Search PubMed⌕ Search

Biomedical subjects

P de Lucas Ramos

Publications and source records attributed to P de Lucas Ramos.

17 recordsLinked to original sources
PubMed2005

[Effectiveness of a recuperative primary care intervention in patients with chronic obstructive pulmonary disease].

OBJECTIVES: The main objective is to assess the effect of a respiratory rehabilitation programme on the quality of life of patients with COPD. Secondary aims are to determine whether the intervention, as against the habitual monitoring, improves tolerance to exercise and pulmonary function, and reduces dyspnoea, the number of crises and hospital admissions due to COPD and the medication used to control the disease. DESIGN: Pragmatic cluster-randomised clinical trial. SETTING: Clinics of 16 PC teams in various health areas of the Community of Madrid. PARTICIPANTS: 476 patients with light-moderate COPD, who sign their informed consent. VARIABLES: Quality of life, number of crises, packages of medicines used to control the disease, unscheduled attendance, pulmonary function, dyspnoea and tolerance to exercise. METHOD: The consultations will be assigned to the control and intervention groups at random. At each clinic there will be a randomised selection from all patients with COPD and in a stable clinical condition. 238 patients are needed in each group, in order to detect a minimum difference of 4 points in quality of life, assuming a standard deviation of 16, 95% confidence level, 80% power and 20% losses. The effect between each factor and the variables evaluated through multivariate analysis will be calculated. DISCUSSION: This research project aims to show that a basic recuperative intervention, which is feasible and primary care-based, can achieve improvements in the quality of life of patients with COPD.

Humans↗
PubMed2005

[Factors affecting drug prescription in patients with stable COPD: results from a multicenter Spanish study (IDENTEPOC)].

OBJECTIVE: To determine what factors are associated with prescription of drugs to patients with stable chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: We studied 568 patients with stable COPD. Assessments included determination of the severity of dyspnea, body mass index, health-related quality of life, and spirometry testing. RESULTS: The forced expiratory volume in 1 second was significantly associated with prescription of long-acting beta2-adrenergic agonists (odds ratio [OR]=0.98; 95% confidence interval [CI], 0.96-1) and inhaled corticosteroids (OR=0.98; 95% CI, 0.96-1). Quality of life was related to administration of short-acting beta2-adrenergic agonists (OR=1.02; 95% CI, 1-1.03), long-acting beta2-adrenergic agonists (OR=1.02; 95% CI, 1-1.03), ipratropium bromide (OR=1.03; 95% CI, 1-1.04), theophylline drugs (OR=1.02; 95% CI, 1-1.03), and inhaled corticosteroids (OR=1.02; 95% CI, 1-1.03). The severity of dyspnea was significantly associated with prescription of oral corticosteroids (for grade IV dyspnea, OR=15.25; 95% CI, 2.40-97.02). Body mass index was not related to drug administration. CONCLUSIONS: Drug prescription in patients with stable COPD correlates not only with forced expiratory volume in 1 second but also with other parameters such as health-related quality of life and dyspnea.

Aged↗
PubMed2004

[Bacterial colonization and home mechanical ventilation: prevalence and risk factors].

OBJECTIVE: To investigate the prevalence of bacterial contamination of ventilators and colonization of patients, the bacteria implicated, and predisposing factors in noninvasive home ventilation. MATERIAL AND METHODS: Forty patients on a home noninvasive ventilation program (mean [SD] age: 63.1 [12] years; time on ventilation: 30.7 [25] months; daily use: 8.1 [2] hours) were enrolled in this descriptive cross-sectional study. Microbiological samples for semiquantitative cultures were swabbed from the ventilator (mask and tubing) and the nostrils. A questionnaire was completed on the underlying disease, time on the ventilation program, type of ventilator, presence of a humidifier, and attention to ventilator cleanliness and maintenance. We defined "colonization" as the presence of microorganisms in the nostrils without evidence of a host immune response, and "contamination" as the presence of surface microorganisms (on tubing or the nasal mask). RESULTS: Potentially pathogenic bacteria were isolated from 6 ventilators (15%) and the nasal swabs of 10 patients (25%). Staphylococcus aureus was the most frequently isolated one (in 5 ventilators and 6 patients--contamination coinciding with colonization in 3 cases). Other potentially pathogenic bacteria isolated were Proteus species (from the nostrils of 2 patients) and an unidentified gram-negative bacillus from the ventilator. On analysis by underlying disease, 60% of the patients with obesity had been colonized. No other findings of note were obtained for other diseases. Contamination and colonization correlated with attention to cleanliness and maintenance of the ventilator but not with type of ventilator, time on the ventilation program, or use of a humidifier. CONCLUSIONS: Home mechanical ventilators are a potential source of nasal colonization. The most frequently encountered microorganism was S. aureus. The degree of ventilator cleaning and disinfection seems to affect contamination; thus it is necessary to impress on patients the need for adequate maintenance of their ventilators.

Adult↗
PubMed2004

[Quality of life with chronic obstructive pulmonary disease: the influence of level of patient care].

OBJECTIVE: The aim of the study was to determine the factors related to the health-related quality of life (HRQL) of patients with stable chronic obstructive pulmonary disease (COPD) and to assess the degree of influence of level of patient care (primary or specialized). MATERIAL AND METHOD: An observational descriptive, cross-sectional, multicenter study was carried out. The study sample was a randomized selection taken from a stratified sample of patients treated by primary care physicians and pneumologists from each Spanish region. Only those patients whose level of health care was indicated and whose diagnosis of COPD was confirmed by spirometry were enrolled in the study. RESULTS: Five hundred sixty patients were assessed, 100 from primary health care and 460 from pneumology practices. No significant differences between the 2 levels of care were found in the scores on the HRQL questionnaire (Spanish version of the St George's Respiratory Questionnaire). There was a weak correlation between patients' perception of health and lung function parameters. Factors related to HRQL in the multivariate analysis were dyspnea, the presence of COPD exacerbations in the previous year, consequent visits to the emergency department, age, and degree of airflow restriction, but not level of patient care. CONCLUSIONS: Stable COPD patients' HRQL is not related to their level of care, be it primary or specialized, but is related to other factors such as dyspnea, presence of exacerbations or consequent visits to the emergency department, age, and degree of airflow restriction.

Adult↗
PubMed2003

[Drug treatment of chronic obstructive pulmonary disease on two levels of patient care: degree of compliance with recommended protocols].

OBJECTIVE: The aims of this study were to identify the drug treatment protocols applied by primary care physicians or pneumologists for patients with stable chronic obstructive pulmonary disease (COPD) in Spain, to determine the agreement between prescription practices and current recommendations and to assess differences between the two levels of patient care. PATIENTS AND METHODS: The study was observational, descriptive and multicenter. A stratified random sample of patients treated by family physicians or pneumologists was taken for every region in Spain. RESULTS: Five hundred sixty-eight (63.2%) of the 898 subjects fulfilled COPD diagnostic criteria; 100 were treated by primary care physicians and 460 by pneumologists. In 8 cases the caregiver was unknown. Obstruction was mild-to-moderate in 144 cases and severe in 416. The drugs most commonly prescribed were ipratropium bromide (77.8%), inhaled short-acting beta(2) agonists (65.8%), inhaled corticosteroids (61.0%), long-acting beta(2) agonists (46.4%) and theophyllines (41.3%). Primary care physicians prescribed inhaled short-acting beta 2-agonists most often, whereas pneumologists prescribed anticholinergics most often. In the primary care setting, no differences in treatment protocols were observed based on severity of COPD, degree of dyspnea or quality of life. More consistent differences were seen in treatment by pneumologists. In both settings, prescription was more frequently given when COPD was severe. The most commonly prescribed inhalation device was the Turbuhaler in primary care and the pressurized canister in pneumology. CONCLUSIONS: Treatments prescribed for COPD patients do not follow current guidelines strictly, particularly in the primary care setting. Different prescription protocols are used at the different levels of patient care.

Aged↗
PubMed2003

[Reliability of chronic obstructive pulmonary disease diagnosis by primary care physicians and pneumologists in Spain. Predictive factors].

OBJECTIVE: The aims of this study were to assess the methods used by primary care physicians and pneumologists to diagnose chronic obstructive pulmonary disease (COPD) in Spain, and to analyze the factors affecting correct diagnosis of the disease. MATERIAL AND METHODS: This observational, descriptive, cross-sectional and multicenter study enrolled a stratified randomized sample from each Spanish region from the practices of primary care physicians and pneumologists. RESULTS: Five hundred sixty-eight (63.2%) of the 898 subjects enrolled had airway obstruction, 92 (10.3%) did not fulfill functional criteria for COPD and 238 (26.5%) did not perform spirometric tests to confirm the diagnosis and establish severity of disease. Primary care physicians classified 29.3% of the patients correctly, whereas pneumologists diagnosed 84.8% correctly. Clinical and/or radiologic criteria were the basis for correct diagnosis in 38.6% of the cases managed by primary care physicians and 10.2% of those treated by pneumologists. Spirometry was available to 49.1% of the primary care physicians and 97.8% of the pneumologists' cases (p < 0.001). Moreover, only 29.9% of the primary care settings had a technician in charge of performing the study, in comparison with 97.8% of the specialized pneumology settings (p < 0.001). The use of spirometry in diagnosing COPD was related to level of patient care (primary or specialized), availability of the test in the primary care setting, place of residence and a patient's situation of temporary absence from work due to COPD. CONCLUSIONS: Many COPD patients are incorrectly diagnosed, particularly in primary care. There are differences in diagnostic procedures at the different levels of patient care. The availability of spirometry is an important factor for correctly diagnosing COPD.

Aged↗
PubMed2000

[Current status of home mechanical ventilation in Spain: results of a national survey].

Home mechanical ventilation (HMV) is used to treat chronic respiratory insufficiency in patients who are clinically stable and require partial or total support ventilation. To determine how HMV is being used in Spain, we mailed a questionnaire to the respiratory medicine departments of all hospitals in the public health system. The closing date for receipt of responses was April 1999. Forty-three hospitals in 14 autonomous communities of Spain responded. At the time of the survey, 1,821 patients were using HMV, which had been introduced in 1987. Volumetric respirations were being used by 856 patients and various models for delivering support pressure were being used by 965. Nasal masks connected to respirators were being used by 90%, while 6% were ventilated through a tracheotomy, 2% through face masks and fewer than 1% trough mouth devices. In conclusion, HMV has been widely applied in Spain and non invasive ventilation is usually provided through a face mask. HMV is prescribed for the usual reasons (chest and neuromuscular diseases) and for such conditions as hypoventilation due to obesity and chronic obstructive pulmonary disease.

Health Care Surveys↗
PubMed1998

[Training of inspiratory muscles in chronic obstructive lung disease. Its impact on functional changes and exercise tolerance].

The aim of this study was to evaluate the impact of inspiratory muscle training on lung function and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). Thirty-five patients with stable COPD were enrolled. We measured lung function variables and peak inspiratory and expiratory pressures (PImax and PEmax). Tests of progressive maximal exercise tolerance and stable submaximal exercise tolerance were administered. Two study groups were formed. Group A patients (n = 20) were enrolled in a respiratory muscle training program lasting four months. Group B (n = 15) was the control group. At the end of the study period the patients underwent testing similar to the first battery of tests. All showed moderate to severe obstruction with no significant differences between groups (FEV1: group A 37.6 +/- 13%, group B 36.6 +/- 12%; FVC: group A 80.4 +/- 15%, group B 80 +/- 12%). Nor were there any significant differences between the two groups in initial results of either maximal respiratory pressures or exercise tolerance. No lung function changes were observed in either group. PImax in group A increased significantly at the end of the study (from 54 +/- 9 to 78 +/- 16 cmH2O; p < 0.001); there were no changes in group B. No changes were seen in VO2max or ventilatory response and/or gasometry during exercise in any of the groups. The trained group, on the other hand, experienced a significant decrease in dyspnea evaluated on the Borg scale exercise in maximal (5.7 +/- 1.1 versus 4.7 +/- 1.2, p < 0.005) and submaximal (5.9 +/- 0.9 versus 4.9 +/- 1.3, p < 0.005) and an increase in time of submaximal exercise tolerance (5.5 +/- 2 versus 7 +/- 3 min, p < 0.05), changes that were not observed in the control group. Based on these results, and although specific training of inspiratory muscles does not appear to improve lung function in patients with COPD, it is accompanied by a decreased sense of dyspnea during exercise and greater tolerance.

Aged↗
PubMed1998

[Role of postoperative estimate of maximum oxygen uptake in predicting cardiorespiratory insufficiency in the immediate postoperative period in thoracic surgery].

We sought to determine if predicted post-operative maximal oxygen uptake (VO2max/kg-PPO) was associated to the occurrence of respiratory or cardiac failure within the 60 days following lung surgery and to evaluate its validity as operability criterion. We studied 47 patients with chronic air-flow limitation (COPD) with FEV1 > 0.8 1 and without hypercapnia, that underwent lung surgery. Age was 56 (SD 11) years, FEV1 = 1.8 (SD 0.5) 1 (61% predicted (SD 13%) and FEV1/FVC = 55 (SD 7.5). Ten patients presented serious cardiac or respiratory complications (3 died). Significant correlation with complications was found for RV, TL-COsb-PPO, VO2max/kg, resection size and VO2max/kg-PPO. VO2max/kg-PPO correlation (-0.73) was significantly higher (p = 0.0016) than all the pulmonary function test (PFT) correlation and than VO2max/kg correlation (p = 0.049) as well. Cut-off points, positive and negative predictive values were respectively: 12.6 ml/min/kg, 0.75 y 0.90% for VO2max/kg-PPO; 17 ml/min/kg 0.83 and 0.87 for VO2max/kg and 148%, 0.67 and 0.82 for RV (the best of the pulmonary function tests). Multivariable models did not improve discriminant power. We conclude that, out of the studied variables, VO2max/kg-PPO showed higher correlation with the complications sought than PFT or VO2max/kg. As criterion to predict cardiac or respiratory failure, with the observed prevalence, its negative predictive values is good, but its positive predictive value is relatively low. None parameter was able to predict all the complications.

Adult↗
PubMed1996

[Role of bronchoalveolar lavage and transbronchial biopsy in the diagnosis of pneumonia in patients with organ transplantation].

Pneumonia in patients with organ transplantation constitutes a very frequent cause of mortality, as a result precocious aetiologic diagnosis is indispensable. The bronchoscopic techniques, bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB), constitute fundamental procedures for these diagnoses. We begin this study with the aim of evaluating the profitability obtained with these procedures. 36 bronchoscopies were performed on 29 patients with organ transplantation, in all of them we realized BAL and in 20 TBB. We confirm the presence of pneumonia in 30 (in 15 of them we had performed TBB), the BAL was diagnostic in 20 cases (66.6%) and the TBB in 7 (46.6%). With both, BAL and TBB, we obtained a sensitivity of 80% and a specificity of 75%. We isolated 10 bacteria, 8 Citomegalovirus (CMV), 6 Pneumocystis carinii and 2 Aspergillus fumigatus. The BAL and the TBB contributed significantly in the aetiologic diagnosis of pneumonia in patients with organ transplantation, consequently we consider them basic tools in the management of these infections.

Adult↗
PubMed1996

[Usefulness of the visual analysis of night oximetry as a screening method in patients with suspected clinical obstructive sleep apnea syndrome].

Conventional polysomnography (CPS) is a complex, costly procedure that is not widely available, meaning that it is difficult to apply it in patients suspected of having obstructive sleep apnea syndrome (OSAS). Various procedures have therefore been proposed for screening candidates for CPS. We studied the usefulness of visual analysis of nocturnal oximetry in 96 patients suspected of having OSAS. The OSAS diagnosis was confirmed by CPS in 67 (69.8%). Oximetry was positive in 70 cases. Sixty-one patients were positive by both oximetry and CPS, while 9 and positive oximetry results and a negative CPS. We conclude that nocturnal oximetry has a 91% sensitivity and 69% specificity for OSAS, with a positive predictive value of 87% and a negative predictive value of 77%. We believe that nocturnal oximetry may be a useful way of screening for OSAS, in order to decrease the number of CPS performed on patients without the disease.

Adult↗
PubMed1990

[3 cases of diffuse lymphangioleiomyomatosis of the lung].

Three new cases of diffuse pulmonary lymphangioleiomyomatosis are presented. Case number 1 is a female patient who presented repeated pneumotorax and dyspnea without evidence by CT scan and gynecological ultrasound of extrathoracic lesions. This patient did not respond to medroxiprogesterone and died 5 years after the initial diagnosis having suffered chronic, severe, global respiratory failure for 4 years. Case number 2 is a female patient who presented dyspnea, chyloptysis and chylothorax, with iliac, paraaortic and mediastinic lymphangioleiomyomas. The last time she was seen, she was still alive after 6 years without treatment. Case number 3 presented lymphangioleiomyomatosis associated to undifferentiated breast carcinoma. The evolution was apparently slow probably because it was diagnosed 14 years after menopause, and died due to a relapse of the neoplasia. All three patients had radiographic images and respiratory functional studies characteristic of this disease and diagnosis was confirmed by biopsy. The literature is reviewed.

Adult↗