title: [Care for patients with altered states of consciousness in a hospital for chronic and long-stay patients].
abstract: BACKGROUND
  Between 30% and 40% of patients with brain damage present alterations in their level of consciousness and, in some cases, altered states of consciousness: unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS). Recovery varies and survival is threatened by a number of complications.
  
  
  OBJECTIVE
  The purpose of this study is to present the working methodology used at the Hospital La Pedrera (HLP) for patients in UWS or MCS and to analyse the clinical characteristics of the patients attended to, their progress, and the functional and cognitive situation at the time of their discharge from hospital.
  
  
  METHODS
  The work consisted in a prospective descriptive study of patients seen at the HLP over the period 2009-2013, who had been diagnosed with UWS or MCS.
  
  
  RESULTS
  The HLP uses the case management method, offering integrated care dispensed by a multidisciplinary team. Patients are classified according to healthcare goals. Patients with UWS or MCS are included in the integrated care and adaptation programme. A total of 23 patients (86.9% males) were attended to, the mean age being 54.9 years. Aetiology: brain haemorrhage, 30.4%; anoxic encephalopathy, 26.6%; metabolic encephalopathy, 17.3%; and other causes, 17.3%. Altogether 73.9% were admitted in UWS and the rest in MCS.
  
  
  RESULTS
  43.4% improved their initial cognitive situation and 88.8% presented a situation of total dependence at the time of discharge. The most frequent complications were respiratory and urinary infections (53.6%). Death occurred in 65.2% of cases.
  
  
  CONCLUSIONS
  Medical attention in UWS or MCS is complex and requires multidisciplinary care. Almost half of the patients improved their cognitive situation, which justifies a proactive attitude that attempts to improve the quality of life of both patients and their families.
authors.affiliation: Hospital La Pedrera, Alicante, Espana.
authors.forename: Gemma
authors.initials: G
authors.lastname: Más-Sesé
authors.forename: M José
authors.initials: MJ
authors.lastname: Sanchis-Pellicer
authors.forename: Esther
authors.initials: E
authors.lastname: Tormo-Micó
authors.forename: Josep
authors.initials: J
authors.lastname: Vicente-Más
authors.forename: Manuel
authors.initials: M
authors.lastname: Vallalta-Morales
authors.forename: Diego
authors.initials: D
authors.lastname: Rueda-Gordillo
authors.forename: Antonia
authors.initials: A
authors.lastname: Conejo-Alba
authors.forename: Juan
authors.initials: J
authors.lastname: Berbegal-Serra
authors.forename: Pedro
authors.initials: P
authors.lastname: Martínez-Avilés
authors.forename: Joan A
authors.initials: JA
authors.lastname: Oltra-Masanet
authors.forename: Miquel
authors.initials: M
authors.lastname: Femenia-Pérez
mesh_terms: D002908:Chronic Disease; D003071:Cognition; D005260:Female; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000523:psychology / Q000628:therapy*; D011446:Prospective Studies; D012893:Sleep Wake Disorders / Q000523:psychology / Q000628:therapy*