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E) Índice BODE, F) estadio GOLD, G) fenotipo de la GesEPOC, H) CAT, índice de masa corporal, déficit de alfa-1-antitripsina y tratamiento domiciliario con BiPAP en los pacientes con EPOC.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AG: agudizador; BC: bronquitis crónica; BiPAP: <span class="elsevierStyleItalic">Bilevel Positive Airway Pressure</span>; CAT: <span class="elsevierStyleItalic">Chronic Obstructive Pulmonary Disease Assessment Test</span>; DA1AT: déficit alfa-1-antitripsina; Enf: enfisema; IMC: índice de masa corporal; mMRC: <span class="elsevierStyleItalic">modified Medical Research Council</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tamara Lourido-Cebreiro, Carlota Rodríguez-García, Francisco Gude, Luis Valdés" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Tamara" "apellidos" => "Lourido-Cebreiro" ] 1 => array:2 [ "nombre" => "Carlota" "apellidos" => "Rodríguez-García" ] 2 => array:2 [ "nombre" => "Francisco" "apellidos" => "Gude" ] 3 => array:2 [ "nombre" => "Luis" "apellidos" => "Valdés" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212917301787" "doi" => "10.1016/j.arbr.2017.05.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917301787?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616303313?idApp=UINPBA00003Z" "url" => "/03002896/0000005300000007/v2_201706291228/S0300289616303313/v2_201706291228/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1579212917301805" "issn" => "15792129" "doi" => "10.1016/j.arbr.2017.05.009" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "1491" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2017;53:402-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1598 "formatos" => array:3 [ "EPUB" => 134 "HTML" => 1022 "PDF" => 442 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "An Unusual Occupant of the Pulmonary Artery" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "402" "paginaFinal" => "404" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un ocupante insólito de la arteria pulmonar" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1191 "Ancho" => 1427 "Tamanyo" => 261200 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography showing hypodense nodular images in the interior of the right pulmonary artery suggestive of cysts in the axial, sagittal, and coronal projections (A–C). Intra-operative view after clamping of the right pulmonary artery and arteriotomy of the lower lobe branch, showing hydatid membranes in the interior (D).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Teresa Gómez Hernández, María Rodríguez Pérez, Pilar García Hernández, Marcelo F. Jiménez López" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M. Teresa" "apellidos" => "Gómez Hernández" ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Rodríguez Pérez" ] 2 => array:2 [ "nombre" => "Pilar" "apellidos" => "García Hernández" ] 3 => array:2 [ "nombre" => "Marcelo F." 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"tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "400" "paginaFinal" => "402" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Tamara Lourido-Cebreiro, Carlota Rodríguez-García, Francisco Gude, Luis Valdés" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Tamara" "apellidos" => "Lourido-Cebreiro" "email" => array:1 [ 0 => "tamara.lourido.cebreiro@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Carlota" "apellidos" => "Rodríguez-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Francisco" "apellidos" => "Gude" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Luis" "apellidos" => "Valdés" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Epidemiología Clínica, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Grupo Epidemiología de Enfermedades Frecuentes, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Neumología, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es útil un hospital de día de enfermedades respiratorias en pacientes graves?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2311 "Ancho" => 3337 "Tamanyo" => 361365 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Level of physical activity, (B) dyspnea grade, (C) 6-minute walk test, and (D) FEV<span class="elsevierStyleInf">1</span> in the overall study population. (E) BODE index, (F) GOLD stage, (G) GesEPOC phenotype, (H) CTA, body mass index, alpha-1 antitrypsin deficiency, and BiPAP home therapy in COPD patients. A1ATD: alpha-1 antitrypsin deficiency; BiPAP: bilevel positive airway pressure; BMI: body mass index; CAT: chronic obstructive pulmonary disease assessment test; CB: chronic bronchitis; Em: emphysema; Ex: exacerbator; mMRC: modified Medical Research Council.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Respiratory day hospitals (RDH) are a useful alternative form of hospitalization.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> However, no studies are available that demonstrate their suitability for managing exacerbations in patients with severe respiratory disease. In this communication, we report our experience in this area.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Between December 2013 and November 2014, we performed an observational, longitudinal, quasi-experimental study (patients were their own controls) of all patients who attended the RDH (2 or more admissions/emergency visits due to decompensation of an underlying respiratory disease in the previous year). All patients were followed for 1 year, and data from the previous year were obtained from their clinical records. The study was approved by the Ethics Committee (no. 2016/424). Widely accepted criteria were used to establish the diagnosis of COPD, asthma, and bronchiectasis, and to determine levels of physical activity, dyspnea grade, deterioration of state of health, BODE index, 6-minute walk test, classification of COPD patients, and definition of sepsis.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">2–12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A descriptive analysis was conducted of patient characteristics, and visits to the emergency department/hospitalizations between the year prior to and the year after the patient's first visit to the RDH were compared using the Wilcoxon non-parametric test for paired data, and variables associated with hospitalization were studied. It was estimated that the mean annual number of events (emergency visits and admissions) in these patients would be 9–10, and that after implementation of the RDH this rate could be reduced by 25%. To achieve a power of 85%, 125 patients would be needed to detect significant differences (<span class="elsevierStyleItalic">p</span><0.05) between the number of events before and after RDH.</p><p id="par0020" class="elsevierStylePara elsevierViewall">During the study period, 1053 visits to the RDH for exacerbations were recorded in 129 patients (COPD [87], bronchiectasis [12], asthma [7], and others [23]). <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the level of physical activity (low/moderate in 112/129) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), dyspnea grade (mMRC 34 in 71/129) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B), 6-minute walk test (42/129 walked<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>250<span class="elsevierStyleHsp" style=""></span>m) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C), and FEV1 (84/129<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>50%) of the overall study population (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). Among COPD patients, 57/87 had a BODE index<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>4 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E), 82/87 were GOLD stage D (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>F), 76/87 had a GesEPOC exacerbator phenotype (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>G), 76/87 had CAT<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>10, 5/87 had a body mass index<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>21, 5/87 had alpha-1 antitrypsin deficiency, and 16/87 were receiving BiPAP home oxygen therapy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>H). In total, 8.6% of visits (91/1053) required hospital admission, mainly due to the need for intravenous antibiotics (25; 27.5%), acute respiratory failure (21; 23.1%), and failure of previous outpatient therapy (12; 13.2%). When the year prior to and the year after the first visit to the RDH were compared, a reduction in both the number of visits to the emergency room (110 vs 57; <span class="elsevierStyleItalic">P</span>=.001), and in the number of hospital admissions (236 vs 183; <span class="elsevierStyleItalic">P</span>=.006) was observed. Results were similar when data from patients who died during the follow-up year (19; 14.7%) were excluded: 90 vs 43 visits to the emergency room (<span class="elsevierStyleItalic">P</span>=.002); and 190 vs 141 hospital admissions (<span class="elsevierStyleItalic">P</span>=.003). Moreover, 81.8% (45/55) of patients receiving continuous home oxygen therapy had COPD.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">A multivariate analysis of COPD patients found that factors associated with a greater risk of admission were respiratory acidosis (OR 9.67, 95% CI: 1.48–62.9), diabetes mellitus (OR 2.01; 95% CI: 1.08–3.77), low blood pressure (OR 0.99; 95% CI: 0.97–1.00), tachycardia (OR 1.02; 95% CI: 1.00–1.04), diuretic failure (OR 19.7; 95% CI: 4.32–89.8), isolation of a multiresistant microorganism in sputum (OR 4.41; 95% CI: 2.06–9.42), sepsis (OR 4.01; 95% CI: 1.16–13.8), and use of accessory muscles (OR 4.94; 95% CI: 2.60–9.40).</p><p id="par0030" class="elsevierStylePara elsevierViewall">This study confirms that even in the first year of functioning, the RDH can reduce pressure on the emergency department and the number of admissions, despite the advanced respiratory disease status and high comorbidity burden of the patients seen. Moreover, it shows that certain factors are associated with a higher risk of admission among COPD patients. Our results coincide with those of other studies,<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1,13,14</span></a> although our series differs in that that most of our patients had very severe disease and presented higher exacerbation rates.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The significant reduction, in both the number of visits to the emergency room (110 vs 57; <span class="elsevierStyleItalic">P</span>=.001), and the number of hospital admissions (236 vs 183; <span class="elsevierStyleItalic">P</span>=.006) compared to the previous year appears to confirm the efficacy of the RDH. These results may be directly associated with the more specialized care provided the RDH doctors and nurses in the management of the respiratory patient.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The opening hours of the RDH are limited and a patient's destination must be decided within a few hours, so we examined which factors in COPD patients might predict hospitalization, to be able to anticipate their final destination. Some of the factors we identified are indicative of very severe COPD exacerbations<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a>: patients who may need ventilation (acidosis) or who have hemodynamic instability (tachycardia and hypotension).</p><p id="par0045" class="elsevierStylePara elsevierViewall">The limitations of this study are: (1) no strict protocol for reevaluation of each exacerbation (all patients were seen 72 hours after an exacerbation,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> but some had to be seen several times); (2) use of an mMRC scale for evaluating dyspnea in all patients although it is only validated for COPD. We decided to use this tool because it is easy to apply and because it is usually collected in the emergency department; and (3) lack of a cost-effectiveness study.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In short, a RDH can constitute an alternative to conventional hospitalization, and is suitable for the outpatient management of a large number of respiratory exacerbations, even in severe patients. COPD patients present a series of factors that predict a greater risk of hospital admission.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lourido-Cebreiro T, Rodríguez-García C, Gude F, Valdés L. ¿Es útil un hospital de día de enfermedades respiratorias en pacientes graves? Arch Bronconeumol. 2017;53:400–402.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2311 "Ancho" => 3337 "Tamanyo" => 361365 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Level of physical activity, (B) dyspnea grade, (C) 6-minute walk test, and (D) FEV<span class="elsevierStyleInf">1</span> in the overall study population. (E) BODE index, (F) GOLD stage, (G) GesEPOC phenotype, (H) CTA, body mass index, alpha-1 antitrypsin deficiency, and BiPAP home therapy in COPD patients. A1ATD: alpha-1 antitrypsin deficiency; BiPAP: bilevel positive airway pressure; BMI: body mass index; CAT: chronic obstructive pulmonary disease assessment test; CB: chronic bronchitis; Em: emphysema; Ex: exacerbator; mMRC: modified Medical Research Council.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospitales de día de enfermedades respiratorias: ¿qué hemos aprendido?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "X. Pomares-Amigó" 1 => "C. 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Year/Month | Html | Total | |
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2022 September | 31 | 30 | 61 |
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2022 June | 26 | 37 | 63 |
2022 May | 31 | 28 | 59 |
2022 April | 25 | 39 | 64 |
2022 March | 34 | 43 | 77 |
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2020 December | 22 | 16 | 38 |
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2020 September | 18 | 11 | 29 |
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2020 July | 27 | 30 | 57 |
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2020 May | 26 | 14 | 40 |
2020 April | 34 | 21 | 55 |
2020 March | 28 | 9 | 37 |
2020 February | 32 | 22 | 54 |
2020 January | 36 | 23 | 59 |
2019 December | 29 | 22 | 51 |
2019 November | 40 | 22 | 62 |
2019 October | 19 | 19 | 38 |
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2018 December | 19 | 14 | 33 |
2018 November | 35 | 24 | 59 |
2018 October | 45 | 17 | 62 |
2018 September | 17 | 6 | 23 |
2018 May | 13 | 1 | 14 |
2018 April | 21 | 4 | 25 |
2018 March | 22 | 7 | 29 |
2018 February | 30 | 8 | 38 |
2018 January | 87 | 5 | 92 |
2017 December | 86 | 12 | 98 |
2017 November | 32 | 26 | 58 |
2017 October | 28 | 19 | 47 |
2017 September | 0 | 2 | 2 |