https://hdl.handle.net/2072/451660 Mon, 06 Apr 2026 23:29:25 GMT 2026-04-06T23:29:25Z https://hdl.handle.net/11351/13942 Emergency Department Reconsultations After a Secondary Prevention Bundle for Medication-Related Problems: A Retrospective Cohort Study Plaza Diaz, Adrian; Juanes Borrego, Ana; Sanz-Lopez, Natalia; González Bueno, Javier; Fernández-Morató, Jordi; Garcia-Pelaez, Milagros Drug-related problems; Emergency department; Older adults; Readmission; Secondary prevention; Problemas relacionados con medicamentos; Servicio de urgencias; Reingreso; Prevención secundaria; Problemes relacionats amb medicaments; Servei d'urgències; Reingrés; Prevenció secundària; Background/Objective: Drug-related problems (DRPs) are a common, potentially avoidable cause of emergency department (ED) use. In December 2022, our hospital integrated a pharmacist-led intervention into routine ED practice. This intervention comprised medication optimization, adherence counseling, and coordinated hand-off to primary care. We quantified 30- and 90-day reconsultations after discharge and explored factors associated with DRP-related revisits. Methods: A retrospective cohort of adults (≥18 years) who attended a tertiary ED (Barcelona, Spain). We included index DRP visits from 1 December 2022 to 30 June 2024. All received the bundle. Demographic, clinical, and pharmacotherapeutic data were extracted from the Catalan Shared Health Record; an independent committee classified revisits as a DRP or non-DRP. Predictors of 30-day DRP revisits were assessed with multivariable logistic regression. Results: Among 1247 patients (mean age 78.6 ± 16.2 years; 59.2% women; and median nine drugs), 120 (9.6%) reconsulted the ED within 30 days, and 194 (15.5%) within 90 days for any cause. DRP-specific rates were 30.8% (37/120) at 30 days and 26.3% (51/194) at 90 days; 81% and 80% of these revisits, respectively, involved a recurrence of the same DRP. The most frequent index DRPs were constipation (14.2%), gastrointestinal bleeding (9.2%), hypertension (8.3%), seizures (8.3%) and hyponatraemia (6.7%). An age ≥ 80 years independently predicted fewer 30-day DRP revisits (OR 0.32; 95% CI 0.13-0.79); hypertension and cognitive impairment were not significant after adjustment. Conclusions: In this single-arm implementation cohort, overall, 30-day ED reconsultations were 9.6% and about one-third were DRP-related, predominantly recurrences, and chiefly gastrointestinal bleeding and seizures. These descriptive findings should be interpreted cautiously given potential survivorship bias and residual confounding; the apparently lower risk among patients aged ≥ 80 years is hypothesis-generating and may reflect geriatric care pathways and caregiver engagement. Targeted post-discharge monitoring for high-recurrence DRPs may help reduce avoidable ED use, and future evaluations should test this in quasi-experimental or randomized designs. Mon, 27 Oct 2025 13:44:32 GMT https://hdl.handle.net/11351/13942 2025-10-27T13:44:32Z https://hdl.handle.net/11351/10146 Importance of physical exercise prescription in patients with chronic kidney disease: results of the survey of the Grupo Español Multidisciplinar de Ejercicio Físico en el Enfermo Renal [Spanish Multidisciplinary Group of Physical Exercise in Kidney Patients] (GEMEFER); Importancia de la prescripción de ejercicio físico en pacientes con enfermedad renal crónica: resultados de la encuesta del Grupo Español Multidisciplinar de Ejercicio Físico en el Enfermo Renal (GEMEFER) Villanego Fernández, Florentino; Arroyo, David; Martínez-Majolero, Víctor; Hernández-Sánchez, Sonsoles; Esteve Simó, Vicent Diàlisi; Exercici; Insuficiència renal crònica; Diálisis; Ejercicio físico; Insuficiencia renal crónica; Dialysis; Exercise; Chronic renal failure; Introduction: Despite the benefits of physical exercise (PE) for patients with chronic kidney disease (CKD), the number of Nephrology services that have PE programs is limited. Objectives: To describe the degree of knowledge of PE benefits in patients with CKD among professionals, as well as the level of implementation and characteristics of PE programs in Nephrology services in Spain. Methods: A questionnaire on the degree of knowledge and prescription of PE in patients with CKD was designed and sent to members of the Spanish Nephrology and Nephrology Nursing Societies, as well as to physiotherapists and professionals in the Sciences of Physical Activity and Sport (PASS). Results: 264 professionals participated. 98.8% agreed on the importance of prescribing PE, but only 20.5% carry out an assessment of functional capacity and 19.3% have a PE program for patients with CKD in their centre. The most frequent programs are performed for haemodialysis patients and strength and aerobic resistance exercises are combined. A physiotherapist or a PASS usually participates in its prescription. The main barriers were the absence of human and/or physical resources and the lack of training. Conclusions: Healthcare workers know the benefits of PE in patients with CKD. However, the implementation of these programs in Spain is low, motivated by the lack of resources and training of professionals. We must establish strategies to guarantee an adequate functional capacity within the care of our patients.; Introducción: A pesar de los beneficios del ejercicio físico (EF) para pacientes con enfermedad renal crónica (ERC), el número de servicios de Nefrología que han implementado programas de EF es limitado. Objetivos: Describir el grado de conocimiento del EF en pacientes con ERC entre los profesionales, así como el nivel de implementación y las características de los programas de EF en los servicios de Nefrología en España. Métodos: Se diseñó un cuestionario sobre el grado de conocimiento y de prescripción del EF en pacientes con ERC que se envió a los socios de la Sociedad Española de Nefrología y de la Sociedad Española de Enfermería Nefrológica, así como a fisioterapeutas y profesionales de las Ciencias de la Actividad Física y del Deporte (CAFyD). Resultados: Participaron 264 profesionales. El 98,8% coincidían en la importancia de prescribir EF, pero solo el 20,5% realizan una valoración de la capacidad funcional y solo el 19,3% disponen de un programa de EF para pacientes con ERC en su centro. Los programas más frecuentes están dirigidos a pacientes en hemodiálisis y combinan ejercicios de fuerza y de resistencia aeróbica. En la prescripción habitualmente interviene un fisioterapeuta o un CAFyD. Las principales barreras fueron la ausencia de recursos humanos y/o físicos y la falta de formación. Conclusiones: Los profesionales sanitarios conocen los beneficios del EF en el paciente renal. Sin embargo, la implementación de estos programas en España es baja, debido a la falta de recursos y a la falta de formación de los profesionales. Debemos establecer estrategias para garantizar una adecuada capacidad funcional dentro de los cuidados de nuestros pacientes. Thu, 24 Aug 2023 08:15:22 GMT https://hdl.handle.net/11351/10146 2023-08-24T08:15:22Z https://hdl.handle.net/11351/9930 Nationwide COVID-19-EII Study: Incidence, Environmental Risk Factors and Long-Term Follow-Up of Patients with Inflammatory Bowel Disease and COVID-19 of the ENEIDA Registry Marín-Jiménez, Ignacio; Rodríguez - Lago, Iago; Martín-Arranz, María Dolores; Guerra, Iván; Mena, Raquel; Zabana, Yamile; PIQUERAS CANO, MARTA; Vera, Isabel COVID-19; SARS-CoV-2; inflammatory bowel disease; COVID-19; SARS-CoV-2; Malaltia inflamatòria intestinal; COVID-19; SARS-CoV-2; Enfermedad inflamatoria intestinal; We aim to describe the incidence and source of contagion of COVID-19 in patients with IBD, as well as the risk factors for a severe course and long-term sequelae. This is a prospective observational study of IBD and COVID-19 included in the ENEIDA registry (53,682 from 73 centres) between March-July 2020 followed-up for 12 months. Results were compared with data of the general population (National Centre of Epidemiology and Catalonia). A total of 482 patients with COVID-19 were identified. Twenty-eight percent were infected in the work environment, and 48% were infected by intrafamilial transmission, despite having good adherence to lockdown. Thirty-five percent required hospitalization, 7.9% had severe COVID-19 and 3.7% died. Similar data were reported in the general population (hospitalisation 19.5%, ICU 2.1% and mortality 4.6%). Factors related to death and severe COVID-19 were being aged ≥ 60 years (OR 7.1, 95% CI: 1.8-27 and 4.5, 95% CI: 1.3-15.9), while having ≥2 comorbidities increased mortality (OR 3.9, 95% CI: 1.3-11.6). None of the drugs for IBD were related to severe COVID-19. Immunosuppression was definitively stopped in 1% of patients at 12 months. The prognosis of COVID-19 in IBD, even in immunosuppressed patients, is similar to that in the general population. Thus, there is no need for more strict protection measures in IBD. Thu, 29 Jun 2023 09:15:22 GMT https://hdl.handle.net/11351/9930 2023-06-29T09:15:22Z https://hdl.handle.net/11351/7109 Critical appraisal of international guidelines for the management of fecal incontinence in adults: is it possible to define what to do in different clinical scenarios? Baanante, Juan Carlos; Navarro-Luna, Albert; Muñoz-Duyos, Arantxa; Lagares-Tena, Laura; Ribas, Yolanda Faecal incontinence; Treatment algorithm; Guidelines; Review; Incontinencia fecal; Algoritmo de tratamiento; Guias; Revisión; Incontinència fecal; Algorisme de tractament; Guies; Revisió; Fecal incontinence (FI) is a complex often multifactorial functional disorder which is associated with a significant impact on patients’ quality of life. There is a broad spectrum of symptoms, and degrees of severity and diverse patient backgrounds. Several treatment algorithms from different professional societies and experts are available in the literature. However, no consensus has been reached on several aspects of FI management. We performed a critical review of the most recently pub- lished guidelines on FI, emphasising the lack of consensus, highlighting specific topics mentioned in each of the guidelines that are not covered in the others and defining the treatment proposed in different clinical scenarios. Thu, 03 Mar 2022 12:07:34 GMT https://hdl.handle.net/11351/7109 2022-03-03T12:07:34Z