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de Asúa DR, Olaciregui Dague K, Arriaga A, Herreros B. Animating Clinical Ethics: A Structured Method to Teach Ethical Analysis Through Movies. HEC Forum 2023; 35:325-335. [PMID: 35092518 DOI: 10.1007/s10730-022-09470-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 12/28/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
Movies can serve valuable didactic purposes teaching clinical ethics to medical students. However, using film sequences as means to develop critical thinking is not a straightforward task. There is a significant gap in the literature regarding how to analyse the ethical content embedded in these clips systematically, in a way that facilitates the students' transition from anecdotal reflections to abstract thinking. This article offers a pedagogical proposal to approach the ethical analysis of film sequences in a systematic fashion. This structured stepwise method encourages students to identify the main ethical problem of a selected scene and to reflect on the theoretical principles involved, emphasizing the application of these norms and values in a contextually situated analysis. We believe this method in film studies both reinforces the students' comprehension of the theoretical framework of an ethical topic, and casts light on its pertinence and limitations under the circumstances of the scene, thus proving a constructive tool to strengthen the bridge between the theoretical teaching of clinical ethics and clinical practice.
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Affiliation(s)
- Diego Real de Asúa
- Division of Medical Ethics, Department of Medicine, Weill Cornell Medical College, New York, NY, United States
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Plaza Francisco Morano S/N, 28005, Madrid, Spain
- Clinical Bioethics and Professionalism Working Group, Spanish Society of Internal Medicine, Madrid, Spain
- Department of Internal Medicine, Hospital Universitario de La Princesa, Madrid, Spain
| | - Karmele Olaciregui Dague
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Plaza Francisco Morano S/N, 28005, Madrid, Spain
- Epileptology Department, University Hospital Bonn, Bonn, Germany
| | - Andrés Arriaga
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Plaza Francisco Morano S/N, 28005, Madrid, Spain
| | - Benjamin Herreros
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Plaza Francisco Morano S/N, 28005, Madrid, Spain.
- Clinical Bioethics and Professionalism Working Group, Spanish Society of Internal Medicine, Madrid, Spain.
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Domínguez-Alegría A, Pinto-Pastor P, Herreros B, Real-de-Asúa D. Should the pharmaceutical industry be involved in continuing medical education? Rev Clin Esp 2022; 222:393-400. [DOI: 10.1016/j.rceng.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
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Romero‐Correa M, Salamanca‐Bautista P, Bilbao‐González A, Quirós‐López R, Nieto‐Martín MD, Martín‐Jiménez ML, Morales‐Rull JL, Quiles‐García D, Gómez‐Gigirey A, Formiga F, Aramburu‐Bodas Ó, Arias‐Jiménez JL, Choucino‐Fernández T, Porto‐Pérez A, Piñeiro‐Parga P, Pedrosa‐Fraga C, Suárez‐Gil R, González‐Soler J, López‐Mato P, Latorre‐Díez A, Ferreira‐González L, Sánchez‐Cembellin M, Gallego‐Villalobos M, Rugeles‐Niño J, Rodríguez‐Avila E, González‐Franco A, Guerra‐Acebal C, Sebastián‐Leza A, Monte‐Armenteros J, Frutos‐Muñoyerro G, Clemente‐Sarasa C, Díez‐Manglano J, Josa‐Laorden C, Torres‐Courchoud I, Gómez‐Aguirre N, Jordana‐Camajuncosa R, Cajamarca‐Calva L, Torrente‐Jiménez I, Serrado‐Iglesias A, Ceresuela L, Salas‐Campos R, Delás‐Amat J, Brasé‐Arnau A, Petit‐Salas I, Romaní‐Costa V, Expósito‐López A, Sabbagh‐Fajardo C, Recio‐Iglesias J, Alemán‐Llansó C, Suriñach‐Caralt J, Trullás‐Vila J, Armengou‐Arxe A, García‐Torras S, Solé‐Felip C, Lacal‐Martínez A, Otero‐Soler M, Muela‐Molinero A, Carrera‐Izquierdo M, Arribas‐Arribas P, Inglada‐Galiana L, Ruiz ‐de Temiño Á, Silva‐Vázquez Á, Fuentes‐Pardo L, García‐García M, Piniella‐Ruiz E, Pérez‐Alves B, Gonzalo‐Pascua S, Marrero‐Francés J, Méndez‐Bailón M, Martín‐Sánchez F, Varas‐Mayoral M, Asenjo‐Martínez M, Yebra‐Yebra M, Sánchez‐Sauce B, Herreros B, Quesada‐Simón A, Vives‐Beltrán I, Álvarez‐Troncoso J, Martínez‐Marín L, Martínez PG, Mayorga ED, Moreno‐Palanco M, Soler‐Rangel L, Abellán‐Martínez J, Colás‐Herrera A, López‐Castellanos G, Ruíz‐Ortega R, Ruiz‐Barraza E, Montero‐Hernández E, Arévalo‐Lorido J, Carretero‐Gómez J, Calderón‐Jiménez P, Herrero‐Domingo A, Martín‐Barba S, Blázquez‐Encinar J, Jiménez‐Guardiola C, Cepeda‐Rodrigo J, Carrascosa‐García S, Llacer‐Iborra P, Moreno‐García M, Díez‐García L, Sánchez‐López P, Martínez‐Soriano M, Menor E, Montero‐Pérez‐Barquero M, Anguita‐Sánchez M, Sánchez‐Moruno M, Fuentes‐Espínola M, Zambrana‐García J, Guisado‐Espartero E, Mejías‐Real I, Alcalá‐Pedrajas J, Carrasco‐Sánchez F, Díaz‐Pérez C, Guzmán‐García M, Domingo‐Roa S, Cortés‐Rodríguez B, García‐Redecillas C, Martín‐Navarro R, Macías‐Ávila P, Antequera‐Martín‐Portugués I, Blanco‐Soto M, Flores‐Álvarez F, Aparicio‐Santos R, García‐Serrano R, Jiménez‐de‐Juan C, Ternero‐Vega J, Villalonga‐Comas M, Díaz‐Cañestro M, Asensio‐Rodríguez J, Gil‐Díaz A, Marrero‐Medina I, Puente‐Fernández A, Gudiño‐Aguirre D, Dávila‐Ramos M, Calderón E, Fernández‐Martínez J, Vázquez‐Rodríguez P, Conde‐Martel A, García‐García J, Páez‐Rubio I, López‐Reboiro M, Sánchez‐Sánchez C. The EPICTER score: a bedside and easy tool to predict mortality at 6 months in acute heart failure. ESC Heart Fail 2022. [PMCID: PMC9288794 DOI: 10.1002/ehf2.13924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims Estimating the prognosis in heart failure (HF) is important to decide when to refer to palliative care (PC). Our objective was to develop a tool to identify the probability of death within 6 months in patients admitted with acute HF. Methods and results A total of 2848 patients admitted with HF in 74 Spanish hospitals were prospectively included and followed for 6 months. Each factor independently associated with death in the derivation cohort (60% of the sample) was assigned a prognostic weight, and a risk score was calculated. The accuracy of the score was verified in the validation cohort. The characteristics of the population were as follows: advanced age (mean 78 years), equal representation of men and women, significant comorbidity, and predominance of HF with preserved ejection fraction. During follow‐up, 753 patients (26%) died. Seven independent predictors of mortality were identified: age, chronic obstructive pulmonary disease, cognitive impairment, New York Heart Association class III–IV, chronic kidney disease, estimated survival of the patient less than 6 months, and acceptance of a palliative approach by the family or the patient. The area under the ROC curve for 6 month death was 0.74 for the derivation and 0.68 for the validation cohort. The model showed good calibration (Hosmer and Lemeshow test, P value 0.11). The 6 month death rates in the score groups ranged from 6% (low risk) to 54% (very high risk). Conclusions The EPICTER score, developed from a prospective and unselected cohort, is a bedside and easy‐to‐use tool that could help to identify high‐risk patients requiring PC.
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Affiliation(s)
| | - Prado Salamanca‐Bautista
- Internal Medicine Department Hospital Universitario Virgen Macarena Seville Spain
- University of Seville Seville Spain
| | - Amaia Bilbao‐González
- Osakidetza Basque Health Service, Research Unit Basurto University Hospital Bilbao Spain
- Health Service Research Network on Chronic Diseases (REDISSEC) Barakaldo Spain
- Kronikgune Institute for Health Services Research Barakaldo Spain
| | | | | | | | | | - Dolores Quiles‐García
- Internal Medicine Department Hospital Universitario General de Valencia Valencia Spain
| | | | - Francesc Formiga
- Internal Medicine Department Hospital Universitari de Bellvitge Barcelona Spain
| | - Óscar Aramburu‐Bodas
- Internal Medicine Department Hospital Universitario Virgen Macarena Seville Spain
- University of Seville Seville Spain
| | - José Luis Arias‐Jiménez
- Internal Medicine Department Hospital Universitario Virgen Macarena Seville Spain
- University of Seville Seville Spain
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Sáez-Jiménez R, Esteban-Hernández J, Herreros B, Huelmos A, Guijarro C, Guijarro C, Belinchón JC, Aranda C, Herreros B, González Anglada I, Téllez M, Huelmos AI, López-Bescós L, Sánchez C, Barriga F, Gutiérrez M, Puras E, Casas ML, Tolón R. La albuminuria y la enfermedad polivascular mejoran la capacidad predictiva de los modelos multivariados después de un evento cardiovascular agudo. Cohorte AIRVAG. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Domínguez-Alegría A, Pinto-Pastor P, Herreros B, Real-de-Asúa D. ¿Debe la industria farmacéutica participar en la formación médica continuada? Revista Clínica Española 2022. [DOI: 10.1016/j.rce.2021.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Velasco Sanz TR, Pinto Pastor P, Moreno-Milán B, Mower Hanlon LF, Herreros B. Spanish regulation of euthanasia and physician-assisted suicide. J Med Ethics 2021; 49:medethics-2021-107523. [PMID: 34330794 DOI: 10.1136/medethics-2021-107523] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
In March 2021, the Spanish Congress approved the law regulating euthanasia, that regulates both euthanasia and physician-assisted suicide (PAS). In this article, we analyse the Spanish law regulating euthanasia and PAS, comparing it with the rest of the European laws on euthanasia and PAS (Netherlands, Belgium and Luxembourg). Identified strengths of the Spanish law, with respect to other norms, are that it is a law with many safeguards, which broadly recognises professionals' right to conscientious objection and the specification that it makes on the prior comprehensive care of the patient, including the approach to care dependency. Regarding its shortcomings, the law does not differentiate well between euthanasia and PAS; it barely assigns a role to the healthcare team as a whole (similar to other regulations); it does not clarify the functions of the different professionals involved; it does not detail the specific composition and duration of theevaluation commission; it has not been accompanied by a prior or simultaneous regulation of palliative care; and, lastly, the period of time to implement the law is too short.
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Affiliation(s)
- Tamara Raquel Velasco Sanz
- Departamento Enfermería, Complutense University of Madrid, Madrid, Spain
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain
| | - Pilar Pinto Pastor
- Medicina Legal, psiquiatría y patología, Complutense University of Madrid, Madrid, Spain
| | - Beatriz Moreno-Milán
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain
- Departamento de Psicología Clínica. Facultad de Psicología, Complutense University of Madrid, Madrid, Spain
| | - Lydia Frances Mower Hanlon
- Departamento Enfermería, Complutense University of Madrid, Madrid, Spain
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain
| | - Benjamin Herreros
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain
- Unidad de Medicina Interna, Hospital Universitario Fundacion Alcorcon, Alcorcón, Madrid, Spain
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Sáez-Jiménez R, Esteban-Hernández J, Herreros B, Huelmos A, Guijarro C. Albuminuria and polyvascular disease improve multivariate predictive models after an acute cardiovascular event. The AIRVAG cohort. Rev Clin Esp 2021; 222:138-151. [PMID: 34147423 DOI: 10.1016/j.rceng.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS There is no consensus regarding risk stratification tools for secondary prevention in atherosclerotic cardiovascular disease. Our aim was to compare the discriminative performance of the Framingham, REGICOR, SCORE, and REACH risk functions and the Bohula-TIMI and SMART risk scores, as well as to assess the potential added value of other clinical variables for the prediction of recurrent events in patients with established vascular disease. METHODS A cohort of 269 patients with established vascular disease (52.8% coronary, 32% cerebrovascular, 15.2% PAD) was included. The survival functions of risk groups (low/medium/high) according to commonly used cutoff points for each function/score were compared, and hazard ratios for each were estimated using Cox regression. We calculated Δ Harrell's C statistic, cat-NRI, and cNRI after adding new predictors to a base model including age, sex, total cholesterol, current smoking status, hypertension, and diabetes. RESULTS After six years of follow-up (median 4.82 years), 61 events occurred (23%). High-risk groups had a higher risk of recurrent event: SMART (HR: 3.17 [1.55-6.5]), Framingham (HR: 3.08 [1.65-5.75]), REGICOR (HR: 2.71 [1.39-5.27]), SCORE (HR: 2.14 [1.01-4.5], REACH (HR: 5.74 [2.83-11.7]), B-TIMI (HR: 3.68 [0.88-15.3]). Polyvascular disease (three territories HR: 5.6 [2.2-14.25]), albuminuria (HR: 3.55 [2.06-6.11]), and heart failure (HR: 3.11 [1.34-7.25]) also increased risk. Discrimination (Harrell's C) was low but improved after adding albuminuria and polyvascular disease. Both variables also improved the performance of the base model (cNRI.326 [.036; .607]). CONCLUSIONS The Framingham, REGICOR, SCORE, and REACH functions and the B-TIMI and SMART scores showed low yet similar performance in secondary prevention. Albuminuria and polyvascular disease improved the predictive performance of major classical cardiovascular risk factors.
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Affiliation(s)
- R Sáez-Jiménez
- Centro de Atención Primaria Presentación Sabio, Móstoles, Madrid, Spain; Área de Salud Pública y Medicina Preventiva, Facultad de Medicina, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - J Esteban-Hernández
- Área de Salud Pública y Medicina Preventiva, Facultad de Medicina, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - B Herreros
- Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - A Huelmos
- Servicio de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - C Guijarro
- Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Madrid, Spain; Facultad de Medicina, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Affiliation(s)
- R García Caballero
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid. Grupo de Trabajo de Bioética y Profesionalismo de Sociedad Española de Medicina Interna.
| | - B Herreros
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid. Instituto de Ética Clínica Francisco Vallés-Universidad Europea, Madrid, España
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García Caballero R, Real de Asúa D, García Olmos L, Herreros B. Do internists know what limitation of therapeutic effort means? Rev Clin Esp 2021; 221:274-278. [PMID: 32414562 DOI: 10.1016/j.rce.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To ascertain whether internists know what limitation of therapeutic effort (LTE) means and whether training in palliative care affects this understanding. METHODS A survey was administered to Spanish internists on their knowledge of LTE and training in palliative care. RESULTS A total of 273 respondents completed the survey (mean age, 42±12 years), 80.2% of whom were associates. Some 23.8% of the respondents identified the complete definition of LTE. The most frecuently selected responses were «not starting an active treatment»(85.0%) and «withdrawing an active treatment» (65.9%). Forty-three percent of the respondents lacked training in palliative care, 73.3% considered their level of understanding to be good or very good, 62.3% stated that they became anxious when addressing planning for end-of-life care with a patient, and 81.3% stated that they had experienced some conflict with their LTE decisions. CONCLUSIONS Only 1 of every 4 internists knew the proper definition of LTE, with no association with level of training in palliative care.
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Affiliation(s)
- R García Caballero
- Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna; Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes (Madrid), España; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, España.
| | - D Real de Asúa
- Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, España; Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
| | - L García Olmos
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria, Sureste, Madrid, España
| | - B Herreros
- Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, España; Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), España
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Abstract
BACKGROUND Traditionally, the psychological well-being of healthcare workers has been taken for granted - it has even been considered a part of the requirements that were demanded of them. When these professionals have experienced suffering and psychological depletion, they have been held accountable for this suffering, adopting an individualistic and reductionist viewpoint focused only on the professional. This approach has become obsolete due to its proven ineffectiveness, especially from an ethics of responsibility and organization viewpoint. CONTEXT The psychological well-being of the healthcare worker (and its opposites: suffering, exhaustion, and disenchantment) is advantageous to the professional's commitment to the institution, to their work performance, and to their personal life. OBJECTIVE The objective of this paper is to reflect on the psychological suffering of the palliative care professional. METHOD We will reflect on the three levels of responsibility that influence such suffering (micro-meso-macro-ethical; worker-environment-institution). RESULTS We will propose a global strategy for the care of psychological well-being supported by scientific evidence and key references. SIGNIFICANCE OF RESULTS We conclude with some contributions on what we have learned and still have to learn on this topic.
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Affiliation(s)
- Beatriz Moreno-Milan
- Department of Palliative Care, Hospital de la Fuenfria, Cercedilla, Madrid, Spain
| | - Bill Breitbart
- Memorial Sloan-Kettering Cancer Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Benjamin Herreros
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea de Madrid Campus de Villaviciosa de Odón, Madrid, Spain
| | | | - María Cristina Coca Pereira
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea de Madrid Campus de Villaviciosa de Odón, Madrid, Spain
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García-Caballero R, Real de Asúa D, García Olmos L, Herreros B. Do internists know what limitation of therapeutic effort means? Rev Clin Esp 2021; 221:274-278. [PMID: 33998513 DOI: 10.1016/j.rceng.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/21/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To ascertain whether internists know what limitation of therapeutic effort (LTE) means and whether training in palliative care affects this understanding. METHODS A survey was administered to Spanish internists on their knowledge of LTE and training in palliative care. RESULTS A total of 273 respondents completed the survey (mean age, 42±12 years), 80.2% of whom were associates. Some 23.8% of the respondents identified the complete definition of LTE. The most frequently selected responses were "not starting an active treatment" (85.0%) and "withdrawing an active treatment" (65.9%). Forty-three percent of the respondents lacked training in palliative care, 73.3% considered their level of understanding to be good or very good, 62.3% stated that they became anxious when addressing planning for end-of-life care with a patient, and 81.3% stated that they had experienced some conflict with their LTE decisions. CONCLUSIONS Only 1 of every 4 internists knew the proper definition of LTE, with no association with the level of training in palliative care.
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Affiliation(s)
- R García-Caballero
- Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, Spain; Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain.
| | - D Real de Asúa
- Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, Spain; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain; Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain
| | - L García Olmos
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria, Sureste, Madrid, Spain
| | - B Herreros
- Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, Spain; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain; Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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Blanco Portillo A, García-Caballero R, Real de Asúa D, Herreros B. Which are the most prevalent ethical conflicts for Spanish internists? Rev Clin Esp 2020; 221:S0014-2565(20)30150-8. [PMID: 32650946 PMCID: PMC7340392 DOI: 10.1016/j.rce.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/03/2020] [Accepted: 05/11/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Clinicians face a multitude of ethical conflicts in their daily practice. There have been no studies on the types of ethical conflicts encountered most frequently and that are of most concern to clinicians in Spain. The aim of this study is to report the most common ethical conflicts faced by Spanish internists, as well as the importance that the practitioners attribute to each conflict. MATERIALS AND METHODS Our observational cross-sectional study employed a voluntary and anonymous survey aimed at Spanish medical internists and distributed through an ad hoc platform of the Spanish Society of Internal Medicine. RESULTS The most common and relevant ethical issues for Spanish internists are related to patients' end of life (decisions limiting therapeutic effort, use of palliative treatments, the establishment of do-not-resuscitate orders), the conflicts arising within the doctor-patient/family relationship, and making decisions with noncompetent patients. These results are similar to those of other English and European series. The ethical problems further complicate the healthcare activity of clinicians who more often notice these problems (50.3%) than those who do not notice them (16%). CONCLUSIONS The most common and relevant ethical conflicts among Spanish internists are related to managing patients' end of life, followed by those related to the doctor-patient relationship and the management of noncompetent patients. It is essential that training programs be designed to better address and recognise these problems.
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Affiliation(s)
- A Blanco Portillo
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - R García-Caballero
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Grupo de Trabajo de Bioética y Profesionalismo, Sociedad Española de Medicina Interna , Madrid, España
| | - D Real de Asúa
- Grupo de Trabajo de Bioética y Profesionalismo, Sociedad Española de Medicina Interna , Madrid, España; Servicio de Medicina Interna, Hospital Universitario de La Princesa , Madrid, España; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, España
| | - B Herreros
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Grupo de Trabajo de Bioética y Profesionalismo, Sociedad Española de Medicina Interna , Madrid, España; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, España
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Herreros B, Gella P, Real de Asua D. Triage during the COVID-19 epidemic in Spain: better and worse ethical arguments. J Med Ethics 2020; 46:455-458. [PMID: 32424063 PMCID: PMC7242823 DOI: 10.1136/medethics-2020-106352] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 05/06/2023]
Abstract
The COVID-19 pandemic has generated an imbalance between the clinical needs of the population and the effective availability of advanced life support (ALS) resources. Triage protocols have thus become necessary. Triage decisions in situations of scarce resources were not extraordinary in the pre-COVID-19 era; these protocols abounded in the context of organ transplantation. However, this prior experience was not considered during the COVID-19 outbreak in Spain. Lacking national guidance or public coordination, each hospital has been forced to put forth independent and autonomous triage protocols, most of which were, nonetheless, based on common ethical principles and clinical criteria. However, controversial, non-clinical criteria have also been defended by Spanish scientific societies and public institutions, including setting an age cut-off value for unilaterally withholding ALS, using 'social utility' criteria, prioritising healthcare professionals or using 'first come, first served' policies. This paper describes the most common triage criteria used in the Spanish context during the COVID-19 epidemic. We will highlight our missed opportunities by comparing these criteria to those used in organ transplantation protocols. The problems posed by subjective, non-clinical criteria will also be discussed. We hope that this critical review might be of use to countries at earlier stages of the epidemic while we learn from our mistakes.
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Affiliation(s)
- Benjamin Herreros
- Internal Medicine, Hospital Universitario Fundacion Alcorcon Servicio de Medicina Interna, Alcorcón, Comunidad de Madrid, Spain
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea de Madrid Campus de Villaviciosa de Odón, Villaviciosa de Odón, Madrid, Spain
| | - Pablo Gella
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea de Madrid Campus de Villaviciosa de Odón, Villaviciosa de Odón, Madrid, Spain
| | - Diego Real de Asua
- Department of Internal Medicine, Hospital Universitario de la Princesa, Madrid, Spain
- Division of Medical Ethics, Cornell University Joan and Sanford I Weill Medical College, New York, New York, USA
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Palacios G, Pinto P, Marquez O, Herreros B. Valoración de la competencia de los pacientes para tomar decisiones. Rev Clin Esp 2020; 220:256-262. [DOI: 10.1016/j.rce.2019.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/30/2019] [Accepted: 04/09/2019] [Indexed: 11/27/2022]
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Saez R, Esteban J, Herreros B, Casas M, Huelmos A, Sanchez C, Fernandez de Velasco D, Guijarro C. Predictive performance of framingham, regicor, score, reach, b-timi and smart scales in secondary cardiovascular prevention. The airvag cohort. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Alonso M, Pacios E, Herreros B. Are the management objectives for hospital physicians ethical? Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2018.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Herreros B, Del Olmo Ibáñez M, López Wolf D, González E, Pintor E, Márquez O. [Javier Sádaba: A bioethics against suffering]. J Healthc Qual Res 2018; 33:170-175. [PMID: 30337021 DOI: 10.1016/j.jhqr.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/23/2018] [Accepted: 03/05/2018] [Indexed: 06/08/2023]
Abstract
The philosopher Javier Sádaba (Portugalete, 1940) is the author of an extensive work in the field of bioethics. It is a procedural bioethics (based on the agreement between the participants, not on absolute truths), casuistry (is based on the analysis of specific problem cases), social (evaluates the context in decision-making), gradual (considers other species, is not "narcissistically human"), and secular (autonomous with respect to religion). Sádaba has also opted for an affirmative bioethics, which seeks to improve the living conditions of humans (in medicine, the quality of life). This is difficult to construct because, for the philosopher, the duty and to establish limits are infinitely easier to elaborate than the specific good and to pursue happiness. In its application to medicine, Sádaba's bioethics focuses on avoiding unnecessary suffering, because suffering does not contribute anything positive and hinders happiness. Likewise, he strives to extract the best of science and open the doors to everything that can bring improvements for the human being, but without ceasing to mention responsibility, because man is capable of the best and the worst. From this perspective, the author is faced with the bioethical issues, leaving the greatest possible margin to freedom of choice.
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Affiliation(s)
- B Herreros
- Instituto de Ética Clínica Francisco Vallés-Universidad Europea, Madrid, España; Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - M Del Olmo Ibáñez
- Grupo de investigación Humanismo-Europa, Universidad de Alicante, Alicante, España
| | - D López Wolf
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, Universidad Autónoma del Estado de México, México
| | - E González
- Instituto de Ética Clínica Francisco Vallés-Universidad Europea, Madrid, España
| | - E Pintor
- Instituto de Ética Clínica Francisco Vallés-Universidad Europea, Madrid, España
| | - O Márquez
- Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, Universidad Autónoma del Estado de México, México
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García Caballero R, Herreros B, Real de Asúa D, Gámez S, Vega G, García Olmos L. Limitación del esfuerzo terapéutico en pacientes hospitalizados en servicios de medicina interna. Rev Clin Esp 2018; 218:1-6. [DOI: 10.1016/j.rce.2017.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/04/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
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García Caballero R, Herreros B, Real de Asúa D, Gámez S, Vega G, García Olmos L. Limitation of therapeutic effort in patients hospitalized in departments of internal medicine. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2017.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Herreros B, Real de Asua D, Palacios G. [Are we still our patients' keepers?: James Drane's contribution to clinical ethics in the current context]. J Healthc Qual Res 2018; 33:54-59. [PMID: 29291915 DOI: 10.1016/j.cali.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 11/22/2022]
Abstract
The current article analyzes the figure of the American bioethicist James Drane (1930). Drane not only played a crucial role in the birth of Bioethics in the United States, but was also instrumental in the inception and development of the field in Spain and Latin America. His «sliding scale» was the first dynamic tool encouraging a systematic evaluation of a patient's capacity to make healthcare-related decisions. However Drane's major contribution to the field was his application of virtue Ethics to the doctor-patient relationship. His proposal rests on the physician's compromise with the patient in all his/her dimensions. This goal will guide the physician's character and serve as compass, with which to exercise a virtuous practice, since only by exercising these virtues can doctors become truly good.
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Affiliation(s)
- B Herreros
- Instituto de Ética Clínica Francisco Valles, Universidad Europea, Madrid, España; Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, España.
| | - D Real de Asua
- Instituto de Ética Clínica Francisco Valles, Universidad Europea, Madrid, España; Division of Medical Ethics, Department of Medicine, Weill Cornell College of Medicine, Nueva York, Estados Unidos; Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, España
| | - G Palacios
- Instituto de Ética Clínica Francisco Valles, Universidad Europea, Madrid, España; Division of Medical Ethics, Department of Medicine, Weill Cornell College of Medicine, Nueva York, Estados Unidos; Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, España
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Léger CL, Herreros B, Hepp MA, Thoret J, Potvin C, Man PP, Fraissard J. Study of NH4-Y zeolites dealuminated by (NH4)2SiF6. ACTA ACUST UNITED AC 2017. [DOI: 10.1051/jcp/1994910916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Real de Asúa D, Herreros B. Why dedicate yourself to bioethics? Seven reasons to get you started. Rev Clin Esp 2016. [DOI: 10.1016/j.rceng.2015.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Real de Asúa D, Herreros B. Why dedicate yourself to bioethics? Seven reasons to get you started. Rev Clin Esp 2016; 216:271-5. [PMID: 26823202 DOI: 10.1016/j.rce.2015.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/22/2015] [Accepted: 12/13/2015] [Indexed: 11/25/2022]
Abstract
The aim of clinical bioethics is to promote rational clinical decisions that take into account the clinical facts and the preferences and values of individuals involved in a situation that entails a moral problem. The objective of the present study is to list the reasons why we consider bioethics knowledge and skills to be essential in daily practice and to promote a proactive mindset in clinical bioethics research. The arguments set forth include the need to adapt to changes in the clinical relationship in recent decades, the importance of an ethical approach both for the physician and the patient, the role of bioethics in preventing professional burnout, the ability of ethics to promote a more equitable distribution of resources and the possibility of conducting clinical research in bioethics, a field that has scarcely been explored in Spain.
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Affiliation(s)
- D Real de Asúa
- Servicio de Medicina Interna, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España; Grupo de Trabajo de Bioética y Profesionalismo, Sociedad Española de Medicina Interna, España; Instituto de Ética Clínica «Francisco Vallés», Universidad Europea de Madrid, Madrid, España.
| | - B Herreros
- Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Grupo de Trabajo de Bioética y Profesionalismo, Sociedad Española de Medicina Interna, España; Instituto de Ética Clínica «Francisco Vallés», Universidad Europea de Madrid, Madrid, España
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Palacios G, Herreros B, Pacho E. Refusal to medical interventions. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Palacios G, Herreros B, Pacho E. Rechazo a las actuaciones médicas. Rev Clin Esp 2014; 214:389-95. [DOI: 10.1016/j.rce.2014.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/27/2014] [Accepted: 04/21/2014] [Indexed: 10/25/2022]
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Herreros B, Ramnath VR, Bishop L, Pintor E, Martín MD, Sánchez-González MA. Clinical ethics protocols in the clinical ethics committees of Madrid. J Med Ethics 2014; 40:205-208. [PMID: 23579231 DOI: 10.1136/medethics-2012-100791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Currently, The nature and scope of Clinical Ethics Protocols (CEPs) in Madrid (Spain) are not well understood. OBJECTIVES The main objective is to describe the features of 'guideline/recommendation' type CEPs that have been or are being developed by existing Clinical Ethics Committees (CECs) in Madrid. Secondary objectives include characterisation of those CECs that have been the most prolific in reference to CEP creation and implementation and identification of any trends in future CEP development. METHODS We collected CEPs produced and in process by CECs accredited in the public hospitals in Madrid, Spain, from 1996 to 2008. RESULTS CECs developed 30 CEPs, with 10 more in process. The most common topic is refusal of treatment (seven CEPs developed; two in process). If CEPs addressing terminal illness, Do-Not-Resuscitate orders and advance directives are placed into a separate 'ethical problems at the end of life' category, this CEP subject emerges as the most common (eight developed; four in process). There is a relationship between the age of the CEC and the development of CEPs (the oldest CECs have developed more CEPs). CECs now seem to be more likely to engage in CEP development. CONCLUSIONS The CECs in Madrid, Spain, have developed a significant number of CEPs (30 in total and 10 in process) and there is a trend towards continued development. The most frequent topics are ethical problems at the end of life and refusal of treatment by the patient.
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Affiliation(s)
- Benjamin Herreros
- Department of Biomedical Sciences, European University of Madrid, , Villaviciosa de Odon, Madrid, Spain
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Pérez M, Herreros B, Martín MD, Molina J, Guijarro C, Velasco M. [Changes in knowledge and carrying out the advance directives of patients admitted to internal medicine]. ACTA ACUST UNITED AC 2013; 28:307-12. [PMID: 24021533 DOI: 10.1016/j.cali.2013.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 03/10/2013] [Accepted: 03/11/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUNDS Advance directives (ADs), are documents in which patients express in advance that their wishes are fulfilled when they are unable to communicate them. It is unknown whether patients admitted to internal medicine are more aware of and make ADs. OBJECTIVE To study the changes in the level of knowledge and implementation of AD among patients admitted to an internal medicine department of a hospital in Madrid since a specific regulation to implement them was introduced. PATIENTS AND METHODS A survey was conducted among patients admitted to internal medicine in two periods: 2008 and 2010. RESULTS A total of 206 surveys were analysed (84 in 2008 and 122 in 2010). The mean age of the patients was 76.8 years, and 51.5% were women. More than two-thirds (69.4%) had a co-morbidity. and 4.4% had a terminal illness, with no statistical differences between the periods. Only 5.3% knew what ADs are, 1 had implemented ADs, and 46.1%, once informed, would like to implement them. There were no differences between 2008 and 2010 as regards knowledge and implementation of AD. In 2010 there was a greater interest to implement them (would like to implement them: 52.5 vs 36.9%), although in 2010 less respondents believe that AD would change the attitude of the doctor (not change the attitude: 92.6 vs. 69%, P<.001). CONCLUSIONS Knowledge and implementation of AD did not change significantly in the years following the regulation (from 2008-2010). In both periods, their knowledge and implementation are scarce.
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Affiliation(s)
- M Pérez
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón (HUFA), Alcorcón, Madrid, España
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Anguera I, Dallaglio PD, Alvarez M, Jimenez-Candil J, Arcocha MF, Peinado R, Garcia-Seara J, Herreros B, Hernandez-Madrid A, Sabate X. Acute success and predictors of recurrences after ablation of right atrial macro-reentrant tachyarrhythmias following surgical repair of congenital and acquired heart disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dallaglio PD, Anguera I, Alvarez M, Jimenez-Candil J, Arcocha MF, Peinado R, Garcia Seara J, Herreros B, Quesada A, Sabate X. Clinical characteristics and long-term follow-up after ablation of right atrial macro-reentrant tachyarrhythmias following surgical repair of congenital and acquired heart disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Calvo D, Jalife J, Saiz J, Rubín J, Herreros B, Arenal Á, Atienza F, Berenfeld O. Phase- and Frequency-Domain Analysis of the Surface ECG Localizes Arrhythmogenic Sources of Ventricular Fibrillation in Humans. Heart Rhythm 2012. [DOI: 10.1016/j.hrthm.2012.09.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pintor E, Gargantilla P, Rubio M, Herreros B. [Electronic media used by medical students during theoretical classes: are they learning instruments or distractions sources?]. Rev Clin Esp 2012; 212:469-70. [PMID: 22664217 DOI: 10.1016/j.rce.2012.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 04/10/2012] [Indexed: 11/24/2022]
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Pérez Rueda M, Herreros B, Guijarro C, Comeche B. Neoplasias diagnosticadas en planta de medicina interna: características y factores determinantes para limitar los esfuerzos diagnóstico-terapéuticos. Rev Clin Esp 2010; 210:592-3. [DOI: 10.1016/j.rce.2010.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 05/21/2010] [Indexed: 10/18/2022]
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Gonzálvez-Gasch A, de Casasola GG, Martín RB, Herreros B, Guijarro C. A simple prognostic score for risk assessment in patients with acute pancreatitis. Eur J Intern Med 2009; 20:e43-8. [PMID: 19393477 DOI: 10.1016/j.ejim.2008.09.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 09/06/2008] [Accepted: 09/24/2008] [Indexed: 12/13/2022]
Abstract
BACKGROUND Acute pancreatitis (AP) is a common disease that poses potential serious problems. Its clinical course is often unpredictable. Identification of high risk patients enables early appropriate treatment. METHODS We conducted a prospective study to develop a new prognostic method that can objectively and easily grade the severity of AP within the first 72 h of admission. The prediction rule was based on clinical and analytical parameters in 308 patients admitted in a community-based hospital. We validated the score in 193 additional patients in the same hospital. RESULTS Independent prognostic factors related to poor prognosis were age >65 years, leucocytes >13,000/mm(3), albumin <2.5 mg/dL, calcium <8.5 mg/dL and reactive C protein >150 mg/dL. We assigned points to each of the independent factors for complicated AP in proportion to the regression coefficients. We defined three different risk groups according to the points obtained in the prediction rule. Low risk, 0 points (18% patients, 0% risk), moderate, 1-3 points (56% patients, 19% risk) and high, 4-6 points (26% patients, 73% risk). The sensitivity of this formula was 90% with specificity of 63%. The positive and negative predictive values were 50% and 94% respectively. CONCLUSIONS Our simple prediction rule is an additional tool that may help physicians stratifying the severity of AP. Patients with high risk for complicated AP should be kept under close surveillance whereas low risk patients would not need special monitoring.
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Affiliation(s)
- A Gonzálvez-Gasch
- Unidad de Medicina Interna, USP Hospital San Jaime, Partida de la Loma s/n, 03184 Torrevieja, Alicante, Spain.
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Abstract
Studies are revealing that lymphoid neoplasms are characterized by well-defined chromosome translocations and by the accumulation of subsequent molecular alterations involving mainly the cell cycle and/or apoptotic pathways. However, survival of B and T tumor cells is also dependent on the interactions with the accompanying cells that comprise the lymphoma microenvironment. Although non-tumor cells can contribute both positive and negative signals to the lymphoma cells, in this review we present compelling evidence of the essential influence of the tumor microenvironment on the initiation and progression of specific lymphoma types, highlighting some new therapeutic approaches that target the lymphoma microenvironment.
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Affiliation(s)
- B Herreros
- Lymphoma Group, Molecular Pathology Program, Centro Nacional de Investigaciones Oncologicas (CNIO), Madrid, Spain
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Herreros B, Ascaso JF, Mora F, Costa AJ, Sanchiz V, Minguez M, Benages A. Absence of cardiovascular autonomic dysfunction and vagal pancreatic impairment in idiopathic achalasia of the oesophagus. Neurogastroenterol Motil 2007; 19:646-52. [PMID: 17640179 DOI: 10.1111/j.1365-2982.2007.00920.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Extra-oesophageal autonomic dysfunction in idiopathic achalasia is not well documented, due to contradictory results reported. We aimed to study the cardiovascular and pancreatic autonomic function in patients with idiopathic achalasia. Thirty patients with idiopathic achalasia (16M/14F; 34.5 +/- 10.8 years) and 30 healthy volunteers (13M/17F; 34.8 +/- 10.7 years) were prospectively studied. Age >60 years and conditions affecting results of autonomic evaluation were excluded. Both groups underwent the sham feeding test and plasmatic levels of pancreatic polypeptide (PP) were determined by radioimmunoassay (basal, at 5, 10, 20 and 30 min). Cardiovascular parasympathetic (deep breathing, standing, Valsalva) and sympathetic function (postural decrease of systolic blood pressure, Handgrip test) were assessed. Statistical comparison of basal and increase levels of PP and parasympathetic/sympathetic cardiovascular parameters was performed between groups. Basal levels of PP were similar in controls and patients and maximum increase of PP during sham feeding test. A similar rate of abnormal cardiovascular tests was found between groups (P > 0.05). E/I ratio was the mostly impaired parameter (patients: 36.7% vs controls: 20%, P = 0.15, chi-squared test). Autonomic cardiovascular tests and pancreatic response to vagal stimulus are not impaired in patients with primary achalasia of the oesophagus.
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Affiliation(s)
- B Herreros
- Department of Gastroenterology, University Clinic Hospital, University of Valencia, Avenida Blasco Ibanez 14, 46010 Valencia, Spain
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Ascaso JF, Herreros B, Sanchiz V, Lluch I, Real JT, Minguez M, Mora F, Benages A. Oesophageal motility disorders in type 1 diabetes mellitus and their relation to cardiovascular autonomic neuropathy. Neurogastroenterol Motil 2006; 18:813-22. [PMID: 16918760 DOI: 10.1111/j.1365-2982.2006.00799.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The relationship between cardiovascular autonomic neuropathy (CVAN) and oesophageal dysfunction in diabetes mellitus has not been well established because reports are contradictory. The aim of this study was to assess oesophageal function and its correlation with CVAN in type 1 diabetic patients without oesophageal symptoms. Forty-six type 1 diabetic patients without oesophageal symptoms (DG) and 34 healthy volunteers (CG) were studied. Both groups underwent CVAN tests and oesophageal manometry and pH-metry. Differences between groups regarding results of cardiovascular autonomic tests and oesophageal studies were statistically analysed. Compared with the CG, the DG group showed insufficient lower oesophageal sphincter (LOS) relaxation and a higher percentage of simultaneous waves (P < 0.01). Patients with CVAN (n = 22) showed a higher prevalence of pathological simultaneous contractions (>10%), and the prevalence of simultaneous waves related to the degree of autonomic neuropathy was: 9% of patients without CVAN, 7% of those suspected to have it and 50% of patients with CVAN (P < 0.001). Factors associated with the presence of pathological simultaneous waves (>10%) were the presence of CVAN and duration of diabetes (P < 0.05, logistic regression analysis). Increase in simultaneous waves and impaired relaxation of LOS are more frequent in diabetic patients with CVAN.
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Affiliation(s)
- J F Ascaso
- Department of Endocrinology, University of Valencia, Valencia, Spain
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Ballester A, Mínguez M, Herreros B, Hernández V, Sanchiz V, Benages A. Prevalence of silent fecal and urinary incontinence in women from the town of Teruel. Rev esp enferm dig 2005; 97:78-86. [PMID: 15801883 DOI: 10.4321/s1130-01082005000200002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To study the prevalence of fecal (FI) and urinary incontinence (UI) in women from Teruel (Spain), as well as the clinical conditions associated with these disorders. METHODS We studied prospectively women with an age range of 20-64 years who were randomly selected from the population seen in a primary care center because of medical disorders not related to incontinence. Patients with functional or cognitive impairment were excluded. Medical and obstetric antecedents, as well as the type and frequency of incontinence symptoms were collected in a questionnaire. RESULTS Out of 115 women, 103 completed the study (mean age: 41+/-12 years range 20-64). UI was present in 34.9% (stress 33%, urge 14%, mixed 47%), FI in 14 (13.6%) (flatus 57%, liquid stools 43%), and 10 (9.7%) displayed both disorders. Age > 42 years and body mass index more or equal of 25 were associated with FI and UI; pregnancy was only associated with UI, but the group of women with more or equal of 2 vaginal deliveries showed a higher frequency of FI (p < 0.05, Chi squared test). In the multivariate analysis, only the presence of UI was associated with FI (OR 6.0; CI 95% 1.7-21). Association of FI and UI was more frequent in women older than 42 years (OR 16.7, CI 95% 1.9-141). No statistical differences were found when smoking, exercise, and type of childbirth were compared between the presence/absence of FI or UI. CONCLUSIONS Urinary and fecal incontinence are frequent in women, and the coexistence of both disorders is not uncommon. Age, overweight and parity are associated with the presence of fecal and/or urinary incontinence.
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Affiliation(s)
- A Ballester
- Familiar and Communitary Medicine, Centro de Salud Catarroja, Valencia, Spain
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Fenoll-Palomares C, Muñoz Montagud JV, Sanchiz V, Herreros B, Hernández V, Mínguez M, Benages A. Unstimulated salivary flow rate, pH and buffer capacity of saliva in healthy volunteers. Rev esp enferm dig 2004; 96:773-83. [PMID: 15584851 DOI: 10.4321/s1130-01082004001100005] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the salivary flow rate, pH, and buffer capacity of healthy volunteers, and their relationships with age, gender, obesity, smoking, and alcohol consumption, and to establish the lower-end value of normal salivary flow (oligosialia). METHODS A prospective study was conducted in 159 healthy volunteers (age > 18 years, absence of medical conditions that could decrease salivary flow). Unstimulated whole saliva was collected during ten minutes, and salivary flow rate (ml/min), pH, and bicarbonate concentration (mmol/l) were measured using a Radiometer ABL 520. The 5 percentile of salivary flow rate and bicarbonate concentration was considered the lower limit of normality. RESULTS Median salivary flow rate was 0.48 ml/min (range: 0.1-2 ml/min). Age younger than 44 years was associated with higher flow rates (OR 2.10). Compared with women, men presented a higher flow rate (OR 3.19) and buffer capacity (OR 2.81). Bicarbonate concentration correlated with salivary flow rate. The lower-end values of normal flow rate and bicarbonate concentration were 0.15 ml/min and 1.800 mmol/l, respectively. The presence of obesity, smoking, and alcohol consumption did not influence salivary parameters. CONCLUSIONS In healthy volunteers, salivary flow rate depends on age and gender, and correlates with buffer capacity. Obesity, smoking, and alcohol use do not influence salivary secretion.
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Affiliation(s)
- C Fenoll-Palomares
- Medicina Familiar y Comunitaria, Centro de Atención Primaria, Rafelbunyol, Valencia, Spain
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Muñoz JV, Herreros B, Sanchiz V, Amoros C, Hernandez V, Pascual I, Mora F, Minguez M, Bagan JV, Benages A. Dental and periodontal lesions in patients with gastro-oesophageal reflux disease. Dig Liver Dis 2003; 35:461-7. [PMID: 12870730 DOI: 10.1016/s1590-8658(03)00215-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Dental erosion has been considered an extraesophageal manifestation of gastro-oesophageal reflux disease, but few reports have studied the relationship between this disease and other periodontal or dental lesions. The aim of this study was to investigate the prevalence of dental and periodontal lesions in patients with gastro-oesophageal reflux disease. PATIENTS AND METHODS A total of 253 subjects were prospectively studied between April 1998 and May 2000. Two study groups were established: 181 patients with gastro-oesophageal reflux disease and 72 healthy volunteers. Clinical assessment, including body mass index and consumption of tobacco and alcohol, was performed in all subjects, as well as a dental and periodontal examination performed by a dentist physician, blind as to the diagnosis of subjects. Parameters evaluated were: (a) presence and number of dental erosion, location and severity, according to the Eccles and Jenkins index [Prosthet Dent 1979;42:649-53], modified by Hattab [Int J Prosthes 2000;13:101-71; (b) assessment of dental condition by means of the CAO index; and (c) periodontal status analysed by the plaque index, the haemorrhage index, and gingival recessions. RESULTS Clinical parameters were similar in both groups (p > 0.05). Age was statistically associated with the CAO index, presence of dental erosion, and gingival recession (p < 0.001, Student's t-test). Compared with the control group, the percentage of dental erosion was significantly higher in the gastro-oesophageal reflux disease group (12.5 vs. 47.5%, p < 0.001, chi2-test), as was the number and severity of dental erosions (p < 0.001, Student's t-test). Location of dental erosion was significantly different between groups. Age was not statistically related to either the amount or severity of dental erosion. CAO and periodontal indices were similarly distributed between groups. CONCLUSIONS Dental erosion may even be considered as an extraesophageal manifestation of gastro-oesophageal reflux disease. The fact that the prevalence of caries and periodontal lesions is similar in patients with gastro-oesophageal reflux disease and in healthy volunteers suggests a lack of relationship with gastro-oesophageal reflux disease.
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Affiliation(s)
- J V Muñoz
- Department of Gastroenterology, Clinic University Hospital, University of Valencia, Avda. Blasco Ibanez 17, 46010 Valencia, Spain
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Asensio E, Mont L, Rubín JM, Herreros B, Ninot S, Brugada J, Mulet J. [Prospective and comparative study of pacemaker implants carried out at the electrophysiology laboratory and the operating room]. Rev Esp Cardiol 2000; 53:805-9. [PMID: 10944973 DOI: 10.1016/s0300-8932(00)75161-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Permanent pacemaker implantation is done by different physicians with either a surgical or clinical training. Our objective was to evaluate if there were significant differences in the implantation parameters and in the complication rate among implantations performed by cardiologists in the electrophysiologic laboratory and cardiological surgeons in the operating room. MATERIAL AND METHODS We prospectively collected those patients' data who received a first pacemaker implantation by cardiovascular surgeons and electrophysiologists during the year 1998. Data collected included demographic information, indication for pacing, surgical time, complications during procedure, stimulation and sensing thresholds as well as type of pacing. RESULTS We first-implanted 216 pacemakers in a one year period, 101 by cardiovascular surgeons and 115 by electrophysiologists. 56% were male patients. Average age in the surgery group was 74.2 +/- 9 years and 72.09 +/- 12 in the electrophysiology group (p = NS). Main diagnoses were as follows: complete heart block in 32.9% patients, complete heart block 2. degrees 16.4%, sinus node dysfunction 12.2%, AV node ablation 12.2% and others. The complications rate for surgery group was 4% and 1.7% for electrophysiologists (p = NS). Electrophysiologists placed more bicameral devices. No clinically significant differences were found among other implant parameters. CONCLUSIONS Pacemaker implant by cardiologists in an electrophysiologists laboratory is a safe procedure that does not have more complications when compared to the same procedure done in the operating room by surgeons. This allows hospital resource optimization and reduction of hospital stay length.
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Affiliation(s)
- E Asensio
- Unitat d'Arítmies, Hospital Clínic, Institut de Malalties Cardiovasculars, Barcelona
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Abstract
The low order moments for chemical shift and second-order quadrupolar powder patterns have been calculated as functions of the anisotropy and asymmetry parameter of the governing interaction, and the expressions inverted to give these parameters as a function of the moments. Theoretical simulations and experimental experience show that moment analysis in most cases equals and in some cases exceeds the accuracy of direct inspection as a method of obtaining NMR parameters. We illustrate the efficacy of the method applied to 31P chemical shift spectra of nucleic acids, and 39K second-order patterns of series of potassium salts.
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Affiliation(s)
- B Herreros
- Department of Chemistry, University of Nebraska at Lincoln, 68588-0304, USA
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Brugada J, Valls V, Freixa R, Gonzalez E, Herreros B, Matas M, Mont L. Radiofrequency ablation of a posteroseptal atrioventricular accessory pathway in a left-sided tricuspid ring with Ebsteinlike anomaly in a patient with congenitally corrected transposition of the great arteries. Pacing Clin Electrophysiol 2000; 23:133-6. [PMID: 10666764 DOI: 10.1111/j.1540-8159.2000.tb00660.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Radiofrequency ablation successfully eliminated a posteroseptal accessory pathway in a left-sided tricuspid ring with Ebsteinlike anomaly in a patient with a congenitally corrected transposition of the great arteries.
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Affiliation(s)
- J Brugada
- Arrhythmia Unit, Hospital Clínic, University of Barcelona, Spain
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Mont L, Valentino M, Vacca M, Aguinaga L, Matas M, Herreros B, Brugada J. [Analysis of local electrograms and characteristics of the ablation procedure in left-sided accessory pathways that required five or more pulses of radiofrequency]. Rev Esp Cardiol 1999; 52:570-6. [PMID: 10439657 DOI: 10.1016/s0300-8932(99)74973-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Radiofrequency ablation of left sided accessory pathways requires multiple pulses in some patients due to different factors such as inadequate mapping, inappropriate tissue electrode contact and particular anatomic factors. However these characteristics have not been specifically analyzed. METHODS We have studied a prospective ablative series of 65 consecutive patients with left-sided pathways submitted to radiofrequency ablation by a simplified technique. In every application point, we analyzed the electrogram features, application point, impedance, potency and temperature. RESULTS 52 patients (80%) required less than 5 radiofrequency pulses (group A) and 13 (20%) required > or = than 5 pulses (group B). The presence of a suggestive potential accessory pathway in local electrogram was similar in both groups and there were no differences in the local A-V or V-A intervals. However, in patients with pre-excitation the Delta-V interval was shorter in group A than in group B (8 ms vs 15 ms; p < 0.001). Furthermore, the impedance observed from the ablation point in group A was lower (108 +/- 12 vs 121 +/- 22 ohms; p < 0.001), and the maximum watts required to reach the predetermined temperature was higher in group A (42 +/- 16 vs 31 +/- 18 watts; p < 0.001). Final success of the procedure was 100%. CONCLUSIONS Patients requiring more than 5 radiofrequency pulses had electrograms and tissue contact equal or better than those requiring less than 5 pulses. This suggests that difficulties encountered in some procedures can be due to anatomical factors rather than inaccurate mapping or insufficient tissue contact.
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Affiliation(s)
- L Mont
- Unidad de Arritmias, Hospital Clínic, Universidad de Barcelona.
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Fernández MI, Herreros B, Bermejo C, Bautista M, Rojo M, Herrera B. [Prevalence of drinkers at risk and associated factors among men attending primary care clinics]. Aten Primaria 1996; 17:182-6. [PMID: 8664428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To quantify the prevalence of risk drinkers among men seeking health care, establish consumption patterns and relate them to socio-demographic features and health habits. DESIGN Crossover study. First phase of an experimental study. SETTING Four primary care teams in Area 10, Madrid. PATIENTS Males between 18 and 65 who attended for on-demand medical care. A systematic sample was selected (n = 562). MEASUREMENTS A questionnaire collecting socio-demographic characteristics, health habits and alcohol consumption (frequency, consumption pattern, intake of Weekly Units of alcohol (WU) and alcohol-related problems). 94.2% replied. 38% were habitual drinkers (drink four or more days a week), while 18.9% were week-end drinkers. Prevalence of drinkers consuming over 21 WU was 24.8%; and over 35 WU, 16.2%. Whether the cut-off point was fixed at 21 or 35 WU. The alcohol taken was related to educational level, physical exercise, smoking and taking other drugs. On average, single people, smokers, other drug-consumers, ex-drinkers and habitual drinkers were those who displayed most problems connected with alcohol consumption. CONCLUSIONS There is a similar profile of health habits for the groups consuming over 21 WU and 35 WU, which should make preventive care pay attention to both groups of drinkers.
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MacAllister RJ, Calver AL, Collier J, Edwards CM, Herreros B, Nussey SS, Vallance P. Vascular and hormonal responses to arginine: provision of substrate for nitric oxide or non-specific effect? Clin Sci (Lond) 1995; 89:183-90. [PMID: 7554760 DOI: 10.1042/cs0890183] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
1. The vascular and hormonal effects of L- and D-arginine were compared in healthy subjects and in patients with insulin-dependent diabetes mellitus or untreated essential hypertension. 2. Infusion of L- or D-arginine (40 mumol/l) in the forearm vascular bed, sufficient to increase the local concentration approximately 20-fold, had no effect on blood flow or the vasodilator response to acetylcholine (30 and 100 nmol/min) in patients with insulin-dependent diabetes (n = 7) or essential hypertension (n = 7), or in age- and sex-matched control subjects (n = 7 in both groups). 3. Systemic infusion of 10 g of L-arginine (n = 5) or D-arginine (n = 3) increased plasma concentration of arginine approximately 20-fold without altering supine or erect haemodynamics. Increases in plasma insulin, prolactin and glucagon were seen with both enantiomers. The stereopurity of arginine was confirmed in a cell-culture assay system. 4. We conclude that, in healthy subjects and patients with essential hypertension or insulin-dependent diabetes, synthesis of nitric oxide within the vasculature is not limited by substrate availability. At high concentrations of arginine, non-stereospecific effects, including alterations in hormone concentration, occur. It remains to be determined whether these non-stereospecific hormonal changes might contribute to certain haemodynamic effects of arginine.
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Affiliation(s)
- R J MacAllister
- Department of Pharmacology and Clinical Pharmacology, St George's Hospital Medical School, London, U.K
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Rocher A, Obeso A, Cachero MT, Herreros B, González C. Participation of Na+ channels in the response of carotid body chemoreceptor cells to hypoxia. Am J Physiol 1994; 267:C738-44. [PMID: 7943202 DOI: 10.1152/ajpcell.1994.267.3.c738] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The role played by Na+ channels of carotid body (CB) chemoreceptor cells was investigated by studying the effects of tetrodotoxin (TTX) on the release of 3H-labeled catecholamines ([3H]CA) by adult rabbit CBs previously incubated with the precursor [3H]tyrosine. TTX inhibited partially the release of [3H]CA elicited by mild hypoxia (10 or 7% O2) or by depolarizing incubation medium containing 20 or 30 mM KCl, but the response to more intense hypoxia (5 or 2% O2) or to higher KCl concentration (40 or 50 mM) was not significantly affected. The release of [3H]CA elicited by acidic stimuli, either 20% CO2 (pH 6.6) or the protonophore dinitrophenol (100 microM), although comparable in magnitude to that elicited by mild hypoxia, was not modified by TTX. These results provide evidence for the first time that Na+ channels of chemoreceptor cells participate in the transduction of hypoxic stimuli into the neurotransmitter release response of these cells and suggest that Na+ current operates as an amplifying device that enhances the initial cell depolarization mediated by the closure of the O2-sensitive K+ channels. Sympathetic denervation of CBs was followed by a marked reduction in the release of [3H]CA elicited by veratridine or by 20 mM KCl, suggesting that the number of Na+ channels in chemoreceptor cells decreases after denervation.
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Affiliation(s)
- A Rocher
- Departamento de Bioquímica y Biología Molecular y Fisiología, Facultad de Medicina, Universidad de Valladolid, Spain
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Abstract
Sodium silicoglycolate, an organosilicon compound in which silicon is in 5-coordination with respect to oxygen, is shown to be a reaction intermediate in the synthesis of a purely siliceous sodalite with ethylene glycol as solvent. The presence of silicon-29 nuclear magnetic resonances at -105.5 +/- 0.3 parts per million in solution and -102.7 parts per million in the solid state as well as x-ray powder diffraction patterns demonstrate that 5-coordinate silicon is intimately involved in the synthesis. Silicon compounds of the 5-coordinate type are highly reactive and are promising starting materials for the synthesis of novel silicone polymers, molecular sieves, glasses, semiconductors, and ceramics. We have used sodium silicoglycolate to prepare the molecular sieve silicalite as well as sodalites of different compositions.
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Rocher A, Obeso A, Herreros B, González C. Assessment of Na+ channel involvement in the release of catecholamines from chemoreceptor cells of the carotid body. Adv Exp Med Biol 1994; 360:201-4. [PMID: 7872086 DOI: 10.1007/978-1-4615-2572-1_28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- A Rocher
- Departamento de Bioquímica y Biología Molecular y Fisiología, Facultad de Medicina, Universidad de Valladolid, Spain
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Pérez-García MT, Obeso A, López-López JR, Herreros B, González C. Characterization of cultured chemoreceptor cells dissociated from adult rabbit carotid body. Am J Physiol 1992; 263:C1152-9. [PMID: 1476161 DOI: 10.1152/ajpcell.1992.263.6.c1152] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Short-term cell cultures were obtained from enzymatically dissociated carotid bodies from adult rabbits, and morphological and functional characterization of the cultured chemoreceptor cells were carried out. Under phase contrast, freshly isolated type I cells are round, bright, and 10-14 microns in diameter and exhibit strong fluorescence when stained with the glyoxylic acid technique. The content of endogenous dopamine in the cultures increased from 80 pmol/10(5) cells 2 h after plating the cells to 200 pmol/10(5) cells on the 3rd day, and the rate of synthesis and storage of [3H]dopamine from the precursor [3H]tyrosine increased from 1.7 pmol.10(5) cells-1.h-1 in 1-day cultures to 4 pmol.10(5) cells-1.h-1 on the 3rd day; the later values represent 80-85% of the expected values for the intact carotid body. After labeling with [3H]tyrosine, cultured chemoreceptor cells release [3H]dopamine when challenged by hypoxia, high external K+, or the protonophore dinitrophenol, the pattern of response being similar to that of the intact carotid body. When studied by whole cell clamp recording, individual chemoreceptor cells exhibit a marked variability in the properties of some ionic currents; the data, however, do not support the existence of distinct subpopulations of type I cells.
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Affiliation(s)
- M T Pérez-García
- Departamento de Bioquímica y Biología Molecular y Fisiología, Facultad de Medicina, Universidad de Valladolid, Spain
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