Atención clínica, toma de decisiones y soporte nutricional en pacientes con esclerosis lateral amiotrófica / Clinical care, decision making and nutritional support in patients with amyotrophic lateral sclerosis

Introducción: En los pacientes afectos de Esclerosis Lateral Amiotrófica, es indispensable ofertar una adecuada información, que conlleve una acertada toma de decisiones, debido a las situaciones de alta complejidad que presentan durante su enfermedad. Con esta idea de fondo, se creó en nuestro Hospital Universitario Puerta del Mar de Cádiz un equipo interdisciplinar e interniveles para la atención de pacientes con esta entidad. Objetivos: Comparar variables relacionadas con la evolución clínica y la de toma de decisiones antes y después de la creación del equipo. Material y Método: Estudio descriptivo, observacional. Se comparan variables, pre y post intervención, destacando: sintomatología que motiva la consulta o el ingreso, episodios de atención en el hospital, interconsultas a profesionales, registro en la historia clínica de haber proporcionado información sobre la posibilidad de expresar la Voluntad Vital Anticipada y/o la existencia de la misma, soporte nutricional recibido. Resultados: Se obtuvieron 15 pacientes en el primer grupo y 13 en el segundo. Existe mejora en los porcentajes obtenidos en todas las variables, destacando el registro de voluntades vitales, toma de decisiones y soporte nutricional. Discusión-Conclusiones: La creación de un equipo interdisciplinar que hace partícipe al paciente de todo su proceso, además de asegurar una adecuada toma de decisiones por parte del paciente, conlleva la mejora de los resultados de indicadores clínicos (AU)

Background: In cases of ALS, due to the highly complex situations arising during the disease, it is essential to provide adequate information to the patient, so they can make suitable decisions concerning quality of life and symptom management over the course of their disease. To this end, an interdisciplinary and interlevel team has been created in the Hospital Universitario Puerta del Mar of Cádiz to provide the best care for people living with ALS. Objectives: Compare variables related to the clinical outcome and decision in-making before and after the creation of the team. Methods: Descriptive and observational study. Variables under evaluation were compared pre- and post- intervention, including: symptoms at the admission or consultation stages, care taking episodes in the hospital, interdepartmental clinical issues, entries in the medical record of existence or prospect of completing the advance health care directive, decision-making and nutritional support. Result: For sake of comparison, two groups were formed, the first one was made of 15, whereas the second one composed of 13 patients. There was a significant improvement in all the variables under study. It is especially remarkable the advance in the living will records, decision-making and nutritional support. Discussion-Conclusion: The creation of an interdisciplinary team capable fo engaging the patient of ALS in the clinical issues and symptom management over the course of the disease, not only ensures an adequate decision-making by the patient, but improves the results of the corresponding clinical indicators (AU)

Clinical outcomes and cost analysis of exacerbations in chronic obstructive pulmonary disease.

BACKGROUND: Exacerbations are a major cause of disability, hospital admissions, and increased healthcare costs in patients with chronic obstructive pulmonary disease (COPD). This study investigated the clinical outcomes of outpatients with moderate to severe exacerbated COPD and their related costs. METHODS: An observational study on the outcomes of ambulatory exacerbations of COPD was conducted. The course of the exacerbation was evaluated at a follow-up visit at 4 weeks. A cost analysis that encompassed the use of healthcare resources for treatment of the exacerbation was performed. RESULTS: A total of 260 patients were included, with a mean age of 68.3 years and a mean FEV1 (% predicted) of 58.9 %. Twenty-two percent of patients had significant cardiovascular comorbidity. The most frequently prescribed antibiotics were moxifloxacin in 137 cases and amoxicillin-clavulanate in 50 cases. The rate of failure at 4 weeks was 12.5 %, with no differences between the two most prescribed antibiotics; however, patients treated with moxifloxacin had symptoms for 1.9 fewer days (P = 0.01). The mean cost of the exacerbation was 344.96 (95 % CI: 48.55-641.78), with 9.6 % of the costs for drugs and 72.9 % for hospital care of patients for whom treatment had failed. CONCLUSIONS: Antibiotic treatment of our population was in compliance with local guidelines. The rate of failure observed in our study was lower than that reported in previous studies; however, the small percentage of patients that required hospital attention generated almost two-thirds of the total costs of the exacerbations.