Encuesta de utilización de la función pulmonar en los hospitales públicos de Cataluña en 2009 / Survey About the Use of Lung Function Testing in Public Hospitals in Catalonia in 2009

Introducción: El infradiagnóstico es uno de los problemas de mayor impacto en las enfermedades respiratorias y requiere intervenciones específicas. Una de ellas es tener acceso a una espirometría de calidad. Este es uno de los objetivos del Plan Director de Enfermedades Respiratorias del Departament de Salut de la Generalitat de Catalunya. Objetivo: Conocer la utilización de la espirometría hospitalaria en Cataluña, y conocer los posibles déficits y las opciones de mejora. Método: Estudio transversal mediante una encuesta a los 65 hospitales públicos de Cataluña durante el año 2009. Se realizó un análisis descriptivo para cada región sanitaria. Resultados: Se observó una falta de homogeneidad en la utilización de la espirometría a nivel territorial (de 0,98 a 1,50 espirometrías por 100 habitantes). Se identificaron 2 factores que están asociados a una mayor tasa de espirometrías: la existencia de un servicio de neumología en el centro y disponer de una ubicación estable para realizar espirometrías. Como áreas de mejora se identificaron el control de calidad de la prueba, la inclusión en los sistemas hospitalarios de información y los programas de formación continuada. Conclusiones: Los resultados de este estudio han permitido identificar las áreas de mejora para un programa a desarrollar (AU)

Background: Underdiagnosis is one of the problems with the greatest impact on respiratory disease management and requires specific interventions. Access to quality spirometry is especially important and is an objective of the Master Plan for Respiratory Diseases of the Department of Health of the Generalitat de Catalunya. Objective: To determine the current use of spirometry at public hospitals in Catalonia, possible deficiencies and options for improvement. Methods: A cross-sectional survey of 65 public hospitals in Catalonia in 2009. Descriptive analyses were developed for each public health-care region. Results: A lack of uniformity was observed in the use of spirometry at the regional level (between 0.98 and 1.50 spirometries per 100 inhabitants). We identified two factors associated with a higher rate of spirometry: (i) the existence of a Respiratory Medicine Department at the hospital, and (ii) the existence of a set location to carry out spirometries. Several areas for improvement also were identified: quality control of the test itself, the inclusion of spirometry in electronic health-care records and continuing education programmes. Conclusions: The results of this study have identified areas for improvement in spirometry programmes (AU)

Survey about the use of lung function testing in public hospitals in Catalonia in 2009.

BACKGROUND: Underdiagnosis is one of the problems with the greatest impact on respiratory disease management and requires specific interventions. Access to quality spirometry is especially important and is an objective of the Master Plan for Respiratory Diseases of the Department of Health of the Generalitat de Catalunya. OBJECTIVE: To determine the current use of spirometry at public hospitals in Catalonia, possible deficiencies and options for improvement. METHODS: A cross-sectional survey of 65 public hospitals in Catalonia in 2009. Descriptive analyses were developed for each public health-care region. RESULTS: A lack of uniformity was observed in the use of spirometry at the regional level (between 0,98 and 1.50 spirometries per 100 inhabitants). We identified two factors associated with a higher rate of spirometry: i) the existence of a Respiratory Medicine Department at the hospital, and ii) the existence of a set location to carry out spirometries. Several areas for improvement also were identified: quality control of the test itself, the inclusion of spirometry in electronic health-care records and continuing education programs. CONCLUSIONS: The results of this study have identified areas for improvement in spirometry programs.

Telemedicine enhances quality of forced spirometry in primary care.

Forced spirometry is pivotal for diagnosis and management of respiratory diseases, but its use in primary care is suboptimal. The aim of the present study was to assess a web-based application aiming at fostering high-quality spirometry in primary care. This was a randomised controlled trial with 12 intervention primary care units (PCi) and six control units (PCc) studied over 12 months. All 34 naïve nurses (PCi and PCc) received identical training. The PCi units had access to educational material and remote expert support. Quality of spirometry and usability of the web application were assessed. We included 4,581 patients (3,383 PCi and 1,198 PCc). At baseline, quality was similar (PCi 71% and PCc 67% high-quality tests). During the study, PCi showed higher percentage (71.5%) of high-quality tests than PCc (59.5%) (p<0.0001). PCi had 73% more chance of high-quality performance than PCc. The web application was better for assessing quality of testing than the automatic feedback provided by the spirometer. Healthcare professionals' satisfaction and usability were high. The web-based remote support for primary care by specialists generated a sustained positive impact on quality of testing. The study expands the potential of primary care for diagnosis and management of patients with pulmonary diseases.

Management of sleep apnea: concordance between nonreference and reference centers.

BACKGROUND: When a disorder is as prevalent as sleep apnea-hypopnea syndrome (SAHS), different medical levels and approaches should be involved in facilitating the diagnosis, at least, of patients with symptoms that disrupt social or working life, and of risk groups such as professional drivers. We sought to analyze the degree of concordance between management and treatment decisions for SAHS patients at sleep reference centers (RCs) and at non-RCs (NRCs). MATERIALS AND METHODS: Eighty-eight consecutive patients with suspected SAHS were referred by family doctors to the NRC. The patients were studied randomly at the RC, using full polysomnography, and at the NRC, employing respiratory polygraphy. The concordance in the therapeutic approach between both centers was analyzed via the outcomes, and the physiologic variables of the sleep studies were also evaluated. RESULTS: The concordance in the final clinical decision was substantial. There was a good agreement with respect to apnea-hypopnea index as a categoric variable and as a continuous variable. CONCLUSIONS: These results suggest that respiratory physicians with simple sleep studies are able to manage a large number of patients with SAHS. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT 00424658.

Phosphodiesterase 7A1 is expressed in human CD4+ naïve T cells at higher levels than in CD4+ memory cells and is not required during their CD3/CD28-dependent activation.

PDE7A1 is a cAMP-hydrolyzing phosphodiesterase expressed in lymphoid tissue, where its possible role during T cell activation remains unclear. We have characterized the functional relevance of PDE7A1 in the naïve (CD4+CD45RA+) and memory (CD4+CD45RO+) subsets of human peripheral CD4+ T cells during CD3/CD28-dependent stimulation. Our results indicate that PDE7A1 is expressed in resting naïve CD4+ T cells at higher levels than in the corresponding memory cells and that levels of PDE7A1 mRNA are not upregulated upon CD3/CD28 mediated stimulation of these T cell subsets. Treatment with a selective inhibitor of PDE7A1 does not impair CD3/CD28 induced activation of naïve or memory CD4+ T cells, nor does it increase intracellular cAMP in CD4+ T cells. We conclude that PDE7A1 is not required during CD3/CD28-dependent activation of naïve and memory CD4+ T cells, but cannot rule out other regulatory roles of PDE7A1 during maturation of CD4+ T cells.