Follow-up with Telemedicine in Early Discharge for COPD Exacerbations: Randomized Clinical Trial (TELEMEDCOPD-Trial).

The results reported by different studies on telemonitoring in patients with chronic obstructive pulmonary disease (COPD) have been contradictory, without showing clear benefits to date. The objective of this study was to ascertain whether an early discharge and home hospitalization telehealth program for patients with COPD exacerbation is as effective as and more efficient than a traditional early discharge and home hospitalization program. A prospective experimental non-inferiority study, randomized into two groups (telemedicine/control) was conducted. The telemedicine group underwent monitoring and was required to transmit data on vital constants and ECGs twice per day, with a subsequent telephone call and 2 home visits by healthcare staff (intermediate and at discharge). The control group received daily visits. The main variable was time until first exacerbation. The secondary variables were: number of exacerbations; use of healthcare resources; satisfaction; quality of life; anxiety-depression; and therapeutic adherence, measured at one and 6 months of hospital discharge. A total of 116 patients were randomized (58 to each group) without significant differences in baseline characteristics or time until first exacerbation, i.e. median 48 days (pp. 25-75:23-120) in the control group, and 47 days (pp. 25-75:19-102) in the intervention group; p = 0.52). A significant decrease in the number of visits was observed in the intervention versus the control group, 3.8 ± 1 vs 5.1 ± 2(p = 0.001), without significant differences in the number of exacerbations. In conclusion follow-up via a telemedicine program in early discharge after hospitalization is as effective as conventional home follow up, being the cost of either strategy not significantly different.

Abordaje mutidisciplinar en las unidades de asma grave / Multidisciplinary approach in the severe asthma units

El asma es una enfermedad crónica muy prevalente que genera un consumo importante de recursos sanitarios. El mal manejo de estos enfermos conlleva a un inadecuado control de la enfermedad, a un mayor coste sanitario y a un aumento de la morbimortalidad. La creación de unidades multidisciplinares es muy recomendable, principalmente en las formas más graves y ha demostrado una mejoría asistencial (efectividad), reduciendo notablemente los costes económicos de la enfermedad (eficiencia). Dichas unidades precisan un coordinador (neumólogo) que sea conocedor de todos los aspectos del asma y que organice todo el cuidado, incluyendo al resto de las especialidades implicadas (alergólogos, otorrinolaringólogos, gastroenterólogos, endocrinos, psicólogos y psiquiatras)

Asthma is a very prevalent chronic disease that generates a significant consumption of health resources. The mismanagement of these patients leads to poor control of the disease, a higher health cost and an increase in morbidity and mortality. The creation of multidisciplinary units is highly recommended, mainly in the most severe forms. It requires a coordinator (pneumologist) who is knowledgeable about all aspects of asthma and who organizes all the care, including the rest of the specialties involved (allergists, otolaryngologists, gastroenterologists, endocrines, psychologists and psychiatrists). The creation of these units has shown a welfare improvement (effectiveness), significantly reducing the economic costs of the disease (efficiency)

Actinomicosis pulmonar simulando cáncer. Descripción de un caso y revisión de la literatura / Pulmonary actinomycosis mimicking cancer. A case report and literature review

La actinomicosis es una enfermedad crónica granulomatosa infrecuente causada por Actinomyces spp, una bacteria anaerobia gram positiva que normalmente coloniza la boca, genitales y tracto digestivo en humanos1. En la mayor parte de los casos, la enfermedad se manifiesta en la región cervicofacial. Sin embargo, se han descrito varios casos en los que la actinomicosis puede simular procesos malignos en localizaciones no comunes, como en el pulmón. Se presenta el caso de una paciente con un cuadro constitucional de 20 días de evolución con una masa paramediastínica, a la que se le diagnostica de actinomicosis pulmonar tras una lobectomía por sospecha clínica de malignidad

Actinomycosis is a rare chronic granulomatous disease caused by Actinomyces spp, an anaerobic gram positive bacteria that colonizes mouth, large bowel and genitals. Actinomycosis occurs most frequently at oral and cervicofacial region. Less commonly affected areas include thoracic, abdominal, pelvic and central nervous system. We report a case about a patient with constitucional syndrome and a paramediastinal ma ss who was diagnosed with pulmonary actinomycosis after a lobectomy because of clinical suspicion of malingnancy

Novedades en la GEMA4.0 / No disponible

Desde la última edición de la GEMA, han surgido nuevos aspectos conceptuales y terapéuticos que obligaban a su actualización. El objetivo de esta guía es mejorar el control y la calidad de vida de los pacientes con asma mediante el incremento de la formación de los sanitarios que deben atenderlos, prestando especial atención a los aspectos relacionados con la prevención, diagnóstico y tratamiento de la enfermedad. La nueva versión incorpora 3 nuevos capítulos: asma y EPOC, asma grave no controlada y plan de difusión e implementación. A continuación se detallan los aspectos más destacados de esta versión de la guía

Since the last edition of the GEMA, there have been new conceptual and therapeutic aspects which required updating. The aim of this guide is to improve the control and quality of life of patients with asthma by increasing the training of doctors and nurses that should take care of them, paying particular attention to aspects related to the prevention, diagnosis and treatment of disease. The new version adds three new chapters: asthma and COPD overlap syndrome, uncontrolled severe asthma and implementation-promotion plan. Following the highlights of this version of the guide are detailed

Documento de consenso sobre asma grave ATS/ERS / No disponible

No disponible