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Gonzalez del Castillo J.,Hospital Universitario Clinico San Carlos
European Journal of Emergency Medicine | Year: 2015

OBJECTIVE: To determine the validity of the classic sepsis criteria or systemic inflammatory response syndrome (heart rate, respiratory rate, temperature, and leukocyte count) and the modified sepsis criteria (systemic inflammatory response syndrome criteria plus glycemia and altered mental status), and the validity of each of these variables individually to predict 30-day mortality, as well as develop a predictive model of 30-day mortality in elderly patients attended for infection in emergency departments (ED). METHODS: A prospective cohort study including patients at least 75 years old attended in three Spanish university ED for infection during 2013 was carried out. Demographic variables and data on comorbidities, functional status, hemodynamic sepsis diagnosis variables, site of infection, and 30-day mortality were collected. RESULTS: A total of 293 patients were finally included, mean age 84.0 (SD 5.5) years, and 158 (53.9%) were men. Overall, 185 patients (64%) fulfilled the classic sepsis criteria and 224 patients (76.5%) fulfilled the modified sepsis criteria. The all-cause 30-day mortality was 13.0%. The area under the curve of the classic sepsis criteria was 0.585 [95% confidence interval (CI) 0.488–0.681; P=0.106], 0.594 for modified sepsis criteria (95% CI: 0.502–0.685; P=0.075), and 0.751 (95% CI: 0.660–0.841; P<0.001) for the GYM score (Glasgow <15; tachYpnea>20 bpm; Morbidity–Charlson index ≥3) to predict 30-day mortality, with statistically significant differences (P=0.004 and P<0.001, respectively). The GYM score showed good calibration after bootstrap correction, with an area under the curve of 0.710 (95% CI: 0.605–0.815). CONCLUSION: The GYM score showed better capacity than the classic and the modified sepsis criteria to predict 30-day mortality in elderly patients attended for infection in the ED. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Alfonso F.,Hospital Universitario Clinico San Carlos
Archivos de Cardiologia de Mexico | Year: 2010

The main objective of biomedical journals is to publish high-quality scientific studies and to ensure a widespread dissemination of their contents. Journals compete for the best science generated in their respective disciplines and, therefore, they critically scrutinize the scientific quality of all submitted papers in order to identify and select only those that merit publication. The "peer review" system represents the cornerstone of the scientific process. It provides a critical appraisal, by external independent experts, of the studies under consideration. The system is intended to improve the quality of the submitted papers but also to help the Editors in their decision-making process. The process has been widely embraced by the scientific and editorial international community but it is not free from caveats. In fact, although several strategies have been implemented to improve its quality and the results obtained, limitations still persist. Accordingly, its quality should be closely monitored to ensure excellence. Surprisingly, although the "peer review" process is universally accepted to validate the science, limited scientific information exists on its real value. In this review we will critically analyze the "peer review" process and we will advance some ideas that may help to understand why, in spite of its limitations, it remains the "gold standard" for the selection of scientific manuscripts by biomedical journals. © 2010 Instituto Nacional de Cardiología Ignacio Chávez.

Biomedical journals must adhere to strict standards of editorial quality. In a globalized academic scenario, biomedical journals must compete firstly to publish the most relevant original research and secondly to obtain the broadest possible visibility and the widest dissemination of their scientific contents. The cornerstone of the scientific process is still the peer-review system but additional quality criteria should be met. Recently access to medical information has been revolutionized by electronic editions. Bibliometric databases such as MEDLINE, the ISI Web of Science and Scopus offer comprehensive online information on medical literature. Classically, the prestige of biomedical journals has been measured by their impact factor but, recently, other indicators such as SCImago SJR or the Eigenfactor are emerging as alternative indices of a journal's quality. Assessing the scholarly impact of research and the merits of individual scientists remains a major challenge. Allocation of authorship credit also remains controversial. Furthermore, in our Kafkaesque world, we prefer to count rather than read the articles we judge. Quantitative publication metrics (research output) and citations analyses (scientific influence) are key determinants of the scientific success of individual investigators. However, academia is embracing new objective indicators (such as the "h" index) to evaluate scholarly merit. The present review discusses some editorial issues affecting biomedical journals, currently available bibliometric databases, bibliometric indices of journal quality and, finally, indicators of research performance and scientific success. © 2010 SEEN.

The " peer-review" system is used to improve the quality of submitted scientific papers and provides invaluable help to the Editors in their decision-making process. The " peer-review" system remains the cornerstone of the scientific process and, therefore, its quality should be closely monitored. The profile of the " elite" reviewers has been described, but further studies are warranted to better identify their main characteristics. A major challenge, not only for Editors but also for medical scientific societies as a whole, is to continue to guarantee the excellence in the " peer-review" process and to ensure that it receives adequate academic recognition. © 2010 Sociedad Española de Neurología.

Alfonso F.,Hospital Universitario Of La Princesa | Perez-Vizcayno M.J.,Hospital Universitario Clinico San Carlos | Cardenas A.,Hospital Universitario Clinico San Carlos | Garcia Del Blanco B.,Hospital Universitario Vall dHebron | And 17 more authors.
Journal of the American College of Cardiology | Year: 2015

Background Treatment of patients with drug-eluting stent (DES) in-stent restenosis (ISR) remains a major challenge. Objectives This study evaluated the comparative efficacy of drug-eluting balloons (DEB) and everolimus-eluting stents (EES) in patients presenting with DES-ISR. Methods The study design of this multicenter randomized clinical trial assumed superiority of EES for the primary endpoint, in-segment minimal lumen diameter at the 6- to 9-month angiographic follow-up. Results A total of 309 patients with DES-ISR from 23 Spanish university hospitals were randomly allocated to DEB (n = 154) or EES (n = 155). At late angiography (median 247 days; 90% of eligible patients), patients in the EES arm had a significantly larger minimal lumen diameter (2.03 ± 0.7 mm vs. 1.80 ± 0.6 mm; p < 0.01) (absolute mean difference: 0.23 mm; 95% CI: 00.7 to 0.38), net lumen gain (1.28 ± 0.7 mm vs. 1.01 ± 0.7 mm; p < 0.01), and lower percent diameter stenosis (23 ± 22% vs. 30 ± 22%; p < 0.01) and binary restenosis rate (11% vs. 19%; p = 0.06), compared with patients in the DEB arm. Consistent results were observed in the in-lesion analysis. At the 1-year clinical follow-up (100% of patients), the main clinical outcome measure (composite of cardiac death, myocardial infarction, and target vessel revascularization) was significantly reduced in the EES arm (10% vs. 18%; p = 0.04; hazard ratio: 0.58; 95% CI: 0.35 to 0.98), mainly driven by a lower need for target vessel revascularization (8% vs. 16%; p = 0.035). Conclusions In patients with DES-ISR, EES provided superior long-term clinical and angiographic results compared with DEB. (Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting Balloon vs Everolimus-Eluting Stent [RIBS IV]; NCT01239940) © 2015 American College of Cardiology Foundation.

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