Economic Impact of Lean Healthcare Implementation on the Surgical Process.

Objectives: The objective of this study was to analyse and detail surgical process improvement activities that achieve the highest economic impact.

Methods: Over 4 years, a team of technicians and healthcare professionals implemented a set of Lean surgical process improvement projects at Vall d'Hebron University Hospital (VHUH), Barcelona, Spain. Methods employed in the study are common in manufacturing environments and include reducing waiting and changeover time (SMED), reducing first time through, pull, and continuous flow.

Risk factors for hospital readmission in patients with chronic obstructive pulmonary disease.

Background: Hospital readmissions for acute exacerbation of chronic obstructive pulmonary disease (COPD) are one of the leading causes of health care expenditures worldwide.

Objectives: To identify risk factors for hospital readmission in COPD patients.

Methods: We prospectively evaluated 129 consecutive patients hospitalized for acute exacerbation of COPD.

Genotypic and phenotypic resistance patterns at virological failure in a simplification trial with nevirapine, efavirenz or abacavir.

Background: The NEFA Study was a randomized study comparing nevirapine (NVP), efavirenz (EFV) or abacavir (ABC) as substitutes for protease inhibitors in a large group of HIV-1-infected patients successfully treated with antiretroviral regimens containing protease inhibitors.

Objective: To evaluate genotype and phenotype resistance patterns among patients who have experienced virological failure under one of the three study arms.

Methods: Patients with virological failure, defined as two consecutive determinations of HIV-1 RNA > 200 copies/ml, were analysed for phenotypic susceptibility and HIV-1 mutations.

[Hospital admission, duration of stay and mortality in community-acquired pneumonia in an acute care hospital. Correlation between a pneumonia prognosis index and conventional clinical criteria for assessing severity].

Introduction: The objective of this study was to evaluate the management of community acquired pneumonia (CAP) according to conventional clinical criteria applied in the emergency room as compared to a pneumonia prognosis index (PPI) (Fine et al. NEJM 1997). We also analyzed which factors were associated with the need for inpatient treatment in PPI risk category III patients.

Failure of macrolide antibiotic treatment in patients with bacteremia due to erythromycin-resistant Streptococcus pneumoniae.

The rate of macrolide resistance among Streptococcus pneumoniae is increasing, but some investigators have questioned its clinical relevance. We conducted a matched case-control study of patients with bacteremic pneumococcal infection at 4 hospitals to determine whether development of breakthrough bacteremia during macrolide treatment was related to macrolide susceptibility of the pneumococcal isolate. Case patients (n=86) were patients who had pneumococcal bacteremia and an isolate that was either resistant or intermediately resistant to erythromycin.

Mortality after hospitalization for COPD.

Objectives: To identify variables associated with mortality in patients admitted to the hospital for acute exacerbation of COPD.

Design: Prospective cohort study.

Setting: Acute-care hospital in Barcelona (Spain).