Profile of users receiving Speech-Language Therapy service at a Critical Patient Unit

ABSTRACT Objective: to describe the profile of patients treated by Speech-Language therapists in a Critical Patient Unit. Methods: an ex post facto, observational and descriptive study was carried out. Monthly statistical data of patients hospitalized in the period January-December 2018 were analyzed, in the Intensive Care Unit at a public hospital. Data were described from the analysis of frequency and measures of central tendency. The distribution of the variables was determined through the skewness-kurtosis test, considering a significance level of p<0.05. Results: 217 individuals got 868 speech-language therapy services. Men (57.26%), older than 65 years old, required a more frequent intervention. The main medical diagnosis of admission to the unit corresponded to non-specific pathologies (57.14%), respiratory disease (15.21%) and cerebrovascular disease (12.79%). The speech-language therapy functions were related to the evaluation of swallowing (54.31%) and voice (32.4%). In relation to the intervention, the treatment of dysphagia (25.82%) and oral motor functions (25.04%) was predominant in the duties. Functions associated with language, speech and cognition were secondary. Conclusion: the profile of the critical patient and the speech-language therapy work in this field represent a first step to characterize the role of the speech-language therapist in Intensive Medicine teams.

Ethical aspects of dying and death in clinical practice in anaesthesiology and intensive medicine departments

In clinical practice, modern medicine, especially intensive medicine, has made outstanding technological progress that has changed diagnostic and therapeutic paradigms. Nowadays, some patients for whom there were no treatments in the past not only survive but return to active life thanks to intensive medicine. However, in some cases intensive care will not help patients in a critical condition and merely prolong death. In such situations, the treatment is terminated or not extended, and the patient is allowed to die in dignity. In this specific situation all intensive procedures are terminated. Palliative care is the next stage. This is a sensitive issue that should be discussed with healthcare professionals and experts from other areas of life to ensure it is communicated appropriately to patients and their relatives.

Age factor and COVID-19 potential ethical and unethical issues

The presentation of ethical guidelines by various scientific societies during the scenario of the COVID-19 pandemic in Spain is surprising when evidencing proposals for treatment and support due to "age ranges" that could be ethically unfair or at least not clearly understandable for the older group, unlike other guides such as the American and European Society for Critical Care and Intensive Medicine. Terms such as distributive justice, prioritization without paternalistic interference, introduction of strategies that maximize survival to hospital discharge, and the number of years of life saved are discussed during the presentation.The aim of this presentation is to clarify different ethical aspects about the elderly patients in the time of being admitted in the ICU during COVID-19 scenario.

All for One and One for All: Voluntary Physicians in the Intensive Medicine Units During the COVID-19 Outbreak in Spain

ABSTRACT Objectives: Our purpose was to determine the intensive care units’ (ICU’s) medical staff surge capacity during the coronavirus disease 2019 (COVID-19) outbreak in Spring 2020 in Spain. Methods: A multicenter retrospective survey was performed addressing the medical specialties present in the ICUs and the increase in bed capacity during this period. Results: Sixty-seven centers (62.04%) answered the questionnaire. The ICU bed capacity during the pandemic outbreak increased by 160% (95% confidence interval [CI], 128.97-191.03%). The average number of beds per intensive care medicine (ICM) specialist was 1.5 ± 0.60 and 3.71 ± 2.44 beds/specialist before and during the COVID-19 outbreak, respectively. Non-ICM specialists and residents were present in 50 (74.63%) and 23 (34.3%) ICUs during the outbreak, respectively. The number of physicians (ICM and non-ICM residents and specialists) in the ICU increased by 89.40% (95% CI, 64.26114.53%). The increase in ICM specialists was, however, 4.94% (95% CI, −1.35-11.23%). Most non-ICM physicians were anesthetists, followed by pediatricians and cardiologists. Conclusions: The majority of ICUs in our study were able to rapidly expand critical care capacity by adapting areas outside of the normal ICU to manage critically ill patients, and by extending the critical care staff with noncritical care physicians working as force multipliers.

Categorize Readmitted Patients in Intensive Medicine by Means of Clustering Data Mining

With a constant increasing in the health expenses and the aggravation of the global economic situation, managing costs and resources in healthcare is nowadays an essential point in the management of hospitals. The goal of this work is to apply clustering techniques to data collected in real-time about readmitted patients in Intensive Care Units in order to know some possible features that affect readmissions in this area. By knowing the common characteristics of readmitted patients it will be possible helping to improve patient outcome, reduce costs and prevent future readmissions. In this study, it was followed the Stability and Workload Index for Transfer (SWIFT) combined with the results of clinical tests for substances like lactic acid, leucocytes, bilirubin, platelets and creatinine. Attributes like sex, age and identification if the patient came from the chirurgical block were also considered in the characterization of potential readmissions. In general, all the models presented very good results being the Davies-Bouldin index lower than 0.82, where the best index was 0.425.