Time filter

Source Type

Gallardo C.R.,University Miguel Hernandez | Rigau D.,Iberoamerican Cochrane Center | Irfan A.,Interactive Research and Development | Ferrer A.,Iberoamerican Cochrane Center | And 6 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2010

SETTING: Clinical practice guidelines have been developed for many disorders, but their quality varies greatly and does not always reach an acceptable standard. No evaluation of clinical practice guidelines on tuberculosis (TB) has been carried out to date. OBJECTIVE: To identify and assess the quality of TB guidelines. DESIGN: We systematically searched documents published from January 1998 to May 2008 in Medline and the Turning Research into Practice (TRIP) database and in clearing houses and on websites of scientific socie ties. Three appraisers evaluated each guideline using the AGREE (Appraisal of Guidelines, Research and Evaluation) instrument. A standardised score was calculated separately for each of the six domains. RESULTS: A total of 36 guidelines for TB were identified, and after appraisal good overall agreement was observed among the three evaluators. Results revealed that quality was acceptable in two domains but had serious shortcomings in the other four. A slight improvement in quality was observed in documents published in 2005 or later. After global assessment, 18 documents were considered 'recommended with provisos' and only two documents 'strongly recommended' for use in clinical practice. CONCLUSION: The methodological quality of TB guidelines was disappointingly low. All guideline developers should adhere to instruments such as AGREE to produce documents of optimal quality. © 2010 The Union. Source

Dominguez A.,University of Barcelona | Dominguez A.,CIBER ISCIII | Izquierdo C.,Generalitat of Catalonia | Ruiz L.,Generalitat of Catalonia | And 5 more authors.
Clinical Microbiology and Infection | Year: 2013

The number of elderly patients in the community with immunosuppressive conditions has increased progressively over recent decades. We sought to determine the incidence, causative organisms and outcome of community-acquired pneumonia (CAP) occurring in immunocompromised older patients. We prospectively compared cases of CAP in immunocompromised and non-immunocompromised patients admitted to five public hospitals in three Spanish regions. Of 320 cases studied, 115 (36%) occurred in immunocompromised patients, including: solid or hematological malignancy (97), corticosteroids or other immunosuppressive drugs (44), solid organ or stem cell transplant (five), and other conditions (eight). The etiology was established in 44% of immunocompromised patients vs. 32% of non-immunocompromised patients (p0.03). Streptococcus pneumoniae was the most common causative organism in both groups (29% vs. 21%; p0.08), followed by Legionella pneumophila (3% vs. 6%; p0.01). Gram-negative bacilli were more frequent among immunocompromised patients (5% vs. 0.5%; p<0.01), particularly Pseudomonas aeruginosa (3% vs. 0%; p0.04). Nocardiosis was only observed in immunocompromised patients (two cases). Bacteremia occurred similarly in the two groups. No significant differences were found with respect to ICU admission (8%, in both groups) or the length of stay (12.5 vs. 10.4days). The early (<48h) (3.5 vs. 0.5%; p0.04) and overall case-fatality rates (12% vs. 3%; p<0.01) were higher in immunocompromised patients. In conclusion, a substantial number of older patients hospitalized for CAP are immunocompromised. Although relatively uncommon, CAP due to gram-negative bacilli, including P. aeruginosa, is more frequent among these patients. CAP occurring in immunocompromised patients causes significant morbidity and mortality. © 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases. Source

Barrabeig I.,Epidemiological Surveillance Unit of Costa Ponent | Rovira A.,Epidemiological Surveillance Unit of Costa Ponent | Rius C.,Public Health Agency of Barcelona | Rius C.,CIBER ISCIII | And 7 more authors.
Pediatric Infectious Disease Journal | Year: 2011

The effectiveness of measles vaccine for postexposure prophylaxis at educational centers was investigated. A total of 166 children who shared the classroom with 10 confirmed cases during the infectious period of cases were studied. Of total susceptible exposed children, 72% (54/75) were vaccinated and 25 contracted measles. Vaccine effectiveness in children vaccinated within 72 hours of exposure was 90.5% (95% confidence interval, 34%-99%). © 2010 Lippincott Williams & Wilkins. Source

Dominguez A.,University of Barcelona | Dominguez A.,CIBER ISCIII | Izquierdo C.,Generalitat of Catalonia | Salleras L.,University of Barcelona | And 9 more authors.
European Respiratory Journal | Year: 2010

The objective of our study was to evaluate the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPV) in preventing hospital admission for community-acquired pneumonia (CAP) in people ≥65 yrs of age. We conducted a matched case-control study in patients with CAP admitted to five Spanish hospitals. Cases were persons aged ≥65 yrs admitted to hospital through the emergency department, who presented a clinical and radiological pattern compatible with pneumonia, assessed using established criteria. We matched each case with three control subjects by sex, age (±5 yrs), date of hospitalisation (±30 days) and underlying disease. The study period was May 1, 2005 to January 31, 2007. The PPV immunisation status of cases and controls was investigated. Adjusted ORs for vaccination were calculated using logistic regression analysis. A total of 489 cases and 1,467 controls were included in the final analysis. The overall adjusted vaccination effectiveness for all patients was 23.6% (95% CI 0.9-41.0). The adjusted vaccination effectiveness for immunosuppressed patients was 21.0% (95% CI -18.7-47.5). Our results suggest that the PPV may potentially reduce hospitalisations for pneumonia in the elderly and supports vaccination programmes in this age group. Copyright©ERS 2010. Source

Perez-Sautu U.,University of Barcelona | Costafreda M.I.,University of Barcelona | Cayla J.,Public Health Agency of Barcelona | Tortajada C.,Public Health Agency of Barcelona | And 3 more authors.
Emerging Infectious Diseases | Year: 2011

Six hepatitis A virus antigenic variants that likely escaped the protective effect of available vaccines were isolated, mostly from men who have sex with men. The need to complete the proper vaccination schedules is critical, particularly in the immunocompromised population, to prevent the emergence of vaccine-escaping variants. Source

Discover hidden collaborations