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J Solà

Publications and source records attributed to J Solà.

6 recordsLinked to original sources
PubMed2006

[Effectiveness and efficiency of a specialized unit in the care of patients with chronic obstructive pulmonary disease and respiratory insufficiency].

OBJECTIVE: In the absence of a clear health care model for the management of patients with chronic obstructive pulmonary disease and chronic respiratory insufficiency, we evaluated the effectiveness and efficiency of a specialized outpatient unit for these patients managed by the hospital s respiratory medicine department. PATIENTS AND METHODS: This was a 1-year prospective study of a group of patients for whom historical control data were available. The mean (SD) descriptive data for the 124 patients (105 men) were as follows: age, 69 (7) years; forced vital capacity, 64.6% (16.1%); forced expiratory volume in the first second (FEV1), 35.6% (12.8%); PaO2, 56.6 (8.3) mm Hg; PaCO2, 49.8 (6.7) mm Hg. Forced spirometry and arterial blood gas analysis were performed at 3-monthly visits. Participants completed a quality-of-life questionnaire (Guyatt's Chronic Respiratory Disease Questionnaire) at the beginning and end of the study. The following variables were analyzed: forced spirometry, arterial blood gases, quality of life, number of emergency visits and hospital admissions, mean length of stay in hospital, reduction in the number of inpatient bed-days, mean cost of emergency visits, mean cost of hospital stays for both the Catalan Health Service (CHS) and the hospital, mean total cost per patient for the CHS and the hospital, and aggregate cost for the CHS and the hospital. The results were compared with data for the preceding year taken from the hospital records. RESULTS: Significant improvement was found in forced vital capacity and PaO2 (which went from 56.6 [8.2] mm Hg to 59.1 [8.9] mm Hg during the prospective part of the study); FEV1 also tended to improve (875 [282] mL as against 912 [321] mL), but this change was not significant (P= .17). A significant reduction was observed in the following variables: PaCO2; hospital admissions, 1.16 (1.15) in the historical control period compared to 0.67 (1.17) during the prospective study; emergency visits, 2.06 (1.9) as against 1.5 (2.1); mean length of stay in hospital, 14.2 (19) compared to 8.1 (16) days; total number of inpatient bed-days (756 inpatient bed-days were saved in the study period); mean cost of emergency visits and hospital stays for both the hospital (2246 euros [3007 euros] in the historical period as against 1297 euros [2639 euros] with the new management system) and for the CHS; and the aggregate cost both for the hospital (40,011 euros in the historical control period as against 6048 euros with the new model) and the CHS (238,513 euros as against 152,312 euros). The quality-of-life score improved, but the change was not significant. CONCLUSIONS: The change in the health care model used to manage these patients led to an improvement in care (effectiveness) as well as a marked reduction in costs (greater efficiency) for both the funding entity (CHS) and for the care provider (the hospital). No change was observed in the quality of life as reported by the patients.

Aged↗
PubMed2001

[Probabilistic models of mortality for patients hospitalized in conventional units].

BACKGROUND: We have developed a tool to measure disease severity of patients hospitalized in conventional units in order to evaluate and compare the effectiveness and quality of health care in our setting. PATIENTS AND METHOD: A total of 2,274 adult patients admitted consecutively to inpatient units from the Medicine, Surgery and Orthopaedic Surgery, and Trauma Departments of the Corporació Sanitària Parc Taulí of Sabadell, Spain, between November 1, 1997 and September 30, 1998 were included. The following variables were collected: demographic data, previous health state, substance abuse, comorbidity prior to admission, characteristics of the admission, clinical parameters within the first 24 hours of admission, laboratory results and data from the Basic Minimum Data Set of hospital discharges. Multiple logistic regression analysis was used to develop mortality probability models during the hospital stay. RESULTS: The mortality probability model at admission (MPMHOS-0) contained 7 variables associated with mortality during hospital stay: age, urgent admission, chronic cardiac insufficiency, chronic respiratory insufficiency, chronic liver disease, neoplasm, and dementia syndrome. The mortality probability model at 24-48 hours from admission (MPMHOS-24) contained 9 variables: those included in the MPMHOS-0 plus two statistically significant laboratory variables: hemoglobin and creatinine. CONCLUSIONS: Severity measures, in particular those presented in this study, can be helpful for the interpretation of hospital mortality rates and can guide mortality or quality committees at the time of investigating health care-related problems.

Female↗
PubMed2000

Factors explaining the geographical differences in Disability Free Life Expectancy in Spain.

OBJECTIVE: To study the geographical variations in Disability Free Life Expectancy (DFLE) at birth (DFLEb) and at 65 years (DFLE65) in Spain and to identify the main factors that explain these variations. DESIGN: Ecological study with the 50 provinces of Spain as the units of analysis. Sullivan's method is used to calculate DFLE for each province based on information from the death registry and the survey on disabilities, impairments and handicaps. Information on the independent variables-socioeconomic level, factors related with the health system and risk factors-was taken from various sources. MAIN OUTCOME MEASURE: Simple correlation coefficients were obtained between each dependent variable (DFLEb and DLFE65) and the independent variables. Two multiple linear regression models were fit to obtain the best set of factors that explain the geographical distribution of DFLEb and DLFE65. RESULTS: Both DFLEb and DLFE65 vary widely among provinces. The multiple linear regression analysis shows that the illiteracy rate, the percentage of the unemployed and the percentage of smokers in the population were the main factors associated with the geographical variation of DFLE. The models explained approximately 40% of the variance for DFLEb and 30% for DLFE65. CONCLUSIONS: The results obtained show the influence of education, the unemployment rate and smoking on the geographical differences of DFLE. The DFLE indicators are shown to be valid for use in health policy.

Adolescent↗
PubMed1996

Determination of the anti-platelet-activating factor BN-50727 and metabolites in human urine by high-performance liquid chromatography using solid-phase extraction.

A sensitive and selective HPLC solid-phase extraction procedure was developed for the determination of platelet-activating factor antagonist BN-50727 and its metabolites in human urine. The procedure consisted in a double solid-phase extraction of the urine samples on cyanopropyl and silica cartridges, followed by an automated solid-phase extraction of the drug and metabolites on CBA cartridges and posterior elution on-line to the chromatographic system for its separation. The method allowed quantitation in the concentration range 10-2400 ng/ml urine for both BN-50727 and the main metabolite, the O-demethylated BN-50727 product. The limit of quantitation for both compounds was 10 ng/ml. The inter-assay precision of the method, expressed as relative standard deviation, ranged from 1.9 to 4.5% for BN-50727 and from 2.5 to 9.0% for the metabolite. The accuracy, expressed as relative error, ranged from -2.4 to 4.2% and from 0.2 to 6.2%, respectively. This paper describes the validation of the analytical methodology for the determination of BN-50727 in human urine and also for its metabolites. The method has been used to follow the time course of BN-50727 and its metabolites in human urine after single-dose administration.

Azepines↗
PubMed1988

Longitudinal study of renal prostaglandin excretion in cirrhotic rats: relationship with the renin-aldosterone system.

1. A cross-sectional study (protocol A) was performed in 19 rats with cirrhosis, induced by carbon tetrachloride (CCl4), and ascites and in 10 control animals to assess renal prostaglandin (PG) excretion in experimental cirrhosis. In an additional group of animals, including nine rats chronically exposed to CCl4 (CCl4 rats) and six control rats, a longitudinal study (protocol B) was performed to investigate the temporal relationship between changes in renal PG excretion, the renin--aldosterone system and renal function. 2. Urinary PG excretion was assessed by specific radioimmunoassay of PGE2, PGF2 alpha, 6-keto-PGF1 alpha and thromboxane (TX) B2 after extraction with octadecyl silica cartridges and h.p.l.c. purification. Recoveries for each prostanoid (61 +/- 8% for PGE2, 64 +/- 12% for PGF2 alpha, 65 +/- 11% for 6-keto-PGF1 alpha and 66 +/- 17% for TXB2) were determined in every sample by adding tritiated standards, and the final values were corrected according to the individual recoveries. 3. Cirrhotic rats with ascites in protocol A showed a significantly higher plasma renin and aldosterone concentrations and urinary excretion of 6-keto-PGF1 alpha and TXB2 than did control animals. Urinary excretion of PGE2 and PGF2 alpha, however, was significantly reduced in cirrhotic animals as compared with controls. 4. In CCl4 rats included in protocol B, there was a close chronological relationship between the activation of the renin-aldosterone system, as estimated by urinary aldosterone excretion, the onset of sodium retention and the increase in urinary excretion of 6-keto-PGF1 alpha and TXB2. The urinary excretion of PGE2 and PGF2 alpha in CCl4 rats was reduced throughout the study.(ABSTRACT TRUNCATED AT 250 WORDS)

6-Ketoprostaglandin F1 alpha↗