To test a new approach to characterise accessibility to tertiary care emergency health services in urban Cali and assess the links between accessibility and sociodemographic factors relevant to health equity.
The impact of traffic congestion on accessibility to tertiary care emergency departments was studied with an equity perspective, using a web-based digital platform that integrated publicly available digital data, including sociodemographic characteristics of the population and places of residence with travel times.
Cali, Colombia (population 2.258 million in 2020) using geographic and sociodemographic data. The study used predicted travel times downloaded for a week in July 2020 and a week in November 2020.
The share of the population within a 15 min journey by car from the place of residence to the tertiary care emergency department with the shortest journey (ie, 15 min accessibility rate (15mAR)) at peak-traffic congestion hours. Sociodemographic characteristics were disaggregated for equity analyses. A time-series bivariate analysis explored accessibility rates versus housing stratification.
Traffic congestion sharply reduces accessibility to tertiary emergency care (eg, 15mAR was 36.8% during peak-traffic hours vs 84.4% during free-flow hours for the week of 6–12 July 2020). Traffic congestion sharply reduces accessibility to tertiary emergency care. The greatest impact fell on specific ethnic groups, people with less educational attainment and those living in low-income households or on the periphery of Cali (15mAR: 8.1% peak traffic vs 51% free-flow traffic). These populations face longer average travel times to health services than the average population.
These findings suggest that health services and land use planning should prioritise travel times over travel distance and integrate them into urban planning. Existing technology and data can reveal inequities by integrating sociodemographic data with accurate travel times to health services estimates, providing the basis for valuable indicators.
This paper proposes a novel, trauma-informed, conceptual model of care for Post-Acute Sequelae of COVID-19 illness (PASC).
This paper describes essential elements, linkages and dimensions of the model that affect PASC patient experiences and the potential impact of trauma-informed care on outcomes.
PASC is a consequence of the global pandemic, and a new disease of which little is known. Our model was derived from the limited available studies, expert clinical experience specific to PASC survivors and publicly available social media narratives authored by PASC survivors.
The model provides a critical and novel framework for the understanding and care of persons affected by PASC. This model is aimed at the provision of nursing care, with the intention of reducing the traumatic impacts of the uncertain course of this disease, a lack of defined treatment options and difficulties in seeking care. The use of a trauma-informed care approach to PASC patients can enhance nurses' ability to remediate and ameliorate both the traumatic burden of and the symptoms and experience of the illness.
Applying a trauma-informed perspective to care of PASC patients can help to reduce the overall burden of this complex condition. Owing to the fundamentally holistic perspective of the nursing profession, nurses are best positioned to implement care that addresses multiple facets of the PASC experience.
The proposed model specifically addresses the myriad ways in which PASC may affect physical as well as mental and psychosocial dimensions of health. The model particularly seeks to suggest means of supporting patients who have already experienced a life-threatening illness and are now coping with its long-term impact. Since the scope of this impact is not yet defined, trauma-informed care for PASC patients is likely to reduce the overall health and systems burdens of this complex condition.
Objetivo: Demostrar que el uso de solución salina 0.9% es tan eficaz como la heparina sódica para mantener la permeabilidad y prevenir obstrucciones del catéter central de inserción periférica en pacientes oncológicos tratados con quimioterapia. Metodología: Estudio analítico de cohortes retrospectivo, en pacientes oncológicos portadores de un catéter central de inserción periférica para administración de quimioterapia ambulatoria en un hospital de Tarragona. Resultados: De los 103 pacientes estudiados, 4 presentaron obstrucción del catéter. La incidencia de obstrucción fue superior en catéteres heparinizados que en catéteres salinizados. Conclusión: La heparina sódica y la solución salina demuestran la misma eficacia para el mantenimiento de la permeabilidad del catéter y la prevención de obstrucciones. Además, es suficiente la salinización del catéter cada 3 semanas, suponiendo una disminución en el número de visitas al centro sanitario y, por consiguiente, una mejora en la calidad de vida de los pacientes.
To explore what it is like for children in the family setting to live with parental mental illness.
There are reported risks of negative social and behavioural outcomes among children living with parental mental illness such as poor school performance, isolation and poor mental health. There is yet more to know about how children's interactions with significant members of the family shape their experiences.
A phenomenological design following Husserl's concepts of lifeworld and inter-subjectivity was adapted for the study.
Twenty-one children (ages 10–17) who lived with a parent with mental illness were interviewed. The data were analysed to attain the essential features of the phenomenon. The study followed the COREQ checklist for qualitative studies.
The essence of the phenomenon ‘living with parental mental illness’ in the family setting comprises strain, sadness and some happy moments. Living with parental mental illness can produce unpredictable life situations for children as relationships and interactions in the family setting can be chaotic and confusing. The ups and downs define their lifeworld as a roller coaster. Strenuous family environment, sibling interaction, navigating separate living arrangements and there are good days were specific themes that clarified the children's lives as a roller coaster.
A concept called the ‘parent paradox’ is coined to reflect how children are torn between what their living situation looks like comparing the parent with mental illness and the other without mental illness. The paradox is founded on children's loyalty towards their parents.
To break the unhealthy cycle created by the parent paradox, mental health nurses should ensure that children are well informed about the parent's mental condition including information about treatment procedures and recovery. Child's psychological distress may be reduced when they are informed.
Restrictions due to the COVID-19 pandemic mandated fundamental changes to student evaluations, including the administration of the observed structured clinical examination (OSCE). This study aims to conduct an in-person OSCE to verify students’ practical skills under necessary infection control practices and the impact of face masks on student–patient interactions.
The OSCE at Medical School of Tuebingen takes place in October 2020.
A total of 149 students (third year of study) completed the survey (RR=80.1%). It was their first OSCE.
Primary outcome measure was how this type of OSCE was evaluated by participating students in regard to preparation, content and difficulty as well as in real life. Secondary outcome measures were how the implemented hygiene actions influenced the OSCE, including the interaction and communication between students and standardised patients (SPs). Items were rated on a 6-point Likert scale (1=completely to 6=not at all). Means, SDs, frequencies and percentages were calculated.
149 students, 32 SPs and 59 examiners participated. The students rated the OSCE with 2.37 (±0.52) for preparation and 2.07 (±0.32) for content. They perceived the interaction to be significantly disrupted by the use of face masks (3.03±1.54) (p
An in-person OSCE, even in the midst of a global pandemic, is feasible and acceptable to both students and faculty. When compared the students’ results to previous students’ results who completed the OSCE before the pandemic, the results indicated that students felt less prepared than under non-pandemic circumstances; however, their performances on this OSCE were not lower.
Objetivo principal: asociar comparativamente el riesgo de violencia de pareja y la dependencia afectiva con el diagnóstico de preeclampsia en gestantes que fueron atendidas en el Centro de Salud Santa Rosa en la ciudad de Riobamba, Ecuador, durante el período abril-agosto 2019. Metodología: se utilizó un diseño no experimental, de tipo correlacional, con 60 participantes divididas en dos grupos de estudio de 30 individuos cada uno. Los datos fueron recolectados mediante la aplicación de la Guía de evaluación de riesgos de agresión conyugal, Spouse Abuse Risk Assessment (SARA, por sus siglas en inglés) y el cuestionario de dependencia emocional (CDE). Resultados principales: en el grupo de preeclámticas predominaron aquellas con un alto nivel de riesgo de violencia en la pareja (56,7%) y el 90% fueron valoradas con elevado nivel de dependencia emocional. La distribución de los datos resultó normal. Las diferencias entre ambos grupos resultaron significativas bilateralmente (p=0,000), a partir de la prueba de T-Students. También, la relación resultó estadísticamente muy significativa (p≤0,01) según el test chi cuadrado. Conclusión principal: el diagnóstico de preeclampsia se relacionó significativamente con los niveles de dependencia emocional y riesgo de violencia. Además, se establecieron diferencias estadísticamente significativas entre ambos grupos estudiados, según los niveles de dependencia emocional y riesgo de violencia.
Intraoperative arterial hypotension is associated with poor postoperative outcomes. The Hypotension Prediction Index (HPI) developed using machine learning techniques, allows the prediction of arterial hypotension analysing the arterial pressure waveform. The use of this index may reduce the duration and severity of intraoperative hypotension in adults undergoing non-cardiac surgery. This study aims to determine whether a treatment protocol based on the prevention of arterial hypotension using the HPI algorithm reduces the duration and severity of intraoperative hypotension compared with the recommended goal-directed fluid therapy strategy and may improve tissue oxygenation and organ perfusion.
We will conduct a multicentre, randomised, controlled trial (N=80) in high-risk surgical patients scheduled for elective major abdominal surgery. All participants will be randomly assigned to a control or intervention group. Haemodynamic management in the control group will be based on standard haemodynamic parameters. Haemodynamic management of patients in the intervention group will be based on functional haemodynamic parameters provided by the HemoSphere platform (Edwards Lifesciences), including dynamic arterial elastance, dP/dtmax and the HPI. Tissue oxygen saturation will be recorded non-invasively and continuously by using near-infrared spectroscopy technology. Biomarkers of acute kidney stress (cTIMP2 and IGFBP7) will be obtained before and after surgery. The primary outcome will be the intraoperative time-weighted average of a mean arterial pressure
Ethics committee approval was obtained from the Ethics Committee of Hospital Gregorio Marañón (Meeting of 27 July 2020, minutes 18/2020, Madrid, Spain). Findings will be widely disseminated through peer-reviewed publications and conference presentations.
As part of the PIONEER Consortium objectives, we have explored which diagnostic and prognostic factors (DPFs) are available in relation to our previously defined clinician and patient-reported outcomes for prostate cancer (PCa).
We performed a systematic review to identify validated and non-validated studies.
MEDLINE, Embase and the Cochrane Library were searched on 21 January 2020.
Only quantitative studies were included. Single studies with fewer than 50 participants, published before 2014 and looking at outcomes which are not prioritised in the PIONEER core outcome set were excluded.
After initial screening, we extracted data following the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of prognostic factor studies (CHARMS-PF) criteria and discussed the identified factors with a multidisciplinary expert group. The quality of the included papers was scored for applicability and risk of bias using validated tools such as PROBAST, Quality in Prognostic Studies and Quality Assessment of Diagnostic Accuracy Studies 2.
The search identified 6604 studies, from which 489 DPFs were included. Sixty-four of those were internally or externally validated. However, only three studies on diagnostic and seven studies on prognostic factors had a low risk of bias and a low risk concerning applicability.
Most of the DPFs identified require additional evaluation and validation in properly designed studies before they can be recommended for use in clinical practice. The PIONEER online search tool for DPFs for PCa will enable researchers to understand the quality of the current research and help them design future studies.
There are no ethical implications.
To develop and psychometrically test a self-assessment tool that measures undergraduate nursing and midwifery students’ perceptions of spiritual care competence in health care practice.
Spiritual care is part of nurses/midwives’ responsibility. There is a need to better benchmark students’ competency development in spiritual care through their education. The EPICC Spiritual Care Education Standard served as groundwork for the development of the EPICC Spiritual Care Competency Self-Assessment Tool.
Cross sectional, mixed methods design. A STROBE checklist was used.
The Tool (available in English, Dutch and Norwegian) was developed by an international group. It was tested between July–October 2020 with a convenience sample of 323 nursing/midwifery students at eight universities in five countries. The Tool was tested for validity using Kaiser–Meyer–Olkin (KMO) test, exploratory and confirmatory factor analysis, one-way ANOVA and independent samples t test. The reliability was tested by Cronbach's alpha coefficient. Qualitative data were analysed using thematic analysis.
The KMO test for sampling adequacy was 0.90. All, but two, items were related to the same factor. Cronbach's alpha coefficient for the Tool was 0.91. Students found the Tool easy to use, and they gained new insights by completing it. However, students felt that some questions were repetitive and took time to complete.
The Tool has construct and discriminant validity, and high internal consistency (is reliable). In addition, students found the Tool useful, especially in early stages of education.
The Tool affords student nurses and midwives the opportunity to self-evaluate their knowledge, skills and attitudes about spirituality and spiritual care. The Tool offers students, educators and preceptors in clinical practice a tangible way of discussing and evaluating spiritual care competency.
Objetivo: Explorar los factores de la estigmatización social de las enfermeras de cuidados intensivos al inicio de la pandemia por Covid-19. Método: Estudio observacional exploratorio para comprobar los factores de la estigmatización social en enfermeras de cuidados intensivos que atendieron a pacientes con Covid-19 al inicio de la pandemia mediante muestreo no probabilístico. Se empleó el Cuestionario de Estigma Referenciado para Enfermeras en Cuidados Intensivos. Resultados: Participaron 135 enfermeras, 82,2 % mujeres, 85,9 % entre 25 y 44 años. Manifestaron como sintomatología asociada estrés (36,3 %), insomnio (32,6 %) y ansiedad (31,8 %). La escala mostró un coeficiente α Cronbach 0,866, un índice Kaiser Mayer Olkin 0,886, y Bartlett <0,001, con tres esferas de estigma social que alcan-zaron el 61,71 % de la variabilidad del constructo: Aislamiento Social, Exposición a SARS-Cov-2 y Vulnerabilidad profesional. Conclusiones: La vulnerabilidad profesional se asienta sobre el estrés, la sensación de fragilidad o la preocupación por el contagio, presentándose sentimientos ambivalentes. El aislamiento social estaría causado por las actitudes negativas sociales que provocan estereotipos. El estigma social se presenta en el contexto de atención a pacientes con enfermedades infectocontagiosas emergentes.
Peer-to-peer (PTP) HIV self-testing (HIVST) distribution models can increase uptake of HIV testing and potentially create demand for HIV treatment and pre-exposure prophylaxis (PrEP). We describe the acceptability and experiences of young women and men participating in a cluster randomised trial of PTP HIVST distribution and antiretroviral/PrEP promotion in rural KwaZulu-Natal.
Between March and September 2019, 24 pairs of trained peer navigators were randomised to two approaches to distribute HIVST packs (kits+HIV prevention information): incentivised-peer-networks where peer-age friends distributed packs within their social network for a small incentive, or direct distribution where peer navigators distributed HIVST packs directly. Standard-of-care peer navigators distributed information without HIVST kits. For the process evaluation, we conducted semi-structured interviews with purposively sampled young women (n=30) and men (n=15) aged 18–29 years from all arms. Qualitative data were transcribed, translated, coded manually and thematically analysed using an interpretivist approach.
Overall, PTP approaches were acceptable and valued by young people. Participants were comfortable sharing sexual health issues they would not share with adults. Coupled with HIVST, peer (friends) support facilitated HIV testing and solidarity for HIV status disclosure and treatment. However, some young people showed limited interest in other sexual health information provided. Some young people were wary of receiving health information from friends perceived as non-professionals while others avoided sharing personal issues with peer navigators from their community. Referral slips and youth-friendly clinics were facilitators to PrEP uptake. Family disapproval, limited information, daily pills and perceived risks were major barriers to PrEP uptake.
Both professional (peer navigators) and social network (friends) approaches were acceptable methods to receive HIVST and sexual health information. Doubts about the professionalism of friends and overly exclusive focus on HIVST information materials may in part explain why HIVST kits, without peer navigators support, did not create demand for PrEP.
To synthesise the evidence on the role of compositional or contextual characteristics of schools in the association between students' socioeconomic position and their health in primary and secondary education in developed economies.
Scoping review. We included studies examining the role of at least one school or class characteristic on students’ health inequalities and was published since 1 January 2000, in English or German. We searched PubMed/Medline, Web of Science and Education Resources Information Center. We provided a narrative synthesis and an overview of findings. School characteristics were grouped into five broad categories: school composition, school climate, school policies and organisation, food environment and facilities.
Of 8520 records identified, 26 studies were included. Twelve studies found a moderating and 3 a mediating effect. The strongest evidence came from studies examining the moderating effect of school composition, that is, the negative impact of a low individual socioeconomic position on mental health and well-being was aggravated by a low average socioeconomic position of schools. Evidence concerning the role of school climate, school stratification (eg, performance base tracking) and sponsorship, food environment and sport facilities and equipment was generally weak or very weak and mostly based on singular findings. Overall, favourable meso-level characteristics mitigated the negative impact of low individual socioeconomic position on health outcomes.
School characteristics affect health inequalities in children and adolescents to some degree, but future research is necessary to strengthen the existing evidence and address under-represented aspects in school characteristics and health outcomes.
To investigate alcohol use recording in people with newly diagnosed depression in English primary care and individual characteristics associated with the recording of alcohol use.
A population-based cross-sectional study.
Primary care data from English practices contributing to the UK Clinical Practice Research Datalink.
We included adults (18+ years) diagnosed with depression between 1 January 2011 and 1 January 2017 without previous antidepressant use and at least 1 year of registration before diagnosis.
We described the proportion of individuals with alcohol use and level of alcohol use recorded at four time points (the date of depression diagnosis, 3 months before or after depression diagnosis, 12 months before or after depression diagnosis and any point pre or postdepression diagnosis). We used logistic regression to investigate individual characteristics associated with alcohol use recording in the 3 months before or after depression diagnosis.
We identified 36 424 adults with depression. 538 (2%) had alcohol use recorded in the 3 months before or after depression diagnosis using formal validated methods such as the Alcohol Use Disorders Identification Test and its abbreviated versions. At each time point, most individuals with alcohol use recorded were low risk drinkers. Alcohol use recording in the 3 months before or after depression diagnosis was associated with male sex (OR=1.38, 95% CI 1.29 to 1.48) and several other individual-level factors.
Our study shows low levels of alcohol use recording in the 3 months before or after depression diagnosis. Levels of alcohol use recording varied depending on individual characteristics. Incentivised recording of alcohol use will increase completeness, which could improve clinical management and reduce missed opportunities for care in people with depression.
Stroke rehabilitation guidelines suggest a high-frequency task-oriented training at high intensity. A targeted and self-paced daily training with intermittent supervision is recommended to improve patients’ self-management and functional output. So far, there is conflicting evidence concerning the most effective home-training delivery method.
The purpose of this pilot study is to compare the feasibility and preliminary effects of task-oriented home-exercises in patients in the subacute stage after stroke. Twenty-four patients will be randomised (1:1) to a Video group (a) or Paper group (b) of an individualised, task-oriented home-training (50 min, 6x/week, for 4 weeks) based on Wulf and Lewthwaite’s Optimizing Performance Through Intrinsic Motivation and Attention for Learning theory of motor learning. Patient-relevant goals will be identified using Goal Attainment Scaling and exercises progressively adapted. Semistructured interviews and a logbook will be used to monitor adherence, arm use and acceptability. Primary outcome will be the feasibility of the methods and a full-scale trial employing predefined feasibility criteria (recruitment, retention and adherence rates, patients’ satisfaction with the home-exercise programme and their progress, affected hand use and acceptance of the intervention). Assessed at baseline, post intervention and 4-week follow-up, secondary outcomes include self-perceived hand and arm use, actual upper extremity function and dexterity, hand strength, independence in activities of daily living and health-related quality of life. Interview data will be analysed using qualitative content analysis. Medians (ranges) will be reported for ordinal data, means (SD) for continuous and frequency (percentage) for nominal data.
This study follows the Standard Protocol Items: Recommendations for Interventional Trials-Patient-Reported Outcome (PRO) Extension guideline. Ethical approval was received from the Ethics Committee of the Medical University of Innsbruck, Austria (1304/2020). Written informed consent will be obtained from all participants prior to data collection. Study results will be disseminated to participating patients, patient organisations, via the clinic’s homepage, relevant conferences and peer-reviewed journals.
Study protocol, second revision, 5 December 2021.
The purpose of this study is to assess the ability of two new ECG markers (Regional Repolarisation Instability Index (R2I2) and Peak Electrical Restitution Slope) to predict sudden cardiac death (SCD) or ventricular arrhythmia (VA) events in patients with ischaemic cardiomyopathy undergoing implantation of an implantable cardioverter defibrillator for primary prevention indication.
Multicentre Investigation of Novel Electrocardiogram Risk markers in Ventricular Arrhythmia prediction is a prospective, open label, single blinded, multicentre observational study to establish the efficacy of two ECG biomarkers in predicting VA risk. 440 participants with ischaemic cardiomyopathy undergoing routine first time implantable cardioverter-defibrillator (ICD) implantation for primary prevention indication are currently being recruited. An electrophysiological (EP) study is performed using a non-invasive programmed electrical stimulation protocol via the implanted device. All participants will undergo the EP study hence no randomisation is required. Participants will be followed up over a minimum of 18 months and up to 3 years. The first patient was recruited in August 2016 and the study will be completed at the final participant follow-up visit. The primary endpoint is ventricular fibrillation or sustained ventricular tachycardia
Ethical approval has been granted by Research Ethics Committees Northern Ireland (reference no. 16/NI/0069). The results will inform the design of a definitive Randomised Controlled Trial (RCT). Dissemination will include peer reviewed journal articles reporting the qualitative and quantitative results, as well as presentations at conferences and lay summaries.
La unidad de cuidado intensivo es un servicio especializado de alta complejidad en el cual se hace necesario una interacción constante entre la enfermera y el equipo interdisciplinario de salud. En este contexto las enfermeras identifican a la ronda interdisciplinaria como un mecanismo para comunicarse y establecer planes de cuidados.
Objetivo: Presentar la categoría: Ronda interdisciplinaria: acto de mayor interacción entre la enfermera y el equipo de salud.
Metodología: Estudio cualitativo con las herramientas analíticas de la Teoría Fundamentada según Corbin y Strauss, realizado con enfermeras de una unidad de cuidado Intensivo adulto a través de entrevista en profundidad.
Resultados: La ronda interdisciplinaria es uno de los encuentros de mayor interacción entre la enfermera y el equipo de salud, es un espacio académico alrededor del cuidado en el cual es reconocido el saber y labor de enfermería buscando valorar y tomar decisiones para los pacientes.
Conclusiones: Las enfermeras consideran que la ronda interdisciplinaria promueve la comunicación con el equipo de salud. Es una rutina clínica formal y programada en la cual cada disciplina tiene la oportunidad de intervenir desde sus conocimientos y experiencias.
En la Fundación Cardioinfantil Instituto de Cardiología (FCI -IC), que es un Hospital Universitario colombiano de alta complejidad, se identificó que el trabajo en alianza docencia – asistencia para el desarrollo de un modelo de cuidado podría mejorar la práctica de enfermería en sus diferentes roles. Con el objetivo de describir el desarrollo conceptual logrado, el presente artículo documenta cada una de las fases de desarrollo del modelo que incluyeron: la revisión de antecedentes institucionales en el empleo de modelos conceptuales de enfermería; la revisión de literatura mundial sobre los modelos de práctica para enfermería; y la construcción colectiva del modelo de enfermería; y la validación interna y externa de dicho modelo. El Modelo de enfermería para fortalecer la capacidad de cuidado FCI – IC, responde a lecciones aprendidas a nivel interno y externo; su desarrollo es coherente con el estado del arte y su contenido refleja tanto el consenso institucional como la derivación teórica lograda a partir de la identificación de los conceptos paradigmáticos y supuestos de cuidado, ajustados durante la validación. Este modelo ha permitido mayor apropiación y liderazgo de enfermería en la práctica, a la que se espera aportar indicadores que permitan evaluar los diferentes roles.
Un fenómeno no puede ser comprendido sin la experiencia de quien lo vive. Pero, ¿cómo acercarse a la realidad de otra persona sin comprometer su privacidad? El Relato Biográfico es la herramienta que nos ayuda a conocer lo cotidiano, es decir, las ocurrencias en el espacio en el que una persona vivencia su realidad. Se trata de un diseño propio de la investigación cualitativa, que se inscribe dentro de los métodos biográficos. Pero también es un formato de artículo que cada vez está más presente en las revistas científicas. De hecho, este tipo de publicación ha crecido notablemente en el ámbito de la salud, habiéndose favorecido por el desarrollo de herramientas metodológicas y la creación revistas especializadas en investigación cualitativa, como Archivos de la Memoria, que cuenta con una sección específica. El Relato Biográfico devuelve el protagonismo al sujeto, pues obliga al investigador a reposar en una narrativa expresada en primera persona por aquella que ha experimentado la vivencia, ayudando a comprender los fenómenos en función de la manera en que esta conceptualiza y clasifica su mundo. Precisamente, por el interés que despierta el Relato biográfico como método para analizar la experiencia vivida, resulta pertinente esquematizar el proceso de investigación que nos lleva hasta el informe final que va a ser publicado. Esta guía breve proponemos una manera sencilla de hacerlo en forma de decálogo [fragmento del contenido].
To estimate the frequency of chronic conditions and geriatric syndromes in older patients admitted to hospital because of an exacerbation of their chronic conditions, and to identify multimorbidity clusters in these patients.
Multicentre, prospective cohort study.
Internal medicine or geriatric services of five general teaching hospitals in Spain.
740 patients aged 65 and older, hospitalised because of an exacerbation of their chronic conditions between September 2016 and December 2018.
Active chronic conditions and geriatric syndromes (including risk factors) of the patient, a score about clinical management of chronic conditions during admission, and destination at discharge were collected, among other variables. Multimorbidity patterns were identified using fuzzy c-means cluster analysis, taking into account the clinical management score. Prevalence, observed/expected ratio and exclusivity of each chronic condition and geriatric syndrome were calculated for each cluster, and the final solution was approved after clinical revision and discussion among the research team.
740 patients were included (mean age 84.12 years, SD 7.01; 53.24% female). Almost all patients had two or more chronic conditions (98.65%; 95% CI 98.23% to 99.07%), the most frequent were hypertension (81.49%, 95% CI 78.53% to 84.12%) and heart failure (59.86%, 95% CI 56.29% to 63.34%). The most prevalent geriatric syndrome was polypharmacy (79.86%, 95% CI 76.82% to 82.60%). Four statistically and clinically significant multimorbidity clusters were identified: osteoarticular, psychogeriatric, cardiorespiratory and minor chronic disease. Patient-level variables such as sex, Barthel Index, number of chronic conditions or geriatric syndromes, chronic disease exacerbation 3 months prior to admission or destination at discharge differed between clusters.
In older patients admitted to hospital because of the exacerbation of chronic health problems, it is possible to define multimorbidity clusters using soft clustering techniques. These clusters are clinically relevant and could be the basis to reorganise healthcare circuits or processes to tackle the increasing number of older, multimorbid patients.