[Effectiveness and efficiency of a specialized unit in the care of patients with chronic obstructive pulmonary disease and respiratory insufficiency]. / Efectividad y eficiencia de una consulta monográfica hospitalaria para pacientes con EPOC e insuficiencia respiratoria.

OBJECTIVE: In the absence of a clear health care model for the management of patients with chronic obstructive pulmonary disease and chronic respiratory insufficiency, we evaluated the effectiveness and efficiency of a specialized outpatient unit for these patients managed by the hospital s respiratory medicine department. PATIENTS AND METHODS: This was a 1-year prospective study of a group of patients for whom historical control data were available. The mean (SD) descriptive data for the 124 patients (105 men) were as follows: age, 69 (7) years; forced vital capacity, 64.6% (16.1%); forced expiratory volume in the first second (FEV1), 35.6% (12.8%); PaO2, 56.6 (8.3) mm Hg; PaCO2, 49.8 (6.7) mm Hg. Forced spirometry and arterial blood gas analysis were performed at 3-monthly visits. Participants completed a quality-of-life questionnaire (Guyatt's Chronic Respiratory Disease Questionnaire) at the beginning and end of the study. The following variables were analyzed: forced spirometry, arterial blood gases, quality of life, number of emergency visits and hospital admissions, mean length of stay in hospital, reduction in the number of inpatient bed-days, mean cost of emergency visits, mean cost of hospital stays for both the Catalan Health Service (CHS) and the hospital, mean total cost per patient for the CHS and the hospital, and aggregate cost for the CHS and the hospital. The results were compared with data for the preceding year taken from the hospital records. RESULTS: Significant improvement was found in forced vital capacity and PaO2 (which went from 56.6 [8.2] mm Hg to 59.1 [8.9] mm Hg during the prospective part of the study); FEV1 also tended to improve (875 [282] mL as against 912 [321] mL), but this change was not significant (P= .17). A significant reduction was observed in the following variables: PaCO2; hospital admissions, 1.16 (1.15) in the historical control period compared to 0.67 (1.17) during the prospective study; emergency visits, 2.06 (1.9) as against 1.5 (2.1); mean length of stay in hospital, 14.2 (19) compared to 8.1 (16) days; total number of inpatient bed-days (756 inpatient bed-days were saved in the study period); mean cost of emergency visits and hospital stays for both the hospital (2246 euros [3007 euros] in the historical period as against 1297 euros [2639 euros] with the new management system) and for the CHS; and the aggregate cost both for the hospital (40,011 euros in the historical control period as against 6048 euros with the new model) and the CHS (238,513 euros as against 152,312 euros). The quality-of-life score improved, but the change was not significant. CONCLUSIONS: The change in the health care model used to manage these patients led to an improvement in care (effectiveness) as well as a marked reduction in costs (greater efficiency) for both the funding entity (CHS) and for the care provider (the hospital). No change was observed in the quality of life as reported by the patients.

Efectividad y eficiencia de una consulta monográfica hospitalaria para pacientes con EPOC e insuficiencia respiratoria / Effectiveness and efficiency of a specialized unit in the care of patients with Chronic Obstructive Pulmonary disease and respiratory insufficiency

Objetivo: Puesto que no existe un modelo asistencial claro para la atención a los pacientes con enfermedad pulmonar obstructiva crónica e insuficiencia respiratoria crónica, se ha evaluado la efectividad y eficiencia de una consulta externa hospitalaria monográfica controlada por el Servicio de Neumología. Pacientes y métodos: Se ha realizado un estudio prospectivo de un año de seguimiento con control histórico. La población estaba constituida por 124 pacientes (105 varones; edad media ± desviación estándar de 69 ± 7 años; capacidad vital forzada: 64,6 ± 16,1%; volumen espiratorio forzado en el primer segundo: 35,6 ± 12,8%; presión arterial de oxígeno: 56,6 ± 8,3 mmHg; presión arterial de anhídrido carbónico: 49,8 ± 6,7 mmHg). En cada visita trimestral se practicaron una espirometría forzada y una gasometría arterial, y al inicio y al final del estudio se pasó un cuestionario de calidad de vida (Chronic Respiratory Disease Questionnaire, elaborado por Guyatt). Se estudiaron las siguientes variables: espirometría forzada, gasometría arterial, calidad de vida, número de ingresos en urgencias y planta, duración media de la hospitalización, ahorro de días de hospitalización, coste medio de las visitas en urgencia, coste medio de las hospitalizaciones para el Servei Català de la Salut (SCS) y el hospital, coste medio total por paciente para el SCS y el hospital, y coste agregado para el SCS y el hospital. Los resultados se compararon con los datos de los pacientes registrados en la Corporació Parc Taulí durante el año previo. Resultados: Se observó una mejoría estadísticamente significativa de la capacidad vital forzada y presión arterial de oxígeno (56,6 ± 8,2 frente a 59,1 ± 8,9 mmHg); el volumen espiratorio forzado en el primer segundo mejoró (875 ± 282 frente a 912 ± 321 ml), pero sin significación (p = 0,17), así como un descenso significativo de la presión arterial de anhídrido carbónico, número de ingresos en planta (1,16 ± 1,15 frente a 0,67 ± 1,17) y urgencias (2,06 ± 1,9 frente a 1,5 ± 2,1), duración media de la hospitalización (14,2 ± 19 frente a 8,1 ± 16 días) y días total de hospitalización (se ahorraron 756 días de hospitalización), coste medio de visitas en urgencias y hospitalización para el hospital (2.246 ± 3.007 frente a 1.297 ± 2.639 €) y el SCS, y costes agregados tanto para el hospital (­40.011 frente a ­-6.048 €) como para el SCS (238.513 frente a 152.312 €). El índice de calidad de vida mejoró, pero no significativamente. Conclusiones: El cambio de la atención sanitaria de estos pacientes ha generado una mejoría asistencial (efectividad) reduciendo notablemente los costes económicos (eficiencia) tanto para el financiador (SCS) como para el proveedor de servicios sanitarios (hospital), sin que se hayan observado cambios en la calidad de vida de los pacientes

Objective: In the absence of a clear health care model for the management of patients with chronic obstructive pulmonary disease and chronic respiratory insufficiency, we evaluated the effectiveness and efficiency of a specialized outpatient unit for these patients managed by the hospital´s respiratory medicine department. Patients and Methods: This was a 1-year prospective study of a group of patients for whom historical control data were available. The mean (SD) descriptive data for the 124 patients (105 men) were as follows: age, 69 (7) years; forced vital capacity, 64.6% (16.1%); forced expiratory volume in the first second (FEV1), 35.6% (12.8%); PaO2, 56.6 (8.3) mm Hg; PaCO2, 49.8 (6.7) mm Hg. Forced spirometry and arterial blood gas analysis were performed at 3-monthly visits. Participants completed a quality-of-life questionnaire (Guyatt's Chronic Respiratory Disease Questionnaire) at the beginning and end of the study. The following variables were analyzed: forced spirometry, arterial blood gases, quality of life, number of emergency visits and hospital admissions, mean length of stay in hospital, reduction in the number of inpatient bed-days, mean cost of emergency visits, mean cost of hospital stays for both the Catalan Health Service (CHS) and the hospital, mean total cost per patient for the CHS and the hospital, and aggregate cost for the CHS and the hospital. The results were compared with data for the preceding year taken from the hospital records. Results: Significant improvement was found in forced vital capacity and PaO2 (which went from 56.6 [8.2] mm Hg to 59.1 [8.9] mm Hg during the prospective part of the study); FEV1 also tended to improve (875 [282] mL as against 912 [321] mL), but this change was not significant (P= .17). A significant reduction was observed in the following variables: PaCO2; hospital admissions, 1.16 (1.15) in the historical control period compared to 0.67 (1.17) during the prospective study; emergency visits, 2.06 (1.9) as against 1.5 (2.1); mean length of stay in hospital, 14.2 (19) compared to 8.1 (16) days; total number of inpatient bed-days (756 inpatient bed-days were saved in the study period); mean cost of emergency visits and hospital stays for both the hospital (€ 2246 [€ 3007] in the historical period as against € 1297 [€ 2639] with the new management system) and for the CHS; and the aggregate cost both for the hospital (€ 40 011 in the historical control period as against € 6048 with the new model) and the CHS (€ 238 513 as against € 152 312). The quality-of-life score improved, but the change was not significant. Conclusions: The change in the health care model used to manage these patients led to an improvement in care (effectiveness) as well as a marked reduction in costs (greater efficiency) for both the funding entity (CHS) and for the care provider (the hospital). No change was observed in the quality of life as reported by the patients

Long-term effects of almitrine bismesylate in COPD patients with chronic hypoxaemia.

BACKGROUND: Almitrine bismesylate (AB) is a peripheral chemoreceptor agonist which is believed to improve oxygenation of COPD patients with chronic hypoxaemia, probably by improving the ventilation perfusion mismatch. We studied the long-term effects of AB in COPD patients with chronic hypoxaemia. DESIGN: Prospective, randomised, double-blind, placebo-controlled trial. SETTING: Eight hundred bed teaching hospital with a catchment population of 350,000 inhabitants. PATIENT RECRUITMENT: COPD outpatients consulting between September 95 and September 99. INCLUSION CRITERIA: (1) COPD (FEV1 < 50%). (2) PaO2 < or = 65 mmHg. (3) Stable arterial blood gases (ABG), spirometry (S) and clinical state. EXCLUSION CRITERIA: Asthma, restrictive disease, sleep apnoea syndrome, advanced renal or hepatic disease, peripheral neuropathy, use of respiratory stimulants or psychotrophic drugs. TREATMENT: AB 1 mg/kg/day (weight < 75 kg = 50 mg/day; weight > or = 75 kg = 100 mg/day) in an intermittent schedule with resting periods of 1 month after the third, 6th and 9th months during 1 year. INSTRUMENTATION: Stabilisation period: S, ABG. Run-in period: S, ABG, 6-min walking test (WT), nocturnal pulse oximetry (NP) and quality of life evaluation (CRQ). Third, 6th and 9th months: S, ABG. End of the study: S, ABG, WT, NP, CRQ. STATISTICS: ANOVA for repeated measurements. RESULTS: Two hundred and eighty-nine patients were evaluated and 81 were included in the study. Sixty-six were followed for 6 months, 53 for 9 months and 42 for 1 year. Almitrine and placebo groups did not present significant differences in ABG and S in the 6th, 9th and 12th months. Evolution in WT, NP and CRQ were similar in the two groups. No relevant side-effects were detected: only two patients stopped treatment (one placebo and one AB). CONCLUSION: In an intermittent schedule, although well tolerated, at doses of 1 mg/kg/day, AB was not effective in long-term treatment of chronic hypoxemia in COPD patients.

Intoxicación por monóxido de carbono causada por un brasero de carbón / Intoxication with monoxide caused by a carbon heater

No disponible

[An assessment of the quality of life of patients with COPD and chronic hypoxemia by using the Spanish version of the Chronic Respiratory Disease Questionnaire]. / Valoración de la calidad de vida de los pacientes con EPOC e hipoxemia crónica mediante la versión española del Chronic Respiratory Disease Questionaire.

INTRODUCTION: The Chronic Respiratory Disease Questionnaire (CRDQ) is a specific evaluation instrument that has been recently translated to Spanish and validated in patients with COPD without chronic respiratory insufficiency. OBJECTIVE: To study the relation of CRDQ scores to several lung function parameters in COPD patients with chronic hypoxemia (PaO2 < 65). MATERIAL AND METHODS: Forty-four middle aged [68 (7)] men with COPD (FEV1 post-PBD < 50%; PaO2 < 65 mmHg) were enrolled with established medical histories, including blood gas and spirometric data. We collected the patients' responses to the CRDQ and measured blood gas levels, spirometric and plethysmographic variables and DLCO. Performance on a six-minute walking test was recorded, with dyspnea assessed on a visual analogue scale (VAS) initially and at the end of the walk. Nighttime pulse oximetry was also monitored. Pearson's and Spearman's correlation coefficients were used to study the relation between CRDQ scores and the aforementioned parameters. Gas and spirometric data were compared to CRDQ scores between groups of patients treated with continuous domiciliary oxygen therapy (CDOT) and the untreated group, using Student t-test and a Mann-Whitney U-test. RESULTS: Results are expressed as means and standard deviations within parentheses. FVC was 2,609 (618) ml, 72 (15)%; FEV1 867 (297) ml, 34 (11)%; FEV1/FVC 33 (8)%; PaO2 55(8) mmHg; and PaCO2 49(6) mmHg. The overall CRDQ score was related to FEV1 (0.38; p < 0.01); FEV1/FVC (0.43, p < 0.005); walking test distance (0.49, p < 0.01); final VAS (-0.64, p < 0.0001) and DLCO (0.59, p < 0.01). No relation was observed between CRDQ score and blood gases, nighttime pulse oximetry or plethysmograph data. "Dyspnea", "fatigue", "emotional function" and "disease control" dimensions of the CRDQ were related to the same variables as was the overall score, with the exception of FEV1/FVC for the "fatigue" dimension and FEV1 and DLCO for the "disease control" dimension. The CRDQ scores were similar in the CDOT and non-CDOT groups in spite of differences in their spirometric and gasometric variables. CONCLUSIONS: 1) Score on the CRDQ is related to FEV1, the FEV1/FVC ratio, walking test distance, dyspnea and DLCO but not to blood gases, FVC, lung volume or nighttime pulse oximetry. 2) The VAS dyspnea score recorded at the end of the walking test is the variable that is most strongly related to CRDQ score. 3) We found that use of CDOT did not undermine the COPD patient's quality of life.

[The 1st case in Spain of detection of occult squamous carcinoma using LIFE system]. / Primer caso en España de detección de un carcinoma escamoso oculto mediante la utilización del sistema LIFE.

LIFE system (lung imaging fluorescence endoscope) is a new system of detection for early lung cancer using a He-Cd laser through a conventional fiberoptic bronchoscope. This system is able to capture and processing the autofluorescence from the bronchial mucosa and to show it in a video screen in real time. In the screen the normal tissue appears in green colour and the neoplastic tissue in brown colour. The first studies performed with LIFE system show the same specificity of the conventional bronchoscopy but the sensibility is 50% higher. In this paper we present the first case of detection of a occult squamous cell carcinoma with sputum and bronchial aspiration cytology positive for carcinoma but chest X ray, CT scanner and bronchoscopy negative for lung cancer. The LIFE system was able to detect carcinoma in the carina.