 percent CI 4.21‐5.36). The most frequent error in this phase was failing to observe international prescribing standards. The highest error rate was found in transcription (14.61 percent, 95 percent CI 13.67‐15.54). Almost 1,900 dose administrations were observed. There was a 9.32 percent error rate (95 percent CI 7.98‐10.67). The commonest error in this phase was omission. Most were transcription errors, which were detected before harm was done.Research limitations/implicationsThe dispensation phase is absent.Practical implicationsErrors can be reduced if they are understood. Education and training based on the study's findings can reduce medication errors.Originality/valueThe paper highlights ways to reduce errors in the medication process.

Resumen Objetivos Conocer el impacto que las enfermedades hepaticas tienen sobre la actividad asistencial en los ambitos nacional y autonomico, y en un hospital de tercer nivel con seccion de hepatologia. Material y metodos Se ha procedido al analisis de los datos del Conjunto Minimo Basico de Datos (CMBD) desde 1999 hasta 2003. En el estudio de los casos pertenecientes al Hospital Gregorio Maranon se han utilizado las bases de datos de los anos 2000-2004, y se han calculado ciertos indicadores, como el porcentaje de casos de enfermedades digestivas sobre el total de altas hospitalarias, de los pacientes con enfermedades digestivas ingresados en el servicio de aparato digestivo, y sobre el total de altas de dicho servicio las que proceden de enfermedades hepaticas. Resultados Las enfermedades hepaticas representan alrededor del 23% de las altas producidas en los servicios de gastroenterologia a nivel nacional y de forma similar a nivel autonomico. El hepatocarcinoma presenta un incremento lento y sostenido que alcanza el 22,7% de las altas por enfermedades hepaticas en el ano 2003. La tasa de mortalidad especifica por enfermedades hepaticas se situa en el 12% en el ano 2003. En el estudio realizado en un hospital de tercer nivel, durante el ultimo ano analizado, el 21,2% del total de las altas hospitalarias se debe a una enfermedad digestiva; de estos pacientes, habia ingresado en el servicio de aparato digestivo solo el 12,48%. De las altas del servicio de aparato digestivo, mas del 50% se atribuye al area de hepatologia. Conclusiones La hepatologia representa un area de atencion asistencial de gran importancia dentro de la gastroenterologia, y ha presentado un crecimiento sostenido en los ultimos anos.

PurposeMedication errors (MEs) are important in terms of their magnitude and severity, and there are numerous systems in place to reduce their occurrence. However, the ideal system has not yet been identified. The authors' institution uses three different medication prescription‐dispensation systems which operate simultaneously. ME rates were compared, overall and by phase (prescription, transcription and administration) and their overall and specific clinical impact.Design/methodology/approachThe administration of medicinal products was observed directly and compared with medical and nursing prescriptions. Errors and adverse events were classified by a consensus of experts.FindingsIn the traditional system the error prevalence rate was 13.59 per cent, (99 per cent CI, 12.15‐14.61 per cent), in the single dose system it was 6.43 per cent (99 per cent CI, 5.53‐7.32) and in the electronic prescription system it was 8.86 per cent (99 per cent CI, 7.33‐10.17). The highest error rates in all phases were found in the traditional system. The phase affected by most errors in all three models was transcription, and the least affected was administration, except for the single dose system, in which prescription was the worst. The effects of errors in the administration phase are greater, although less so than with the automated system.Research limitations/implicationsThe dispensation phase was not analyzed.Practical implicationsA study of errors will enable us to reduce their occurrence if we know the most frequent types and in which phase they are produced, we will be able to prioritise the areas in which to work and select the necessary preventive measures.Originality/valueIt is possible that automated medication dispensation systems reduce error rates and the severity of their effects.

The aim of this article is to describe the methods used to develop the medication reconciliation programme implemented in a tertiary care hospital, and to discuss the main problems encountered and lessons learned during the process. A quasi-experimental study was carried out, analysing discrepancies between routine medication and drugs prescribed in the hospital, before and after an electronic reconciliation tool was introduced at admission. This tool was integrated into the computerized provider order entry system. The implementation of the electronic reconciliation tool has shown a reduction of the rate of discrepancies, decreasing from 7.24% (CI 95% 6.0–8.5) before the intervention to 4.18% (CI 95% 3.2–5.1) afterwards. Projects like this are costly, but this study has made it possible to detect numerous areas where interventions could be useful and proved the importance of a medication reconciliation programme.

To find out the impact of hepatic diseases on care activity at national and autonomous region level, and in a tertiary hospital with a Hepatology Department.An analysis was carried out on BMDS data (Basic Minimum Data Set) from 1999 to 2003. In the study of cases from the Gregorio Marañón Hospital, Madrid, data bases from the years 2000-2004 were used, and indicators were calculated, such as the percentages of digestive diseases of the total hospital discharges, of digestive diseases that were admitted into the Digestive Diseases Department, and of the total discharges form this Department that originated from hepatic diseases.Hepatic diseases represented around 23% of the hospital discharges generated by gastroenterology at national level and about the same at autonomous regional level. Hepatocellular carcinoma shows a slow and sustained increase, reaching 22.7% of discharges, due to hepatic disease, in 2003. The mortality specifically due to hepatic disease was around 12% in the year 2003. In the study carried out in a tertiary hospital, 21.2% of the total hospital discharges were due to digestive diseases, in the last year analysed. Only 12.48% of these had been admitted to the Digestive Diseases Department and more than 50% were attributed to Hepatology.Hepatology is a very important area of health care within Gastroenterology, showing a sustained growth in the last few years.

Objective To describe the incidence and epidemiological characteristics of hip fracture (HF) in patients aged 65 years or over in the various autonomous regions (AR) of Spain from the year 2000 to 2002 and to determine which factors affect in-hospital mortality. Methods Retrospective, observational study including all patients aged > 65 years with acute hip fracture in the 19 AR of Spain from 2000 to 2002. Data were obtained from the National Record of the Minimum Basic Data Set of the Ministry of Health. We analyzed the following: incidence rates (crude and age- and gender-adjusted rates) and incidence of hospital admission by season, length of hospital stay and in-hospital mortality. We used regression analysis to identify the factors that influenced in-hospital mortality. Results There were 107,718 cases of HF in patients aged > 65 years; of these, 74% were women, with a mean age of 79 years (SD 14). The crude incidence rate for HF was 511 cases per 100,000 > 65-year-old patients per year (265 cases per 100,000 men and 688 per 100,000 women and year). Incidence adjusted for age and gender was 503 cases per 100,000 inhabitants per year. Catalonia had the highest age-adjusted incidence and Galicia the lowest (623 and 317 cases per 100,000 inhabitants per year, respectively). Incidence rates increased from spring (24.1%) to winter (25.8%). The mean length of hospital stay was 15 days (SD 13). Seasonal influence and length of stay varied greatly between autonomous regions. While the overall in-hospital mortality rate was 5.3%, the rate for males was double that of females (8.9% and 4.8%, respectively), and in-hospital mortality increased with comorbidity (each point on the Charlson index increased mortality by 34.5%) was higher in winter (11% more risk compared to warmer seasons) and in cold climate regions (15% more risk compared to regions with a warm climate, i.e.: Catalonia, Valencia, Murcia, Andalusia, Balearic Islands and Canary Islands). Conclusions Hip fracture mainly affects elderly women and presents great variability in incidence, seasonality, length of hospital stay and mortality between the different autonomous regions in Spain. Elderly male patients with severe comorbid conditions, who are admitted in winter and in cold climate regions are more at risk of in-hospital mortality.