Examinando por Autor "BARBA MARTIN, RAQUEL"

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Assessing Clinical probability of organic disease in patients with involuntary weight loss: a simple score
(Elsevier, 2002-06) BILBAO GARAY, JAVIER; BARBA MARTIN, RAQUEL; LOSA GARCIA, JUAN EMILIO; MARTIN, HELENA; GARCIA DE CASASOLA, GONZALO; CASTILLA , VIRGILIO; GONZALEZ ANGLADA, ISABEL; ESPINOSA, ALFREDO; GUIJARRO, CARLOS
Involuntary weight loss (IWL) is a frequent complaint with a difficult diagnosis. Any one of a number of different diseases may be the source of the symptom. However, there is no universal clinical protocol that can help physicians study this complex syndrome. METHODS: In March 1998, we defined a diagnostic protocol for the study of IWL. IWL was defined as an involuntary and documented weight loss of at least 5% of the usual body weight in the previous 3 months. We analyzed 78 consecutive patients with IWL who came to our clinic between March 1998 and December 2000. RESULTS: An organic disease was found in 56% of cases; cancer, metabolic and digestive diseases were the most common entities. Psychiatric problems were found in 33% of cases. After extensive study, an idiopathic group of 11% was identified. The variables that were independently predictive of a final diagnosis of organic disease were: age>50 years (OR: 8.6, CI 95%: 1.7-43.6), psychiatric symptoms (OR: 0.2, CI 95%: 0.1-0.8), smoking (OR: 14.3, CI 95% 2.3-74), the presence of guide symptoms (OR: 8.0, CI 95%: 1.8-34.4), and anemia (OR: 3.1, CI 95%: 2.5-387). Sixteen percent of the patients died, more often those suffering from organic diseases. Based on multivariate regression coefficients, a clinical risk score was established. CONCLUSIONS: IWL is a complex and frequent syndrome with a 16% rate of mortality during the first year. A protocol based on clinical data can help in the management of IWL. Our clinical prediction rule may help physicians to identify those patients with IWL who are likely to have an underlying organic disease.
Implementation of an Algorithm of Cohort Classification to Prevent the Spread of COVID-19 in Nursing Homes
(ELSEVIER, 2020-12) GONZALEZ DE VILLAUMBROSIA, CRISTINA; MARTINEZ PEROMINGO, JAVIER; ORTIZ IMEDIO, JUAN; ALVAREZ DE ESPEJO, TERESA; GARCIA-PUENTE SUAREZ, LAURA; NAVAS CLEMENTE, IVAN; MORALES CUBO, SANDRA; COTANO, LAURA ELENA; SUAREZ SANCHEZ, YANIRA; TORRES, SONIA; OÑORO ALGAR, CARLOS; PALICIO MARTINEZ, CAROLINA; PLAZA NOGALES, CARMEN; BARBA MARTIN, RAQUEL
Older adults living in nursing homes are the most vulnerable group of the COVID-19 pandemic. There are many difficulties in isolating residents and limiting the spread in this setting. We have developed a simple algorithm with a traffic light format for resident classification and sectorization within nursing homes, based on basic diagnostic tests, surveillance of symptoms onset, and close contact monitoring. We have implemented the algorithm in several centers with good data on adherence. Suggestions for implementation and evaluation are discussed.
Prestroke dementia
(KRAGER, 2001-04-06) BARBA MARTIN, RAQUEL; CASTRO, MD; MORIN, MARIA DEL MAR; RODRIGUEZ ROMERO, RAFAEL; RODRIGUEZ GARCIA, ELENA; CANTON, RAFAEL; DEL SER, TEODORO
Objective: To determine the frequency, associated factors and outcome of dementia previous to a stroke. Design: Cross-sectional study of a cohort of 324 consecutive unselected stroke patients (mean age 70.9 years, range 20-98; 255 ischaemic, 46 haemorrhagic and 25 indefinite). Methods: Cognitive and functional status prior to stroke were assessed by means of an interview to a relative, a short version of the Informant Questionnaire on Cognitive Decline in the Elderly and the Barthel Index. The DSM-III-R criteria were used to establish the diagnosis of prestroke dementia. Clinical and CT features of patients with and without prestroke dementia were compared. Results: Forty-nine patients (15%) were demented before stroke; they were significantly older, less well educated, they had more frequently female gender, prior cerebrovascular disease, cerebral and medial temporal lobe atrophy and leukoaraiosis in the CT scan, and they had a higher mortality rate. Female sex (OR 3.7, CI 95% 1.2-12), low education (OR 2.1, CI 95% 1.1-4.2), previous stroke (OR 3.6, CI 95% 1.2-11), and cerebral atrophy (OR 3.8, CI 95% 1.7-8.3) were independently associated with prestroke dementia in the logistic regression analysis. Conclusions: Fifteen percent of stroke patients have prestroke dementia and they have a worse outcome. Factors associated with prestroke dementia are reminiscent both of degenerative and vascular brain pathology.
Real life results of direct-acting oral anticoagulants recommended-dose in obese vs normal-weight patients with venous thromboembolism
(Elsevier, 2024-01) RUEDA-CAMINO, JOSE ANTONIO; BARBA MARTIN, RAQUEL; Otálora, S; Bura-Riviere, A; Visonà, A; Mahé, I; Alda-Lozano, A; Alfonso Megido, J; Pacheco-Gómez, N; Rosovsky, RP; MONREAL, M
Background: There is scarce evidence on the effectiveness and safety of recommended-dose direct acting oral anticoagulants (DOACs) in obese patients with venous thromboembolism (VTE). Material and methods: We used the data in the RIETE registry to compare the rates of VTE recurrences and major bleeding during long-term therapy with DOACs at recommended doses in patients with body mass index ≥30 kg/ m2 (obese) vs. those with BMI 18.5–24.9 kg/m2 (normal weight). We performed regression models with competing risks for death. Results: From January 2013 through October 2022, 2885 obese patients and 2676 with normal weight in RIETE received rivaroxaban (n = 3020), apixaban (n = 1754), edoxaban (n = 636) or dabigatran (n = 151). Median age was 63 years and 52 % were female. At baseline, obese patients were more likely to have diabetes (18.6 % vs. 8.4 %), hypertension (51.9 % vs. 31.4 %) or pulmonary embolism (67.7 % vs. 61 %), and less likely to have renal insufficiency (5.3 % vs. 16 %) or anaemia (21.8 % vs. 28 %%). During anticoagulation (median, 147 vs. 101 days), the obese had a similar rate of VTE recurrences (1.71 vs. 2.14 events per 100 patients-years; hazard ratio (HR): 0.81; 95 % CI: 0.49–1.34) or major bleeding (1.45 vs. 1.76 per 100 patients-years; HR: 0.91; 95 % CI: 0.52–1.59) than those with normal weight. These findings persisted after multivariable analysis (recurrent VTE, HR: 0.80; 95 % CI: 0.48–1.32; major bleeding, HR: 1.11; 95 % CI: 0.60–2.07). Conclusion: The use of DOACs at recommended doses in obese patients with VTE was associated with similar rates of VTE recurrences or major bleeding than in patients with normal weight.