[Short stay medical unit. Causes of readmissions]. / Unidad de corta estancia médica. Causas de reingreso.

INTRODUCTION: Hospital readmissions reflect the quality of the Sanitary Attention given. AIM: To identify the factors that predict readmission in patients who are admitted to a Short Stay Medical Unit. MATERIAL AND METHODS: Prospective cohort study. Readmission was defined by an urgent admission after discharge caused by the same main diagnosis. The predicting factors for readmission were calculated by means of log regression. RESULTS: 335 patients were included. Readmission rates at 10, 28 and 90 days was 2.1, 8.4 and 17.0%, respectively. The independent factor of readmission at 10 days was the previous hospitalizations; at 28 days were previous hospitalizations, the length of stay and the educational status; at 90 days were comorbidities and the health related quality of life. CONCLUSIONS: The factors predicting early hospital readmissions were the previous admissions and the length of stay of index admission, while late readmission was related to comorbidities and health related quality of life.

[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.

[Significance of the follow-up of patients with ischemic cardiopathy in the treatment with atorvastatin as secondary prevention. Pilot study]. / Importancia del seguimiento de pacientes con cardiopatía isquémica en tratamiento con atorvastatina como prevención secundaria. Estudio piloto.

OBJECTIVE: To determine the usefulness of different intensities of follow up when atorvastatin is used in the secondary prevention of ischemic heart disease. MATERIAL AND METHODS: Design. Prospective study with balanced randomized allocation including a concurrent control group. SETTING: Ambulatory care. PATIENTS: 75 patients hospitalized because of acute coronary syndromes were administered atorvastatin as secondary prevention of ischemic heart disease and randomized either to intensive follow up or to a control visit 6 months apart. INTERVENTIONS: The intensive follow up group (40 patients) was controlled every 2 months as outpatients and a physical examine and lipid profile was done, enhancing diet and exercise and adjusting the statin dose. The control group was evaluated just once after a 6 six month period. RESULTS: 88% were males and the average age was 63.7 +/- 10 year. Basal characteristics, myocardial infarction, revascularized procedures and initial chemistry and lipid profile were similar in both groups, although there was a higher proportion of patients in the control group taking ACE. After 6 months total cholesterol, LDL cholesterol and triglycerides reduction was higher in the intensive follow up group (33 vs. 24, 34 vs. 26 y 51 vs. 24 mg/dl, respectively) without realising statistical significance. Hospital readmissions were lesser in the intensive group (7.3% vs. 19.4%, P = 0.114). There was one death in each group. CONCLUSIONS: Results show a tendency indicating that follow up planification is relevant to obtain the target lipid level recommended in the secondary prevention.

[Factor analysis of the health related quality of life of patients with stable chronic obstructive pulmonary disease]. / Análisis factorial de la calidad de vida relacionada con la salud de pacientes con enfermedad pulmonar obstructiva crónica estable.

OBJECTIVE: To identify factors associated with the health-related quality of life (HRQL) perceived by patients with stable chronic obstructive pulmonary disease (COPD). DESIGN: Prospective cohort study. SUBJECTS: Patients with stable COPD (n = 204, alpha = 0.05, d = 6.9%). MEASURES AND INTERVENTIONS: For every patient we recorded sociodemographic and treatment data,severity of dyspnea, and the results of gasometry and lung function and stress testing, as well as responses to the Chronic Respiratory Disease Questionnaire (CRDQ). After studying the associations between variables we carried out factor analysis of those that were significantly related to HRQL. RESULTS: Men made up 91.7% of the cohort. The mean age (standard deviation)was 71 (9), FEV1% was 45 (16) and FEV1/FVCwas 48 (10). HRQL was statically related to age, weight, body mass index (BMI), economic status, educational status, chronic treatment with oral corticosteroids, ODCA, PaO2, oxygen saturation, alveolar-arterial oxygen gradient, absolute FEV1, FEV1%, post-bronchodilatation FEV1, absolute FVC, FVC%, distance walked in six minutes, oxygen saturation before the walking test and lowest oxygen saturation during the test,difference in dyspnea before and after the test measured on a visual analog scale. Factor analysis reduced the main variables to six, which explained 74.6% of the variance, as follows: Factor1 PaO2, oxygen saturation and alveolar-arterial oxygen gradient (33.7%); Factor 2 absolute FEV1,FEV1%, FEV1 after bronchodilatation, absolute FVC and FVC% (11.9%); Factor 3 eight and BMI (8.8%); Factor 4 age, severity of dyspnea and walking test distance (8.4%);Factor 5: corticosteroid dependence and domiciliary oxygen therapy(6.3%); and Factor 6: economic and educational status (5.5%). CONCLUSION: HRQL in stable COPD patients is partially related to severity of respiratory insufficiency, airflow obstruction, nutritional status, exercise capacity, severity of disease, and socioeconomic status.

[Etiology, clinical features, precipitating factors, type of ventricular dysfunction, length of stay and mortality of 305 patients admitted to hospital because of heart failure]. / Etiología, características clínicas, causa desencadenante, tipo de disfunción ventricular, estancia media y mortalidad de 305 pacientes ingresados por insuficiencia cardiaca.

OBJECTIVE: To study the etiology, precipitating factors, clinic features, patterns of ventricular disfunction, treatment, hospital length of stay and mortality of patients admitted to hospital because of heart failure. PATIENTS AND METHODS: It's a prospective study of 305 patients with heart failure admitted consecutively in a short stay unit. RESULTS: The mean age was 73.6 +/- 10.8 years. 50.5% were women and 49.5% men. Women (76.5 +/- 9.7 years) were older than men (70.5 +/- 11.0 years). The etiology was valvular heart disease 30.8%, hypertensive heart disease 26.2%, ischemic heart disease 21.6%, idiopathic dilated cardiomyopathy 8.2% and alcoholic cardiomyopathy 5.6%. The more frequent precipitating factors were respiratory infection (37.3%) and arrhythmias (28.7%). No precipitating factor was detected in 13.9%. 46.1% had systolic disfunction (erection fraction < 50%). 96.7% were treated with diuretics, 79.3% with ACE inhibitors and 51.9% with digoxin. 5.3% needed cardiac surgery. Mean length of stay was 5.64 days. In hospital mortality was 5.6%.

[Chronic obstructive pulmonary disease and the seasons of the year]. / La enfermedad pulmonar obstructiva crónica y las estaciones del año.

OBJECTIVE: To study the existence of differences among patients with chronic obstructive pulmonary disease (COPD) hospitalized for exacerbation during different seasons of the year. DESIGN: transversal study. SUBJECTS: all patients admitted to the short-stay medical ward for exacerbation of COPD over a period of one year. MEASUREMENTS: demographic variables, disease history, signs and symptoms, baseline walking test, baseline function tests, baseline blood gases, length of stay and death while hospitalized. INTERVENTIONS: patient variables were described and the characteristics of autumn/winter admissions were compared to those of spring/summer admissions. RESULTS: Two hundred thirty-two patients with a mean age of 70.9 +/- 9.4 years (87.9% male). Eighty-four (36.2%) were admitted in winter, 65 (28%) in spring, 30 (12.9%) in summer and 53 (22.8%) in autumn. Twenty-one percent were being treated with corticoids, 27% were using domiciliary oxygen therapy and 36% had cor pulmonale. Baseline lung function test results were as follows: FEV1 44%, FEV1/FVC 48%, pO2 65.9 mmHg and pCO2 43.5 mmHg. Mean length of stay was 4.9 +/- 6 days; 9 patients (3.9%) died. Only PCO2 upon admission showed seasonal autumn-winter versus spring-summer differences (44.3 versus 49.5, p = 0.0008). Statistically significant differences were not observed for other variables. CONCLUSIONS: Clear seasonal variation can be observed in the number of patients requiring admission due to COPD exacerbation, but we found no relevant seasonally-related differences in disease characteristics.

[The short-stay medical unit of La Coruña: our experience]. / La unidad de corta estancia médica (UCEM) de La Coruña: nuestra experiencia.

During the last years public Hospitals have experienced a progressive saturation. This has motivated the development of short stay medical units (SSMU) as an alternative to the traditional hospitalization. In our Hospital a SSMU begun to admit patients in April of 1994. During the rest of that year, 1814 were admitted to the unit with a mean hospital stay of 3.22 +/- 2.0 days. 68% of the patients were discharged and 32% were transferred to other units in the Hospital according to their diagnoses. 30% of the patients were seen in an external clinic, by the same medical staff, shortly after the discharge. Since the unit is functioning, the number of ectopic patients of the Department of Medicine decreased to a third and the mean hospital stay of all the medical patients decreased by 3.4 days. We consider that it is possible to achieve a short medical stay with the support of a swift external clinic. The SSMU also improved the allocation of the patients throughout the medical units, and contributed to mitigate the number of the ectopic patients.

Guillain-Barré syndrome as an extraintestinal manifestation of Crohn's disease.

A variety of extraintestinal manifestations, probably immune-mediated, may appear during relapses of Crohn's disease. We report the clinical observation of a 34-year-old woman who developed a Guillain-Barré syndrome, aphthous stomatitis and oligoarthritis during a relapse of Crohn's ileocolitis. This case suggests that the Guillain-Barré syndrome may be another extraintestinal manifestation of Crohn's disease.