Coronary obstructive pulmonary disease (COPD) is an escalating health problem for individuals, their families, and the public at large, resulting n considerable morbidity and mortality. A 1-year pilot program was conducted at a managed care medical group to empower COPD patients with self-management skills and improve their quality of life through enhancing cost-effective care. A total of 141 COPD patients were enrolled in the intervention group that imparted self-management principles, and provided telephonic nursing outreach and an action plan for symptom exacerbation. The same number of patients in the control group accessed care from their physician or urgently through emergency departments. At the conclusion of this program, paid claims in the intervention group were significantly (P < 0.001) decreased compared to the control group. Primary care physician visits were also significantly (P < 0.001) greater in the intervention group than in the control group. Although not statistically significant, hospital admissions, bed-days, and emergency department visits showed downward trends in the intervention group. Working with their clinical team, motivated patients can gain health benefits through self-management in an era of rising COPD prevalence and cost of care.

Hospitalists play an important role in treating current and preventing future acute exacerbations of chronic obstructive pulmonary disease (AECOPD), which are associated with high rates of medical resource use and morbidity. Comprehensive admission screening and diagnostic tests are important in enabling hospitalists to reliably identify patients with AECOPD, the severity of the episode, and related issues that may prolong patients' hospital length of stay. Recurring exacerbations, especially those that require repeated acute care, can reduce physical activity and accelerate pulmonary decline and risk of death. Recommended pharmacotherapies for AECOPD should include short-acting bronchodilators, systemic corticosteroids, and appropriate antibiotics in cases of suspected bacterial infection. Patients with demonstrable hypoxemia or respiratory failure may benefit from oxygen and/or ventilatory support. Long-term disease management with the goal of preventing future exacerbations should include ongoing emphasis toward smoking cessation and up-to-date vaccination, in addition to prescribing maintenance pharmacotherapies in accordance with respiratory treatment guidelines. Additional benefits may be derived from nonpharmacologic therapies, such as pulmonary rehabilitation, weight-loss recommendations, and treatment of obstructive sleep dyspnea when present. Effective communication among members of the inpatient and outpatient health care teams, the patient, and his or her caregivers is an important aspect of care transitions. Hospital discharge summaries should be transmitted to the patient's primary care physician and be readily available at the first follow-up visit. Discharge coaches and other allied health care providers can aid hospitalists in reinforcing self-management skills and patient education, and in emphasizing the importance of follow-up visits. Recent findings suggest that health and cost benefits are associated with improved COPD management. This article focuses on the pivotal role of the hospitalist in promoting and facilitating the steps toward improving quality outcomes and transitions of care for patients with COPD.

Background: This study evaluated the non-structural elements of the medical capacity available following the Ji-Ji earthquake. This catastrophic earthquakes registering 7.3 on the Richter scale, struck mid-Taiwan on 21 September 1999, and took a death toll of 2,403, and injured 10,002 persons. Methods: Four affected hospitals participated in the study. Affected hospitals were defined as those with at least 200 beds that were within the epicenter area. The damaged, non-structural elements of these evacuated hospitals were examined and scored. Results: These hospitals suffered from only minor structural damage, but sustained extensive non-structural damage and were forced to evacuate patients from their buildings. Several major operational and functional components (OFC) that were critical to their operations were damaged: falling objects, flooding, loss of electricity, and damaged medical equipment. Conclusion: A well-designed, disaster medical care system should include seismic considerations of these hospitals, especially those key non-structural elements evaluated. In the 1999 Taiwan Ji-Ji quake, these affected hospitals lost most of their medical capacity at a period when patients desperately needed medical attention. It is important to reestablish the advanced design code for the repaired hospitals, providing OFC seismic protection to reduce mortality in next rural temblor.

analysis of phase III registration trials (full-publication if available, and Clinical Trial report/study Synopsis) and EPARs of commonly used short-acting (Insulin Aspart and Insulin Glulisine) and pre-mix (Biphasic Insulin Aspart) insulin analogues. Results: Therapy adjustments based on SMBG data were documented in 5/24 Insulin Aspart-, 3/18 Insulin Glulisine-and 4/15 Biphasic Insulin Aspart phase III registration trials. The EPARs of all three insulin analogues recommend the use of SMBG to adjust the insulin doses, repeatedly and throughout all sections in EPAR. ConClusions: Overall, in 12/57 phase III registration trials the dose of insulin analogues was regularly adjusted based on SMBG data, and the EPARs of all insulin analogues explicitly recommend the use of SMBG to adjust the insulin doses. Therefore, the demonstrated safety and efficacy of these insulin analogues are the result of a complex intervention including insulin analogues, their dose adjustments based on SMBG data as well as training rather than the insulin analogues alone. This is not consequently reflected in reimbursement schemes, in particular in emerging countries. Full study reports were not available for further analysis. These potentially would have provided deeper insights on how SMBG was used in the remaining 45/57 trials.

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