Molina J.,University of Seville |
Penuela I.,University of Seville |
Penuela I.,Complejo Asistencial Universitario of Burgos |
Lepe J.A.,University of Seville |
And 6 more authors.
Journal of Infection | Year: 2013
Objectives: To describe the morbidity and mortality related to coagulase-negative Staphylococci (CNS) bacteremia in non-critical patients. Methods: Prospective, matched case-control study nested in a cohort. Patients with CNS bacteremia and no other isolate in blood cultures during their admission were defined as cases. Each case was matched by age, sex and area of hospitalization to one control. A 30-day follow-up was performed. Mortality and hospital stay were defined as endpoints. Results: 105 cases and 105 controls were included. All cases carried intravascular catheters at the time of inclusion. Cases presented higher mortality compared to controls (14.3% vs. 4.8%), although this association was not independent in a multivariate analysis (p = 0.11). CNS bacteremia was independently associated with longer hospital stay (mean 12 vs. 8.5 days, p = 0.008). Moreover, when patients with CNS bacteremia were specifically analyzed, the persistence of fever (p = 0.005) and inappropriate empirical treatment (p = 0.04) were independently related to mortality. Conclusion: We did not observe increased mortality attributable to CNS bacteremia, although it was associated with longer hospitalizations. Early appropriate empirical antibiotic therapy pending blood culture results might improve the outcome of patients with CNS bacteremia. Close follow-up is recommended if fever persists beyond 72 h. © 2012 The British Infection Association.
Serrano M.,San Pedro Hospital |
Bartulos M.,San Pedro Hospital |
Bartulos M.,Complejo Asistencial Universitario Of Burgos |
Matute B.,Los Manzanos Hospital
Neuroepidemiology | Year: 2013
Background: Hospital administrative data have been suggested as a valuable cost-effective tool for providing information about the stroke burden. Nevertheless, the choice of the diagnosis codes has been a critical issue in the development of case ascertainment algorithms. Methods: In this study, the Minimum Basic Data Set administrative database was used to analyze the accuracy of different ICD-9-CM algorithms based on the neurologist's clinical judgement as the 'gold standard'. Results: The most accurate algorithm observed in our study involved the selection of ICD-9-CM codes 430-438 in the primary diagnosis. It yielded a sensitivity of 96.1%, a specificity of 87.5% and a positive predictive value of 82.5%. Conclusions: The Minimum Basic Data Set is a valuable source to evaluate stroke frequency when using an accurate algorithm to select events. © 2013 S. Karger AG, Basel.
Plaza V.,Autonomous University of Barcelona |
Sanchis J.,Autonomous University of Barcelona |
Roura P.,Hospital General Of Vic |
Molina J.,Health Center France I C |
And 5 more authors.
Journal of Aerosol Medicine and Pulmonary Drug Delivery | Year: 2012
Background: Studies in many countries in the 1990s revealed deficiencies in physicians' knowledge about inhalation therapy. In an attempt to remedy this situation, Spanish scientific societies implemented a variety of educational strategies. The objective of the present study was to assess changes in attitudes and knowledge about inhalers and inhalation techniques in a sizable sample of physicians. Methods: An 11-question multiple choice test was developed and administered throughout Spain to practicing physicians from specialties that frequently prescribe inhaler devices. The survey collected demographic characteristics (four items), preferences (two items), and issues related to knowledge (three items) and education (two items) about devices and inhalation techniques. Completion of the questionnaire was voluntary, individual, and anonymous. Results: A total of 1514 respondents completed the questionnaire. Dry powder inhalers (DPI) were preferred by 61.2% physicians, but only 46.1% identified "inhale deeply and forcefully" as the most significant step in the inhalation maneuver using these devices. Only 27.7% stated that they always checked the patient's inhalation technique when prescribing a new inhaler. A composite variable, general inhaled therapy knowledge, which pooled the correct answers related to knowledge, revealed that only 14.2% physicians had an adequate knowledge of inhaled therapy. Multivariate analysis showed that this knowledge was lowest among internal medicine and primary care physicians. Conclusions: Prescribers' knowledge of inhalers and inhalation techniques remains poor in Spain. The causes should be identified in further research to allow effective educational strategies to be developed. Specific educational policies should be addressed to general practitioners. © Copyright 2012, Mary Ann Liebert, Inc. 2012.
Gutierrez-Garcia A.,Complejo Asistencial Universitario Of Burgos |
Fernandez-Martin A.,University of La Laguna
Ansiedad y Estres | Year: 2012
In this article we review the studies investigating the effects of anxiety on interpretive bias, i.e., the proneness to generate, prioritize or select a threatening interpretation over a neutral interpretation of an ambiguous stimulus. The article is organized in three sections: Conceptualization, Research, and Application. First, we motivate theoretically the relationship between anxiety and interpretive bias, with particular emphasis on the functional role of such a bias in the alarm mechanism of the defensive system. Second, we examine the existing experimental evidence on the issue under investigation in several specific areas. And, third, we address the possibility that the experimental findings on anxiety and interpretive bias can be applied to therapeutical treatments aimed to control and reduce vulnerability to anxiety.
Ferrero-Arias J.,Clinica La Milagrosa |
Goni-Imizcoz M.,Complejo Asistencial Universitario Of Burgos |
Gonzalez-Bernal J.,University of Burgos |
Lara-Ortega F.,University of Burgos |
And 2 more authors.
Alzheimer Disease and Associated Disorders | Year: 2011
Objective: To determine the usefulness of a formal, structured, nonpharmacological treatment for apathetic dementia patients. PATIENTS AND Methods: A controlled, cross-over, randomized, simple-blind, multicentre clinical trial. A total of 146 institutionalized or day care dementia patients with a stage 1 or 2 Clinical Dementia Rating, with no significant motor or sensory problems, or with rapidly evolving dementia and in a clinically stable state were recruited. A cognitive mini examination, and functional, depression, and potential toxicity scales, Neuropsychiatric Inventory Questionnaire (NPI-Q), and Dementia Apathy Interview and Rating (DAIR) scales were applied at baseline. Patients were randomized to initial intervention (music and art therapy and psychomotor activity) or initial control (free activities in the day room) and changed over at 4 weeks. NPI-Q and DAIR scales were administered at the end of weeks 4 and 8. Results: A significant difference between intervention and control periods, as measured using the DAIR scale, was observed, with a difference of 0.21 (95% confidence interval: 0.07-0.34, P<0.005). The difference was very important in the patients with moderated apathy. However, differences were not so important in the patients with severe apathy and there were no differences at all in the non-apathetic patients. No significant differences were found with the NPI-Q scale, although there was a clear improvement trend in the "apathy" question on this scale. This effect seems to extend beyond the therapeutic intervention period. Conclusions: A structured, nonpharmacological, short-term occupational therapy intervention is more useful than activities of the patients' own choice for improving apathy in patients with mild or moderate dementia. Copyright © 2011 by Lippincott Williams & Wilkins.
Lastra-Aras E.,Complejo Asistencial Universitario Of Burgos |
Robles-Diaz L.,Hospital Universitario Doce Of Octubre |
Guillen-Ponce C.,Hospital Universitario Ramon y Cajal |
Alba E.,Hospital Clinico Universitario Virgen Of La Victoria |
Cruz J.-J.,Hospital Universitario Of Salamanca
Clinical and Translational Oncology | Year: 2013
Introduction: Approximately 5 % of all cancer cases are hereditary. Cancer genetic counseling assesses individual and family risks of cancer, conducts genetic studies, interprets results, and advises patients regarding strategies for prevention and risk reduction. Currently, many networks of hereditary cancer genetic counseling units (HCGCUs) are integrated in the medical oncology services of most Spanish hospitals, which are comprised of multidisciplinary teams and offer high-quality care for the treatment of hereditary cancer. Materials and methods: The Spanish Society of Medical Oncology (SEOM) analyzed key issues involving the integration of HCGCUs into the National Health Service. These included basic compliance issues by these units regarding their operation and organization, as well as prerequisites in quality control thereof. Results: This document describes the specific roles and clinical processes performed in HCGCUs in addition to basic services provided by molecular diagnostic laboratories. It also provides a summary on the coordination of care across different levels for patients and families with hereditary cancers. Finally, this document describes the human and material resources needed for the organization of HCGCUs. Conclusions: SEOM has been a pioneer in the creation and development of HCGCUs. This paper seeks to ensure high-quality care to individuals and families with inherited susceptibility to cancer in Spain. © 2012 Federación de Sociedades Españolas de Oncología (FESEO).
Cubo E.,Complejo Asistencial Universitario of Burgos |
Gonzalez M.,University of Extremadura |
Singer H.,Johns Hopkins University |
Mahone E.M.,Kennedy Krieger Institute |
And 5 more authors.
Movement Disorders | Year: 2013
Background: Understanding the impact of placebo treatment is pivotal to the correct interpretation of clinical trials. The aim of present study was to examine the placebo effect in tic disorders. Methods: Raw data were obtained for 6 placebo-controlledparallel and cross-over trials that involved medical interventions for tic disorders. Tic severity was measured using the Yale Global Tic Severity Scale. Placebo effect was defined as an improvement of at least 30% over baseline scores in the total tic score and was considered clinically relevant when at least 10% of patients in the placebo-arm met that benchmark. Results: In total, 91 placebo-treated patients (80% males; mean age, 16.5 years; standard deviation, 10.5 years) were included. Although there was a trend toward improvement in the total tic scores after placebo administration (P=0.057), the magnitude of the placebo effect was small (Cohen's d=0.16) but relevant (19% of the sample). Females were more likely than males to have a placebo effect. Conclusions: The magnitude of the placebo effect in tic disorders appeared to be small. Further longitudinal studies using objective assessments for tic disorders are warranted to confirm the current results. © 2013 Movement Disorder Society.
Manzanedo Sagredo M.I.,Complejo Asistencial Universitario Of Burgos
Revista de enfermería (Barcelona, Spain) | Year: 2012
The daily evidence, in the course of professional practice shows the important role of nurses in detecting suicidal patient because the staff is in better accessibility unlimited dedication in front of a voluntary consultation and creation of an environment trust. The main objective of this plan is to identify patients at risk of suicidal behavior in psychiatric hospital settings. The basic procedures for achieving these goals are to use methods such as clinical interviews, observation and application of scales that tell us that a patient may be contemplating suicide. This assessment will take into account several variables: physical, psychological, behavioral, verbal, social, familial, demographic, etc. The aim is, likewise, discard myths about suicide which may mask important information and help to identify patients at risk. It should be noted that only a small number of suicides happen without warning. Most suicide give clear warnings of their intentions. These patients do not want to stop living, what they really want is to stop suffering, but his mental condition prevents them from thinking about other solutions while his thoughts focused on the negative aspects of his life without being able to take into account the positive. The result that the aim this plan of care is to prevent the suicide of patients in the hospital. For although not all suicides can be prevented, most do.
[Preliminary results in the correction of the pectus excavatum with the Acastello modified Welch technique]. [Resultados preliminares en la corrección del pectus excavatum con técnica de Welch modificada por Acastello.]
Lorenzo G.R.,Complejo Asistencial Universitario Of Burgos
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica | Year: 2011
Congenital malformations of the chest wall are a heterogeneous group of diseases affecting the costal cartilage, ribs, sternum, scapula and clavicle. The pectus excavatum is characterized by a posterior depression of the sternum. Acastello-Welch technique consists in a partial resection of the costal cartilages adding some bars or plates unilaterally fixed to the sternum in each hemithorax. From October 2008 to March 2011 we evaluated 108 patients with congenital malformations of the chest wall. Forty-seven patients (44%) had a pectus excavatum and 12 were treated with Acastello-Welch technique. There were no intraoperative complications. After a mean follow up of 27 months, correction of the deformity was very satisfactory both objective and subjective for patients. The Welch thoracoplasty modified by Acastello is a good option for the correction of the pectus excavatum associating little morbidity and good esthetic outcomes.
Izquierdo M.J.,Complejo Asistencial Universitario Of Burgos
BMC nephrology | Year: 2012
Treatment with selective vitamin D receptor activators such as paricalcitol have been shown to exert an anti-inflammatory effect in patients on hemodialysis, in addition to their action on mineral metabolism and independently of parathyroid hormone (PTH) levels. The objective of this study was to evaluate the additional antioxidant capacity of paricalcitol in a clinical setting. The study included 19 patients with renal disease on hemodialysis, of whom peripheral blood was obtained for analysis at baseline and three months after starting intravenous paricalcitol treatment. The following oxidizing and inflammatory markers were quantified: malondialdehyde (MDA), nitrites and carbonyl groups, indoleamine 2,3-dioxygenase (IDO), tumor necrosis factor alfa (TNF-α), interleukin-6 (IL-6), interleukin-18 (IL-18) and C-reactive protein (CRP). Of the antioxidants and anti-inflammatory markers, superoxide dismutase (SOD), catalase, reduced glutathione (GSH), thioredoxin, and interleukin-10 (IL-10) levels were obtained. Baseline levels of oxidation markers MDA, nitric oxide and protein carbonyl groups significantly decreased after three months on paricalcitol treatment, while levels of GSH, thioredoxin, catalase and SOD activity significantly increased. After paricalcitol treatment, levels of the inflammatory markers CRP, TNF-α, IL-6 and IL-18 were significantly reduced in serum and the level of anti-inflammatory cytokine IL-10 was increased. In renal patients undergoing hemodialysis, paricalcitol treatment significantly reduces oxidative stress and inflammation, two well known factors leading to cardiovascular damage.