[Predictive factors of unplanned hospital readmission in patients discharged at a short stay medical unit]. / Factores predictores de reingreso hospitalario no planificado en pacientes dados de alta de una Unidad de Corta Estancia Médica.

AIMS: To determine the independent factors that predict unplanned hospital readmission in patients who are admitted to a Short-Stay Medical Unit (SSMU). DESIGN AND FIELD OF THE STUDY: Prospective cohort. Sanitary area: 500,000 inhabitants. SUBJECTS: Patients who survived to an hospital admission in the SSMU of our hospital (n = 196, a = 0.05, d = 7). METHODS: We studied demographic variables, social situation, history of previous admissions to hospital, from each patient. From the index admission we included diagnosis, severity of the disease, complications, type of admission and co-morbility. Validated tests were done to measure functional capability, grade of dependence and psychologic situation. After a three month interval readmission was determined if there had been an urgent admission to any hospital in a 10-day, 28-day or 3-month interval after discharge caused by the same principal diagnosis. A descriptive analysis of the variables was made, and a univariate analysis to stablish their association to readmission. The predicting factors for readmission were calculated by means of logistic regression. RESULTS: The 60.2% were males, the median of the age was 72 years. 75% started or carried out only primary school; 40% were single, separated or widowed; 12% lived alone and 1.5% in an institution. Principal diagnosis at the time of index admission were: chronic obstructive pulmonary disease, congestive cardiac failure, ischemic heart disease, asthma, pneumonia, cardiac arrhythmia and acute cerebrovascular disease. Readmission rate at 10, 28 days and 3 months was 3.6%, 9.7% and 13.3%, respectively. The independent predicting factor for readmission in the 10 days interval from discharge was the number of days of hospitalization in the last year (OR: 1.02, 95% CI: 1.0-1.05). For readmission in a 28-day and 3-month interval from discharge, the only independent predicting factor was the number of admissions to any hospital in the last 3 years (OR: 1.71, 95% CI: 1.32-2.22 and OR: 1.62, 95% CI: 1.28-2.05 respectively). CONCLUSIONS: From the studied factors, those that predict unplanned hospital readmission of patients discharged from a Short-Stay Medical Unit cannot be modified.

Early-stage gastric MALT lymphomas: eradication of H. pylori and outcome.

BACKGROUNDS AND OBJECTIVE: Lymphomas of mucosa-associated lymphoid tissue are special because of their indolent course. Low-grade early-stage tumors resolve after Helicobacter pylori (HP) eradication in a high percentage of cases. The aim of this study was to evaluate this regression in our patients with EI1 stage-low-grade B gastric lymphomas after eradication therapy since the introduction of echoendoscopic examinations in the Gastroenterology Department of 'Juan Canalejo' Hospital. MATERIAL AND METHODS: A retrospective study of all cases of low-grade MALT gastric lymphomas in EI1 stage, diagnosed by histological and echoendoscopic examination, from June 1997 to December 2001. After eradication of HP with triple therapy, patients have been followed-up with endoscopic examinations at 2, 3 and 6 months, and yearly afterwards. RESULTS: There were 14 patients in this period with low-grade EI1 stage gastric MALT B cell lymphoma. The median age was 65 years, and 57% were females. HP was eradicated in all cases with first- or second-line (2 patients) antibiotic treatment. Complete remission was observed in 10 patients (71.4%) in a median time of 4.5 months. The other 4 patients needed chemotherapy because of non-remission or early relapse, and also as initial treatment. Complete remission was also obtained in these patients. Only 9 patients have been followed up in our unit for a median time of 20 months, period after which all remain free of disease. CONCLUSIONS: Low-grade early-stage MALT gastric B-cell lymphomas have a high rate of response to HP eradication therapy. Echoendoscopic staging helps in distinguishing the group of patients who will benefit from conservative treatment. These patients must be followed up as it remains unclear whether remission is maintained in the long term, and to know what factors could be associated with lymphoma relapse.