Frailty is increasingly seen among patients with acute cardiovascular disease. A combination of an ageing population, improved disease survival, treatable long-term conditions as well as a greater recognition of the syndrome has accelerated the prevalence of frailty in the modern world. Yet, this has not been matched by an expansion of research. National and international bodies have identified acute cardiovascular disease in the frail as a priority area for care and an entity that requires careful clinical decisions, but there remains a paucity of guidance on treatment efficacy and safety, and how to manage this complex group. This position paper from the Acute Cardiovascular Care Association presents the latest evidence about frailty and the management of frail patients with acute cardiovascular disease, and suggests avenues for future research.

Lewy bodies (LBs) in the amygdala and in cortical areas increase the risk for major depression in Alzheimer disease. What is common in these two groups is the presence of LBs in the amygdala. That is, all of the cases with cortical LBs also had LBs in the amygdala, making this region the critical area for the development of depression.

SummaryObjectives: To identify common methodological challenges and review relevant initiatives related to the re-use of patient data collected in routine clinical care, as well as to analyze the economic benefits derived from the secondary use of this data. Through the use of several examples, this article aims to provide a glimpse into the different areas of application, namely clinical research, genomic research, study of environmental factors, and population and health services research. This paper describes some of the informatics methods and Big Data resources developed in this context, such as electronic phenotyping, clinical research networks, biorepositories, screening data banks, and wide association studies. Lastly, some of the potential limitations of these approaches are discussed, focusing on confounding factors and data quality. Methods: A series of literature searches in main bibliographic databases have been conducted in order to assess the extent to which existing patient data has been repurposed for research. This contribution from the IMIA working group on "Data mining and Big Data analytics" focuses on the literature published during the last two years, covering the timeframe since the working group's last survey. Results and Conclusions: Although most of the examples of secondary use of patient data lie in the arena of clinical and health services research, we have started to witness other important applications, particularly in the area of genomic research and the study of health effects of environmental factors. Further research is needed to characterize the economic impact of secondary use across the broad spectrum of translational research.

RESUMENLa demanda en la atención urgente ha ido creciendo progresivamente en los últimos años y este incremento es más acusado en la población anciana. Teniendo en consideración que el paciente anciano requiere evaluaciones más complejas con una mayor realización de pruebas complementarias y consultas a otros especialistas, estancias más prolongadas en urgencias y mayor porcentaje de ingresos, el progresivo envejecimiento poblacional puede llegar a repercutir seriamente en la presión asistencial de los servicios de urgencias hospitalarios (SUH).El paciente anciano de alto riesgo es vital detectarlo antes de asignarle una ubicación definitiva. Para ello, es importante instaurar un cribado entre los pacientes ancianos que acuden a urgencias con el fin de seleccionar a los que se van a beneficiar de una valoración geriátrica integral y así poder diseñar un plan específico de cuidados. La intervención urgente en el paciente geriátrico no debe afrontarse exclusivamente como un problema médi-co sino que debe tenerse en cuenta aspectos funcionales, mentales o sociales. Representa un reto para los SUH.En el presente artículo vamos a desarrollar diversos aspectos como la detección y la valoración del paciente geriátrico así como a establecer ciertas recomendaciones para el entorno de urgencias.Palabras clave. Emergencias. Geriatría. Fragilidad. Anciano. Valoración. ABSTRACTDemand in emergency care has been growing progressively in recent years and this increase is more pronounced in the elderly population. Taking into account that the elderly patient requires more complex evaluations with a greater requirement for complementary tests and consultations with other specialists, longer stays in the emergency ward and a greater percentage of admissions, the progressive ageing of the population might come to have a serious repercussion on hospital emergency departments.It is vital to detect high risk elderly patients before assigning them a definitive placement. For this purpose it is important to install a sieving process amongst elderly patients who attend the emergency department in order to select those that will benefit from a comprehensive geriatric assessment and thus be able to design a specific care plan. Emergency intervention in elderly patients should not be faced exclusively as a medical problem, but functional, mental or social aspects should be taken into account. This represents a challenge for emergency care.This article considers different aspects such as the detection and assessment of the geriatric patient, as well as establishing certain recommendations for emergency setting.

resuMen objetivos. Analizar el impacto que tienen los artículos publicados en inglés, en comparación con los publicados en castellano, por revistas biomédicas españolas de edición multilingüe. Metodología.De los artículos publicados entre 2008-2012 en 5 revistas españolas biomédicas multilingües, se analizó el idioma, el número de originales, la nacionalidad de la autoría, las citas recibidas, los artículos citantes y la nacionalidad de los autores citantes.resultados. Se incluyeron 4.296 documentos, 85 de ellos publicados en inglés (2%). Estos últimos tuvieron unos porcentajes significativamente superiores de originales y de artículos sin autoría española, y consiguieron más citas y más artículos citantes por artículo publicado.conclusiones. La proporción de artículos publicados en inglés por las revistas españolas multilingües es bajo, con mayor frecuencia son originales y firmados exclusivamente por autores extranjeros, y reciben más citas que los publicados en español, que son realizadas también más frecuentemente por autores extranjeros. Methodology.We analyzed the language of publication, the number of original articles, the nationality of the authors, the citations received, the citing article and the nationality of the citing authors among the articles published from 2008-2012 in 5 multilingual Spanish biomedical journals.results. The study included 4,296 documents, 85 of which were published in English (2 %). The percentage of original articles and of non Spanish authorship was significantly higher among these latter articles and they also achieved more citations and more citing articles per article published.conclusions. The proportion of articles published in English by multilingual Spanish biomedical journals is low and they are more often originals signed exclusively by foreign authors and receive more citations than those published in Spanish, which are also more frequently done by foreign authors.