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Background and aims. Hospitalisations for chronic obstructive pulmory disease (COPD) exacerbations are major events in the tural history of the disease in terms of survival, quality of life and risk of further episodes of exacerbation. The aims of study were to evaluate: 1. adherence to recommended standards of care; and 2. clinical factors influencing major outcomes during hospitalisation for an episode of COPD exacerbation and within a 6-month follow-up. Methods. An observatiol, prospective study was conducted in 68 centres. Assessment of standards of care included diagnostic procedures (such as pulmory function tests and microbiology) and magement options (such as drug therapies, vaccitions and rehabilitation). Outcome measures relevant to the hospitalisation were: survival, need for mechanical ventilation, and length of stay (LOS). Outcomes at 6-months were: survival, exacerbations and hospitalisations for an exacerbation. Multivariate logistic regression was applied to evaluate the relation between clinical factors and outcomes. Results. 931 patients were enrolled. Only 556 patients (59.7%) were diagnosed COPD and stratified for severity with the support of spirometry (FEV1/VC ‰¤0.7) and were considered for outcome alysis. Among treatments, pulmory rehabilitation and anti-smoking counselling were applied infrequently (14.5 and 8.1% of patients, respectively). Within six months 63 COPD patients (17.7%) had at least one episode of exacerbation prompting a further hospitalisation and 19 died (5.3%). Predictor of mortality was the co-morbidity Charlson index (odds ratio, OR 10.3, p=0.03 CI:1.25-84.96). A further hospitalisation was predicted by hospitalisation for an exacerbation in the previous 12 months (OR 3.59, p=0.003 CI:1.54-8.39). Conclusions. Standards of care were far lower than recommended, in particular 40% of patients were labelled as COPD without spirometry. COPD patients with a second hospitalisation in 12 months for an exacerbation had about 3 times the risk of suffering a new episode and hospitalisation in the following six months.

This paper discusses some important issues regarding the the management of Learning objects covering searching over repositories and different approaches of recommendation systems and presents a multiagent system based application model for indexing, retrieving and recommending learning objects stored in different and heterogeneous repositories. The objects within these repositories are described by filled fields using different metadata (data about data) standards. The searching mechanism covers several different learning object repositories and the same object can be described in these repositories by the use of different types of fields. Aiming to improve accuracy and coverage in terms of recovering a learning object and improve the relevance of the results we propose an information retrieval model based on a multiagent system approach and an ontological model to describe the covered knowledge domain.