ABSTRACT
BACKGROUND: Pulmonary rehabilitation (PR) is recommended after a severe COPD exacerbation, but its short- and long-term effects on health care utilization have not been fully established. AIMS: The aims of this study were to evaluate patient compliance with a chronic disease management (CDM) program incorporating home-based exercise training as the main component after a severe COPD exacerbation and to determine its effects on health care utilization in the following year. MATERIALS AND METHODS: COPD patients with a severe exacerbation were included in a case-cohort study at admission. An intervention group participated in a nurse-supervised CDM program during the 2 months after discharge, comprising of home-based PR with exercise components directly supervised by a physiotherapist, while the remaining patients followed usual care. RESULTS: Nineteen of the twenty-one participants (90.5%) were compliant with the CDM program and were compared with 29 usual-care patients. Compliance with the program was associated with statistically significant reductions in admissions due to respiratory disease in the following year (median [interquartile range]: 0 [0-1] vs 1 [0-2.5]; P=0.022) and in days of admission (0 [0-7] vs 7 [0-12]; P=0.034), and multiple linear regression analysis confirmed the protective effect of the CDM program (ß coefficient -0.785, P=0.014, and R2=0.219). CONCLUSION: A CDM program incorporating exercise training for COPD patients without limiting comorbidities after a severe exacerbation achieves high compliance and reduces admissions in the year following after the intervention.
Subject(s)
Disease Management , Exercise Therapy , Home Care Services , Patient Readmission/trends , Pulmonary Disease, Chronic Obstructive/rehabilitation , Aged , Aged, 80 and over , Case-Control Studies , Disease Progression , Exercise Therapy/statistics & numerical data , Female , Health Resources/statistics & numerical data , Home Care Services/statistics & numerical data , Humans , Linear Models , Male , Multivariate Analysis , Patient Compliance , Program Evaluation , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/physiopathology , Risk Factors , Severity of Illness Index , Time Factors , Treatment OutcomeABSTRACT
El síndrome SAPHO está constituido por la asociación de alteraciones musculoesqueléticas y alteraciones dermatológicas. Presentamos el caso de un varón de 35 años que cumple criterios de síndrome SAPHO. Aunque el tratamiento de estos pacientes aún no está claro, es importante hacer el diagnóstico del síndrome SAPHO para realizar las investigaciones necesarias e instaurar el tratamiento. El término es un acrónimo de las manifestaciones más frecuentes: sinovitis, acné, pustulosis palmo-plantar, hiperostosis y osteítis (AU)
The SAPHO syndrome describes an association between musculoskeletal disorders and various dermatological conditions. We report the case of a 35-years-old man who fulfilled the criteria for SAPHO. Although the optimal treatment for these patients remains unclear, it is important to make the diagnosis of SAPHO to avoid unnecessary investigations and treatment. SAPHO is an acronym of the combination of synovitis, acne, pustulosis, hyperostosis, and osteitis (AU)
Subject(s)
Humans , Male , Mitochondrial Swelling/genetics , Patient-Centered Care , Patient-Centered Care/methods , Sternoclavicular Joint/injuries , Sternoclavicular Joint/metabolism , Acquired Hyperostosis Syndrome/metabolism , Acquired Hyperostosis Syndrome/pathology , Hyperostosis/genetics , Mitochondrial Swelling/physiology , Patient-Centered Care/classification , Patient-Centered Care/organization & administration , Sternoclavicular Joint/abnormalities , Sternoclavicular Joint/cytology , Acquired Hyperostosis Syndrome/complications , Acquired Hyperostosis Syndrome/genetics , Hyperostosis/metabolismABSTRACT
Medical emergencies involving patients with Human Immunodeficiency Virus (HIV) infection comprise an increasing number of the total hospitalary consults and contribute to their overflow. In order to evaluate possible alternative solutions to this problem, we performed a retrospective study of urgent medical consults by HIV patients at three different levels of medical care (primary assistance, extrahospitalary and hospitalary emergencies centers) all included in the same urban area of Barcelona. We demonstrated a growing excess in hospitalary emergencies, with high requirements of complementary explorations and hospitalary admittances. In the extrahospitalary emergency center, we can observe a progressive increasing of emergency consults, but still reasonable in number and adequate to the real possibilities of the center. At primary care level, HIV patients consulted because of less severe reasons. We conclude that a possible solution in order to decrease the assistance requirements in the hospitalary emergencies level could be to try to attend these patients in emergency extrahospitalary centers. These centers should be technically provided and with a close relationship both with the primary assistance care level and with the reference hospital.
