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Mascarenas-Garcia M, Rivero-de-Aguilar A, Pérez-Ríos M, Ruano-Raviña A, Llaneza-Gonzalez MA, Candal-Pedreira C, Rey-Brandariz J, Varela-Lema L. Best practices in phase III clinical trials on DMTs for multiple sclerosis: a systematic analysis and appraisal of published trials. J Neurol Neurosurg Psychiatry 2024; 95:333-341. [PMID: 37541785 DOI: 10.1136/jnnp-2023-331733] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/26/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Great advances have been made in the field of multiple sclerosis (MS) therapy due to the publication of numerous randomised clinical trials (RCTs). In this study, we carried out a critical appraisal of phase III RCTs of disease-modifying therapies (DMTs) for MS published after 2010, intending to identify critical areas of improvement. METHODS We performed a systematic search of published RCTs on MS from January 2010 until December 2021. RCTs were assessed using an ad-hoc tool. This tool was developed based on existing generic methodological instruments and MS-specific guidelines and methodological papers. It included 14 items grouped in 5 domains: methodological quality, adequacy and measurement of outcomes, adverse event reporting, applicability and relevance of results, and transparency and conflict of interest. RESULTS We identified 31 phase III RCTs. Most of them were fully compliant in terms of sample size (87%), randomisation (68%), blinding (61%), participant selection (68%), adverse event reporting (84%) and clinical relevance (52%). Only a few were compliant in terms of participant description (6%), comparison (42%), attrition bias (26%), adequacy of outcome measures (26%), applicability (23%), transparency (36%) and conflict of interest (6%). None were compliant in terms of analysis and reporting of outcomes. The most common limitations related to the absence of comorbidity data, unjustified use of placebo, inadequacy of outcomes design and absence of protocol and/or prospective registration. CONCLUSIONS RCTs for DMTs in MS have relevant and frequent limitations. These should be addressed to enhance their quality, transparency and external validity.
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Affiliation(s)
- Marta Mascarenas-Garcia
- Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Preventive Medicine and Public Health, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alejandro Rivero-de-Aguilar
- Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Neurology, University Hospital Complex of Pontevedra, Pontevedra, Spain
| | - Mónica Pérez-Ríos
- Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain
| | - Alberto Ruano-Raviña
- Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain
| | | | - Cristina Candal-Pedreira
- Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
| | - Julia Rey-Brandariz
- Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Leonor Varela-Lema
- Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain
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2
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Viñolas N, Mezquita L, Corral J, Cobo M, Gil-Moncayo F, Paz-Ares L, Remon J, Rodríguez M, Ruano-Raviña A, Conde E, Majem M, Garrido P, Felip E, Isla D, de Castro J. The role of sex and gender in the diagnosis and treatment of lung cancer: the 6th ICAPEM Annual Symposium. Clin Transl Oncol 2024; 26:352-362. [PMID: 37490262 DOI: 10.1007/s12094-023-03262-x] [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: 02/28/2023] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
The incidence and mortality of lung cancer in women are rising, with both increasing by 124% between 2003 and 2019. The main risk factor for lung cancer is tobacco use, but indoor radon gas exposure is one of the leading causes in nonsmokers. The most recent evidence demonstrates that multiple factors can make women more susceptible to harm from these risk factors or carcinogens. For this consensus statement, the Association for Lung Cancer Research in Women (ICAPEM) invited a group of lung cancer experts to perform a detailed gender-based analysis of lung cancer. Clinically, female patients have different lung cancer profiles, and most actionable driver alterations are more prevalent in women, particularly in never-smokers. Additionally, the impact of certain therapies seems to be different. In the future, it will be necessary to carry out specific studies to improve the understanding of the role of certain biomarkers and gender in the prognosis and evolution of lung cancer.
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Affiliation(s)
- Nuria Viñolas
- Department of Medical Oncology, Barcelona Clinic Hospital, Translational Genomics and Targeted Therapies in Solid Tumours, IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Laura Mezquita
- Department of Medical Oncology, Barcelona Clinic Hospital, Translational Genomics and Targeted Therapies in Solid Tumours, IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Jesús Corral
- Department of Medical Oncology, Jerez de la Frontera University Hospital, Cádiz, Spain
| | - Manuel Cobo
- Department of Medical Oncology, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Francisco Gil-Moncayo
- Department of Psycho-Oncology, Catalan Institute of Oncology-Hospitalet, Barcelona, Spain
| | - Luis Paz-Ares
- Department of Medical Oncology, 12 de Octubre University Hospital, Madrid, Spain
| | - Jordi Remon
- Department of Medical Oncology, HM Nou Delfos Hospital, Barcelona, Spain
| | - María Rodríguez
- Department of Thoracic Surgery, Clínica Universidad de Navarra, Madrid, Spain
| | - Alberto Ruano-Raviña
- Department of Medicine and Public Health, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Esther Conde
- Pathology Department, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Research Institute 12 de Octubre University Hospital (Imas12), CIBERONC, Madrid, Spain
| | - Margarita Majem
- Department of Medical Oncology, Santa Creu y Sant Pau University Hospital, Barcelona, Spain
| | - Pilar Garrido
- Department of Medical Oncology, Ramón y Cajal University Hospital, Madrid, Spain
| | - Enriqueta Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dolores Isla
- Department of Medical Oncology, Lozano Blesa University Clinical Hospital, Saragossa, Spain
| | - Javier de Castro
- Department of Medical Oncology, La Paz University Hospital, Madrid, Spain
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3
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Mauriz-Barreiro V, Ruano-Raviña A, Ferreiro-Iglesias R, Bastón-Rey I, Calviño-Suárez C, Nieto-García L, Porto-Silva S, Martínez-Seara X, Domínguez-Munoz JE, Barreiro-de Acosta M. Is Occupation a Risk Factor for Developing Inflammatory Bowel Disease? A Case-Control Study. Crohns Colitis 360 2023; 5:otad065. [PMID: 37941599 PMCID: PMC10629213 DOI: 10.1093/crocol/otad065] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Indexed: 11/10/2023] Open
Abstract
Background and aims The role of occupation is uncertain in the onset of inflammatory bowel diseases. The aim of this study is to identify if there is a role of occupation in these diseases. Materials and methods A case-control study with incident cases with inflammatory bowel diseases was designed. Cases and controls were recruited simultaneously and controls followed a sex and age frequency matching with cases. A detailed questionnaire was completed by all the participants. To analyze the results, a logistic regression was used. A subgroup analysis was performed for each inflammatory bowel disease. Results A total of 141 patients with incident inflammatory bowel disease (80 ulcerative colitis, 55 Crohn's disease, and 6 unclassified colitis) and 114 controls were included. There were no statistically significant differences in type of work, working hours, contact with animals, or physical activity at work between inflammatory bowel disease patients and controls. After stratifying results according to type of IBD, there were no statistically significant differences either. Conclusions There seems to be no risk for inflammatory bowel disease onset regarding the type of work, working hours, contact with animals, or sedentariness.
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Affiliation(s)
- Violeta Mauriz-Barreiro
- Gastroenterology Department, Clinical University Hospital of Ferrol, Ferrol, Spain
- University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Iria Bastón-Rey
- Clinical University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Laura Nieto-García
- Clinical University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Sol Porto-Silva
- Clinical University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Xurxo Martínez-Seara
- Clinical University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Manuel Barreiro-de Acosta
- University of Santiago de Compostela, Santiago de Compostela, Spain
- Clinical University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
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4
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Rivero-de-Aguilar A, Pérez-Ríos M, Ruano-Raviña A, Candal-Pedreira C, Puente-Hernandez M, Ross JS, Varela-Lema L. Evidence of publication bias in multiple sclerosis clinical trials: a comparative analysis of published and unpublished studies registered in ClinicalTrials.gov. J Neurol Neurosurg Psychiatry 2023; 94:597-604. [PMID: 36977551 DOI: 10.1136/jnnp-2023-331132] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Complete and timely publication of clinical trials ensures that patients and the medical community are fully informed when making treatment decisions. The aim of this study is to assess the publication of phase III and IV clinical trials on multiple sclerosis (MS) drugs that have been carried out between 2010 and 2019 and to identify the factors associated with their publication in peer-reviewed journals. METHODS An advanced search in ClinicalTrials.gov was performed and consecutive searches in PubMed, EMBASE and Google Scholar were conducted looking for the associated publications of all completed trials. Study design characteristics, results and other relevant information were extracted. Data was analysed following a case-control design. Clinical trials with associated publications in peer-reviewed journals were the cases and unpublished trials were the controls. A multivariate logistic regression analysis was performed to identify factors associated with trial publication. RESULTS One hundred and fifty clinical trials were included in the analysis. Ninety-six of them (64.0%) were published in peer-reviewed journals. In the multivariate analysis, factors associated with trial publication were a favourable primary outcome (OR 12.49, 95% CI 1.28 to 122.29) and reaching the originally estimated sample size (OR 41.97, 95% CI 1.96 to 900.48), while those associated with a lower odds of publication were having 20% or more patients lost to follow-up (OR 0.03, 95% CI 0.01 to 0.52) and evaluating drugs intended to improve treatment tolerability (OR 0.01, 95% CI 0.00 to 0.74). CONCLUSIONS Phase III and IV clinical trials on MS drugs are prone to under-reporting and publication bias. Efforts must be made to promote a complete and accurate dissemination of data in MS clinical research.
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Affiliation(s)
- Alejandro Rivero-de-Aguilar
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Neurology, University Hospital Complex of Pontevedra, Pontevedra, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Cristina Candal-Pedreira
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | | | - Joseph S Ross
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Leonor Varela-Lema
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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5
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Branco PTBS, Martin-Gisbert L, Sá JP, Ruano-Raviña A, Barros-Dios J, Varela-Lema L, Sousa SIV. Quantifying indoor radon levels and determinants in schools: A case study in the radon-prone area Galicia-Norte de Portugal Euroregion. Sci Total Environ 2023; 882:163566. [PMID: 37084905 DOI: 10.1016/j.scitotenv.2023.163566] [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] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/09/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
Radon is a carcinogenic compound, and is particularly concerning in the education sector, where children and teachers may be exposed even longer than at home. Thus, this study intended to characterise radon in the indoor air of scholar environments in different provinces/districts of the Euroregion Galicia-Norte de Portugal. With a pioneering approach, this study evaluated the influence of specific factors/characteristics (location, type of management, construction material, season and floor within the building) and quantified their relative contribution to indoor radon levels. Radon was continuously monitored in 416 classrooms from school buildings located in urban and rural sites from different provinces/districts both in the regions of Galicia (A Coruña and Lugo provinces) and Portugal (Porto and Bragança districts), considering rooms for different age groups (from nursery schools to universities). Single and multivariate linear regression models were built considering the radon concentrations as the outcome variable and different room/building characteristics as predictor variables. Mean and median radon concentrations were 332 Bq·m-3 and 181 Bq·m-3, respectively. The radon concentrations observed are a public health concern, as almost 1/3 of the places monitored exceeded the reference limit value of the European legislation (300 Bq·m-3). Moreover, around 50 % of the indoor levels measured could be attributed to room/building characteristics: the building's location and the main construction material, as well as the occupants' age group, the floor within the building and the school's type of management (public/private). This study concluded that radon testing is needed in all school buildings and classrooms without exceptions. Thus, public administrations are urged to dedicate funds for testing, mitigation and public dissemination initiatives in schools. A special protocol for radon sampling in school buildings should also be developed.
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Affiliation(s)
- Pedro T B S Branco
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Lucia Martin-Gisbert
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; Cross-Disciplinary Research in Environmental Technologies (CRETUS), University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), 15706 Santiago de Compostela, Spain.
| | - Juliana P Sá
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; Cross-Disciplinary Research in Environmental Technologies (CRETUS), University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), 28029 Madrid, Spain
| | - Juan Barros-Dios
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), 15706 Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), 28029 Madrid, Spain
| | - Leonor Varela-Lema
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela-IDIS), 15706 Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), 28029 Madrid, Spain
| | - Sofia I V Sousa
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
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6
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Rodríguez-García C, Rodríguez-Ruiz E, Ruano-Raviña A, Cruz R, Piñeiro-Lamas M, Casal A, Lapunzina P, Carracedo Á, Valdés L, Valdés L. Is SARS-COV-2 associated with alpha-1 antitrypsin deficiency? J Thorac Dis 2023; 15:711-717. [PMID: 36910046 PMCID: PMC9992632 DOI: 10.21037/jtd-22-1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/23/2022] [Indexed: 01/31/2023]
Affiliation(s)
| | - Emilio Rodríguez-Ruiz
- Clinical University Hospital of Santiago, Santiago de Compostela, Spain.,Simulation, Life Support and Intensive Care Research Unit of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Ruano-Raviña
- Preventive Medicine and Public Health Unit, University of Santiago de Compostela, Santiago de Compostela, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health - CIBERESP), Madrid, Spain.,Health Research Institute (IDIS), Santiago de Compostela, Spain
| | - Raquel Cruz
- Health Research Institute (IDIS), Santiago de Compostela, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Carlos III Health Institute, Madrid, Spain.,Genomic Medicine Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - María Piñeiro-Lamas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health - CIBERESP), Madrid, Spain.,Health Research Institute (IDIS), Santiago de Compostela, Spain
| | - Ana Casal
- Pulmonology Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
| | - Pablo Lapunzina
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Carlos III Health Institute, Madrid, Spain.,Institute of Medical and Molecular Genetics (INGEMM), University Hospital La Paz - IDIPAZ, Madrid, Spain
| | - Ángel Carracedo
- Health Research Institute (IDIS), Santiago de Compostela, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Carlos III Health Institute, Madrid, Spain.,Genomic Medicine Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), University of Santiago de Compostela, Santiago de Compostela, Spain.,Galician Public Foundation for Genomic Medicine, Galician Health Service (SERGAS), Santiago de Compostela, Spain
| | - Luis Valdés
- Pulmonology Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain.,Health Research Institute (IDIS), Santiago de Compostela, Spain.,Medicine Department, University of Santiago, Santiago de Compostela, Spain
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7
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Mourino N, Ruano-Raviña A, Varela Lema L, Fernández E, López MJ, Santiago-Pérez MI, Rey-Brandariz J, Giraldo-Osorio A, Pérez-Ríos M. Serum cotinine cut-points for secondhand smoke exposure assessment in children under 5 years: A systemic review. PLoS One 2022; 17:e0267319. [PMID: 35511766 PMCID: PMC9070924 DOI: 10.1371/journal.pone.0267319] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022] Open
Abstract
Background Serum cotinine has become the most widely used biomarker of secondhand smoke exposure (SHS) over time in all ages. The aim of this study was to review the serum cotinine cut-points used to classify children under 5 years as exposed to SHS. Methods A systematic review performed in the Pubmed (MEDLINE) and EMBASE databases up to April 2021 was conducted using as key words "serum cotinine", “tobacco smoke pollution” (MeSH), "secondhand smoke", "environmental tobacco smoke" and “tobacco smoke exposure”. Papers which assessed SHS exposure among children younger than 5 years old were included. The PRISMA 2020 guidelines were followed. Analysis was pre-registered in PROSPERO (registration number: CRD42021251263). Results 247 articles were identified and 51 fulfilled inclusion criteria. The selected studies were published between 1985–2020. Most of them included adolescents and adults. Only three assessed postnatal exposure exclusively among children under 5 years. None of the selected studies proposed age-specific cut-points for children < 5 years old. Cut-point values to assess SHS exposure ranged from 0.015 to 100 ng/ml. The most commonly used cut-point was 0.05 ng/ml, derived from the assay limit of detection used by the National Health and Nutrition Examination Survey (NHANES). Conclusions No studies have calculated serum cotinine age-specific cut-points to ascertained SHS exposure among children under 5 years old. Children’s age-specific cut-points are warranted for health research and public health purposes aimed at accurately estimating the prevalence of SHS exposure and attributable burden of disease to such exposure, and at reinforcing 100% smoke-free policies worldwide, both in homes, private vehicles and public places.
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Affiliation(s)
- Nerea Mourino
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- CIBER Epidemiology and Public Health, CIBERESP, Madrid, Spain
| | - Leonor Varela Lema
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- * E-mail:
| | - Esteve Fernández
- Tobacco Control Unit, WHO Collaborating Center for Tobacco Control, Institut Català d’Oncologia (ICO), Badalona, Spain
- Tobacco Control Research Group, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
- School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - María José López
- CIBER Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Servicio de Evaluación y Métodos de Intervención, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Julia Rey-Brandariz
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alexandra Giraldo-Osorio
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Departamento de Salud Pública, Grupo de investigación Promoción de la Salud y Prevención de la Enfermedad (GIPSPE), Universidad de Caldas, Manizales, Colombia
- Fundación Carolina, Madrid, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- CIBER Epidemiology and Public Health, CIBERESP, Madrid, Spain
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8
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Pérez-Ríos M, Rey-Brandariz J, Galán I, Fernández E, Montes A, Santiago-Pérez MI, Giraldo-Osorio A, Ruano-Raviña A. Methodological guidelines for the estimation of attributable mortality using a prevalence-based method: The STREAMS-P tool. J Clin Epidemiol 2022; 147:101-110. [PMID: 35341948 DOI: 10.1016/j.jclinepi.2022.03.016] [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: 07/03/2021] [Revised: 03/04/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is evidence of strong links between exposure to different risk factors and life-threatening diseases. Assessing the burden of a risk factor on the population's mortality due to a given disease provides a clear picture of these links. The estimation of attributable mortality to a risk factor is the most widely used procedure for doing this. Although different methods are available to estimate attributable mortality, the prevalence-based methodology is the most frequent. The main objective of this paper is to develop guidelines and checklists to STrengthen the design and REporting of Attributable-Mortality Studies using a Prevalence-based method (STREAMS-P) and also to assess the quality of an already published study which uses this methodology. METHODS The design of the guideline and checklists has been done in two phases. A development phase, where we set recommendations based on the review of the literature; and a validation phase, where we validated our recommendations against other published studies that have estimated attributable mortality using a prevalence-based method. RESULTS We have developed and tested a guideline that includes the information required to perform a prevalence-based attributable mortality study to a given risk factor; a checklist of aspects that should be present when a report or a paper on attributable mortality is written or interpreted and a checklist of quality control criteria for reports or papers estimating attributable mortality. CONCLUSION To our knowledge, the STREAMS-P is the first set of criteria specifically created to assess the quality of such studies and it could be valuable for authors and readers interested in performing attributable mortality studies or interpreting their reliability.
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Affiliation(s)
- Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; CIBER Epidemiology and Public Health, CIBERESP; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Julia Rey-Brandariz
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Iñaki Galán
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Instituto de Investigaciones Sanitarias Hospital Universitario La Paz, Madrid, Spain
| | - Esteve Fernández
- Tobacco Control Unit, WHO Collaborating Center for Tobacco Control, Institut Català d'Oncologia (ICO), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain; School of Medicine and Health Sciences, Universitat de Barcelona; CIBER of Respiratory Diseases (CIBERES), Spain
| | - Agustín Montes
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; CIBER Epidemiology and Public Health, CIBERESP; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | | | - Alexandra Giraldo-Osorio
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; Departamento de Salud Pública, Grupo de investigación Promoción de la Salud y Prevención de la Enfermedad (GIPSPE), Universidad de Caldas, Manizales, Colombia; Fundación Carolina, Madrid, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; CIBER Epidemiology and Public Health, CIBERESP; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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9
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Ramos-Hernández C, Botana-Rial M, Mouronte-Roibas C, Núñez-Fernández M, González-Montaos A, Caldera-Díaz AC, Ruano-Raviña A, Fernández-Villar A. The Diagnostic Contribution of Systematic Lung Ultrasonography in Patients Admitted to a Conventional Pulmonology Hospitalization Unit. J Ultrasound Med 2022; 41:575-584. [PMID: 33932038 DOI: 10.1002/jum.15731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/29/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Although the evidence to date remains limited, we hypothesized that performing protocolized lung ultrasound (LUS) in patients, admitted to a conventional pulmonology hospitalization unit, could improve diagnostic precision. The main objectives of this study were to evaluate the diagnostic contribution and changes in the treatments administered after performing a protocolized LUS in patients hospitalized in a Pulmonology Department ward. METHODOLOGY This was a prospective, observational study, which included patients admitted from the Emergency Department to a conventional Pulmonology Department hospitalization unit, after first being evaluated by a pulmonologist. LUS was performed within the first 48 hours of admission. The diagnosis at the time of discharge was used as the reference diagnosis. RESULTS A total of 180 patients were included in this study. The admitting diagnoses were the decompensation of an underlying obstructive disease in 60 patients (33.3%), respiratory infection in 93 (51.7%), pulmonary thromboembolism (PE) in 9 (5%), exacerbation of an interstitial lung disease in 14 (7.8%), and other causes in 4 cases (2.2%). Ultrasonography provided new information, unsuspected at the patient's admission, in 117 (65%) of the patients by capturing images suggestive of infection in 63 patients (35%), 1 new case of ILD, 23 (12.7%) cases of cardiogenic edema, and pleural pathology in 19 (10.5%), as well as two tumors and indirect data related to a PE. The use of LUS resulted in the decision to change the already established treatment in 17.2% of the cases. CONCLUSIONS LUS provided additive information in more than half of patients that ended up reclassifying or potentially changing diagnosis or treatment. Thus, including LUS in management algorithms could reduce the need for other complementary tests or unnecessary treatments.
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Affiliation(s)
- Cristina Ramos-Hernández
- Hospital Alvaro Cunqueiro. Vigo. Department of Pneumology, Neumo Vigo I + i. Institute of Health Research Galicia South (IISGS), Vigo, Spain
| | - Maribel Botana-Rial
- Hospital Alvaro Cunqueiro. Vigo. Department of Pneumology, Neumo Vigo I + i. Institute of Health Research Galicia South (IISGS), Vigo, Spain
| | - Cecilia Mouronte-Roibas
- Hospital Alvaro Cunqueiro. Vigo. Department of Pneumology, Neumo Vigo I + i. Institute of Health Research Galicia South (IISGS), Vigo, Spain
| | - Marta Núñez-Fernández
- Hospital Alvaro Cunqueiro. Vigo. Department of Pneumology, Neumo Vigo I + i. Institute of Health Research Galicia South (IISGS), Vigo, Spain
| | - Almudena González-Montaos
- Hospital Alvaro Cunqueiro. Vigo. Department of Pneumology, Neumo Vigo I + i. Institute of Health Research Galicia South (IISGS), Vigo, Spain
| | | | - Alberto Ruano-Raviña
- Department of Preventive and Public Health, Faculty of Medicine, University of Santiago de Compostela, Santiago, Spain
| | - Alberto Fernández-Villar
- Hospital Alvaro Cunqueiro. Vigo. Department of Pneumology, Neumo Vigo I + i. Institute of Health Research Galicia South (IISGS), Vigo, Spain
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10
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Ruano-Raviña A, Provencio-Pulla M, Pérez-Ríos M. Small Cell Lung Cancer-A Neglected Disease With More Data Needed. JAMA Netw Open 2022; 5:e224837. [PMID: 35353171 DOI: 10.1001/jamanetworkopen.2022.4837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
- CIBER de Epidemiología y Salud Pública, CIBERESP, Spain
| | - Mariano Provencio-Pulla
- Department of Oncology, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
- Health Research Institute Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
- CIBER de Epidemiología y Salud Pública, CIBERESP, Spain
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11
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Tubío-Pérez RA, Torres-Durán M, García-Rodríguez ME, Candal-Pedreira C, Rey-Brandariz J, Pérez-Ríos M, Barros-Dios J, Fernández-Villar A, Ruano-Raviña A. Alpha-1 antitrypsin deficiency and risk of lung cancer in never-smokers: a multicentre case–control study. BMC Cancer 2022; 22:81. [PMID: 35045822 PMCID: PMC8767679 DOI: 10.1186/s12885-022-09190-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022] Open
Abstract
Background Lung cancer (LC) is the most commonly diagnosed cancer and the leading cause of cancer-related death in both sexes worldwide. Although the principal risk factor in the western world is tobacco smoking, genetic factors, including alpha-1 antitrypsin deficiency (AATD), have been associated with increased risk. This study is the continuation of an earlier one published by the same group in 2015, aimed at analysing risk of LC in never-smokers, associated with carriers of the AATD genotype. Methods A multicentre case–control study was conducted in Spain across the period January 2011 to August 2019. Cases were non-smokers diagnosed with LC, and controls were composed of never-smoking individuals undergoing major non-cancer-related surgery. Data were collected on epidemiological characteristics, exposure to environmental tobacco smoke (ETS), residential radon levels, and alpha-1 antitrypsin (AAT) genotype. Results The study included 457 cases (42%) and 631 controls (58%), with a predominance of women (72,8%). The most frequent histological type was adenocarcinoma (77.5%), followed by squamous cell carcinoma (7.7%). No association of risk of LC was found with the status of AATD genotype carrier, both overall and broken down by age, sex, or exposure to ETS. Conclusions No risk association was found between being a carrier of an AAT deficiency genotype and LC among never-smokers. In order to establish the existence of an association, we consider it important to expand the studies in never smokers in different geographical areas as well as to include patients with previous chronic lung diseases to assess if it influences the risk.
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12
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Mauriz-Barreiro V, Barreiro-de Acosta M, Bastón-Rey I, Ferreiro-Iglesias R, Calviño-Suárez C, Barros-Dios JM, Domínguez-Munoz JE, Ruano-Raviña A. Radon exposure and inflammatory bowel disease in a radon prone area. Rev Esp Enferm Dig 2021; 114:405-409. [PMID: 34781685 DOI: 10.17235/reed.2021.8239/2021] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Inflammatory Bowel Disease (IBD) is a multifactorial pathology with an increasing incidence. There is no study having assessed a possible relationship with residential radon exposure, very high in the study area. The aim of the study was to analyze if residential radon concentration is associated with a higher incidence of IBD. MATERIAL AND METHODS An ecological study has been performed. All incident cases of Inflammatory Bowel Disease in the area of Santiago de Compostela were included between January and December 2017. Radon levels at a municipal level were correlated with demographic factors and type of IBD. RESULTS 96 patients were included, 63 (65.6%) with ulcerative colitis, 29 (30.25) with Crohn's disease and 4 (4.2%) with indeterminate colitis. The incidence rate per 100,000 inhabitants-year was 21.6 cases. There were no statistically significant differences on the type of disease developed regarding radon levels (p>0.05). No correlation between radon levels and cumulative incidence of Inflammatory Bowel Disease at municipal level was observed (Spearman's rho = 0.13, p-value 0.5). CONCLUSION In the area of Santiago de Compostela there is a higher incidence of IBD in comparison with previous studies taking western countries as reference, but in this study we have not found any correlation with municipal average radon concentration and incidence of IBD or any of its types.
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13
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Rodríguez-Núñez N, Ruano-Raviña A, Lama A, Ferreiro L, Ricoy J, Álvarez-Dobaño JM, Suárez-Antelo J, Toubes ME, Rábade C, Golpe A, Riveiro V, Casal A, Abelleira R, González-Barcala FJ, González-Juanatey JR, Valdés L. Evaluation of the impact of an integrated care pathway for pulmonary embolism: a quasi-experimental pre-post study. J Thorac Dis 2021; 13:5373-5382. [PMID: 34659804 PMCID: PMC8482338 DOI: 10.21037/jtd-21-595] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/16/2021] [Indexed: 11/06/2022]
Abstract
Background An integrated care pathway (ICP) is intended to improve the management of prevalent resource-consuming, life-threatening diseases. The purpose of this study was to determine whether the quality of patient care improved with the establishment of a dedicated unit for pulmonary embolism (PE). Methods A quasi-experimental pre-post study (pre: years 2010–2013; post: 2015–2020; year 2014, “washing” period) of PE patients ≥18 years (January 2010–June 2020). The intervention involved the implementation of an ICP for PE. Results The sample was composed of 1,142 patients (510 pre-intervention and 612 post-intervention) without significant differences between the two populations. In the post-intervention period, significant reductions were observed in the median length of hospital stay (LOS) (8 vs. 6 days); time to start of oral anticoagulation therapy (4.5 vs. 3.5 days; P<0.001); and the percentage of patients with high-risk PE in whom recanalization was not contraindicated (66.7% vs. 96%; P=0.009). In-hospital and 30-day mortality decreased, although not significantly (4.5% vs. 2.8%; P=0.188; 6.1% vs. 5.2%; P=0.531, respectively). Multivariate logistic regression analysis showed that the median LOS intervention decreased significantly according to the service where patients were referred to, and with the use of the simplified PESI. During follow-up, lifelong anticoagulation was prescribed to a higher proportion of patients in the post-intervention period (30.7% vs. 69.3%; P<0.001). Conclusions Although an ICP for PE does not reduce mortality significantly, it improves the quality of patient care.
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Affiliation(s)
- Nuria Rodríguez-Núñez
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, Universidad de Santiago de Compostela, Santiago de Compostela, Spain.,CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain.,Group C013, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Adriana Lama
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Lucía Ferreiro
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Jorge Ricoy
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - José M Álvarez-Dobaño
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - M Elena Toubes
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Carlos Rábade
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Golpe
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Vanessa Riveiro
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Ana Casal
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Romina Abelleira
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Francisco Javier González-Barcala
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - José R González-Juanatey
- Service of Cardiology, Spanish Network-Center for Cardiovascular Biomedical Research (CIBERCV), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Luis Valdés
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
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Pereiro-Brea T, de Alegría AM, Valdés L, Golpe-Gómez A, Carreira-Villamor JM, Ruano-Raviña A. Magnetic resonance imaging for the study of mediastinal adenopathies in lung cancer: Comparison with standard tests. J Cancer Res Ther 2021; 17:917-924. [PMID: 34528542 DOI: 10.4103/jcrt.jcrt_1626_20] [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] [Indexed: 11/04/2022]
Abstract
Background Lung cancer is the second most common cancer in both men and women. Mediastinal lymph node involvement in these patients, determined by imaging tests, indicates prognosis and modifies therapeutic attitude. Purpose The aim of this study was to analyze the diagnostic capacity of magnetic resonance imaging (MRI) in the study of the mediastinum in comparison with conventional tests (computed tomography [CT] and positron-emission tomography [PET] or PET/CT scans), taking histology as the gold standard. Materials and Methods An observational study was conducted on 16 patients with suspicion of primary lung cancer (June 2016 through December 2018). We studied their demographic characteristics and used CT, PET, or PET/CT scans and MRI (diffusion-weighted imaging-MRI sequence) to examine mediastinal disease and compare MRIs diagnostic yield and percentage agreement to that of conventional tests. Results As compared to CT and PET scanning, MRI displayed a very low sensitivity and a specificity of 90 and 88%, respectively; positive predictive value was 0.67 (both) and negative predictive value (NPV) was 0.28 and 0.22, respectively. MRI showed a high degree of agreement in lymph node diagnosis when compared with histology (91.2%; P = 0.001): specificity in this case was high (E = 0.94), as was the NPV (NPV = 0.97). Conclusions The results of this study would appear to indicate that MRI could play a relevant role in mediastinal staging of lung cancer. More prospective, multicenter studies are, however, needed to be able to draw up firm recommendations about the role of MRI and its place in lung cancer staging.
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Affiliation(s)
- Tara Pereiro-Brea
- Complejo Hospitalario Universitario de A Coruña, Departamento de Neumología, As Xubias, A Coruña, Madrid, Madrid, Spain
| | - Anxo Martínez de Alegría
- Complejo Hospitalario Universitario de Santiago de Compostela, Departamento de Radiología, A Choupana, Santiago de Compostela, Madrid, Madrid, Spain
| | - Luis Valdés
- Complejo Hospitalario Universitario de Santiago de Compostela, Departamento de Neumología, A Choupana, Santiago de Compostela; Grupo Interdisciplinar de Investigación en Neumología, Instituto Sanitario de Investigaciones en Santiago (IDIS), Santiago de Compostela, Madrid, Madrid, Spain
| | - Antonio Golpe-Gómez
- Complejo Hospitalario Universitario de Santiago de Compostela, Departamento de Neumología, A Choupana, Santiago de Compostela, Madrid, Madrid, Spain
| | - José Martín Carreira-Villamor
- Complejo Hospitalario Universitario de Santiago de Compostela, Departamento de Radiología, A Choupana, Santiago de Compostela, Madrid, Spain
| | - Alberto Ruano-Raviña
- Universidad de Santiago de Compostela, Departamento de Medicina Preventiva y Salud Pública, Santiago de Compostela; CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Madrid, Spain
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15
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Ruano-Raviña A, Provencio M, Calvo de Juan V, Carcereny E, Moran T, Rodriguez-Abreu D, López-Castro R, Cuadrado Albite E, Guirado M, Gómez González L, Massutí B, Ortega Granados AL, Blasco A, Cobo M, Garcia-Campelo R, Bosch J, Trigo J, Juan Ó, Aguado de la Rosa C, Dómine M, Sala M, Oramas J, Casal-Rubio J, Cerezo S. Lung cancer symptoms at diagnosis: results of a nationwide registry study. ESMO Open 2021; 5:e001021. [PMID: 33214227 PMCID: PMC7678343 DOI: 10.1136/esmoopen-2020-001021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 08/31/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background Lung cancer is currently the leading cause of cancer death. Despite its high incidence and mortality, there are few studies describing its symptoms at diagnosis broken down by tumour stage and tobacco use. Accordingly, this study was proposed to describe the frequency of the most common symptoms of non-small cell lung cancer and small cell lung cancer (SCLC) at diagnosis, with a breakdown by stage and tobacco use. Patients and methods Cases were collected from the Spanish Thoracic Tumour Registry, a nationwide registry sponsored by the Spanish Lung Cancer Group. More than 50 hospitals recruited histologically confirmed lung cancer cases and information was gathered through personal interview plus data contained in the electronic clinical record. There were no data available on the lag between the appearance of the first symptoms and diagnosis of lung cancer. Results A total of 9876 patients (74% male, median age 64 years) were recruited from 2016 to 2019. Of these, 12.5% presented with SCLC. Stage IV was the most frequent stage at diagnosis (46.6%), and the most frequent symptom was cough (33.9%), followed by dyspnoea (26.7%). No symptom was present in 59% of patients diagnosed in stage I; 40% of stage I patients presented with at least one symptom, while 27.7% of patients in stage IV had no symptoms at diagnosis. Cough was the most frequent symptom in SCLC (40.6%), followed by dyspnoea (34.3%). The number of symptoms was similar across the respective smoking categories in SCLC, and differences between the symptoms analysed did not exceed 7% in any case. Conclusion The absence of the most frequent symptoms (ie, cough, pain, dyspnoea) should not lead to a decision to rule out the presence of lung cancer. A relevant percentage of stage IV patients displayed no symptoms at diagnosis.
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Affiliation(s)
- Alberto Ruano-Raviña
- Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Galicia, Spain; CIBER de Epidemiología y Salud Pública, Madrid, Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
| | - Mariano Provencio
- Department of Medical Oncology, Hospital Universitario Puerta del Hierro Majadahonda, Majadahonda, Spain; Department of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.
| | - Virginia Calvo de Juan
- Department of Medical Oncology, Hospital Universitario Puerta del Hierro Majadahonda, Majadahonda, Spain
| | - Enric Carcereny
- Medical Oncology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Teresa Moran
- Medical Oncology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Delvys Rodriguez-Abreu
- Medical Oncology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain
| | | | | | - María Guirado
- Medical Oncology, Elche University Hospital, Elche, Spain
| | | | - Bartomeu Massutí
- Medical Oncology, Alicante General University Hospital, Alicante, Spain
| | | | - Ana Blasco
- Medical Oncology, Valencia General Hospital, Valencia, Spain
| | - Manuel Cobo
- Medical Oncology Department, Hospital Regional Universitario de Málaga, MALAGA, MALAGA, Spain
| | | | - Joaquim Bosch
- Medical Oncology, Institut Catala d'Oncologia Girona, Girona, Catalunya, Spain
| | - José Trigo
- Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Óscar Juan
- Medical Oncology, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | | | - Manuel Dómine
- Medical Oncology, Fundación Jiménez Díaz, Madrid, Spain
| | - María Sala
- Medical Oncology, Hospital de Basurto, Bilbao, Spain
| | - Juana Oramas
- Medical Oncology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | - Sara Cerezo
- Medical Oncology, Hospital La Mancha Centro, Alcázar de San Juan, Spain
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16
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Represas-Represas C, Golpe-Gómez R, Marcos-Rodríguez PJ, Fernández-García A, Torres-Durán M, Pérez-Ríos M, Ruano-Raviña A, Fernández-Villar A. Conocimiento de la enfermedad pulmonar obstructiva crónica (EPOC) en la población gallega: estudio «CoñecEPOC». Open Respiratory Archives 2021. [PMID: 37496773 PMCID: PMC10369644 DOI: 10.1016/j.opresp.2021.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Objectives In 2011, only 18% of the population in Galician knew the COPD. Since then, activities have been carried out to publicize this disease. The objective of this study was to evaluate the current situation regarding the knowledge of COPD in the Galician population. Methodology Cross-sectional study, through telephone surveys. Variables included in the questionnaire, related to knowledge of the disease, were analyzed. Results 872 respondents, 53% women, mean age 54 years. 63% with secondary/university studies. 40% has knowledge of COPD. In contrast, more than 90% of respondents know other high-frequency diseases (diabetes, stroke, asthma). The factors most associated with knowledge of COPD were female gender, having secondary/university studies, and having previously performed spirometry. Conclusions The knowledge of COPD in the Galician population is 40% now, higher than in 2011, but it is far from that of other prevalent diseases.
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Núñez-Fernández M, Ramos-Hernández C, García-Río F, Torres-Durán M, Nodar-Germiñas A, Tilve-Gómez A, Rodríguez-Fernández P, Valverde-Pérez D, Ruano-Raviña A, Fernández-Villar A. Alterations in Respiratory Function Test Three Months after Hospitalisation for COVID-19 Pneumonia: Value of Determining Nitric Oxide Diffusion. J Clin Med 2021; 10:jcm10102119. [PMID: 34068867 PMCID: PMC8153552 DOI: 10.3390/jcm10102119] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 03/22/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 01/08/2023] Open
Abstract
Three to four months after hospitalisation for COVID-19 pneumonia, the most frequently described alteration in respiratory function tests (RFTs) is decreased carbon monoxide transfer capacity (DLCO). Methods: This is a prospective cohort study that included patients hospitalised because of SARS-CoV-2 pneumonia, three months after their discharge. A clinical evaluation, analytical parameters, chest X-ray, six-minute walk test, spirometry and DLCO–DLNO analysis were performed. Demographic variables, comorbidities, and variables related to the severity of the admission were recorded. Results: Two hundred patients completed the study; 59.5% men, age 62 years, 15.5% admitted to the intensive care unit. The most frequent functional alteration, in 27% of patients, was in the DLCO–DLNO combination. This alteration was associated with age, male sex, degree of dyspnoea, poorer perception of health, and limited ability for physical effort. These patients also presented higher levels of D-Dimer and more residual radiological alterations. In 42% of the patients with diffusion alterations, only reduced DLNO was presented, along with lower D-Dimer levels and less capillary volume involvement. The severity of the process was associated with the reduction in DLCO–DLNO. Conclusions: The most sensitive RFT for the detection of the sequelae of COVID-19 pneumonia was the combined measurement of DLCO–DLNO and this factor was related to patient health status and their capacity for physical exertion. In 40% of these cases, there was only a reduction in DLNO, a finding that may indicate less pulmonary vascular involvement.
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Affiliation(s)
- Marta Núñez-Fernández
- Service of Pneumology, University Hospital Complex of Vigo, NeumoVigo I+i. Institute of Health Research South Galicia (IISGS), 36213 Vigo, Spain; (M.N.-F.); (C.R.-H.); (M.T.-D.)
| | - Cristina Ramos-Hernández
- Service of Pneumology, University Hospital Complex of Vigo, NeumoVigo I+i. Institute of Health Research South Galicia (IISGS), 36213 Vigo, Spain; (M.N.-F.); (C.R.-H.); (M.T.-D.)
| | - Francisco García-Río
- Service of Pneumology La Paz-IdiPAZ University Hospital, 28046 Madrid, Spain;
- CIBER Respiratory Diseases (CIBERES), 28046 Madrid, Spain
- Department of Medicine, University Autónoma de Madrid, 28046 Madrid, Spain
| | - María Torres-Durán
- Service of Pneumology, University Hospital Complex of Vigo, NeumoVigo I+i. Institute of Health Research South Galicia (IISGS), 36213 Vigo, Spain; (M.N.-F.); (C.R.-H.); (M.T.-D.)
| | - Andrés Nodar-Germiñas
- Infectious Diseases Unit, Service of Internal Medicine, University Hospital Complex of Vigo, 36213 Vigo, Spain;
| | - Amara Tilve-Gómez
- Service of Radiodiagnosis, University Hospital Complex of Vigo, 36213 Vigo, Spain; (A.T.-G.); (P.R.-F.)
| | - Paula Rodríguez-Fernández
- Service of Radiodiagnosis, University Hospital Complex of Vigo, 36213 Vigo, Spain; (A.T.-G.); (P.R.-F.)
| | - Diana Valverde-Pérez
- Department of Biochemistry, Genetics and Immunology, University of Vigo, 36310 Vigo, Spain;
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15704 Santiago de Compostela, Spain;
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 15704 Santiago de Compostela, Spain
| | - Alberto Fernández-Villar
- Service of Pneumology, University Hospital Complex of Vigo, NeumoVigo I+i. Institute of Health Research South Galicia (IISGS), 36213 Vigo, Spain; (M.N.-F.); (C.R.-H.); (M.T.-D.)
- Correspondence:
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18
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Ferreiro L, Ruano-Raviña A, Otero-Mallo R, Pou-Álvarez C, Riveiro-Blanco V, Casal A, Suárez-Antelo J, Toubes ME, Cruz-Ferro E, Rodríguez-Núñez N, Ursúa-Díaz MI, Lama A, Piñeiro-Lamas M, Rábade C, Zamarrón C, González-Barcala FJ, Valiño-López P, Anibarro L, Taboada-Rodríguez JA, Valdés L. Recent epidemiological trends in extrapulmonary TB in Galicia, Spain. Int J Tuberc Lung Dis 2021; 25:373-381. [PMID: 33977905 DOI: 10.5588/ijtld.20.0910] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE: To describe the epidemiological trends and characteristics of extrapulmonary tuberculosis (EPTB) in Galicia, Spain, from 2000 to 2019.METHODS: This was a retrospective cohort study based on data from the Galician TB information system.RESULTS: Of the total number of TB cases (n = 15,871), 5,428 (34.2%) had EPTB. The absolute number of cases and incidence of EPTB decreased dramatically (from 480 cases and 17.8 cases/100,000 in 2000, to 172 and 6.4 cases/100,000 in 2019, respectively), with a mean annual decrease of respectively 64% and 4.7% for absolute cases and incidence rates. The risk for EPTB was higher in men than in women (RR 3.86, 95% CI 3.66-4.07). The most frequent age group was 15-44 years (2,234 patients, 41.2%); overall reductions per age group were 82% (0-14 years), 75% (15-44 years), 44% (45-64 years) and 63% (≥65 years), with statistically significant differences. The most frequently locations were the pleura (1,916 cases; 35.3%) and the lymph nodes (1,504; 27.7%).CONCLUSION: The incidence of EPTB in Galicia has decreased significantly in the last 20 years. The epidemiological characteristics have not changed, except for the number of patients with risk factors. This improvement of EPTB epidemiological trends coincides with the implementation of the programme for the prevention and control of TB, which suggests that it has been very effective in the control of the EPTB.
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Affiliation(s)
- L Ferreiro
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago de Compostela, Santiago de Compostela, Spain
| | - A Ruano-Raviña
- Departamento de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - R Otero-Mallo
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain
| | - C Pou-Álvarez
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain
| | - V Riveiro-Blanco
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain
| | - A Casal
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain
| | - J Suárez-Antelo
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain
| | - M E Toubes
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain
| | - E Cruz-Ferro
- Programa Gallego de Prevención y Control de la Tuberculosis, Dirección General de Innovación y Gestión de la Salud Pública, Consellería de Sanidad, Xunta de Galicia, Santiago de Compostela, Spain
| | - N Rodríguez-Núñez
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain
| | - M I Ursúa-Díaz
- Programa Gallego de Prevención y Control de la Tuberculosis, Dirección General de Innovación y Gestión de la Salud Pública, Consellería de Sanidad, Xunta de Galicia, Santiago de Compostela, Spain
| | - A Lama
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain
| | - M Piñeiro-Lamas
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - C Rábade
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain
| | - C Zamarrón
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain
| | - F J González-Barcala
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago de Compostela, Santiago de Compostela, Spain
| | - P Valiño-López
- Servicio de Neumología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - L Anibarro
- Unidad de Tuberculosis, Enfermedades Infecciosas, Servicio de Medicina Interna, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - J A Taboada-Rodríguez
- Programa Gallego de Prevención y Control de la Tuberculosis, Dirección General de Innovación y Gestión de la Salud Pública, Consellería de Sanidad, Xunta de Galicia, Santiago de Compostela, Spain
| | - L Valdés
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago de Compostela, Santiago de Compostela, Spain
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19
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Fernández-García S, Represas-Represas C, Ruano-Raviña A, Fernández-García A, González-Montaos A, Priegue-Carrera A, Pérez-Ríos M, Fernández-Villar A. Sociodemographic and Clinical Variables Related to the Overburden of the Informal Caregivers of Patients Hospitalized for Chronic Obstructive Pulmonary Disease Exacerbations. Int J Chron Obstruct Pulmon Dis 2021; 16:1119-1126. [PMID: 33907398 PMCID: PMC8068495 DOI: 10.2147/copd.s301637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/22/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To increase our knowledge of the patient variables related to the overburden of the caregivers of patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). Methodology This was a cross-sectional study of patients with severe COPD who have informal caregivers. We performed a multivariate analysis of sociodemographic (economic situation, care, dependence, social risk, and use of social services) and clinical (degree of dyspnea, previous hospitalizations, disease impact, pulmonary function, and comorbidity) factors and related these to the burden of informal caregivers, as evaluated using the Zarit scale. Results The study included 91 patients, age 72.6±8.7 years and 80 were male (89.7%); the mean modified Medical Research Council dyspnea scale (mMRC) score was 2.5±0.8; mean FEV1 was 39.5 ± 13.2%; and 70 patients (76.9%) were dependent for basic activities. Of the informal caregivers, 90 (90.9%) were women, 49 (49.4%) were partners or spouses, and 29 (29.6%) were daughters. The mean Zarit questionnaire score was 51.4±14.2, with 63 of carers (69.2%) perceiving some overburden, and 34 (37.4%) describing the overburden as mild–moderate. The variables related to informal caregiver overburden in the multivariate study were the previous use of social resources [OR = 8.1 (95% CI = 1.03–69.9); p = 0.04], degree of mMRC dyspnea 3–4 [OR =4.7 (95% CI = 1.7–13.2); p = 0.003], and two or more admissions for AEPOC in the previous year [OR = 4.5 (95% CI = 1.7–13.2); p = 0.003]. Of the informal caregivers of patients who had presented two or more of these variables, 92.3% perceived an overburden. Conclusion The variables associated with overburden are easily accessible in patient medical records, or can be obtained by interviewing patients or their relatives. This information would allow to detect and assess the overburden of informal caregivers to provide an early warning of this problem.
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Affiliation(s)
- Sara Fernández-García
- Pneumology Department, Alvaro Cunqueiro University Hospital, NeumoVigo I+i Research Group, Institute of Health Research Galicia Sur (IISGS), Vigo, Spain
| | - Cristina Represas-Represas
- Pneumology Department, Alvaro Cunqueiro University Hospital, NeumoVigo I+i Research Group, Institute of Health Research Galicia Sur (IISGS), Vigo, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago, Spain.,Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Alberto Fernández-García
- Pneumology Department, Alvaro Cunqueiro University Hospital, NeumoVigo I+i Research Group, Institute of Health Research Galicia Sur (IISGS), Vigo, Spain
| | - Almudena González-Montaos
- Pneumology Department, Alvaro Cunqueiro University Hospital, NeumoVigo I+i Research Group, Institute of Health Research Galicia Sur (IISGS), Vigo, Spain
| | - Ana Priegue-Carrera
- Pneumology Department, Alvaro Cunqueiro University Hospital, NeumoVigo I+i Research Group, Institute of Health Research Galicia Sur (IISGS), Vigo, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago, Spain.,Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Alberto Fernández-Villar
- Pneumology Department, Alvaro Cunqueiro University Hospital, NeumoVigo I+i Research Group, Institute of Health Research Galicia Sur (IISGS), Vigo, Spain
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Botana-Rial M, Ramos-Hernández C, Lojo-Rodríguez I, Represas-Represas C, Ruano-Raviña A, Leiro-Fernández V, Fernández-Villar A. Cost Effectiveness of Malignant Pleural Effusion with Indwelling Catheter: Systematic Review. J Palliat Med 2020; 24:1206-1212. [PMID: 33395352 DOI: 10.1089/jpm.2020.0695] [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] [Indexed: 11/12/2022] Open
Abstract
Background: The current cost of treatment of malignant pleural effusion (MPE) with an indwelling pleural catheter (IPC) is unclear. Objective: We propose a review of the scientific evidence on the cost and effectiveness of this therapeutic option. Methods: Systematic review of the literature on the cost and effectiveness of the treatment of MPE by IPC, according to the PRISMA methodology and quality according to the scientific guidelines. Results: A total of 4 articles, 152 patients, and 159 IPCs were included. The use of IPC was associated with improvement in symptoms and quality of life. The most common complications were infections (empyema in 20.9% of patients and cellulitis in 17.3%); 9% of cases were hospitalized due to complications, and <2% required subsequent procedures. The average cost of IPC (set/drainage bottles) ranged from €2,025.6 to €1,200.5 if it was placed on an outpatient basis, €1,100 if survival was <6 weeks, and €4,028 in patients with mesothelioma. Complications increased the cost, and taking into account follow-up visits, additional tests, and days of admission for complications, the cost was >€5,000. Compared with pleurodesis, the cost of IPC was significantly lower when patient survival was <14 weeks, but not when survival was longer or home care was required. Conclusions: The use of IPC is associated with good control of MPE and seldom requires many subsequent procedures; however, it is also associated with a certain rate of complications, which may increase costs. However, ambulatory management may help reduce costs, which are directly related to the type of tumor, the duration of survival, and the need for specialized treatment.
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Affiliation(s)
- Maribel Botana-Rial
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo, Spain.,PneumoVigoI+I Research Group, Sanitary Research Institute Galicia Sur (IIS Galicia Sur), Vigo, Spain
| | - Cristina Ramos-Hernández
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo, Spain.,PneumoVigoI+I Research Group, Sanitary Research Institute Galicia Sur (IIS Galicia Sur), Vigo, Spain
| | - Irene Lojo-Rodríguez
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo, Spain.,PneumoVigoI+I Research Group, Sanitary Research Institute Galicia Sur (IIS Galicia Sur), Vigo, Spain
| | - Cristina Represas-Represas
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo, Spain.,PneumoVigoI+I Research Group, Sanitary Research Institute Galicia Sur (IIS Galicia Sur), Vigo, Spain
| | - Alberto Ruano-Raviña
- Deparment of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.,Consortium for Biomedical Research in Epidemiologic and Public Health (CIBER en Epidemiologia y Salúd Pública-CIBERESP), Madrid, Spain
| | - Virginia Leiro-Fernández
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo, Spain.,PneumoVigoI+I Research Group, Sanitary Research Institute Galicia Sur (IIS Galicia Sur), Vigo, Spain
| | - Alberto Fernández-Villar
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo, Spain.,PneumoVigoI+I Research Group, Sanitary Research Institute Galicia Sur (IIS Galicia Sur), Vigo, Spain
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Tubío-Pérez RA, Torres-Durán M, Pérez-Ríos M, Fernández-Villar A, Ruano-Raviña A. Lung emphysema and lung cancer: what do we know about it? Ann Transl Med 2020; 8:1471. [PMID: 33313216 PMCID: PMC7723574 DOI: 10.21037/atm-20-1180] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Emphysema and lung cancer (LC) are two diseases which share common risk factors, e.g., smoking. In recent years, many studies have sought to analyse this association. By way of illustration, we conducted a review of the scientific literature of the studies published to date, whose main designated aim was to demonstrate the relationship between emphysema and LC, and this association's influence on the histology, prognosis and molecular mechanisms responsible. We included over 40 studies (ranging from case-control and cohort studies to systematic reviews and meta-analyses), which highlight the association between emphysema and LC, independently of smoking habit. These studies also report a possible influence on histology, with adenocarcinoma being the most frequent lineage, and an association with poor prognosis, which affects both survival and post-operative complications. Oxidative stress, which generates chronic inflammatory status as well as the presence of certain polymorphisms in various genes (CYP1A1, TERT, CLPTM1L, ERK), gives rise-in the case of patients with emphysema-to alteration of cellular repair mechanisms, which in turn favours the proliferation of neoplastic epithelial cells responsible for the origin of LC.
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Affiliation(s)
- Ramón A Tubío-Pérez
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI, Vigo, Spain.,NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Galicia, Spain
| | - María Torres-Durán
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI, Vigo, Spain.,NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Galicia, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.,CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Alberto Fernández-Villar
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI, Vigo, Spain.,NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Galicia, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.,CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
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22
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Rodríguez-Núñez N, Ruano-Raviña A, Lama A, Ferreiro L, Ricoy J, Álvarez-Dobaño JM, Suárez-Antelo J, Toubes ME, Rábade C, Golpe A, Lourido T, González-Barcala FJ, Valdés L. Impact of cardiovascular risk factors on the clinical presentation and survival of pulmonary embolism without identifiable risk factor. J Thorac Dis 2020; 12:5411-5419. [PMID: 33209374 PMCID: PMC7656446 DOI: 10.21037/jtd-20-1634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background The nature of pulmonary embolism (PE) without identifiable risk factor (IRF) remains unclear. The objective of this study is to investigate the potential relationship between cardiovascular risk factors (CVRFs) and PE without IRF (unprovoked) and assess their role as markers of disease severity and prognosis. Methods A case-control study was performed of patients with PE admitted to our hospital [2010–2019]. Subjects with PE without IRF were included in the cohort of cases, whereas patients with PE with IRF were allocated to the control group. Variables of interest included age, active smoking, obesity, and diagnosis of arterial hypertension, dyslipidemia or diabetes mellitus. Results A total of 1,166 patients were included in the study, of whom 64.2% had PE without IRF. The risk for PE without IRF increased with age [odds ratio (OR): 2.68; 95% confidence interval (CI): 1.95–3.68], arterial hypertension (OR: 1.63; 95% CI: 1.27–2.07), and dyslipidemia (OR: 1.63; 95% CI: 1.24–2.15). The risk for PE without IRF was higher as the number of CVRF increased, being 3.99 (95% CI: 2.02–7.90) for subjects with ≥3 CVRF. The percentage of high-risk unprovoked PE increased significantly as the number of CVRF rose [0.6% for no CVRF; 23.8% for a CRF, P<0.001 (OR: 9.92; 95% CI: 2.82–34.9); 37.5% for two CRFs, P<0.001 (OR: 14.8; 95% CI: 4.25–51.85); and 38.1% for ≥3, P<0.001 (OR: 14.1; 95% CI: 4.06–49.4)]. No significant differences were observed in 1-month survival between cases and controls, whereas differences in 24-month survival reached significance. Conclusions A relationship was observed between CVRF and PE without IRF, as the risk for unprovoked PE increased with the number of CVRF. In addition, the number of CVRF was associated with PE without IRF severity, but not with prognosis.
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Affiliation(s)
- Nuria Rodríguez-Núñez
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, Universidad de Santiago de Compostela, Santiago de Compostela, Spain.,CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
| | - Adriana Lama
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Lucía Ferreiro
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Jorge Ricoy
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - José M Álvarez-Dobaño
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - M Elena Toubes
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Carlos Rábade
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Golpe
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Tamara Lourido
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Francisco Javier González-Barcala
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Luis Valdés
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
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Tubío-Pérez RA, Torres-Durán M, Fernández-Villar A, Ruano-Raviña A. Alpha-1 antitrypsin deficiency and risk of lung cancer: A systematic review. Transl Oncol 2020; 14:100914. [PMID: 33142121 PMCID: PMC7642868 DOI: 10.1016/j.tranon.2020.100914] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 12/30/2022] Open
Abstract
Alpha-1 antitrypsin deficiency (AATD) may increase the risk of lung cancer. The lung cancer histological types most frequently associated with AATD are squamous carcinoma and adenocarcinoma. No differences in lung cancer survival have been found acording to the carrier stuatus of alpha 1 antitrypsin deficient alleles.
Introduction Alpha-1 antitrypsin deficiency (AATD) is an inherited genetic disorder associated with a risk of developing lung and liver disease. Several studies have examined its possible association with an increased risk of lung cancer. Materials and Methods Systematic review of the scientific literature on studies analyzing the risk of LC associated with AATD, as well as its impact on the histological type and survival. The information was located in the Medline (PubMed), Cochrane, and EMBASE databases. Results Six studies including a total of 4 038 patients with LC met the inclusion criteria. Most studies included seem to indicate that AATD increases the risk of developing LC, particularly of the squamous and adenocarcinoma types. This risk increases with exposure to tobacco smoke and the diagnosis of chronic obstructive pulmonary disease (COPD). Only one study analyzed the survival of LC patients without finding differences between AATD and non-AATD patients. Conclusions These results suggest that AATD may increase the risk of developing LC, particularly of the squamous and adenocarcinoma histological types, but no impact on patient survival has been demonstrated. However, the low quality of the included studies makes it necessary to carry out more studies with a larger sample size and preferably of a prospective nature to confirm these results.
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Affiliation(s)
- Ramón A Tubío-Pérez
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI Vigo; NeumoVigo I+i Research Group, Vigo Biomedical Research Institute (IBIV), Estrada Clara Campoamor,341. 36213. Vigo, Pontevedra, Spain
| | - María Torres-Durán
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI Vigo; NeumoVigo I+i Research Group, Vigo Biomedical Research Institute (IBIV), Estrada Clara Campoamor,341. 36213. Vigo, Pontevedra, Spain.
| | - Alberto Fernández-Villar
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI Vigo; NeumoVigo I+i Research Group, Vigo Biomedical Research Institute (IBIV), Estrada Clara Campoamor,341. 36213. Vigo, Pontevedra, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicina and Public Health, University of Santiago de Compostela, Spain, CIBER de Epidemiología y Salud Pública, CIBERESP, Spain
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Fernández-García S, Represas-Represas C, Ruano-Raviña A, Fernández Villar A. Reply to "The Importance of Dependence in Global Assessment of Hospitalized Patient". Arch Bronconeumol 2020; 56:834-835. [PMID: 32988680 DOI: 10.1016/j.arbres.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Sara Fernández-García
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, España
| | - Cristina Represas-Represas
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, España
| | - Alberto Ruano-Raviña
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Servicio de Medicina Preventiva, Hospital Clínico Universitario de Santiago de Compostela, CIBER de Epidemiología y Salud Pública (CIBERESP), Santiago de Compostela, España
| | - Alberto Fernández Villar
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, España.
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Campos-Varela I, Villaverde-Castañeda R, Ruano-Raviña A. Retraction of publications: a study of biomedical journals retracting publications based on impact factor and journal category. Gaceta Sanitaria 2020; 34:430-434. [DOI: 10.1016/j.gaceta.2019.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/14/2022]
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Affiliation(s)
- Mariano Provencio
- Department of Medical Oncology, Hospital Universitario Puerta del Hierro Majadahonda, Majadahonda, Spain.
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
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Ruano-Raviña A, Fernández-Villar A, López-Campos JL. Coping With Low Mortality and Exacerbation Rate Differences Between COPD Triple Therapy Studies, and a Proposal for Upcoming Studies. Arch Bronconeumol 2020; 56:336-338. [PMID: 31898995 DOI: 10.1016/j.arbres.2019.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/31/2019] [Accepted: 11/08/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Alberto Fernández-Villar
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
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Fernández-García S, Represas-Represas C, Ruano-Raviña A, Botana-Rial M, Martínez-Reglero C, Fernández Villar A. La dependencia para actividades como factor predictor de mortalidad tras una hospitalización por una agudización de enfermedad pulmonar obstructiva crónica. Arch Bronconeumol 2020; 56:291-297. [DOI: 10.1016/j.arbres.2019.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/02/2019] [Accepted: 10/04/2019] [Indexed: 01/19/2023]
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Fernández-García S, Represas-Represas C, Ruano-Raviña A, Mouronte-Roibás C, Botana-Rial M, Ramos-Hernández C, Fernández-Villar A. Social and clinical predictors of short- and long-term readmission after a severe exacerbation of copd. PLoS One 2020; 15:e0229257. [PMID: 32106226 PMCID: PMC7046279 DOI: 10.1371/journal.pone.0229257] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/02/2020] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to evaluate the predictive ability of multiple social, and clinical factors for readmission after a severe acute exacerbation of COPD (AECOPD) during various time periods. METHODS We performed a prospective cohort study in which recruited patients with AECOPD. We systematically collected numerous clinical (symptoms, pulmonary function, comorbidities, and treatment) and social (financial situation, housing situation, family support, caregiver overload, ability to perform activities, and risk of social exclusion) variables using several questionnaires and indices. The patients were followed closely for one year and readmissions at 30, 60, and 365 days were analysed. RESULTS 253 patients were included, aged 68.9±9.8years, FEV1 = 42.1%±14.2%, and a Charlson's index = 1.8±0.9. Of these patients, 20.2%, 39.6%, and 63.7% were readmitted within the first 30, 90, and 365 days after discharge, respectively. In the multivariate model applied, the variables that were independently associated with readmission over all three periods of the analysis were dependence to perform basic activities of daily living (BADLs) (odds ratio [OR] = 2.10-4.10) and a history of two or more admissions within the previous year (OR = 2.78-3.78). At 90 days, a history of bacterial isolates in a previous sputum culture (OR = 2.39) and at 365 days, a high grade of dyspnoea (OR = 2.51) and obesity (OR = 2.38) were also identified as predictors of hospital readmission. CONCLUSIONS The patients' limitation to perform BADLs and their history of admissions for AECOPD were the best predictive variables for the likelihood of readmission when adjusted for many other social and clinical variables, regardless of the time period considered for such prediction.
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Affiliation(s)
- Sara Fernández-García
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I +i. Institute of Health Research Galicia Sur (IISGS, Instituto de Investigación Sanitaria Galicia Sur), Vigo, Pontevedra, Spain
| | - Cristina Represas-Represas
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I +i. Institute of Health Research Galicia Sur (IISGS, Instituto de Investigación Sanitaria Galicia Sur), Vigo, Pontevedra, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública), Madrid, Spain
| | - Cecilia Mouronte-Roibás
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I +i. Institute of Health Research Galicia Sur (IISGS, Instituto de Investigación Sanitaria Galicia Sur), Vigo, Pontevedra, Spain
| | - Maribel Botana-Rial
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I +i. Institute of Health Research Galicia Sur (IISGS, Instituto de Investigación Sanitaria Galicia Sur), Vigo, Pontevedra, Spain
| | - Cristina Ramos-Hernández
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I +i. Institute of Health Research Galicia Sur (IISGS, Instituto de Investigación Sanitaria Galicia Sur), Vigo, Pontevedra, Spain
| | - Alberto Fernández-Villar
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I +i. Institute of Health Research Galicia Sur (IISGS, Instituto de Investigación Sanitaria Galicia Sur), Vigo, Pontevedra, Spain
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Fernández-García S, Represas-Represas C, Ruano-Raviña A, Mosteiro-Añón M, Mouronte-Roibas C, Fernández-Villar A. Perfil social de los pacientes que ingresan por una agudización de EPOC. Un análisis desde una perspectiva de género. Arch Bronconeumol 2020; 56:84-89. [DOI: 10.1016/j.arbres.2019.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/18/2019] [Accepted: 03/13/2019] [Indexed: 11/29/2022]
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Fernández-García S, Represas-Represas C, Ruano-Raviña A, Mosteiro-Añón M, Mouronte-Roibas C, Fernández-Villar A. Social Profile of Patients Admitted for COPD Exacerbations. A Gender Analysis. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.arbr.2019.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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González-Salvado V, Rodríguez-Ruiz E, Abelairas-Gómez C, Ruano-Raviña A, Peña-Gil C, González-Juanatey JR, Rodríguez-Núñez A. Formación de población adulta lega en soporte vital básico. Una revisión sistemática. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2018.11.015] [Citation(s) in RCA: 1] [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: 12/13/2022]
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Mouronte-Roibás C, Leiro-Fernández V, Ruano-Raviña A, Ramos-Hernández C, Casado-Rey P, Botana-Rial M, García-Rodríguez E, Fernández-Villar A. Predictive value of a series of inflammatory markers in COPD for lung cancer diagnosis: a case-control study. Respir Res 2019; 20:198. [PMID: 31455338 PMCID: PMC6712782 DOI: 10.1186/s12931-019-1155-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is a relationship between Chronic Obstructive Pulmonary Disease (COPD) and the development of lung cancer (LC). The aim of this study is to analyse several blood markers and compare their concentrations in patients with only COPD and LC + COPD. METHODS Case-control study with cases presenting combined LC and COPD and two control groups (patients presenting only COPD and patients presenting only LC). We also included LC patients with descriptive purposes. In both groups, peripheral blood analyses of TNF-α, IL-6, IL-8, total leukocyte, lymphocyte and neutrophil counts, neutrophil-to-lymphocyte ratio, total platelet count, mean platelet volume, platelet-to-lymphocyte ratio, alpha 1-antitripsin (A1AT), IgE, C-reactive protein, fibrinogen, cholesterol and bilirubin were performed. We developed univariate and multivariate analyses of these markers, as well as a risk score variable, and we evaluated its performance through ROC curves. RESULTS We included 280 patients, 109 cases (LC + COPD), 83 controls (COPD) and 88 LC without COPD. No differences were observed in the distribution by sex, age, BMI, smoking, occupational exposure, lung function, GOLD stage or comorbidity. Patients with LC + COPD had significantly higher levels of neutrophils [OR 1.00 (95%CI 1.00-1.00), p = 0.03] and A1AT [OR 1.02 (95%CI 1.01-1.03), p = 0.003] and lower cholesterol levels [OR 0.98 (95%CI 0.97-0.99), p = 0.009] than COPD controls. We developed a risk score variable combining neutrophils, A1AT and cholesterol, achieving a sensitivity of 80%, a negative predictive value of 90.7% and an area under the curve of 0.78 (95%CI 0.71-0.86). CONCLUSIONS COPD patients who also have LC have higher levels of neutrophils and A1AT and lower of cholesterol. These parameters could be potentially predicting biomarkers of LC in COPD patients.
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Affiliation(s)
- Cecilia Mouronte-Roibás
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo Health Area; NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Virginia Leiro-Fernández
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo Health Area; NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain.
| | - Alberto Ruano-Raviña
- University of Santiago de Compostela, Preventive Medicine and Public Health. School of Medicine, San Francisco st s/n Santiago de Compostela, A Coruña, Spain.,CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Cristina Ramos-Hernández
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo Health Area; NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Pedro Casado-Rey
- Clinical Analysis Department, Hospital Álvaro Cunqueiro, Vigo Health Area, Vigo, Spain
| | - Maribel Botana-Rial
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo Health Area; NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Esmeralda García-Rodríguez
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo Health Area; NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Alberto Fernández-Villar
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo Health Area; NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
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Hung RJ, Spitz MR, Houlston RS, Schwartz AG, Field JK, Ying J, Li Y, Han Y, Ji X, Chen W, Wu X, Gorlov IP, Na J, de Andrade M, Liu G, Brhane Y, Diao N, Wenzlaff A, Davies MPA, Liloglou T, Timofeeva M, Muley T, Rennert H, Saliba W, Ryan BM, Bowman E, Barros-Dios JM, Pérez-Ríos M, Morgenstern H, Zienolddiny S, Skaug V, Ugolini D, Bonassi S, van der Heijden EHFM, Tardon A, Bojesen SE, Landi MT, Johansson M, Bickeböller H, Arnold S, Le Marchand L, Melander O, Andrew A, Grankvist K, Caporaso N, Teare MD, Schabath MB, Aldrich MC, Kiemeney LA, Wichmann HE, Lazarus P, Mayordomo J, Neri M, Haugen A, Zhang ZF, Ruano-Raviña A, Brenner H, Harris CC, Orlow I, Rennert G, Risch A, Brennan P, Christiani DC, Amos CI, Yang P, Gorlova OY. Lung Cancer Risk in Never-Smokers of European Descent is Associated With Genetic Variation in the 5 p15.33 TERT-CLPTM1Ll Region. J Thorac Oncol 2019; 14:1360-1369. [PMID: 31009812 PMCID: PMC6833942 DOI: 10.1016/j.jtho.2019.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 02/06/2019] [Revised: 03/30/2019] [Accepted: 04/11/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Inherited susceptibility to lung cancer risk in never-smokers is poorly understood. The major reason for this gap in knowledge is that this disease is relatively uncommon (except in Asians), making it difficult to assemble an adequate study sample. In this study we conducted a genome-wide association study on the largest, to date, set of European-descent never-smokers with lung cancer. METHODS We conducted a two-phase (discovery and replication) genome-wide association study in never-smokers of European descent. We further augmented the sample by performing a meta-analysis with never-smokers from the recent OncoArray study, which resulted in a total of 3636 cases and 6295 controls. We also compare our findings with those in smokers with lung cancer. RESULTS We detected three genome-wide statistically significant single nucleotide polymorphisms rs31490 (odds ratio [OR]: 0.769, 95% confidence interval [CI]: 0.722-0.820; p value 5.31 × 10-16), rs380286 (OR: 0.770, 95% CI: 0.723-0.820; p value 4.32 × 10-16), and rs4975616 (OR: 0.778, 95% CI: 0.730-0.829; p value 1.04 × 10-14). All three mapped to Chromosome 5 CLPTM1L-TERT region, previously shown to be associated with lung cancer risk in smokers and in never-smoker Asian women, and risk of other cancers including breast, ovarian, colorectal, and prostate. CONCLUSIONS We found that genetic susceptibility to lung cancer in never-smokers is associated to genetic variants with pan-cancer risk effects. The comparison with smokers shows that top variants previously shown to be associated with lung cancer risk only confer risk in the presence of tobacco exposure, underscoring the importance of gene-environment interactions in the etiology of this disease.
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Affiliation(s)
- Rayjean J Hung
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | | | | | | | - John K Field
- University of Liverpool, Liverpool, United Kingdom
| | - Jun Ying
- University of Texas McGovern Medical School, Houston, Texas
| | - Yafang Li
- Baylor College of Medicine, Houston, Texas
| | | | - Xuemei Ji
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Wei Chen
- The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Xifeng Wu
- The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Ivan P Gorlov
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jie Na
- Mayo Clinic, Rochester, Minnesota
| | | | - Geoffrey Liu
- Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Yonathan Brhane
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Nancy Diao
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | | | - Maria Timofeeva
- German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Edinburgh, Edinburgh, United Kingdom
| | - Thomas Muley
- German Center for Lung Research, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany
| | - Hedy Rennert
- Technion-Israel Institute of Technology, Haifa, Israel
| | - Walid Saliba
- Technion-Israel Institute of Technology, Haifa, Israel
| | - Bríd M Ryan
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Elise Bowman
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | | | - Mónica Pérez-Ríos
- University of Santiago de Compostela, Praza do Obradoiro, Coruña, Spain
| | | | | | - Vidar Skaug
- National Institute of Occupational Health (STAMI), Oslo, Norway
| | | | - Stefano Bonassi
- San Raffaele University, Rome, Italy; San Raffaele Pisana - Scientific Hospitalization and Care Insitution, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | - M Dawn Teare
- University of Sheffield, Sheffield, United Kingdom
| | | | | | | | - H-Erich Wichmann
- Helmholtz Zentrum Munchen, German Research Center for Environmental Health (GmbH), Bavaria, Germany
| | | | | | - Monica Neri
- San Raffaele Pisana - Scientific Hospitalization and Care Insitution, Rome, Italy
| | - Aage Haugen
- National Institute of Occupational Health (STAMI), Oslo, Norway
| | - Zuo-Feng Zhang
- University of California - Los Angeles, Los Angeles, California
| | | | | | - Curtis C Harris
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Irene Orlow
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gadi Rennert
- Technion-Israel Institute of Technology, Haifa, Israel
| | - Angela Risch
- German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Salzburg, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Olga Y Gorlova
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
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Campos-Varela I, Ruano-Raviña A. Misconduct as the main cause for retraction. A descriptive study of retracted publications and their authors. Gaceta Sanitaria 2019; 33:356-360. [DOI: 10.1016/j.gaceta.2018.01.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 10/14/2022]
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Fernández-García S, Represas-Represas C, Ruano-Raviña A, Botana-Rial M, Mouronte-Roibas C, Ramos-Hernández C, Fernández Villar A. Social and clinical predictors associated with prolonged hospital stays for patients with severe exacerbation of chronic obstructive pulmonary disease. Rev Clin Esp 2019; 220:79-85. [PMID: 31208703 DOI: 10.1016/j.rce.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/25/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether there are social factors that affect the prolonged hospital stay (PHS) of patients with severe chronic obstructive pulmonary disease exacerbation (COPDE), as well as clinical-demographic factors. METHODOLOGY We conducted a prospective cohort study that consecutively included patients who were admitted to a Pneumology department for COPDE. We recorded demographic, clinical (tobacco use, exacerbations and infections, dyspnoea, impact according to CAT questionnaire, pulmonary function, comorbidities, oxygen therapy and noninvasive ventilation) and social (financial status, caregiver availability and overload, dependence for basic and instrumental activities, social risk and use of social services) variables, employing questionnaires and indices such as Barthel, Lawton-Brody, Zarit, Barber and Gijón. We performed a univariate and multivariate analysis using a logistic regression model. RESULTS The study included 253 patients, with a mean age of 68.9±9.8years; 77.1% of whom were men. The logistic regression model included active tobacco use, FEV1 value, CAT score >10, dyspnoea 3-4 on the MMRC, the presence of bacteria in sputum cultures, cardiovascular comorbidity, anaemia, home oxygen therapy, living alone, rural residence, caregiver overload and detecting social-family risks/problems. The variables independently associated with the possibility of PHS were a CAT score >10 (OR, 8.9; P=.04) and detecting a social-family risk/problem (OR, 2.6; P=.04). Active smoking was a predictor of shorter stays (OR, 0.15; P=.002). CONCLUSIONS Variables related to the social sphere play a relevant role in hospital stays, as do the impact of the disease and the persistent use of tobacco by patients with severe COPD exacerbation.
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Affiliation(s)
- S Fernández-García
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - C Represas-Represas
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - A Ruano-Raviña
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela; Servicio de Medicina Preventiva, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - M Botana-Rial
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - C Mouronte-Roibas
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - C Ramos-Hernández
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - A Fernández Villar
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España.
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Mezquita L, Benito A, Ruano-Raviña A, Zamora J, Olmedo ME, Reguera P, Madariaga A, Villamayor M, Cortez SP, Gorospe L, Santón A, Mayoralas S, Hernanz R, Cabañero A, Auclin E, Carrato A, Garrido P. Indoor Radon in EGFR- and BRAF-Mutated and ALK-Rearranged Non-Small-Cell Lung Cancer Patients. Clin Lung Cancer 2019; 20:305-312.e3. [PMID: 31151782 DOI: 10.1016/j.cllc.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/27/2018] [Revised: 03/26/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Radon gas is the leading cause of lung cancer in the nonsmoking population. The World Health Organization (WHO) recommends indoor concentrations of < 100 Bq/m³. Several molecular alterations have been described in non-small-cell lung cancer (NSCLC), mainly in nonsmokers, with no risk factors identified. We studied the role of indoor radon in NSCLC patients harboring specific driver alterations. PATIENTS AND METHODS We assessed the radon concentration from EGFR-, BRAF-mutated (m), and ALK-rearranged (r) NSCLC patients measured by an alpha-track detector placed in their homes between September 2014 and August 2015. Clinical characteristics were collected prospectively, and pathologic samples were reviewed retrospectively. RESULTS Forty-eight patients were included (36 EGFRm, 10 ALKr, 2 BRAFm). Median radon concentration was 104 Bq/m³ (IQR 69-160) overall, and was 96 Bq/m³ (42-915) for EGFRm, 116 (64-852) for ALKr, and 125 for BRAFm, with no significant differences. Twenty-seven patients (56%) had indoor radon above WHO recommendations, 8 (80%) of 10 ALKr, 2 (100%) of 2 BRAFm, and 17 (47%) of 36 EGFRm. CONCLUSION The median indoor radon concentration was above the WHO recommendations, with no differences between EGFR, ALK, and BRAF patients. Concentrations above the WHO recommendations were most common with ALKr and BRAFm. These findings should be validated in larger studies.
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Affiliation(s)
- Laura Mezquita
- Medical Oncology Department, Ramón y Cajal University Hospital, Madrid, Spain; Medical Oncology Department, Gustave Roussy Cancer Center, Villejuif, France
| | - Amparo Benito
- Pathology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Alberto Ruano-Raviña
- Public Health Department, School of Medicine Santiago de Compostela University, Santiago de Compostela, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Javier Zamora
- CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Clinical Biostatistics Unit, Ramón y Cajal University Hospital, Research Institute Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Pablo Reguera
- Medical Oncology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Ainhoa Madariaga
- Medical Oncology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - María Villamayor
- Medical Oncology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | | | - Luis Gorospe
- Radiology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Almudena Santón
- Pathology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | | | - Raúl Hernanz
- Radiotherapy Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Alberto Cabañero
- Thoracic Surgery Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Edouard Auclin
- Medical and Gastrointestinal Oncology Department, Georges Pompidou Hospital, Paris, France
| | - Alfredo Carrato
- Medical Oncology Department, Ramón y Cajal University Hospital, Madrid, Spain; Medicine Department, Universidad de Alcalá, Research Institute Ramón y Cajal (IRYCIS), CIBER Oncology (CIBERONC), Madrid, Spain
| | - Pilar Garrido
- Medical Oncology Department, Ramón y Cajal University Hospital, Madrid, Spain; Medicine Department, Universidad de Alcalá, Research Institute Ramón y Cajal (IRYCIS), CIBER Oncology (CIBERONC), Madrid, Spain.
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González-Salvado V, Rodríguez-Ruiz E, Abelairas-Gómez C, Ruano-Raviña A, Peña-Gil C, González-Juanatey JR, Rodríguez-Núñez A. Training adult laypeople in basic life support. A systematic review. ACTA ACUST UNITED AC 2019; 73:53-68. [PMID: 30808611 DOI: 10.1016/j.rec.2018.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/13/2018] [Accepted: 11/07/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND OBJECTIVES Bystander assistance is decisive to enhance the outcomes of out-of-hospital cardiac arrest. Despite an increasing number of basic life support (BLS) training methods, the most effective formula remains undefined. To identify a gold standard, we performed a systematic review describing reported BLS training methods for laypeople and analyzed their effectiveness. METHODS We reviewed the MEDLINE database from January 2006 to July 2018 using predefined inclusion and exclusion criteria, considering all studies training adult laypeople in BLS and performing practical skill assessment. Two reviewers independently extracted data and evaluated the quality of the studies using the MERSQI (Medical Education Research Study Quality Instrument) scale. RESULTS Of the 1263 studies identified, 27 were included. Most of them were nonrandomized controlled trials and the mean quality score was 13 out of 18, with substantial agreement between reviewers. The wide heterogeneity of contents, methods and assessment tools precluded pooling of data. Nevertheless, there was an apparent advantage of instructor-led methods, with feedback-supported hands-on practice, and retraining seemed to enhance retention. Training also improved attitudinal aspects. CONCLUSIONS While there were insufficiently consistent data to establish a gold standard, instructor-led formulas, hands-on training with feedback devices and frequent retraining seemed to yield better results. Further research on adult BLS training may need to seek standardized quality criteria and validated evaluation instruments to ensure consistency.
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Affiliation(s)
- Violeta González-Salvado
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, A Coruña, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), A Coruña, Spain; Grupo CLINURSID, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - Emilio Rodríguez-Ruiz
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), A Coruña, Spain; Servicio de Medicina Intensiva, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Cristian Abelairas-Gómez
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), A Coruña, Spain; Grupo CLINURSID, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Facultad de Ciencias de la Educación, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Alberto Ruano-Raviña
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Carlos Peña-Gil
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, A Coruña, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), A Coruña, Spain
| | - José Ramón González-Juanatey
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, A Coruña, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), A Coruña, Spain
| | - Antonio Rodríguez-Núñez
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), A Coruña, Spain; Grupo CLINURSID, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Unidad de Cuidados Intensivos Pediátricos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Escuela de Enfermería, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Leiro-Fernández V, Mouronte-Roibás C, García-Rodríguez E, Botana-Rial M, Ramos-Hernández C, Torres-Durán M, Ruano-Raviña A, Fernández-Villar A. Predicting delays in lung cancer diagnosis and staging. Thorac Cancer 2019; 10:296-303. [PMID: 30605236 PMCID: PMC6360216 DOI: 10.1111/1759-7714.12950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 12/25/2022] Open
Abstract
Background Despite growing interest in increasing the efficiency and speed of the diagnosis, staging, and treatment of lung cancer (LC), the interval from signs and symptoms to diagnosis and treatment remains longer than recommended. The aim of this study was to analyze the factors that cause delays in the LC diagnosis/staging process and, consequently, delays in making therapeutic decisions. Methods We analyzed audit data from a prospective dataset of 1330 patients assessed at The Lung Cancer Rapid Diagnostic Unit from 26 June 2013 to 26 March 2016. The number and type of procedures and medical tests and the times of all procedures were recorded. Clinical and epidemiological variables and whether the diagnosis was performed on an inpatient or outpatient basis were also recorded. Results Malignancy was confirmed in 737 (55.4%) of the 1330 patients, with LC in 627 of these (85.2%). The mean interval to final diagnosis was 19.8 ± 13.9 days. Variables significantly related to a longer diagnostic time were the number of days until computed tomography (CT) was performed (odds ratio [OR], 95% confidence interval [CI] 1.347, 1.103–1.645; P = 0.003), until a histology sample was obtained (OR 1.243, 95% CI1.062–1.454; P = 0.007), and the total number of tests performed during the diagnostic and staging process (OR 1.823, 95% CI 1.046–3.177; P = 0.03). Conclusions A greater number of tests and more days to CT and histology led to longer delay times. Optimization of these factors should reduce delays in the LC diagnosis process.
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Affiliation(s)
- Virginia Leiro-Fernández
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Cecilia Mouronte-Roibás
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Esmeralda García-Rodríguez
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Maribel Botana-Rial
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Cristina Ramos-Hernández
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - María Torres-Durán
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Consortium for Biomedical Research in Epidemiology & Public Health, Galicia, Spain
| | - Alberto Fernández-Villar
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
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Mouronte-Roibás C, Fernández-Villar A, Ruano-Raviña A, Ramos-Hernández C, Tilve-Gómez A, Rodríguez-Fernández P, Díaz ACC, Vázquez-Noguerol MG, Fernández-García S, Leiro-Fernández V. Influence of the type of emphysema in the relationship between COPD and lung cancer. Int J Chron Obstruct Pulmon Dis 2018; 13:3563-3570. [PMID: 30464438 PMCID: PMC6214583 DOI: 10.2147/copd.s178109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction There are no studies analyzing the relationship between emphysema and lung cancer (LC). With this aim and in order to make some comparisons between different clinical variables, we carried out the present study. Methods This is a case–control study, patients with COPD and LC being the cases and subjects with stable COPD being the controls. Clinical and functional parameters, as well as the existence of radiological emphysema, were evaluated in a qualitative and quantitative way, using a radiological density of −950 Hounsfield units as a cutoff point in the images. The existence of several different types of emphysema (centrilobular, paraseptal, panacinar, or bullae) was analyzed, allowing patients to have more than one simultaneously. The extent to which lobes were involved was evaluated and the extension of emphysema was graduated for each type and location, following a quantitative scale. Differences between cases and controls were compared by using bivariate and multivariate analyzes with results expressed as OR and 95% CI. Results We included 169 cases and 74 controls, 84% men with a FEV1 (%) of 61.7±18.5, with 90.1% non-exacerbators. Most of them (50%) were active smokers and 47.2% were ex-smokers. Emphysema was found in 80.2% of the subjects, the most frequent type being centrilobular (34.4%). The only significantly different factor was the presence of paraseptal emphysema (alone or combined; OR =2.2 [95% CI =1.1–4.3, P = 0.03]), with adenocarcinoma being significantly more frequent in paraseptal emphysema with respect to other types (67.2% vs 32.8%, P =0.03). Conclusion Patients with COPD and paraseptal emphysema could be a risk group for the development of LC, especially adenocarcinoma subtype.
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Affiliation(s)
- Cecilia Mouronte-Roibás
- Pneumology Department, Álvaro Cunqueiro Hospital, Sanitary Area of Vigo, NeumovigoI+i Investigation Group, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain,
| | - Alberto Fernández-Villar
- Pneumology Department, Álvaro Cunqueiro Hospital, Sanitary Area of Vigo, NeumovigoI+i Investigation Group, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain,
| | - Alberto Ruano-Raviña
- Public Health and Preventive Medicine Department, Medicine School, Santiago de Compostela University, CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Cristina Ramos-Hernández
- Pneumology Department, Álvaro Cunqueiro Hospital, Sanitary Area of Vigo, NeumovigoI+i Investigation Group, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain,
| | - Amara Tilve-Gómez
- Radiology Department, Hospital Sanitary Area of Vigo, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Paula Rodríguez-Fernández
- Radiology Department, Hospital Sanitary Area of Vigo, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Adriana Carolina Caldera Díaz
- Radiology Department, Hospital Sanitary Area of Vigo, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Míriam García Vázquez-Noguerol
- Radiology Department, Hospital Sanitary Area of Vigo, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Sara Fernández-García
- Pneumology Department, Álvaro Cunqueiro Hospital, Sanitary Area of Vigo, NeumovigoI+i Investigation Group, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain,
| | - Virginia Leiro-Fernández
- Pneumology Department, Álvaro Cunqueiro Hospital, Sanitary Area of Vigo, NeumovigoI+i Investigation Group, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain,
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Mouronte-Roibás C, Ruano-Raviña A, Fernández-Villar A. Lung cancer and chronic obstructive pulmonary disease: understanding the complexity of carcinogenesis. Transl Lung Cancer Res 2018; 7:S214-S217. [PMID: 30393605 DOI: 10.21037/tlcr.2018.08.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Cecilia Mouronte-Roibás
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo Health Area, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Alberto Ruano-Raviña
- Preventive Medicine and Public Health, School of Medicine, University of Santiago de Compostela, San Francisco st s/n Santiago de Compostela, A Coruña, Spain.,CIBER de Epidemiología y Salud Pública, CIBERESP, Spain
| | - Alberto Fernández-Villar
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo Health Area, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
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Mouronte-Roibás C, Leiro-Fernández V, Ruano-Raviña A, Ramos-Hernández C, Abal-Arca J, Parente-Lamelas I, Botana-Rial M, Priegue-Carrera A, Fernández-Villar A. Chronic Obstructive Pulmonary Disease in Lung Cancer Patients: Prevalence, Underdiagnosis, and Clinical Characterization. Respiration 2018; 95:414-421. [DOI: 10.1159/000487243] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/25/2018] [Indexed: 11/19/2022] Open
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Torres-Durán M, Fernández-Villar A, Ruano-Raviña A. Lung Cancer Unrelated to Smoking. Arch Bronconeumol 2018; 54:301-302. [PMID: 29422343 DOI: 10.1016/j.arbres.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 12/29/2017] [Accepted: 01/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- María Torres-Durán
- Servicio de Neumoloxía, Hospital Álvaro Cunqueiro, EOXI Vigo, Vigo, España; Grupo de Investigación Neumovigo I+i, IIS Galicia Sur, Vigo, España
| | - Alberto Fernández-Villar
- Servicio de Neumoloxía, Hospital Álvaro Cunqueiro, EOXI Vigo, Vigo, España; Grupo de Investigación Neumovigo I+i, IIS Galicia Sur, Vigo, España.
| | - Alberto Ruano-Raviña
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Departamento de Epidemiología, Madrid, España
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Rodríguez-Núñez N, Ruano-Raviña A, Abelleira R, Ferreiro L, Lama A, González-Barcala FJ, Golpe A, Toubes ME, Álvarez-Dobaño JM, Valdés L. Factors Influencing Hospital Stay for Pulmonary Embolism. A Cohort Study. Arch Bronconeumol 2017; 53:432-436. [PMID: 28238515 DOI: 10.1016/j.arbres.2017.01.003] [Citation(s) in RCA: 2] [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: 12/13/2016] [Revised: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The aim of this study was to identify factors influencing hospital stay due to pulmonary embolism. METHODS We performed a retrospective cohort study of patients hospitalized between 2010 and 2015. Patients were identified using information recorded in hospital discharge reports (ICD-9-CM codes 415.11 and 415.19). RESULTS We included 965 patients with a median stay of 8 days (IQR 6-13 days). Higher scores on the simplified Pulmonary Embolism Severity Index (sPESI) were associated with increased probability of longer hospital stay. The probability of a hospital stay longer than the median was 8.65 (95% CI 5.42-13.79) for patients referred to the Internal Medicine Department and 1.54 (95% CI 1.07-2.24) for patients hospitalized in other departments, compared to those referred to the Pneumology Department. Patients with grade 3 on the modified Medical Research Council dyspnea scale had an odds ratio of 1.63 (95% CI: 1.07-2.49). The likelihood of a longer than median hospital stay was 1.72 (95% CI: 0.85-3.48) when oral anticoagulation (OAC) was initiated 2-3 days after admission, and 2.43 (95% CI: 1.16-5.07) when initiated at 4-5 days, compared to OAC initiation at 0-1 days. CONCLUSIONS sPESI grade, the department of referral from the Emergency Department, the grade of dyspnea and the time of initiating OAC were associated with a longer hospital stay.
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Affiliation(s)
- Nuria Rodríguez-Núñez
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Alberto Ruano-Raviña
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, España; CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, España; Grupo de Epidemiología, Salud Pública y Evaluación de Servicios de Salud, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España.
| | - Romina Abelleira
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Lucía Ferreiro
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España
| | - Adriana Lama
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Francisco J González-Barcala
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España
| | - Antonio Golpe
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - María E Toubes
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - José M Álvarez-Dobaño
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España
| | - Luis Valdés
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España
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González-Salvado V, Barcala-Furelos R, Neiro-Rey C, Varela-Casal C, Peña-Gil C, Ruano-Raviña A, González-Juanatey JR, Rodríguez-Núñez A. Cardiac rehabilitation: The missing link to close the chain of survival? Resuscitation 2017; 113:e7-e8. [PMID: 28130092 DOI: 10.1016/j.resuscitation.2017.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Violeta González-Salvado
- Cardiology Department and Cardiac Rehabilitation Division, Hospital Clinico Universitario de Santiago de Compostela, SERGAS, Santiago de Compostela, Spain
| | - Roberto Barcala-Furelos
- CLINURSID Research Group, School of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain; REMOSS Research Group, University School of Education and Sport Science, University of Vigo, Pontevedra, Spain
| | - Carmen Neiro-Rey
- Cardiology Department and Cardiac Rehabilitation Division, Hospital Clinico Universitario de Santiago de Compostela, SERGAS, Santiago de Compostela, Spain
| | - Cristina Varela-Casal
- REMOSS Research Group, University School of Education and Sport Science, University of Vigo, Pontevedra, Spain
| | - Carlos Peña-Gil
- Cardiology Department and Cardiac Rehabilitation Division, Hospital Clinico Universitario de Santiago de Compostela, SERGAS, Santiago de Compostela, Spain; Institute of Research of Santiago (IDIS), Santiago de Compostela, Spain
| | - A Ruano-Raviña
- Preventive Medicine and Public Health, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Ramón González-Juanatey
- Cardiology Department and Cardiac Rehabilitation Division, Hospital Clinico Universitario de Santiago de Compostela, SERGAS, Santiago de Compostela, Spain; Institute of Research of Santiago (IDIS), Santiago de Compostela, Spain
| | - Antonio Rodríguez-Núñez
- CLINURSID Research Group, School of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain; Institute of Research of Santiago (IDIS), Santiago de Compostela, Spain; Pediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago de Compostela, SERGAS, Santiago de Compostela, Spain; SAMID-II Network, Madrid, Spain.
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Represas-Represas C, Fernández-Villar A, Ruano-Raviña A, Priegue-Carrera A, Botana-Rial M. Screening for Chronic Obstructive Pulmonary Disease: Validity and Reliability of a Portable Device in Non-Specialized Healthcare Settings. PLoS One 2016; 11:e0145571. [PMID: 26726887 PMCID: PMC4699810 DOI: 10.1371/journal.pone.0145571] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 12/04/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction and Objectives The underdiagnosis of chronic obstructive pulmonary disease (COPD) could be improved through screening using portable devices simpler than conventional spirometers in specific healthcare settings to reach a higher percentage of the at-risk population. This study was designed to assess the validity and reliability of the COPD-6 portable device to screen for COPD in non-specialized healthcare settings. Methods Prospective cohort study to validate a diagnostic test. Three cohorts were recruited: primary care (PC), emergency services (ES) and community pharmacies (CPh). Study population: individuals with risk factors for COPD (>40 years, smoking >10 pack-years, with respiratory symptoms). The values measured using the COPD-6 were FEV1, FEV6 and the FEV1/FEV6 ratio. Subsequently, participants underwent conventional spirometry at hospital, using a post-bronchodilator FEV1/FVC value <0.7 as the gold standard criterion for the COPD diagnosis. Results 437 participants were included, 362 were valid for the analysis. COPD was diagnosed in 114 patients (31.5%). The area under the ROC curve for the COPD-6 for COPD screening was 0.8.The best cut-off point for the FEV1/FEV6 ratio was 0.8 (sensitivity, 92.1%) using spirometry with the bronchodilator test as the gold standard. There were practically no differences in the COPD-6 performancein the different settings and also regarding age, gender and smoking status. Conclusions The COPD-6 device is a valid tool for COPD screening in non-specialized healthcare settings. In this context, the best cut-off point for the FEV1/FEV6 ratio is 0.8.
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Affiliation(s)
- Cristina Represas-Represas
- Pulmonology Department, NeumoVigoI+i Research Group, University Hospital Complex of Vigo (CHUVI), Estructura Organizativa de Xestión Integrada de Vigo (EOXI Vigo), BiomedicalResearchInstitute of Vigo (IBIV), Vigo, Spain
- * E-mail:
| | - Alberto Fernández-Villar
- Pulmonology Department, NeumoVigoI+i Research Group, University Hospital Complex of Vigo (CHUVI), Estructura Organizativa de Xestión Integrada de Vigo (EOXI Vigo), BiomedicalResearchInstitute of Vigo (IBIV), Vigo, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and PublicHealth, University of Santiago de Compostela, Santiago de Compostela, Spain, CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Ana Priegue-Carrera
- Pulmonology Department, NeumoVigoI+i Research Group, University Hospital Complex of Vigo (CHUVI), Estructura Organizativa de Xestión Integrada de Vigo (EOXI Vigo), BiomedicalResearchInstitute of Vigo (IBIV), Vigo, Spain
| | - Maribel Botana-Rial
- Pulmonology Department, NeumoVigoI+i Research Group, University Hospital Complex of Vigo (CHUVI), Estructura Organizativa de Xestión Integrada de Vigo (EOXI Vigo), BiomedicalResearchInstitute of Vigo (IBIV), Vigo, Spain
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Fernández-Villar A, Mouronte-Roibás C, Botana-Rial M, Ruano-Raviña A. Ten Years of Linear Endobronchial Ultrasound: Evidence of Efficacy, Safety and Cost-effectiveness. Arch Bronconeumol 2015; 52:96-102. [PMID: 26565072 DOI: 10.1016/j.arbres.2015.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/21/2015] [Accepted: 08/26/2015] [Indexed: 12/25/2022]
Abstract
Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is one of the major landmarks in the history of bronchoscopy. In the 10 years since it was introduced, a vast body of literature on the procedure and its results support the use of this technique in the study of various mediastinal and pulmonary lesions. This article is a comprehensive, systematic review of all the available scientific evidence on the more general indications for this technique. Results of specific studies on efficacy, safety and cost-effectiveness available to date are examined. The analysis shows that EBUS-TBNA is a safe, cost-effective technique with a high grade of evidence that is a valuable tool in the diagnosis and mediastinal staging of patients with suspected or confirmed lung cancer. However, more studies are needed to guide decision-making in the case of a negative result. Evidence on the role of EBUS-TBNA in the diagnosis of sarcoidosis and extrathoracic malignancies is also high, but much lower when used in the study of tuberculosis, lymphoma and for the re-staging of lung cancer after neoadjuvant chemotherapy. Nevertheless, due to its good safety record and lack of invasiveness compared to surgical techniques, the grade of evidence for recommending EBUS-TBNA as the initial diagnostic test in patients with these diseases is very high in most cases.
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Affiliation(s)
- Alberto Fernández-Villar
- Servicio de Neumología de la EOXI Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Pontevedra, España.
| | - Cecilia Mouronte-Roibás
- Servicio de Neumología de la EOXI Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Pontevedra, España
| | - Maribel Botana-Rial
- Servicio de Neumología de la EOXI Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Pontevedra, España
| | - Alberto Ruano-Raviña
- Departamento de Medicina Preventiva, Facultad de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, España; CIBER de Epidemiología y Salud Pública, CIBERESP, España
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Ruano-Raviña A, Quindós-Poncela L, Sainz Fernández C, Barros-Dios JM. Radón interior y salud pública en España. Tiempo para la acción. Gaceta Sanitaria 2014; 28:439-41. [DOI: 10.1016/j.gaceta.2014.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/29/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
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Pérez-Ríos M, Ruano-Raviña A. Investigación de excelencia en España. Ni protagonistas ni papeles secundarios. Med Clin (Barc) 2011; 136:366-7. [DOI: 10.1016/j.medcli.2010.02.035] [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: 02/16/2010] [Accepted: 02/16/2010] [Indexed: 10/19/2022]
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Fernández-Villar A, Botana M, Leiro V, González A, Represas C, Ruano-Raviña A. Validity and reliability of transbronchial needle aspiration for diagnosing mediastinal adenopathies. BMC Pulm Med 2010; 10:24. [PMID: 20426827 PMCID: PMC2868821 DOI: 10.1186/1471-2466-10-24] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 04/28/2010] [Indexed: 11/12/2022] Open
Abstract
Background The aim is to assess the validity and reliability of transbronchial needle aspiration (TBNA) of mediastinal and hilar adenopathies and to evaluate factors predictive of TBNA outcome. Methods We performed an analysis of prospectively collected data of patients (n = 580) who underwent TBNA (n = 685) from January 1998 to December 2007 in our center. Validity and reliability were evaluated for the overall sample and according to specific pathology. Factors predicting the successful acquisition of diagnostic samples were analyzed by multivariate analysis. Results Overall sensitivity, specificity, accuracy, and positive and negative predictive (NPV) values for TBNA were 68%, 100%, 68.8%, 100%, and 10%, respectively. The most sensitive and accurate TBNAs were obtained for patients with small cell lung carcinoma and the worst results were for patients with lymphomas. NPV were similar for all pathologies. The most predictive factors of outcome were adenopathy size and the presence of indirect signs at the puncture site. Conclusion The sensitivity and accuracy of TBNA are high in small cell lung cancer, followed by other types of carcinoma, sarcoidosis, and tuberculosis, and low for lymphoproliferative diseases. The NPV of TBNA for all individual pathologies is low. The size of the adenopathy and the presence of indirect signs at the puncture site predict the achievement of diagnostic samples.
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Affiliation(s)
- Alberto Fernández-Villar
- Bronchoscopy Unit, Pulmonary Department, Xeral-Cíes Hospital, University Hospitalary Complex of Vigo, C/Pizarro 22; 36204 Vigo, Spain.
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