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Fernández López M, Martín-Baranera M, Davins Riu M, Fontecha Gómez B. [Tecuide. Telemonitoring of patients with dementia and their caregivers]. Rev Esp Geriatr Gerontol 2024; 59:101492. [PMID: 38574566 DOI: 10.1016/j.regg.2024.101492] [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: 12/22/2023] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Given the growing increase in dementia, the need to control these patients, together with the rise of new technologies, makes a change in the current control system imperative. MATERIAL AND METHOD We have carried out a single-center, clinical study with two groups, a control group of 72 patients/caregivers, who followed the usual controls in consultations, and another telematic group of 76 patients/caregivers, who followed the controls through of the Tecuide platform. The platform had a survey part to detect problems in patients and caregiver claudication, another training part and another chat for direct communication when the caregiver needed it and also served to respond when a problem was detected. RESULTS After a year of monitoring with the platform we have obtained: a)in patients, reduce behavioral disorders and use of drugs, increase physical exercise and delay institutionalization (DS not found); b)in caregivers there is an improvement in satisfaction with respect to the control of patients with cognitive impairment, and c)in terms of resources, visits to emergency services and dementia consultations have decreased, although admissions to the psychogeriatric unit have increased. CONCLUSIONS The use of Tecuide as a telematic tool in the control of patients with cognitive impairment does not seem to be inferior to the usual controls in consultations and improves caregiver satisfaction.
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Affiliation(s)
- Mercedes Fernández López
- Hospital Sociosanitari de l'Hospitalet - Consorci Sanitari Integral, Hospitalet de Llobregat, Barcelona, España.
| | - Montserrat Martín-Baranera
- Hospital Sociosanitari de l'Hospitalet - Consorci Sanitari Integral, Hospitalet de Llobregat, Barcelona, España
| | | | - Benito Fontecha Gómez
- Hospital Sociosanitari de l'Hospitalet - Consorci Sanitari Integral, Hospitalet de Llobregat, Barcelona, España
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Mena L, Mengual JJ, García-Sánchez SM, Avellaneda-Gómez C, Font MÀ, Montull C, Castrillo L, Blanch P, Castellanos P, Lleixa M, Martín-Baranera M, Armario P, Gómez-Choco M. Relationship of arterial stiffness and baseline vascular burden with new lacunes and microbleeds: A longitudinal cohort study. Eur Stroke J 2024; 9:251-258. [PMID: 37873938 PMCID: PMC10916807 DOI: 10.1177/23969873231207764] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
INTRODUCTION Arterial stiffness may have a significant impact on the development of cerebral small vessel disease (cSVD). PATIENTS AND METHODS We obtained pulse wave velocity (24-h PWV) by means of ambulatory blood pressure monitoring (ABPM) in patients with a recent small subcortical infarct (RSSI). Patients with known cardiac or arterial embolic sources were excluded. Lacunes, microbleeds, white matter hyperintensities and enlarged perivascular spaces at baseline were assessed in a brain MRI and included in a cSVD score. A follow-up MRI was obtained 2 years later and assessed for the appearance of new lacunes or microbleeds. We constructed both unadjusted and adjusted models, and subsequently selected the optimal models based on the area under the curve (AUC) of the predicted probabilities. RESULTS Ninety-two patients (mean age 67.04 years, 69.6% men) were evaluated and 25 had new lacunes or microbleeds during follow-up. There was a strong correlation between 24-h PWV and age (r = 0.942, p < 0.001). cSVD was associated with new lacunes or microbleeds when adjusted by age, 24-h PWV, NT-proBNP and hypercholesterolemia (OR 2.453, CI95% 1.381-4.358). The models exhibiting the highest discrimination, as indicated by their area under the curve (AUC) values, were as follows: 1 (AUC 0.854) - Age, cSVD score, 24-h PWV, Hypercholesterolemia; 2 (AUC 0.852) - cSVD score, 24-h PWV, Hypercholesterolemia; and 3 (AUC 0.843) - Age, cSVD score, Hypercholesterolemia. CONCLUSIONS cSVD score is a stronger predictor for cSVD progression than age or hemodynamic parameters in patients with a RSSI.
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Affiliation(s)
- Luis Mena
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Juan José Mengual
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Sonia María García-Sánchez
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Carla Avellaneda-Gómez
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Maria Àngels Font
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Caterina Montull
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Radiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Laura Castrillo
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Radiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Pedro Blanch
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Cardiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Pere Castellanos
- Internal Medicine Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Mercè Lleixa
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Montserrat Martín-Baranera
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Epidemiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pedro Armario
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Internal Medicine Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Manuel Gómez-Choco
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
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Ramos Bernadó MI, Crusellas Maña O, Martín-Baranera M, Barrios Sánchez P. Morbimortality after 1321 consecutive CRS + HIPEC procedures: seeking excellence in surgery for peritoneal surface malignancy. Clin Transl Oncol 2023; 25:2911-2921. [PMID: 37085638 DOI: 10.1007/s12094-023-03155-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) treatment has classically presented a percentage of associated complications that have limited its expansion. The aim of this study is to describe the morbimortality results obtained from a referral center implemented with the support of a governmental health agency and directed by a surgical team experienced in CRS for Peritoneal Surface Malignancies (PSM). METHODS Data from the Peritoneal Carcinomatosis Program of Catalonia (PCPC) prospective database, including patients who underwent CRS + HIPEC between September 2006 and January 2021, were analyzed. RESULTS A total of 1151 consecutive patients underwent 1321 CRS + HIPEC procedures. Colonic origin of peritoneal metastasis was the most frequent (47.3%). Median PCI was 7 and most patients had CC0-1 (96.1%). Multivisceral resection was performed in 44% of all patients, 57% required digestive anastomosis. Median hospital stay was 11 days (range 6-144 days). High-grade complications occurred in 20% of all patient, most of them surgical complications. Anastomotic leak occurred in 0.6% of all cases. The overall in-stay and 30-day mortality rate was 0.4%. The low-rate of complications and the high rate of complete CRS were achieved from the beginning of the PCPC. Median overall survival was 54.7 months, with a 5-year survival rate of 47.5%. CONCLUSIONS Implementation of a CRS + HIPEC referral program for the treatment of PSM with preferably an experienced surgical team enables acceptable rates of severe morbidity (20%) and mortality (< 1%).
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Affiliation(s)
| | - Oriol Crusellas Maña
- Department of Surgery, Hospital Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Montserrat Martín-Baranera
- Department of Clinical Epidemiology, Hospital Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
- Epidemiology and Preventive Medicine, Autonomous University of Barcelona School of Medicine, Barcelona, Spain
| | - Pedro Barrios Sánchez
- Department of Surgery, Hospital Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
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Gómez-Choco M, Mena L, Font MÀ, Mengual JJ, Garcia-Sanchez SM, Avellaneda C, Montull C, Castrillo L, Blanch P, Lleixa M, Martín-Baranera M, Armario P. NT-proBNP, cerebral small vessel disease and cardiac function in patients with a recent lacunar infarct. J Hum Hypertens 2023; 37:62-67. [PMID: 35013570 DOI: 10.1038/s41371-021-00648-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 01/31/2023]
Abstract
NT-proBNP is produced from both atria and ventricles and it is increased in patients with cardiac disease. NT-proBNP is also associated with cerebral small vessel disease(cSVD) but there are no studies that had carried out a systematic evaluation of cardiac function in this specific setting. We conducted a prospective observational study in 100 patients within 30 days after a recent lacunar infarct by means of brain MRI, 24 h ambulatory blood pressure monitoring, transthoracic echocardiography, and plasmatic NT-proBNP. Global cSVD burden was quantified using a validated visual score (0 to 4) and dichotomized into 2 groups (0-2 or 3-4). Age (73.8 vs 63.5 years) and NT-proBNP (156 vs 76 pg/ml) were increased in patients with SVD 3-4, while daytime augmentation index normalized for the heart rate of 75 bpm (AIx75) (22.5 vs 25.6%) was decreased. The proportion of patients with left atrial enlargement, left ventricular hypertrophy, or septal e' velocity <7 cm/s was not different between both groups. NT-proBNP was increased in patients with left atrial enlargement (126 vs 88 pg/ml). In multivariate analysis, age (OR 1.129 CI 95% 1.054-1.209), daytime AIx75 (OR 0.91 CI 95% 0.84-0.987,) and NT-proBNP (OR 1.007 CI 95% 1.001-1.012,) were independently associated with cSVD score 3-4. In conclusion, as well as in other patients with cSVD we found an association between NT-proBNP and cSVD. This association was independent of cardiac function.
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Affiliation(s)
- Manuel Gómez-Choco
- Neurology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain. .,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
| | - Luis Mena
- Neurology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Maria Àngels Font
- Neurology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Juan José Mengual
- Neurology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Sonia Maria Garcia-Sanchez
- Neurology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Carla Avellaneda
- Neurology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Caterina Montull
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Radiology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Laura Castrillo
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Radiology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Pedro Blanch
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Cardiology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Mercè Lleixa
- Neurology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Montserrat Martín-Baranera
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Epidemiology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pedro Armario
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Internal Medicine Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain.,Universitat de Barcelona, Barcelona, Spain
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Moser CL, Lecumberri Lopez M, Garat M, Martín-Baranera M. Prophylactic intracameral cefazolin and postoperative topical moxifloxacin after cataract surgery: endophthalmitis risk reduction and safety results in a 16-year study. Graefes Arch Clin Exp Ophthalmol 2019; 257:2185-2191. [DOI: 10.1007/s00417-019-04417-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022] Open
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Affiliation(s)
| | | | - Anna Villarroya
- Faculty of Library and Information Science; Universitat de Barcelona; Barcelona Spain
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González-Martínez S, Martín-Baranera M, Martí-Saurí I, Borrell-Grau N, Pueyo-Zurdo JM. Comparison of the risk prediction systems POSSUM and P-POSSUM with the Surgical Risk Scale: A prospective cohort study of 721 patients. Int J Surg 2016; 29:19-24. [PMID: 26970177 DOI: 10.1016/j.ijsu.2016.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 02/08/2016] [Accepted: 03/03/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The outcomes of surgery are subject to variability and difficult to be accurately predicted. Different score systems have been developed to estimating the risk of undergoing a surgical procedure. The aim of this study was to assess the predictive ability of POSSUM and P-POSSUM scoring systems, compared to the Surgical Risk Scale (SRS), in Spanish patients undergoing general surgery. PATIENTS AND METHODS In this prospective observational study, 721 consecutive patients needing a surgical procedure were included. Observed morbidity and mortality after surgery were compared to the expected ones obtained by applying POSSUM, P-POSSUM and SRS. RESULTS Mean age was 59.2 years (standard deviation (SD): 17.4 years), 43.5% were women. 616 (85.5%) patients underwent elective general surgery and 105 (14.5%) emergency surgery. The 30-day morbidity was 15.4%. The reintervention rate was 2.1% and mortality was 2.1%. The discrimination ability was excellent in predicting mortality. The Area Under the Curve (AUC) values were: POSSUM: AUC = 0.97, C.I.95%: 0.948-0.992, p < 0.0001; P-POSSUM: AUC = 0.966, C.I.95%: 0.941-0.991, p < 0.0001; SRS: AUC = 0.91, C.I.95%:0.853-0.967, p < 0.0001. POSSUM was also discriminative in the prediction of morbidity (AUC = 0.772, C.I.95%: 0.719-0.826, p < 0.0001). POSSUM predicted morbidity and mortality were higher than the observed ones (p = 0.01 and p = 0.04). Predicted and observed mortality were very similar for P-POSSUM (p = 0.93) and SRS (p = 0.37). CONCLUSIONS Expected morbidity and mortality determined by POSSUM score showed values significantly above the observed ones. P-POSSUM and SRS systems were effective in predicting mortality. The SRS application is simple and may contribute to appropriate medical decision making.
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Affiliation(s)
- Sergio González-Martínez
- Department of Surgery, Hospital Moises Broggi, Consorci Sanitari Integral, C/Jacinto Verdaguer 90, E-08970, Sant Joan Despi, Barcelona, Spain.
| | - Montserrat Martín-Baranera
- Department of Clinical Epidemiology, Consorci Sanitari Integral, Av. Josep Molins 29-41, E-08906, L'hospitalet de Llobregat, Barcelona, Spain.
| | - Isidro Martí-Saurí
- Department of Surgery, Hospital Moises Broggi, Consorci Sanitari Integral, C/Jacinto Verdaguer 90, E-08970, Sant Joan Despi, Barcelona, Spain
| | - Nuria Borrell-Grau
- Clinical Nursing, Hospital Dos de Maig, Consorci Sanitari Integral, C/Dos de Maig 301, E-08025, Barcelona, Spain.
| | - José M Pueyo-Zurdo
- Department of Surgery Hospital Dos de Maig, Consorci Sanitari Integral, C/Dos de Maig 301, E-08025, Barcelona, Spain.
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Reina D, Roig Vilaseca D, Torrente-Segarra V, Cerdà D, Castellví I, Díaz Torné C, Moreno M, Narváez J, Ortiz V, Blavia R, Martín-Baranera M, Corominas H. Sjögren's syndrome-associated interstitial lung disease: A multicenter study. ACTA ACUST UNITED AC 2015; 12:201-5. [PMID: 26573882 DOI: 10.1016/j.reuma.2015.09.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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: 07/31/2015] [Revised: 09/14/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED Primary Sjögren syndrome (PSS) is a chronic inflammatory autoimmune disease. Interstitial lung disease (ILD) can be an extraglandular complication. OBJECTIVE To evaluate the clinical characteristics of patients diagnosed with PSS with ILD. METHODS Multicentre cohort study with 25 patients diagnosed with PSS and ILD. Data of PSS, prognostic factors, pulmonary involvement variables, complementary tests that suggest a worse diagnosis and treatment given were collected. EULAR index was measured for Sjögren's syndrome. RESULTS We identified 25 patients. In 15/25 the diagnosis of ILD was done before the diagnosis of PSS. The histopathological patterns found were: 12 NSIP, 5 UIP, 4 OP, 2 LIP. PFRs showed restrictive pattern. The majority of the patients received glucocorticoid therapy, antimalarial or immunosuppressive treatment. CONCLUSIONS Patients affected with PSS must be screened to catch a precocious diagnosis of ILD. The majority of the patients were diagnosed of ILD before being diagnosed of PSS. Multicenter cohorts are increasingly demanded and a multidisciplinary management is needed.
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Affiliation(s)
- Delia Reina
- Servicio de Reumatología, Hospital Sant Joan Despí Moisès Broggi, Spain.
| | | | | | - Dacia Cerdà
- Servicio de Reumatología, Hospital Sant Joan Despí Moisès Broggi, Spain
| | | | | | - Mireia Moreno
- Servicio de Reumatología, Hospital Parc Taulí, Spain
| | | | - Vera Ortiz
- Servicio de Reumatología, Hospital de Granollers, Spain
| | - Rosana Blavia
- Servicio de Neumología, Hospital Sant Joan Despí Moisès Broggi, Spain
| | | | - Hèctor Corominas
- Servicio de Reumatología, Hospital Sant Joan Despí Moisès Broggi, Spain
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Oliveras V, Martín-Baranera M, Gracia M, Del Val JL, Plans M, Pujol-Moix N. [The relevance of the ankle-arm index to the reclassification of cardiovascular risk in asymptomatic hypertensive middle-aged males]. Med Clin (Barc) 2015; 144:435-9. [PMID: 24889750 DOI: 10.1016/j.medcli.2014.02.028] [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: 11/07/2013] [Revised: 02/21/2014] [Accepted: 02/27/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The ankle-brachial index allows for the detection of subclinical cardiovascular disease and risk, by diagnosing peripheral arterial disease and arterial calcification. Asymptomatic hypertensive men, between 45-55 years and with the suspicion of low risk, could be an important population group to benefit from this technique. The aim of the study was to compare the frequency of abnormal ankle-brachial index (subclinical peripheral arterial disease and arterial calcification) between asymptomatic hypertensive and non-hypertensive men, of the same age and suspicion of low risk. PATIENTS AND METHODS Two hundred and forty-four asymptomatic men (122 hypertensive and 122 non-hypertensive), between 45 and 55 years and an REGICOR index<10, were voluntarily recruited using consecutive sampling. Complete anamnesis, physical examination, laboratory tests and ankle-brachial index determination were carried out on all patients. RESULTS We detected abnormal ankle-brachial index values in 9.8% (12 cases) of the hypertensive subjects and in 1.6% (2 cases) of non-hypertensive subjects (P=.006). In the multivariate analysis, hypertension was significantly associated with an abnormal ankle-brachial index (P<.026) (odds ratio [OR] 5.9, 95% confidence interval [95% CI] 1.2-28.3), smoking (P=.018) (OR 2.7; 95% CI 1.2-6.2) and abdominal obesity (P=.005) (OR 2.8; 95% CI 1.3-5.9). CONCLUSIONS The population group analyzed in this study might be considered as an overriding segment for detecting subclinical cardiovascular disease and risk with the ankle-brachial index. Further studies are needed to establish the prevalence of abnormal ankle-brachial index in this population in order to assess its efficiency.
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Affiliation(s)
- Víctor Oliveras
- Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Salud Adrià, Institut Català de la Salut, Barcelona, España.
| | - Montserrat Martín-Baranera
- Servicio de Epidemiología Clínica, Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, España
| | - Maya Gracia
- Unitat de Risc Vascular, Clínica Sagrada Familia, Barcelona, España
| | - José Luís Del Val
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
| | - Miquel Plans
- Centro de Salud Verdaguer, Institut Català de la Salut, Sant Joan Despí, Barcelona, España
| | - Núria Pujol-Moix
- Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Institut d'Investigació Biomèdica Sant Pau (IIRB), Barcelona, España
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Garat M, Moser CL, Martín-Baranera M, Alonso-Tarrés C, Alvarez-Rubio L. Prophylactic intracameral cefazolin after cataract surgery. J Cataract Refract Surg 2009; 35:637-42. [PMID: 19304083 DOI: 10.1016/j.jcrs.2008.12.023] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 12/23/2008] [Accepted: 12/23/2008] [Indexed: 11/19/2022]
Affiliation(s)
- Magela Garat
- Ophthalmology Department, Hospital General de L'Hospitalet, Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, Spain
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Martínez Amenós A, Armario P, Hernández del Rey R, Tresserras R, Martín-Baranera M. In memoriam. Hipertensión y Riesgo Vascular 2009. [DOI: 10.1016/s1889-1837(09)70514-8] [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: 10/20/2022]
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12
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Sánchez Ferrín P, Fontecha Gómez BJ, del Val Romero B, Alonso-Tarrés C, Martín-Baranera M. Evolución de la colonización por Staphylococcus aureus resistente a meticilina en un hospital de media y larga estancia. Med Clin (Barc) 2009; 132:43-8. [DOI: 10.1016/j.medcli.2008.06.001] [Citation(s) in RCA: 4] [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] [Received: 03/06/2008] [Accepted: 06/27/2008] [Indexed: 10/20/2022]
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13
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Martín-Baranera M, Campo C, Coca A, de la Figuera M, Marín R, Ruilope LM. Estratificación y grado de control del riesgo cardiovascular en la población hipertensa española. Resultados del estudio DICOPRESS. Med Clin (Barc) 2007; 129:247-51. [PMID: 17683705 DOI: 10.1157/13108347] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Hypertension, together with other contributing risk factors, is a major risk for cardiovascular disease. The aim of this study was to assess the cardiovascular risk in the Spanish hypertensive population according to the 2003 European Society of Hypertension-European Society of Cardiology (ESH/ESC) guidelines criteria and to determine the control rate of the main cardiovascular risk factors (CVRF). PATIENTS AND METHOD Observational and transversal study including 22,639 patients with essential hypertension, who have been admitted to primary care units and hypertension units in Spain. RESULTS Dyslipemia (52.1%), diabetes (36.6%) and smoking (22.3%) were the most prevalent CVRF. Cardiovascular risk stratification according to the ESH/ESC guidelines showed that more than 70% patients were considered at high added risk (36.9%) or at very high added risk (35.8%), whereas only 7.6% were classified in the low-risk stratum. Blood pressure was the worst controlled risk factor among hypertensive patients (80.6%). Total cholesterol was also poorly controlled in a high percentage of the analyzed population (66.4%). Diabetes was the best predictor of uncontrolled blood pressure with an odds ratio of 5.25 (99% confidence interval, 4.57-6.06). CONCLUSIONS Coexistence of several cardiovascular risk factors, as well as the presence of target organ damage and associated cardiovascular conditions in the Spanish hypertensive population, increase the vascular risk, complicate the control in the hypertensive population and show the convenience of using ESH/ESC 2003 guidelines to estimate the cardiovascular risk.
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Monteis Catot J, Martín-Baranera M, Soler N, Vilaró J, Moya C, Martínez F, Riu M, Puig C, Riba A, Navarro G, Espinagosa A, Carrasco Gómez G, Castells X, Peiró S. Impacto de una intervención de autoevaluación clínica sobre la adecuación de la estancia hospitalaria. Gaceta Sanitaria 2007; 21:290-7. [PMID: 17663871 DOI: 10.1157/13108501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM To assess the impact of an intervention on inappropriate hospital stays (IHS) in acute-care hospitals in Catalonia (Spain) with the aim of testing the hypothesis that a simple intervention (adeQhos) reduces the proportion of IHS. METHODS A pre-test/post-test study was performed through the <<adeQhos>> questionnaire. Two intervention groups (internal medicine and general surgery) and 2 control groups (other medical specialities, orthopedics) were compared in 10 acute-care hospitals in Catalonia. The same evaluators assessed appropriateness of hospital stays before and after the intervention, using the Appropriateness Evaluation Protocol. RESULTS A total of 1,594 pre-test stays and 1,495 post-test stays were reviewed. Of all the stays reviewed (day before discharge), 41.1% were inappropriate. The intervention was applied to 4,613 stays. There was a significant increase of IHS in the medicine control group (from 39.7 to 48.6%), and no decrease in the intervention groups (internal medicine [from 46.7 to 50.6%] or general surgery [from 27.2 to 31.2%]). The correlation between the intensity of the intervention and the difference in IHS before and after the intervention was r = -0.373 (p = 0.106). The intensity of intervention differed among the hospitals. In hospitals with an intensity of intervention > 60%, the proportion of IHS decreased by 10.7 points in internal medicine and by 4.8 points in general surgery, while the proportion of IHS increased in the control groups. CONCLUSIONS The prevalanece of IHS the day before discharge in the hospitals studied was high (41.1%). No significant decrease in IHS was observed after a low-intensity intervention.
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Affiliation(s)
- Jaume Monteis Catot
- Hospital General de l'Hospitalet de Llobregat, Consorci Sanitari Integral, Hospitalet de Llobregat, Barcelona, España.
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15
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Martín-Baranera M, Sánchez Ferrín P, Armario P. [Prevalence of hypertension in elderly long-term care residents in Spain. The Geriatric HTA study]. Med Clin (Barc) 2007; 127:681-7. [PMID: 17169293 DOI: 10.1157/13095094] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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
BACKGROUND AND OBJECTIVE This study aimed to estimate the prevalence of hypertension in elderly long-term care residents in Spain and to describe such population in terms of comorbidity and hypertension treatment and control. PATIENTS AND METHOD A countrywide cross-sectional study was conducted in May 2003 among long-term care residents aged 65 or more. Patients in palliative care units were excluded. Hypertension was defined in patients who fulfilled at least one of the following criteria: diagnosis of hypertension on the medical record, antihypertensive medication and/or highest blood pressure values during the previous year > or = 140/90 mmHg. RESULTS Overall, 13,272 subjects - mean age (standard deviation) 82.9 (7.5) years (range: 65-106 years) - were included from 223 centres; 70.6% were women. Almost 2 thirds of patients met at least one hypertension criterion (8,242 patients, 62.1%; 95% confidence interval, 61.3-62.9%). In those patients, other frequent cardiovascular risk factors were obesity (26.3%), diabetes (25.7%) and dislipemia (23.8%). A concomitant diagnosis of dementia, peripheral vascular disease, stroke or congestive heart failure was present in 37.1%, 28.3%, 26.0% and 25.1%, respectively. The proportion of hypertensive patients receiving at least one antihypertensive drug was 69.7%. Diuretics were the most commonly used agents (46.3%), followed by angiotensine converting enzyme inhibitors (34.6%). The latest blood pressure measurement was < 140/90 mmHg in 60.4% of the hypertensive patients. CONCLUSIONS Elderly long-term care residents in Spain showed a high prevalence of hypertension and other cardiovascular risk factors, and a substantial degree of associated clinical conditions. The proportion of antihypertensive drug therapy was comparable to those reported in similar studies.
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Affiliation(s)
- Montserrat Martín-Baranera
- Unidad de Epidemiología Clínica, Hospital General de L'Hospitalet, Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, Spain.
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Hernández del Rey R, Armario P, Martín-Baranera M, Castellanos P. Agregación de factores de riesgo cardiovascular y de prevalencia de síndrome metabólico en personas con hipertensión arterial resistente. Med Clin (Barc) 2006; 127:241-5. [PMID: 16942725 DOI: 10.1157/13091263] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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
BACKGROUND AND OBJECTIVE The aim of this study was to analyse the clustering of cardiovascular risk factors and the prevalence of metabolic syndrome (MS) in this sample of subjects with resistant hypertension (RH). PATIENTS AND METHOD One hundred and fifteen subjects with RH were sequentially included. RH was defined as a level of office blood pressure (BP)>or=140/90 mmHg in subjects treated with at least 3 antihypertensive drugs (one of them a diuretic) during at least 2 months and with good compliance. The usual protocol of the Hypertension Unit and ambulatory BP monitoring during 24 h was applied on all the subjects, and an echocardiogram with Doppler was performed on 68 of them. Subjects with a daytime BP>or=135/85 mmHg were defined as pseudoresistant hypertensive. RESULTS The mean age (standard deviation) was 61 (10) years, and 50 patients (44%) were males. The mean office BP was 166/95 (16/9) mmHg. The daytime BP was 141/83 (15/12) mmHg. Out of the patients, 88 (76.5%) had a family history of cardiovascular disease; 64 (56%) of obesity; 43 (37%) of hypercholesterolemia; 34 (30%) of low high-density lipoprotein cholesterol; 32 (28%) of diabetes mellitus; and 63 (55%) were sedentary. The prevalence of MS was 54%; target organ damage was found in 70 cases (61%), and 44 (38%) had other associated clinical conditions. Out of the subjects with echocardiography, 49 (72%) presented left ventricular hypertrophy. Pseudoresistant hypertension was found in 31 (27%). There were no significant differences in clinical variables between subjects with RH or psudoresistant hypertension. CONCLUSIONS Patients with RH had high cardiovascular risk, independent of a good control of ambulatory BP, because of the high prevalence of cardiovascular risk factors and MS. An optimal antihypertensive treatment including specific programs for the control of obesity and a sedentary lifestyle are necessary in the management of these patients.
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Affiliation(s)
- Raquel Hernández del Rey
- Unidad de Hipertensión Arterial y Riesgo Vascular, Servicio de Medicina Interna, Hospital General de L'Hospitalet, Consorci Sanitari Integral, Facultad de Medicina, Universidad de Barcelona, Spain.
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Pokorny L, Rovira A, Martín-Baranera M, Gimeno C, Alonso-Tarrés C, Vilarasau J. Automatic detection of patients with nosocomial infection by a computer-based surveillance system: a validation study in a general hospital. Infect Control Hosp Epidemiol 2006; 27:500-3. [PMID: 16671032 DOI: 10.1086/502685] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 10/12/2005] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To validate an automated system for the detection of patients with nosocomial infection (NI) in an intensive care unit (ICU). DESIGN Retrospective analysis of data from the hospital information system. We applied 3 different NI suspicion criteria (positive microbiology reports, antibiotic administration, and diagnosis of clinical infection) and compared the results to those of a prospective NI incidence study done in the ICU during the same period (1999-2002). SETTING A 250-bed general hospital in Barcelona, Spain. PATIENTS From April 15, 1999, through June 30, 2002, 1380 patients were admitted to the ICU. Of these, 1043 had an ICU stay of more than 24 hours and were included in the study. RESULTS At least one NI suspicion criterion was present for 242 patients (23.2%); 2 criteria were present for 184 patients (17.6%); and all 3 criteria were present for 112 (11.7%). Comparison of hospital information system data to the results of the prospective study indicated that the combination of 2 criteria demonstrated the most satisfactory sensitivity (94.3%; 95% confidence interval [CI], 79.5%-99.0%) and specificity (83.6%; 95% CI, 76.8%-88.9%). The positive predictive value was 55.9% (95% CI, 42.5%-68.6%); the negative predictive value was 98.5% (95% CI, 94.2%-99.7%). The system could assign a site of infection for 90.4% of the NIs detected. CONCLUSION The hospital information system was a useful tool for retrospectively detecting patients with an NI during the ICU stay. Given its high sensitivity, it may be useful as an alert for the NI team.
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Affiliation(s)
- L Pokorny
- Preventive Medicine Department, School of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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Garat M, Moser CL, Alonso-Tarrés C, Martín-Baranera M, Alberdi A. Intracameral cefazolin to prevent endophthalmitis in cataract surgery: 3-year retrospective study. J Cataract Refract Surg 2005; 31:2230-4. [PMID: 16412945 DOI: 10.1016/j.jcrs.2005.08.053] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Indexed: 11/30/2022]
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Armario García P, Ceresuela Eito L, Hernández del Rey R, Martín-Baranera M. Evolución y pronóstico de la elevación de la presión arterial durante la fase aguda del ictus. Hipertensión y Riesgo Vascular 2005. [DOI: 10.1016/s1889-1837(05)71535-x] [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: 11/26/2022]
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Hernández del-Rey R, Armario P, Martín-Baranera M, Sánchez P, Almendros MC, Coca A, Pardell H. Cardiac damage in hypertensive patients with inverse white coat hypertension. Hospitalet study. Blood Press 2004; 12:89-96. [PMID: 12797628 DOI: 10.1080/08037050310001066] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 10/26/2022]
Abstract
BACKGROUND Few studies have assessed the relationship between ambulatory blood pressure (BP) and cardiac damage in essential hypertensive patients with inverse white coat hypertension (IWCH). OBJECTIVES To determine the frequency of IWCH in untreated grade 1-2 hypertension and to assess possible differences in cardiac damage among patients with IWCH, white coat hypertension (WCH) and the rest of patients with grade 1-2 hypertension. PATIENTS AND METHODS Two hundred and eleven patients with grade 1-2 hypertension were sequentially included. A good quality 24-h ambulatory BP monitoring was obtained in 204 patients (age: 41 +/- 12 years, 56% males). IWCH was defined as a daytime systolic and/or diastolic BP higher than diagnostic office systolic and/or diastolic BP, respectively. WCH was defined as a daytime BP < 135/85 mmHg. A good quality echocardiogram was obtained in 174 patients. We considered left ventricular hypertrophy a left ventricular mass index (LVMI) > or = 125 g/m2. RESULTS We found IWCH in 29 subjects (14%), and WCH in 68 (33%). Office BP in patients with IWCH was in an intermediate position between WCH and the rest of grade 1-2 hypertension patients. The IWCH patients showed 24-h, daytime and night-time BP higher than the other groups. Left ventricular mass was significantly greater in patients with IWCH than in the other grade 1-2 hypertension patients after adjusting for age, gender, body mass index, smoking and office BP (regression coefficient 28.14, 95%CI: 7.36-48.91). CONCLUSION IWCH is independently associated with higher values of left ventricular mass in patients with grade 1-2 hypertension.
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Affiliation(s)
- Raquel Hernández del-Rey
- Unit of Hypertension and Vascular Risk, Department of Internal Medicine, Consorci Sanitari de la Creu Roja a Catalunya, L'Hospitalet de Llobregat, Barcelona, Spain.
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Armario P, Hernández del Rey R, Martín-Baranera M, Andreu Valls N, Almendros M, Ruigómez J. Relación entre frecuencia cardíaca y excreción urinaria de albúmina en sujetos normotensos y en hipertensos grados 1-2 nunca tratados. Hipertensión y Riesgo Vascular 2004. [DOI: 10.1016/s1889-1837(04)71456-7] [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: 10/27/2022]
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Armario P, del R, Martín-Baranera M, Andreu-Valls N, Ceresuela LM, Pardell H. The effect of age on the relationship of pulse pressure and left ventricular mass in untreated patients with mild to moderate hypertension. Blood Press 2003; 11:13-7. [PMID: 11926345 DOI: 10.1080/080370502753543909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/17/2022]
Abstract
AIM To study the relationship between left ventricular mass (LMV) and pulse pressure (PP) in mild to moderate hypertensive patients according to age and gender. DESIGN AND METHODS Two hundred and eleven patients aged 18-65 years, 56% males, with untreated mild to moderate hypertension, were included. A 24-h ambulatory blood pressure (BP) profile was recorded in 204 patients. In 174 of them, an echocardiogram of good quality was obtained. PP was defined as the difference between systolic and diastolic BP. RESULTS Statistically significant differences were observed in office and ambulatory PP according to the age, with a greater PP among hypertensive subjects younger than 30. Globally, there was a significant correlation between LVM and PP, either with clinical PP (r = 0.17, p = 0.024) or with ambulatory PP (24-h PP: r = 0.18, p = 0.016). When stratifying by age group, the stronger correlations were observed in patients younger than 30. When stratifying by gender, previous results were applicable to men, but, in women, no correlation was observed between PP and LVM in either age group. CONCLUSIONS an increased PP was observed in hypertensive patients younger than 30 in comparison with middle-aged hypertensive patients. The correlation between LVM and PP was stronger in younger male hypertensive patients, but not in female.
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Affiliation(s)
- Pedro Armario
- Department of Internal Medicine, L'Hospitalet de Llobregat, University of Barcelona, Spain.
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Affiliation(s)
- Pedro Armario
- Unidad de HTA y Riesgo Cardiovascular, Consorci Sanitari de la Creu Roja a Catalunya, L'Hospitalet de Llobregat, Barcelona, Spain.
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Abstract
AIMS This study was designed to estimate the prevalence of blindness and its main aetiologies in Bioko, an onchocerciasis endemic zone of Equatorial Guinea. METHODS Random sampling was applied, proportionally to population distribution into urban or rural areas. All the subjects underwent a basic eye examination by trained nurses. In the presence of any ocular affection or a visual acuity of less than 0.3, the subject was visited by the ophthalmologist. This visit included direct and indirect ophthalmoscopy, anterior segment examination with a slit lamp, and intraocular pressure recording. Blindness and visual impairment were defined by using the WHO criteria. RESULTS 3218 subjects were screened, with a mean age of 34.1 (SD 21.6) years, ranging from 1 month to 102 years (median 34 years). The overall prevalence of blindness was 3.2% (95% CI: 2.6% to 3.9%). Unilateral blindness was present in 4.2%. Visual impairment was diagnosed in 200 patients (6.8%). More than 20% of the acuities inferior to 0.7 improved when explored with a pinhole. The main causes of blindness were cataracts (61.3%); macular affection (25.3%), optic atrophy (16%), and glaucoma (13.3%). Ocular onchocerciasis was detected in 12 cases (0.4%). CONCLUSION Ocular onchocerciasis was very uncommon in an area of high endemicity. Results also pointed at the lack of basic ophthalmologist eye care and optician resources in the island.
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Affiliation(s)
- C L Moser
- Ophthalmology Unit, Consorci Sanitari de la Creu Roja a Catalunya, Hospital de l'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain.
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Reig L, Fernández M, García M, Martín-Baranera M. [Factors which influence cardiopulmonary resuscitation and medical information preferences in a geriatric population]. Med Clin (Barc) 2002; 118:94-6. [PMID: 11825550 DOI: 10.1016/s0025-7753(02)72296-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 12/13/2022]
Abstract
BACKGROUND Whether or not performing cardiopulmonary resuscitation (CPR) is a complex decision that requires taking account of several factors. The aim of this study was to analyse the preferences of elderly people with regard to CPR. SUBJECTS AND METHOD Survey administered to 181 elderly subjects from nursing homes and ambulatory care centres. RESULTS 66.9% of them would request information if hospitalised. 80.7% would wish to undergo CPR. However, this figure decreased to 40.9% in case of serious sequeles as a result of the procedure and to 32.5% in case of previous dementia. CONCLUSIONS Request information would be high. Age and functional status of the elderly person
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Affiliation(s)
- Luis Reig
- Consorci Sanitari Creu Roja a Catalunya, Hospital de L'Hospitalet, Barcelona, Spain.
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Peraire M, Martín-Baranera M, Pallarés C. [Impact of thrombolytic therapy on short and long-term survival of a cohort of patients with acute myocardial infarction consecutively admitted to all the hospitals of a health care area. GESIR-5 study]. Rev Esp Cardiol 2001; 54:150-8. [PMID: 11181303 DOI: 10.1016/s0300-8932(01)76285-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM This study aims to assess the application of thrombolysis in patients with acute myocardial infarction admitted to all the hospitals of a health care area in Catalonia (Spain), and to estimate the effect of thrombolysis on short and long-term survival. METHODS From May 1992 to May 1993, all the patients with myocardial infarction admitted to the hospitals of the Costa de Ponent area in the first 72 hours after the initial symptoms were consecutively included in this prospective study. Information on pre-hospital phase, emergency room management and hospitalization was collected. All the patients discharged alive from hospital were followed up by telephone one and four years after hospital admission. RESULTS 521 patients aged 74 years or less were included. Thrombolytic therapy was applied in 35.3%. There were no statistically significant differences in the proportion of thrombolysis between hospitals with or without intensive care or coronary units. Ten patients died in the emergency room; in the remaining cases, the 28-day case fatality was 10.0%. The effect of thrombolytic treatment on 28-day case fatality was estimated in a logistic regression model, after controlling for age, gender, Killip, ventricular arrhythmia and location of infarction (OR: 0.36; CI 95%: 0.15-0.88). In 28-day survivors, the 4-year cumulated probability of survival was 88.4%, being significantly higher in the group who had received thrombolytic therapy. CONCLUSIONS In the population studied, 28-day case mortality of acute myocardial infarction is similar to that reported in other Mediterranean regions. The benefits of thrombolysis in the acute phase are found to persist after 4 years.
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Affiliation(s)
- M Peraire
- Hospital Sant Camil, Ctra. Puigmolto, s/n 08810 Sant Pere de Ribes, Barcelona, Spain.
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27
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Oliva G, Vilarasau Farré J, Martín-Baranera M. [Survey on the preoperative evaluation in Catalonian surgical centers. II. What is the attitude and opinion of the professionals involved?]. Rev Esp Anestesiol Reanim 2001; 48:11-6. [PMID: 11234600] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Previous studies have provided evidence of the existence of differences in preoperative assessment practices and have questioned the usefulness of generalized testing for all patients. The objective of this study was to determine the attitudes and opinions of anesthesiologists and surgeons about their application of preoperative assessment procedures and their knowledge of the scientific principles underlying their practice. SUBJECTS AND METHODS A questionnaire was mailed to 227 specialists in anesthesiology and postoperative intensive care, general and gastrointestinal surgery, orthopedic surgery and traumatology of all hospitals in Catalonia (Spain) with active operating theaters. RESULTS The overall response rate was 61% of the surveyed population, with 86% of the Catalan hospitals represented. The medical literature supports the routine performance of a chest x-ray and an ECG in the opinion of 17 and 26% of the respondents, respectively. Those two procedures are always ordered by 43 and 37%, respectively, even if they believe that the medical literature does not support generalized application. Legal protection was given as the reason for routine ordering of preoperative tests in asymptomatic patients, and 89% believed that a protocol for selective preoperative assessment procedures would improve efficiency. CONCLUSIONS This study reveals a discrepancy between the opinions of professionals involved in preoperative assessment and their real practice in Catalan hospitals, probably influenced by perceived need for legal protection.
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Affiliation(s)
- G Oliva
- Agència d'Avaluació de Tecnologia i Recerca Mèdiques, Barcelona.
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Vilarasau Farré J, Martín-Baranera M, Oliva G. [Survey on the preoperative evaluation in Catalonian surgical centers. I. What is the preoperative routine?]. Rev Esp Anestesiol Reanim 2001; 48:4-10. [PMID: 11234606] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To describe the preoperative assessment procedures currently used in hospitals in Catalonia (Spain). SUBJECTS AND METHODS The study population consisted of all heads of departments of anesthesiology, general and gastrointestinal surgery, orthopedic surgery and traumatology of hospitals and clinics in Catalonia with active operating theaters. Information was obtained by self-administered questionnaire prepared by an interdisciplinary team. RESULTS Of the 227 questionnaires sent, 139 (61%) were answered and returned. A preoperative assessment visit was programmed according to 112 (81%) of the respondents and 123 (89.8%) reported following a protocol that included ordering preoperative tests. The same tests were ordered for all patients by 25% of the respondents. A chest film and an ECG were always ordered according to 61 and 65%, respectively, and always when the patient was over a certain age according to 36 and 32%, respectively. Coagulation and blood sugar tests and a complete blood workup were always ordered according to 94%, 95% and 89%, respectively. Tests were considered valid for less than six months by most. CONCLUSIONS This survey provides evidence of widespread use of preoperative assessment, although application falls short of including all scheduled patients. According to these results, selective protocols for ordering complementary preoperative tests are rarely applied.
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Affiliation(s)
- J Vilarasau Farré
- Consorci Sanitari de la Creu Roja a Catalunya, L'Hospitalet de Llobregat, Barcelona.
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Armario P, Hernández del Rey R, Martín-Baranera M, Almendros M, Andreu N, Ruigómez J, Ceresuela L, Pardell H. Ausencia de relación entre insulinemia y afectación orgánica en hipertensos no tratados grados 1-2. Hipertensión y Riesgo Vascular 2001. [DOI: 10.1016/s1889-1837(01)71792-8] [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: 11/29/2022]
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Martín-Baranera M, Sancho JJ, Sanz F. Controlling for chance agreement in the validation of medical expert systems with no gold standard: PNEUMON-IA and RENOIR revisited. Comput Biomed Res 2000; 33:380-97. [PMID: 11150233 DOI: 10.1006/cbmr.2000.1552] [Citation(s) in RCA: 5] [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: 12/26/2022]
Abstract
In the validation of medical expert systems, agreement among different human specialists on a random sample of cases may be taken as a substitute to a missing gold standard. Distance measures between pairs of experts, extensively described in previous studies, do not take into account the influence of chance-expected agreement. A weighted kappa index, with three different weighting schemes, is proposed as an alternative to be applied in the general situation of N cases assessed by E experts about K possible diagnoses, each of them qualified with one of G ordinal categories. A hierarchical cluster analysis, applied to the kappa matrices generated, allows for the classification of the expert system among clinical specialists, providing a relative assessment of its diagnostic ability. The above methodology is applied to the validation of two medical expert systems, PNEUMON-IA and RENOIR.
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Affiliation(s)
- M Martín-Baranera
- Department of Medical Informatics, Institut Municipal d'Investigacio Mèdica (IMIM), Universitat Autònoma de Barcelona, Dr. Aiguader 80, E-08003 Barcelona, Spain.
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Armario P, del Rey RH, Sánchez P, Martín-Baranera M, Torres G, Juliá J, Pardell H. Determinants of left ventricular mass in untreated mildly hypertensive subjects: hospitalet study in mild hypertension. Am J Hypertens 1999; 12:1084-90. [PMID: 10604484 DOI: 10.1016/s0895-7061(99)00134-x] [Citation(s) in RCA: 22] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objectives of this cross-sectional study were to identify the determinants of left ventricular mass in untreated mildly hypertensive subjects at the Hypertension Unit, Department of Internal Medicine, Red Cross Hospital, Hospitalet de Llobregat, Barcelona, Spain. One hundred seventy-one untreated mildly hypertensive subjects, with a mean age of 41.1+/-11.8 years (from 18 to 65 years) were sequentially visited in our Unit; 54% were men. Echocardiographic measurements of good quality were obtained in 142 subjects (83%). Two-dimensional guided M-mode echocardiograms were used and left ventricular mass was estimated according to the Penn convention. Left ventricular mass (LVM) was analyzed as a continuous variable. In the bivariate analysis, the variables that significantly correlated with LVM were patient's height (r = 0.42, P<.0005), weight (r = 0.47, P< or =.0005), heart rate (r = -0.22, P = .01), HDLc (r = -0.30, P = .002), hematocrit (r = -0.28, P = .001), urinary sodium excretion (r = 0.23, P = 0.012), and different measurements from the ambulatory blood pressure profile for 24 h. By means of multiple regression analysis, a maximum of 41.2% of LVM variability could be explained from the factors registered in our study. The final model included age, gender, patient's weight, and diastolic night load from ambulatory blood pressure monitoring. When added to different models, weight and diastolic night load showed a similar strength in predicting left ventricular mass. In untreated patients with mild hypertension, traditional factors such as blood pressure levels explain a maximum of 41.2% of LVM variability. More knowledge is needed about factors that may alter cardiac morphology in the evolution of hypertensive patients.
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Affiliation(s)
- P Armario
- Department of Internal Medicine, Red Cross Hospital, Hospitalet de Llobregat, Barcelona, Spain
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Armario P, Hernández del Rey R, Torres G, Martín-Baranera M, Cruz Almendros M, Pardell H. [Relationship in cardiovascular reactivity to mental stress and early involvement of target organs in non-treated mild arterial hypertension. Hospitalet Study]. Med Clin (Barc) 1999; 113:401-6. [PMID: 10562950] [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: 02/14/2023]
Abstract
BACKGROUND It has been previously reported that an exaggerated response of blood pressure to mental stress tasks is associated to an increased cardiovascular risk. The objective of this cross-sectional study, with sequential inclusion of subjects who met the inclusion criteria, was to asses the relationships between the response of blood pressure and heart rate to two different mental stress tasks and early target organ-damage, defined as abnormalities in the echocardiogram and/or an increase of urinary albumin excretion (UAE) or microalbuminuria, in untreated mild hypertensive subjects. SUBJECTS AND METHODS Two hundred and eleven subjects aged 18 to 65 years (56% males) with mild hypertension (SBP between 140-180 mmHg and/or DBP between 90-105 mmHg) were included in Hospitalet Study. One hundred and thirty seven of them accepted to participate in the study of cardiovascular reactivity. Two different tasks were applied in the same day: a stressful interview (SI) and a mental arithmetic stress tasks (MAST). An echocardiogram of good quality was obtained in 123 cases (89.8%) and 24 h UAE was measured in 108 cases (78.8%). RESULTS The prevalence of left ventricular hypertrophy was 21.1% (95% CI = 14.3-29.4) and the prevalence of microalbuminuria was 15.7% (95% CI = 9.4-24.4%). After adjusting for the baseline blood pressure, a significant correlation was observed between increase of systolic BP during SI and UAE (r = 0.21; p = 0.03) and between increase of diastolic BP during SI and relative wall thickness (r = 0.32; p < 0.005). When we analyzed the changes of BP during MAST, a significant correlation was observed between increase of diastolic BP (adjusted for baseline diastolic BP) and left atrial size (r = 0.21; p = 0.02). We did not find any significant correlation between the increases of BP (systolic or diastolic) during MAST or increases of heart rate during both tasks and left ventricular mass index or UAE. CONCLUSIONS A weak correlation was observed between cardiovascular reactivity of blood pressure during mental stress tasks and early target organ damage in mild hypertension. We did not find any relationship between the response to heart rate during the tasks and early target organ damage.
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Affiliation(s)
- P Armario
- L'Hospital de la Creu Roja de l'Hospitalet de Llobregat, Departamento de Medicina, Facultad de Medicina, Universidad de Barcelona.
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Sancho JJ, Planas I, Domènech D, Martín-Baranera M, Palau J, Sanz F. IMASIS. A multicenter hospital information system--experience in Barcelona. Stud Health Technol Inform 1999; 56:35-42. [PMID: 10351871] [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: 02/12/2023]
Abstract
The present study aimed to analyse physicians' attitudes towards IMASIS, and their potential influence on IMASIS medical record project. IMAS (Institut Municipal d'Assistència Sanitària) is the health care organisation of the City Council of Barcelona. IMAS hospital information system (IMASIS), which first applications were designed and implemented in 1984, is currently facing a new phase, focused on clinical information management. Our approach included a personal interview with representatives of every hospital unit, and a self-administered questionnaire distributed to every clinician. Both provided a worthy insight into the cultural patterns to be considered in the HIS implementation process. Moreover, the results helped to define the subsequent steps of IMASIS evolution. Our experience is proposed as a tool to assess clinical informations systems from a user point of view.
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Affiliation(s)
- J J Sancho
- Dept of Informatics, Institut Municipal d'Assistència Sanitària (IMAS), Barcelona, Spain
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Armario P, del Rey R, Martín-Baranera M, Torres G, Ruigómez J, Pardell H. 1.P.372 Prevalence and related factors to hypoalpha-liproteinemia in untreated mild hypertension. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)88547-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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