[Chronic obstructive pulmonary disease in the setting of hospital at home. Study of 522 episodes]. / Enfermedad pulmonar obstructiva crónica en hospitalización a domicilio. Estudio de 522 casos.

OBJECTIVES: To assess the effectiveness, respiratory status, services of origin and outcome of patient with exacerbated COPD attended in Hospital at Home (HaH) regimen. PATIENT AND METHOD: Study of patients with an exacerbated COPD in HaH from Vitoria-Gasteiz, Spain during the period March 1999-October 2004, in whom hospital admission had been recommended after medical assessment. We studied: age, gender, patient's stay, oxygen-saturation or arterial blood gas analysis, FEV1 (basal), dyspnea status (basal and current), coexisting diseases, exacerbation causes, Services of origin, use of home nebulizers and oxygen therapy, intravenous drugs, course (discharges/admissions/deaths). We analyzed the number of visits to the Emergency Department and hospital admissions 90 days before and after discharge from Hospital at home. RESULTS: A total of 302 patients who generated 522 cases with exacerbated COPD were accepted, 81% of whom are men. Means stay was 11 days (0-111). Three hundred ninety six (76%) of the cases were discharge from HaH, 111 (21%) had to be hospitalized for different reasons, on 13 (2.5%) died. Of these, 43% came from the Respiratory Department and 39% from the Emergency one. Mean FEV1 was 45.4. A total of 89% of the patients had dyspnea 4/4 and 34% 3/4 when seen and 9% of the patients had pneumonia. During the 90 days following discharge from Hospital at Home, the number of visits to the Emergency Department and the rate of hospital admissions decreased significantly (p < 0.001). CONCLUSIONS: Our data confirm that Hospital at Home is a good alternative to conventional hospital admission for the management of patients with exaxerbated COPD.

Enfermedad pulmonar obstructiva crónica en hospitalización a domicilio. Estudio de 522 casos / Chronic obstructive pulmonary disease in the setting of hospital at home. Study of 522 episodes

Objetivos. Analizar la efectividad, situación respiratoria, servicios de procedencia, causas de reingreso y evolución de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) agudizada en una Unidad de Hospitalización a Domicilio (HaD). Pacientes y método. Estudio de pacientes con EPOC agudizada atendidos en la Unidad de HaD de Vitoria-Gasteiz entre marzo de 1999 y octubre de 2004, donde el ingreso hospitalario es recomendado tras valoración médica. Variables estudiadas: edad, sexo, estancia media, saturación de oxígeno o gasometría arterial, volumen espiratorio forzado en el primer segundo (FEV1) basal, grado de disnea (basal y actual), enfermedades coexistentes, causas de la agudización, servicios de procedencia, utilización de nebulizadores, oxigenoterapia y medicación intravenosa y evolución (altas/ingresos/fallecimientos). Analizamos el número de visitas a Urgencias y los ingresos hospitalarios 3 meses antes y 3 meses después de la intervención de HaD. Resultados. Trescientos dos pacientes que generaron 522 casos con EPOC agudizada fueron aceptados. El 81% eran hombres. La mediana de la estancia fue de 11 días (rango: 1-111). En 396 (76%) casos se dio el alta desde HaD. Ciento once (21%) tuvieron que ser hospitalizados por diferentes causas y 13 (2,5%) fallecieron. El 43 % procedían del Servicio Respiratorio y el 39% de Urgencias. El FEV1 medio fue de 45,4. El 89% de los pacientes tenían disnea 3-4/4 en el momento de ser atendidos. El 9% de los pacientes tuvieron neumonía. Durante los 90 días posteriores al alta por HaD el número de visitas a Urgencias y de ingresos disminuyó significativamente (p < 0,001). Conclusiones. Nuestros datos confirman que la HaD es una buena alternativa a la hospitalización convencional para el manejo de pacientes con EPOC agudizada (AU)

Objectives. To assess the effectiveness, respiratory status, services of origin and outcome of patient with exacerbated COPD attended in Hospital at Home (HaH) regimen. Patient and method. Study of patients with an exacerbated COPD in HaH from Vitoria-Gasteiz, Spain during the period March 1999-October 2004, in whom hospital admission had been recommended after medical assessment. We studied: age, gender, patient's stay, oxygen-saturation or arterial blood gas analysis, FEV1 (basal), dyspnea status (basal and current), coexisting diseases, exacerbation causes, Services of origin, use of home nebulizers and oxygen therapy, intravenous drugs, course (discharges/admissions/deaths). We analyzed the number of visits to the Emergency Department and hospital admissions 90 days before and after discharge from Hospital at home. Results. A total of 302 patients who generated 522 cases with exacerbated COPD were accepted, 81% of whom are men. Means stay was 11 days (0-111). Three hundred ninety six (76%) of the cases were discharge from HaH, 111 (21%) had to be hospitalized for different reasons, on 13 (2.5%) died. Of these, 43% came from the Respiratory Department and 39% from the Emergency one. Mean FEV1 was 45.4. A total of 89% of the patients had dyspnea 4/4 and 34% 3/4 when seen and 9% of the patients had pneumonia. During the 90 days following discharge from Hospital at Home, the number of visits to the Emergency Department and the rate of hospital admissions decreased significantly (p < 0.001). Conclusions. Our data confirm that Hospital at Home is a good alternative to conventional hospital admission for the management of patients with exaxerbated COPD (AU)

[Incidence and characteristics of Q fever in a community habitat]. / Incidencia y características de la fiebre Q en un hábitat comarcal.

Q fever is more common in our country than is usually thought, as shown by the diagnostic incidence curve, which approached an exponential rather than lineal function. Sixty cases were diagnosed between 1985 and October 1989. The disease predominated in middle aged males. The suspect epidemiologic contacts did not have any significance. Q fever was more frequent during autumn. Its usual clinical presentation was pneumonia (75%), commonly associated with a flu-like syndrome. Liver was commonly involved (66.6%), although in a mild degree. One of the patients had chronic Q fever, with granulomatous and hepatic, but not endocardial, involvement. The diagnosis was based on seroconversion detected by indirect immunofluorescence. As a rule, the course of the disease was favorable independently from therapy.