Hospitalization model and the readmission frequency in patients with copd exacerbation

Objetivo. Evaluar la efectividad de (UCE) en pacientes con (EPOC) agudizada frente a (HC) en términos de reingreso y mortalidad. Método. Estudio de cohortes retrospectivo no aleatorizado de pacientes hospitalizados por exacerbación de EPOC durante 2004 en un hospital general. El seguimiento se prolongó hasta el 31 de diciembre de 2006. La censura de datos se produce en la fecha final de seguimiento o aparición de muerte o reingreso. El análisis estadístico se basó en Kaplan-Meier, test del log-rank y regresión de Cox. Resultados. De los 543 pacientes incluidos, 252 ingresaron en UCE y 291 en HC. Los pacientes de UCE eran mayores (75,4 frente a 71,7 años; p < 0,001), y tendencia a un menor I. Charlson (0,46 frente a 0,58; p <0,07) que los pacientes de HC. La estancia media fue de 3,2 días en UCE frente a 8,9 días en HC (p <0,001). En el análisis univariante, los pacientes ingresados en UCE mostraron una mayor incidencia de muerte o reingreso (Riesgo Relativo [RR] 1,31; p<0,001), a expensas de los reingresos (RR 1,53; p= 0,013), no hubo diferencias de mortalidad (RR 0,82; p=0,34). Al ajustar para las covariables del modelo de hospitalización mediante regresión de Cox, estas estimaciones no cambiaron El análisis de las curvas de supervivencia demostró que las diferencias no se debieron a un aumento de los reingresos precoces. Conclusiones. En el estudio, los pacientes con exacerbación de EPOC ingresados en UCE tuvieron peores resultados en términos de reingreso que los de HCABSTRACT Objective: To evaluate the effectiveness of the Short Stay Unit (USS) in patients who suffer from a chronic obstructive pulmonary disease (COPD) that worsens versus conventional hospitalization (CH) in terms of readmission and mortality. Patient and Method. Non randomized retrospective study of cohorts of patients hospitalized due to exacerbation of EPOC during 2004 in a general hospital. The monitoring was prolonged until December 31st 2006 or the occurrence of an event (death or readmission). The statistical analysis was based on the Kaplan-Meier method, the log-rank test and Cox regression. Results. Of the 543 subjects, 252 were admitted in USS and 291 in CH. Those admitted in USS were more advanced in years (75.4 versus 71.7 years; p < 0,001), and with a tendency to a smaller Charlson index (0.46 versus 0.58; p < 0,07) than the patients in HC. The average stay was 3.2 days in UCE versus 8.9 days in CH (p < 0,001). In the univariant analysis, the patients admitted in USS showed a major incidence of death or readmission (Relative Risk [RR] 1.31; p < 0,001), at the expense of the readmission (RR 1.53; p = 0,013), while there were no differences in mortality (RR 0,82; p=0 ,34). After applying the Cox regression for the hospitalization covariables fit, there was no substantial change in the estimates. The analysis of the survival curves demonstrated that the differences were not due to an increase in precocious readmissions. Conclusions. In the field of the study, the patients with exacerbation of COPD admitted in USS had worse results in readmission terms than the patients admitted in CH

A teaching project to give the medical-surgical nursing clinical practicum convergent to the european space for higher education

El objetivo de este artículo es realizar un análisis de la legislación actual y la repercusión del cambio ya iniciado en algunas titulaciones como es el caso de Enfermería en el marco académico de la Educación Superior, reforma importante del Sistema Universitario Español. Para ello se revisa el contenido y análisis de la documentación publicada en el Ministerio de Educación relativa a Educación Superior; la legislación vigente española y la legislación Comunitaria con objeto de aproximar la legislación al marco de los estudios de enfermería.ABSTRACT Nowadays the number of nursing schools including in their study plans the Practicum subjects are increasing. These subjects are devoted to clinical practice and the majority of practical credits belonging to clinical subjects are concentrated on them. The reasons for it are that these subjects link the learning methodology proposed by the European Space for Higher Education. In the present work, which is a continuation of a previous one published in this Enfermería Global Nº 8 Mayo 2006 Página 2 journal, we propose a Teaching Project to give the Medical-Surgical Nursing clinical practicum of the study plans for the Registered Nursing degree. Following the same structure of our previous work, we propose a methodology based on the teaching of competences. The program and the system of credits are in line with the ancient Law of University Reform but they are also compatible with convergent method of the European Space for Higher Education. In the same way, we chose this subject on the grounds of its high credit load on the current study plans (being clinical the majority of them). All this make that steps to achieve convergence for this subject could be used for other nursing subject