We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
Would you like to know what your stay at Vall d'Hebron will be like? Here you will find all the information.
The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
Chronic obstructive pulmonary disease or COPD is a respiratory disease that leads to obstruction of airways. The main symptoms are coughing, hawking and difficulty breathing, requiring particular effort. Although it can be due to other reasons, it is mainly caused by exposure to tobacco smoke. The main treatment is bronchodilators administered using an inhaler.
COPD is a respiratory disease that mainly appears in smokers or ex-smokers and causes the airway to become obstructed or blocked.
The main symptoms are coughing, hawking and difficulty breathing, requiring particular effort. Patients with COPD can also present with infection or worsening of symptoms, known as exacerbation.
The illness mainly affects smokers and ex-smokers. It is also associated with exposure to other sources of smoke, such as biomass smoke. In a small proportion of cases it may be due to genetic causes. The prevalence of COPD is up to 10% of the adult population aged over 40 in Spain.
Diagnosis of COPD is confirmed using a respiratory test: spirometry. This is a very simple test that can be conducted in a primary care centre (CAP). This test should be performed on all individuals over the age of 40 with a history of smoking who have respiratory symptoms such as breathlessness or coughing.
Typical treatment for COPD involves using bronchodilators administered via an inhaler. There are two different types of bronchodilator that may be administered together or separately, depending on each patient’s needs. The aim of this treatment is to reduce the sensation of breathlessness and the number of exacerbations and improve lung capacity. In some patients, administering corticosteroids via inhaler may also be necessary. The best treatment for COPD is stopping smoking.
As well as spirometry, other tests that may be required include chest x-ray, CAT scan, sputum culture or other more complete breathing tests. A blood test is normally performed to rule out genetic causes.
As tobacco is the main risk factor, the best prevention for COPD is not smoking. Exposure to environmental pollution and passive smoking should also be avoided.
Arthrosis is a degenerative process characterised by lesions of the cartilage in joints. A joint is the area where a bone connects with another bone, allowing movement. Cartilage is a tissue that covers the joints, acts as a shock absorber for impacts, and also allows the joints to move without friction. Normally, this condition appears in the spinal column, neck, hip, knees, and hands.
Symptoms
The most common manifestation is pain that improves with rest, stiffness when initiating movement, deformities, and difficulty moving the affected joints. There can be a certain degree of inflammation, which will cause swelling due to the excessive accumulation of liquid in the joint.
However, it must be differentiated from arthritis, which is a rheumatic inflammatory disease rooted in joint inflammation that can cause pain which does not improve with rest. Arthrosis is often also called osteoarthritis, which can create some confusion.
Prevalence
This disease is very prevalent and has a high social and health impact. The EPISER2016 study, by the Spanish Society of Rheumatology, showed that the prevalence in the population over 40 years of age is 29%.
Causes
Age is the main risk factor. It is more frequent in women. A deterioration of the cartilage is clearly associated with obesity and a lack of regular physical exercise. A misaligned joint or poor posture can also be predisposing factors. Sometimes the cause is a traumatic injury or previous disorder of the affected joint. It has a genetic component (especially arthrosis of the hands).
Diagnosis
A diagnosis is obtained by looking at the symptoms, physical examination, and the imaging tests.
Treatment
Treatment for this disease is aimed at improving symptoms and quality of life for patients while slowing down its clinical evolution. A treatment plan must be individually prepared for each patient and type of joint.
Non-pharmaceutical treatment is essential. We recommend:
Pharmacological treatment normally consists of conventional pain relievers such as paracetamol, which is the analgesic treatment of choice. There are slow-acting treatments, such as chondroitin sulphate (taken orally) or hyaluronic acid (given as an injection), which can improve pain, especially in arthrosis of the knees. Surgery (joint replacement) is reserved for cases in which the joint is destroyed and other measures have failed.
Delirium is an acute attention and cognitive disorder that frequently appears in elderly hospitalised patients, although it can affect anyone with a severe illness, including children.
Presentation of this mental state alteration is both acute (its onset can be quite precisely recognised) and fluctuating (there are moments in the day when the person has more manifestations). However, with appropriate interventions, it can be fully or partially reversible and even prevented.
Delirium usually involves multiple factors, but the main causes that can trigger it during hospitalisation are:
They may present with one or several of the following symptoms:
Inform the healthcare staff if you detect any of these manifestations in the person you are accompanying. In addition, bear in mind that the episode of delirium may last from hours to days in most cases, but it can also last for weeks or months.
In 40% of cases, delirium can be prevented if you follow these recommendations:
As well as implementing non-pharmaceutical measures, the medical team and nurses will analyse the possible causes of the delirium and adopt the most appropriate measures for each patient, such as diagnosing and treating infections, controlling pain, correcting dehydration, and reviewing treatment and catheter use, among other measures.
On some occasions, it will be necessary to administer medication to help control the delirium, calm the person and make them more collaborative to remove the risk of accidents and injury.
People who suffer episodes of delirium during their hospitalisation may suffer falls, bronchospasms and loss of autonomy in activities for daily living, possibly requiring more help than before hospitalisation; they may even need to stay in hospital or another centre for longer to recover their lifestyle.
In some cases, patients with delirium require subsequent follow-up due to the risk of developing cognitive impairment.
Collaboration with the family is essential, as they know the patient best and can best help to prevent some of the associated complications.
Whenever possible, it is important for the person to be accompanied by a family member or close friend, especially in their first 48 hours of admission. This will calm and reassure them.
If the companion has to go and leave the person alone, the nurses should be informed so they can supervise the necessary care.
You can follow the prevention recommendations and also bear in mind the following:
Lupus is a chronic immunological disease characterised by the production of antibodies. It mainly affects women of child bearing age, evolves into flare-ups and can affect any organ.
It is characterised by the production of immune complexes found on any organ and that cause inflammation and, in some cases, even organ damage. The cause is unknown but is understood to be down to multiple factors. Genetic, environmental and hormonal factors play a role.
These cause a change to apopstosis (cell death) that means new antigens appear and the innate and the adaptive systems are activated, which are responsible for producing antibodies.
The most common symptoms are: joint pain or arthritis (85-90 %) and skin lesions (70 %), but it may also affect any organ.
Lupus can affect different parts of the body:
Lupus mainly affects women, with a ratio of 9:1 of those affected being of childbearing age, although it may appear during childhood or later in life.
Its is prevalent in 10/10,000 people of Caucasian origin, but is more prevalent and severe among African American and Hispanic patients.
With improved treatment in developed countries, the survival rate is over 90% after 20 years, although the disease’s effects on the renal and central nervous system increase morbidity and mortality.
Diagnosis is founded on clinical suspicion based on the symptoms described and laboratory data showing the presence of antinuclear antibodies and anti-dsDNA antibodies, which are specific to the disease. The criteria provided by the American College of Rheumatology is used for diagnosis. If the patient fulfils 4 of the 11 criteria, they are classified as having systemic lupus erythematosus.
Treatment is specific to each case. In general, anti-inflammatories, cortisone and antimalarial drugs are used. In severe cases, immunosuppressants may be used (Imurel®, methotrexate and mycophenolate, for example), or to avoid flare ups, lasting effects and also reduce the need for corticosteroids. In the last 50 years, only belimumab, or anti-BLys, has been approved for the treatment of lupus.
Unfortunately there is no preventative treatment for lupus. The most important factor to avoid lasting damage is early diagnosis and treatment by experts in the field.
Providing patients with the right information at the time of diagnosis is essential to prevent future complications, as is treatment monitoring.
Pulmonary arterial hypertension (PAH) is a disorder of the arteries that connect the lungs to the heart. Symptoms are shortness of breath or laboured breathing (dyspnoea).
Pulmonary arterial hypertension is a rare and serious condition that affects the pulmonary artery system. As the disease progresses, blood flow reduces. To compensate for this, the right side of the heart grows excessively, creating breathing difficulties.
It is defined by a rise in pulmonary artery pressure caused by abnormalities in the precapillary pulmonary arterioles due to uncontrolled hypertrophy, hyperplasia and proliferation.
Dyspnoea, syncope, palpitations.
It affects children and adults, especially women (65-80%) and usually appears in adulthood.
In around 50% of cases of pulmonary arterial hypertension the cause is unknown. The other 50% are related to:
In Spain there are 16 cases for every million adults and the incidence rate is 3.7 for every million adults per year.
Diagnosis is via a series of tests:
Although they will not cure it, there are several treatments that can significantly improve the condition, its prognosis and patients’ quality of life.
We are fortunate to have access to all the pharmaceuticals beneficial in fighting this disease:
The decision about the most suitable drugs for each patient needs to be made by centres with experience. Lastly, if these measures are insufficient, a lung transplant can be considered in some cases.
Taking anorectics, amphetamines and cocaine should be avoided. The HIV virus can also cause this condition and all factors, principally alcohol, that may lead to liver failure. Apart from these measures there are no other means of prevention and efforts should focus on early detection.
Anticoagulants are the treatment of choice for venous thromboembolic disease. They are also used in patients with a heart arrhythmia or heart condition that predisposes them to having a systemic embolism (formation of a clot or thrombus that travels from the heart to any blood vessel in the body) or from the heart to the veins in the brain causing a stroke.
Anticoagulants are medication that modify blood clotting so that a thrombus or clot does not form inside the blood vessels. The main effect is to slow the blood’s clotting time.
There are different types of anticoagulants: injectable or oral.
Low molecular weight or unfractionated heparin. Should be started at therapeutic doses as soon as thrombosis is suspected, even before the diagnosis is confirmed, or as prophylaxis (prevention), at prophylactic doses, when the person has one or more risk factors that could trigger a venous thromboembolism (such as hip or knee replacement surgery). They are administered at fixed doses according to the patient’s weight, the type of thrombosis being treated or risk factor being controlled.
They are used as maintenance therapy when oral anticoagulants are contraindicated (e.g. pregnancy) or have been ineffective.
They are used as maintenance treatment (longer use) and are given on confirmation of the diagnosis of deep vein thrombosis or pulmonary embolism. There are two types of oral anticoagulants: vitamin K antagonists and direct-acting.
The anticoagulant treatment is controlled with blood tests or capillary blood tests (by pricking the patient's finger). Monitoring of patients on anticoagulant treatment is done by haematology and haemotherapy specialists.
At the Internal Medicine Department, we offer comprehensive internal medicine care to adult patients in our region, both at the Hospital and in Primary Care. We are a leading point of reference in both Catalonia and Spain in systemic autoimmune diseases. In addition, the Ageing and Chronic Patient Section covers Geriatrics and coordinates and collaborates with social-healthcare provision throughout the region.
The Internal Medicine Department is the cornerstone of medical care at Vall d'Hebron University Hospital. It is key in providing support to the other medical and surgical departments and the Accident and Emergency Department.
The Rheumatology Department's Teaching Unit is officially authorised for the training of resident Rheumatology interns. At present, we offer two training places for residents every year. One of our priority objectives is to attract and train resident doctors in order to return the knowledge we have gained to society and to further the training of highly-qualified professionals to face the future challenges of medicine, also known as personalised or precision medicine.
At the Rheumatology Section, we carry out extensive teaching activity, both in continuous education within the department itself, and in the organisation of seminars and courses aimed at professionals from other hospitals and other medical specialities. One of our objectives is to enhance the health workshops aimed at patients. We actively participate in national and international congresses.
We are a leading national and international centre with a high number of applications for training places, especially in the areas of paediatric rheumatology, chronic inflammatory arthritis and systemic autoimmune diseases, musculoskeletal ultrasound and central sensitivity syndromes.
We give theory and practical classes in Rheumatology in the Medicine Degree course at the Autonomous University of Barcelona. We also undertake intense teaching activities in Master’s courses and other postgraduate activities.
Rheumatology training itinerary
We are a clinical unit that aims to offer high-quality, cross-cutting care and teaching, as well as developing research excellence in the area of musculoskeletal and connective tissue diseases. We have extensive experience in training specialists in rheumatology. We guarantee rigorous, high-quality training in all the professional care, research and teaching skills in our area.
The training programme includes residents in the Rheumatology research group’s lines of research, so that they receive general training in research methodology, conventional and new areas of research, such as precision medicine, as well as evidence-based precision medicine, evidence-based medicine and research based on healthcare outcomes. Furthermore, our residents have the chance to undertake training periods in internationally renowned centres in both Europe and the United States.
Experience in research allows us to offer students a high-quality doctoral programme to carry out a thesis project and become a Doctor of Medicine. We also offer the opportunity to actively collaborate on research projects assessed by national and European public research bodies, and to co-author the resulting papers.
Why do your residency at Vall d’Hebron University Hospital?
Geriatrics is a speciality that consists of the comprehensive management of elderly people, requiring multidisciplinary participation in order to properly care for the patient. The Vall d'Hebron University Hospital Geriatrics Teaching Unit forms part of the Internal Medicine Department, and works in collaboration with the Faculty of Medicine at the UAB. It involves the participation of other hospital departments, including the Internal Medicine, Cardiology, Neurology and A&E departments.
Geriatrics training itinerary
Geriatrics residents must:
Residents are thus trained to offer a high quality service whereby a strong focus on the patient, with the help of the interdisciplinary team (medicine, nursing, social work, physiotherapy, psychology, etc.) and coordination with other primary care specialists, the intermediate care hospital and acute care hospital are vital.
This 4-year specialisation programme is split into two training periods:
Both the basic and specialised formative periods offer ample opportunities for elective rotations, including an external rotation during the final year.
The Geriatrics Teaching Unit encourages research, and offers the opportunity to do a doctoral thesis at the Autonomous University of Barcelona (UAB). Attendance at national and international geriatrics congresses, as well as that of the Catalan Geriatrics and Gerontology Society (SCGiG), is always encouraged.
The Hospital Radiophysics Teaching Unit is made up of hospital radiophysics specialists and senior technicians specialising in radiotherapy and/or radiodiagnosis.
Itinerario formativo en Radiofísica hospitalaria
The Medical Physics and Radiation Protection Department was accredited as a teaching unit in 1995 and is one of the first to receive accreditation in Spain. Some of our former residents now hold important positions in hospitals throughout Spain. Being part of Catalonia’s biggest hospital, with a technology park that is updated constantly, allows us to offer state-of-the-art training in all the areas of the speciality: radiotherapy, nuclear medicine, radiodiagnosis, and radiation protection in healthcare. It is unique, thanks to its extensive experience in advanced radiation oncology techniques in adult and paediatric patients, along with the scope of the radiation protection operations it carries out within the hospital, in both clinical and research facilities. The department has a laboratory where the hospital’s radiation detectors can be calibrated.
Additionally, the Vall d'Hebron Campus offers the possibility of actively participating in national and international research projects and clinical trials linked to its two research institutions, the Vall d'Hebron Institute of Oncology and the Vall d'Hebron Research Institute.
Why specialise at Vall d’Hebron?
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