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      Características clínicas y epidemiológicas de los pacientes ingresados en la Unidad de Hospitalización Domiciliaria del Hospital Regional de Talca durante el año 2019 Translated title: Clinical and Epidemiological Characteristics of the patients admitted to the Hospital at Home unit of the Regional Hospital of Talca during the year 2019

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          Abstract

          Resumen Introducción: La hospitalización domiciliaria nace como un servicio que proporciona intervenciones agudas, domiciliarias y complejas a corto plazo. En el Hospital Regional de Talca esta unidad tiene 7 años, este estudio busca determinar en la población que ingresa a la unidad, características clínicas y comorbilidades. Método: Estudio retrospectivo, analítico descriptivo, información recolectada mediante entrevista, se recolectan datos durante el año 2019, con un análisis descriptivo de las variables del estudio, las variables continuas se describieron como media y desviaciones estándar, las variables categóricas como frecuencias absolutas y porcentajes, para el análisis estadístico se usó Microsoft Excel 2016. Resultados: La Unidad de Hospitalización Domiciliaria durante el año 2019 ingresa 484 pacientes, representando un aumento del 233,8%. Dentro de las variables del estudio, el mes con más ingresos fue julio con 50 pacientes, la edad promedio son 64,9 años (DE 3,34 años), sexo femenino (60,95%), Casados (47,3%), no realizaban actividad física (76,5%), con Índice de Masa Corporal (IMC) normal (34,7%), dentro de las comorbilidades tuvo mayor incidencia la hipertensión arterial (HTA) y diabetes mellitus (DM) con 329 y 209 diagnósticos respectivamente, la patología más derivada fueron las infecciones urinarias (32,2%). Conclusiones: el presente trabajo muestra la variabilidad de los pacientes ingresados, se redujeron los costos y la menor utilización de insumos médicos, mejora de la actividad física y reducción de la discapacidad adquirida, disminuye la readmisión, siendo una modalidad de atención eficaz, eficiente, segura, con una alta tasa de satisfacción sin mermar la calidad y la seguridad del paciente.

          Translated abstract

          Abstract Introduction: Home hospitalization was born as a service that provides acute, home and complex interventions in the short term. In the Regional Hospital of Talca this unit is 7 years old, this study seeks to determine in the population that enters the unit, clinical characteristics and comorbidities. Method: Retrospective, descriptive analytical study, information collected by interview, data are collected during the year 2019, with a descriptive analysis of the study variables, continuous variables were described as mean and standard deviations, categorical variables as absolute frequencies and percentages, for the statistical analysis was used Microsoft Excel 2016 Results: The Home Hospitalization Unit during 2019 admitted 484 patients, representing an increase of 233.8%. Within the study variables, the month with the most admissions was July with 50 patients, the average age was 64.9 years (SD 3.34 years), female (60.95%), Married (47.3%) , did not perform physical activity (76.5%), with normal BMI (34.7%), within the comorbidities, HT and DM had a higher incidence with 329 and 209 diagnoses respectively, the most derived pathology was urinary infections (32.2%). Conclusions: The present work shows the variability of admitted patients, reduced costs and less use of medical supplies, improved physical activity and reduced acquired disability, decreased readmission, being an effective, efficient, safe care modality, with a high satisfaction rate without compromising quality and patient safety.

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          Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial

          The Hygia Chronotherapy Trial, conducted within the clinical primary care setting, was designed to test whether bedtime in comparison to usual upon awakening hypertension therapy exerts better cardiovascular disease (CVD) risk reduction. In this multicentre, controlled, prospective endpoint trial, 19 084 hypertensive patients (10 614 men/8470 women, 60.5 ± 13.7 years of age) were assigned (1:1) to ingest the entire daily dose of ≥1 hypertension medications at bedtime (n = 9552) or all of them upon awakening (n = 9532). At inclusion and at every scheduled clinic visit (at least annually) throughout follow-up, ambulatory blood pressure (ABP) monitoring was performed for 48 h. During the 6.3-year median patient follow-up, 1752 participants experienced the primary CVD outcome (CVD death, myocardial infarction, coronary revascularization, heart failure, or stroke). Patients of the bedtime, compared with the upon-waking, treatment-time regimen showed significantly lower hazard ratio—adjusted for significant influential characteristics of age, sex, type 2 diabetes, chronic kidney disease, smoking, HDL cholesterol, asleep systolic blood pressure (BP) mean, sleep-time relative systolic BP decline, and previous CVD event—of the primary CVD outcome [0.55 (95% CI 0.50–0.61), P < 0.001] and each of its single components (P < 0.001 in all cases), i.e. CVD death [0.44 (0.34–0.56)], myocardial infarction [0.66 (0.52–0.84)], coronary revascularization [0.60 (0.47–0.75)], heart failure [0.58 (0.49–0.70)], and stroke [0.51 (0.41–0.63)]. Routine ingestion by hypertensive patients of ≥1 prescribed BP-lowering medications at bedtime, as opposed to upon waking, results in improved ABP control (significantly enhanced decrease in asleep BP and increased sleep-time relative BP decline, i.e. BP dipping) and, most importantly, markedly diminished occurrence of major CVD events. ClinicalTrials.gov, number NCT00741585.
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            Clinical characteristics of hospitalized and home isolated COVID-19 patients with type 1 diabetes

            Background and aims To elucidate the clinical features of COVID-19 patients with type 1 diabetes (T1D) under hospitalization and home isolation conditions. Method This retrospective study was conducted among 32 patients with COVID-19 and T1D, who sought treatment at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia between May 01, 2020 and July 30, 2020. Patients data were extracted from electronic medical records. Results Of the total of 32 COVID-19 patients with T1D, 21.9% required hospitalization, while 78.1% underwent home isolation. Among the study population, 9.4% (3/32) were reported to have hypertension, 21.9% (7/32) had chronic pulmonary disease (CPD), 18.8% (6/32) had thyroid disorders, and 18.8% (6/32) had the celiac disease. Among patients with chronic kidney disease (CKD), 68.8% (22/32) of them were reported have CKD 1, 28.1% (9/32) had CKD II and 3.1% (1/32) had end-stage renal failure. The most common symptoms observed among the hospitalized patients were nausea and vomiting (71.4%; 5/7), followed by fever (57.1%; 4/7), cough (42.8%; 3/7), sore throat (42.8%; 3/7), abdominal pain (42.8%; 3/7) and dyspnea (42.%; 3/7). The most common reasons for hospitalization were diabetic ketoacidosis (71.4%; 5/7) followed by bacterial pneumonia (14.3%; 1/7), fever (14.3%; 1/7), sore throat (14.3%; 1/7), severe hyperglycemia (14.3%; 1/7) and COVID-19 pneumonia (14.3%; 1/7). Except the severity of COVID-19 disease (p = 0.0001), none of the demographic and clinical parameters indicated statistically significant differences between patients requiring hospitalization and home isolation. Conclusion Majority of the COVID-19 patients with T1D recovered with conservative treatment at home. Diabetic ketoacidosis was the most common reason for hospitalization.
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              Effects of 12-month home-based physiotherapy on duration of living at home and functional capacity among older persons with signs of frailty or with a recent hip fracture - protocol of a randomized controlled trial (HIPFRA study)

              Background Health concerns, such as frailty and osteoporotic fractures decrease functional capacity and increase use of health and social care services in the aging population. The ability to continue living at home is dependent on functional capacity, which can be enhanced by rehabilitation. We study the effects of a 12-month home-based physiotherapy program with 12-month follow-up on duration of living at home, functional capacity, and the use of social and health care services among older persons with signs of frailty, or with a recently operated hip fracture. Methods This is a non-blinded, parallel group, randomized controlled trial performed in South Karelia Social and Health Care District, Finland (population 131,000). Three hundred community-dwelling older persons with signs of frailty (age ≥ 65) and 300 persons with a recent hip fracture (age ≥ 60) will be recruited. Frailty is screened by FRAIL questionnaire and verified by modified Fried’s frailty criteria. Both patient groups will be randomized separately to a physiotherapy and a usual care arm. Individualized, structured and progressive physiotherapy will be carried out for 60 min, twice a week for 12 months at the participant’s home. The primary outcome at 24 months is duration of living at home. Our hypothesis is that persons assigned to the physiotherapy arm will live at home for six months longer than those in the usual care arm. Secondary outcomes are functional capacity, frailty status, health-related quality-of-life, falls, use and costs of social and health care services, and mortality. Assessments, among others Short Physical Performance Battery, Functional Independence Measure, Mini Nutritional Assessment, and Mini-Mental State Examination will be performed at the participant’s home at baseline, 3, 6, and 12 months. Register data on the use and costs of social and health care services, and mortality will be monitored for 24 months. Discussion Our trial will provide new knowledge on the potential of intensive, long-term home-based physiotherapy among older persons at risk for disabilities, to enhance functional capacity and thereby to postpone the need for institutional care, and diminish the use of social and health care services. Trial registration ClinicalTrials.gov Identifier: NCT02305433, Registered Nov 28, 2014.
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                Author and article information

                Journal
                had
                Hospital a Domicilio
                Hosp. domic.
                Centro Internacional Virtual de Investigación en Nutrición (CIVIN) (Alicante, Alicante, Spain )
                2530-5115
                March 2022
                : 6
                : 1
                : 11-26
                Affiliations
                [1] Talca orgnameHospital Regional de Talca Dr. César Garavagno Burotto orgdiv1Servicio de Salud del Maule orgdiv2Unidad de Hospitalización Domiciliaria Chile
                Article
                S2530-51152022000100011 S2530-5115(22)00600100011
                10.22585/hospdomic.v6i1.143
                b92539d7-6170-46e2-8b26-b4e2b0654cff

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 30 July 2021
                : 13 November 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 16
                Product

                SciELO Spain

                Categories
                Artículos originales

                Home Care Services,Epidemiología,Características de la Población,Signos y Síntomas,Servicios de Atención de Salud a Domicilio,Epidemiology,Population Characteristics,Signs and Symptoms

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