Longitudinal cystic fibrosis care.

Cystic fibrosis is a complex disease entity that presents considerable lifelong challenges. Implementation of medical and surgical treatment options involves multisystem interventions to prevent and treat lung and gastrointestinal manifestations of cystic fibrosis and associated comorbidities. From birth through adulthood, cystic fibrosis care entails a longitudinal regimen aimed at achieving relief of disease symptoms and enhanced life expectancy. With increased knowledge of the molecular behavior of the cystic fibrosis transmembrane conductance regulator (CFTR) in health and disease, clinical practice has been enriched by the prospect of novel strategies, including mutation-specific drug and gene therapy targeting restoration of corrupted transepithelial ion transport. Emerging paradigms of comprehensive care increasingly enable personalized solutions to address the root cause of disease-transforming management options for individuals with cystic fibrosis.

Internación por cuidados progresivos: propuesta metodológica para su implementación en un hospital general de agudos / Progressive patient care

Implementar un sistema de cuidados progresivos y atención interdisciplinaria en los hospitales generales del subsector público representa un desafío para el sistema de atención de la salud. El modelo, ya presente en un importante número de establecimientos del subsector privado y de la seguridad social, ubica a los pacientes en sectores de internación según sus necesidades de cuidado y dependencia, y no según las especialidades médicas tradicionales. En el presente artículo se presenta el marco conceptual y una propuesta metodológica para su efectiva implementación en un hospital público venciendo las naturales resistencias al cambio.

Implementation of progressive care patients and interdisciplinary care models in General Hospitals has been challengin for Public Health Care Sistems. The model actualy present in some Social Security and Private Hospitals place the patients in areas or units on the basis of their needs for care as deter­minated by the degree of illnes rather than on the basis of a medical specialty. This article describes the models theory and how it is posible to implement in a Public General Hospital despite of the natural resistence to change.

Atención continuadaen la zona de Valtierra-Cadreita(Navarra) / Continued healthcare in the Valtierra-Cadreita area (Navarra)

Objetivos: identificar las características de la población que acudea los servicios de Atención Continuada (AC), el tipo de atencióndemandada, las técnicas y procedimientos enfermeros quese llevan a cabo y las derivaciones que se hacen al hospital.Material y métodos: estudio descriptivo transversal en una poblaciónde 15.000 personas del entorno rural que acudió a losservicios de AC, tanto de presencia física como localizada duranteun año (entre 2005 y 2006). Además de las técnicas y procedimientosrealizados a cada paciente, se registró edad, sexo,localidad, hora del aviso, atención domiciliaria o centro y derivacióndel paciente.Resultados: se atendieron 1.730 pacientes, 669 con atenciónlocalizada y 1.061 en la zona con presencia física. El grupo másdemandante fue el comprendido entre 76-80 años de edad,con 152 visitas (8,78%). Acudieron más los hombres (58%) quelas mujeres. Un 70% de los avisos fueron en horario de tarde.En la zona con presencia física, la atención a los pacientes serealizó fundamentalmente en el centro de salud (62%). Se derivarona 220 pacientes (13%) al centro hospitalario más cercano.Las curas fueron la técnica más realizada (n=393, 37%).Conclusiones: la zona más demandante es aquélla con presenciafísica, la población más demandante es la anciana y ungrupo importante de mediana edad. Acuden también más loshombres y en la franja horaria de la tarde sobre todo. Un reducidoporcentaje es derivado al hospital. El estudio permitióidentificar las técnicas y procedimientos más frecuentementerealizados. Los hallazgos encontrados han posibilitado hacercambios para la mejora de la calidad (AU)

Objectives: to identify the characteristics of the populationwho seek continued medical healthcare, the type of healthcareservice sought, nursing techniques and procedures thatare carried out and hospital referrals.Material and methods: cross-sectional, descriptive study of apopulation comprised of 15,000 people from a rural setting whosought continued healthcare (CH) services, both at the pointof care (hospital or ambulatory setting) and localized (domiciliarycare or nursing home), throughout one year (between2005 and 2006). Aside from techniques and procedures performedon each patient, age, sex, city/town of residence, timeof consultation request, domiciliary care or centre and patientreferral were registered.Results: a total of 1,730 patients were seen, of whom 669 requireddomiciliary care and 1,061 required care in the area’spoint of care. The group which most sought healthcare serviceswas the one ranging between 76 and 80 years of age,with 152 visits (8,78%). More men (58%) than women soughthealthcare services. 70% of visits took place in the afternoon.In the point of care, healthcare delivery to patients was performedmainly in the health centre (62%). 220 patients (13%)were referred to the nearest hospital. Wound care was the mostfrequently performed technique (n=393, 37%).Conclusions: the most requested area is the one at the point ofcare. The elderly and an important middle-age group constitutethe population with the highest number of requests. Moremen than women seek healthcare services. Visits take placeespecially in the afternoon. A small percentage of patients isreferred to the hospital. The study enabled us to identify the mostfrequently performed techniques and procedures. Our findingshave allowed us to make changes with a view to improvethe quality of the service provided (AU)

Discharge setting for patients with hip fracture: trends from 2001 to 2005.

OBJECTIVES: To examine recent trends in discharge disposition after hospitalization for hip fracture. DESIGN: Retrospective observational study using data from the 5% random sample of Medicare claims data from 2001 to 2005 that the Centers for Medicare and Medicaid Services makes available for research purposes. SETTING: Inpatient medical rehabilitation pre- and postimplementation of prospective payment (2001-2005). PARTICIPANTS: Forty-four thousand six hundred eighty-four Medicare patients. MEASURES: Postacute discharge setting (home, inpatient rehabilitation, skilled nursing facility, and long-term care nursing home/hospital/hospice). RESULTS: Bivariate analyses showed that discharge from acute care to inpatient rehabilitation increased from 12.2% in 2001 to 23.9% in 2005. The odds of discharge to inpatient medical rehabilitation were 2.26 (95% confidence interval=2.09-2.45) greater in 2005 than in 2001 after adjustment for patient characteristics (age, sex, and race or ethnicity), admitting diagnoses, type of treatment (internal fixation vs arthroplasty), and length of stay. CONCLUSION: The move from fee for service to prospective payment for postacute services for persons with hip fracture was associated with greater use of inpatient medical rehabilitation. Further research is necessary to confirm the trend in discharge setting and determine whether it is related to changes in reimbursement for postacute care.