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Biomedical subjects

V Plaza

Publications and source records attributed to V Plaza.

At least 19 recordsLinked to original sources
PubMed2003

[Primary care physicians' and patients' degree of satisfaction with a new respiratory medicine health care program].

BACKGROUND: No ideal model for coordinating primary care and specialized respiratory medicine has been established. OBJECTIVE: To evaluate primary care physicians' and patients' degree of satisfaction with a new program for coordinating respiratory medicine and primary care. METHOD: A questionnaire survey of the level of satisfaction with a program combining consultation and direct patient care. The study was carried out at a primary care facility whose staff comprised 31 general practitioners. The respiratory medicine staff consisted of one physician and two nurses from the reference hospital. A questionnaire to determine the physicians' and patients' satisfaction with the program asked for a) overall evaluation on a scale of 0 to 10; b) evaluation on a scale naming five levels from "very bad" to "very good", and c) comparison of the new program with previous ones. RESULTS: One thousand one hundred seventy patients were seen in 12 months; 663 (57%) received a first visit, 400 (34%) received a second visit, and 107 (9%) received emergency care. The level of satisfaction was 7.8 (1.2) among physicians and 8.7 (1.5) among patients (p = 0.030); 97% of the physicians and 94% of the patients described the program as "very good" or "good". According to 100% of the physicians and 64% of the patients, the new program was better than the old one (p = 0.110). CONCLUSIONS: The coordinated care plan proposed is accepted by most physicians and patients and uses primary respiratory medicine resources more efficiently.

Adult↗
PubMed2002

Frequency and clinical characteristics of rapid-onset fatal and near-fatal asthma.

The onset of fatal and near-fatal asthma attacks can be rapid. The objective of this study was to determine the frequency and clinical characteristics of rapid-onset asthma (ROA) in patients suffering fatal and near-fatal crises. Two-hundred and twenty patients with fatal or near-fatal attacks were enrolled in a multicentre, prospective study. ROA was defined as a crisis developing in < or =2 h. Data on patient and clinical characteristics were collected, and spirometric and allergy studies were performed when the patients were in a stable condition. Forty-five attacks (20%) were ROA and 175 (80%) were slow-onset asthma (SOA). The triggers for SOA and ROA attacks were different, with the ROA group having a significantly lower rate of suspected respiratory infection (7% versus 38%), higher rates of fume/irritant inhalation (9% versus 1%) and a higher intake of nonsteroidal antiinflammatory drugs (14% versus 3%). The ROA group exhibited significantly higher rates of impaired consciousness (63% versus 44%), absence of lung sounds upon admission (68% versus 42%), fewer hours of mechanical ventilation (13 h versus 28 h) and fewer days of hospitalization (8 days versus 9.5 days) than the SOA group. The 20% frequency of rapid-onset fatal and near-fatal attacks in this study suggests that rapidly developing attacks may not be rare. These findings also support a distinct clinical profile for rapid-onset asthma marked by differences in triggers, severity of exacerbation and clinical course.

Adult↗
PubMed2000

Spontaneous reversibility of "pleural thickening" in a patient with semi-invasive pulmonary aspergillosis: radiographic and CT findings.

We present serial radiographic and CT findings of spontaneous reversibility of "pleural thickening" in a patient with proved semi-invasive pulmonary aspergillosis who developed bilateral intracavitary aspergillomas. To the best of our knowledge, this is the first report in the literature of this feature. Radiologists should be aware that pleural thickening in patients with semi-invasive aspergillosis does not necessarily indicate irreversible pleural fibrosis.

Aged↗
PubMed2000

[The prognostic factors of invasive pulmonary aspergillosis in patients with chronic pneumopathy].

OBJECTIVES: a) To determine in patients with chronic respiratory disease the risk factors for death due to semi-invasive and invasive pulmonary aspergillosis (SIPA), and b) to describe the clinical features of SIPA in such patients. METHOD: Twenty-one patients with chronic respiratory disease were enrolled (9 with chronic obstructive pulmonary disease, 2 asthmatics and 3 with bronchiectasis, 5 with post-tubercular sequelae and 2 mixed cases). A diagnosis of SIPA was established in our hospital when, in a patient with a clinical picture consistent with such a diagnosis, the fungus was isolated in bronchial secretions or parenchymal pulmonary specimens were obtained during autopsy. RESULTS: The most common symptoms were dyspnea (81%), cough (67%) and expectoration (62%) increasing over the levels usual for patients with chronic respiratory disease. Hemoptysis was present in only 14%. Eight patients (38%) died as a result of SIPA. A comparison of those surviving and non-surviving patients revealed that the latter had significantly higher LDH levels and white cell counts, and significantly lower total plasma protein and platelet counts. CONCLUSIONS: a) Low protein levels and high LDH levels and white cell counts with thrombopenia are indicators of poor prognosis in chronic respiratory disease patients with SIPA, and b) such patients do not usually present signs or symptoms that lead to a suspicion of SIPA given that such signs are typical of failing compensatory mechanisms in the disease itself.

Aged↗
PubMed2000

Quality of life and economic features in elderly asthmatics.

BACKGROUND: In the geriatric population, asthma tends to be overlooked. Moreover, typical symptoms of asthma may mimic chronic bronchitis and emphysema. OBJECTIVE: To compare the characteristics of asthma between elderly (>/=65 years) and adult (<65 years) asthma patients with regard to asthma severity, health-related quality of life, and direct expenditures for medical care generated by the disease. METHODS: A cross-sectional study was made in the asthmatic population older than 14 years in the area of Barcelona, Spain. Asthma severity was determined according to the International Consensus criteria of 1992. St. George's Respiratory Questionnaire (SGRQ) was used to measure the quality of life. Direct costs were calculated registering all costs generated by each patient per year. RESULTS: The study population consisted of 282 adult asthmatics and 51 elderly asthmatics. Asthma was more severe in the elderly group (mild 10%, moderate 35%, severe 55%) than in the adult group (mild 47%, moderate 35%, severe 18%). Elderly asthmatics had significantly higher total SGRQ scores (48 vs. 35, p < 0.001) than adult asthmatics, as well as significantly higher scores for all subscales. Asthma-derived direct costs in elderly asthmatics (mean USD 1,490 vs. USD 773) were double those in adult asthmatics, mainly due to higher costs of hospitalization and medication in the elderly. CONCLUSIONS: Asthma in elderly people as compared with asthma in adulthood was more severe and was associated with a worse health-related quality of life, and significantly higher expenditures for medical care.

Aged↗
PubMed2000

Semiinvasive pulmonary aspergillosis in chronic obstructive pulmonary disease: radiologic and pathologic findings in nine patients.

OBJECTIVE: The purpose of this study is to assess the radiographic, thin-section CT, and histologic findings of semiinvasive aspergillosis in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: The study included nine patients with COPD seen at the Hospital de Sant Pau during a 3-year period who had histopathologically proven aspergillosis with tissue invasion. Chest radiography and thin-section (2-mm collimation) CT of the chest were available in all cases. RESULTS: Nine patients had semiinvasive aspergillosis proven at autopsy (n = 7) or by thoracoscopically guided lung biopsy (n = 2). The radiologic findings consisted of parenchymal consolidation (n = 6) and nodules larger than 1 cm in diameter (n = 3). Parenchymal consolidation involved the upper lobes in five patients and was bilateral in four. Cavitation was present in two of the patients with consolidation and in two of the patients with nodular opacities. Adjacent pleural thickening was revealed by CT in four patients. Histologically, the areas of consolidation represented active inflammation and intraalveolar hemorrhage containing Aspergillus organisms. In the three patients with multiple cavitated nodules, a variable degree of central necrosis was observed. The inflammatory infiltrate extended into the surrounding lung parenchyma, and adjacent areas of hemorrhage were also seen. Aspergillus colonies were identified within the lung tissue. CONCLUSION: Upper lobe consolidation or multiple nodules in patients with COPD should raise the possibility of semiinvasive aspergillosis.

Aged↗
PubMed1999

[Hospital admission for asthma. Descriptive analysis and prognostic factors after discharge].

BACKGROUND: Few authors have looked at admissions in Spain of patients with acute asthma attacks. The aim of this study was to determine the clinical profile of such patients and analyze factors influencing disease course after release. METHODS: Asthmatics admitted to our hospital were enrolled prospectively over 12 consecutive months. The patients were telephoned one and four months after release. Demographic and clinical data were collected in addition to data on exacerbations, readmissions, treatment and medical follow-up. RESULTS: Sixty-five patients (44 women and 21 men, mean age 45, SD 19). Most (54%) were admitted in autumn and the most common cause of exacerbation was respiratory tract infection (68%). Before admission, 54% had severe asthma, 32% had moderate asthma and 14% had mild asthma. At least one exacerbation occurred for 54% of patients, while 38% required emergency assistance and 19% were readmitted. Two patients (3%) died of asthma. Multiple factor logistic regression analysis showed a relation between the appearance of exacerbation after release and greater severity of asthma and the absence of long-lasting (beta-adrenergic drugs. Readmission was related to shorter duration of treatment with oral glucocorticoids after release and a higher number of prior hospital admissions. CONCLUSIONS: 1) Admission due to asthma occurs mainly in autumn and is probably related to respiratory infections, rather than exclusively to severe asthma. 2) After release, short-term morbidity and mortality due to the disease are high. 3) Disease severity itself and inadequate treatment are both related to poor clinical course after release.

Adult↗
PubMed1998

[Thyroid function and difficult to manage asthma].

Hyperthyroidism can cause asthma to worsen, such that analysis of thyroid function has been recommended when the course of asthma is unfavorable. The aim of this study was to determine whether systematic analysis of thyroid function is useful for all patients with difficult-to-manage asthma. For prospective study, we enrolled 48 asthmatics whose condition had deteriorated due to no known cause. All patients were studied as follows: a) all were assessed for thyrotropin (TSH) levels and, if alterations were detected, we ordered analysis of free thyroxin (FT4), and b) case histories were taken to rule out the existence of active thyroid disease. Nine patients (19%) were suspected of thyroid disease. TSH levels were abnormal in only 5 (10%) patients in this group (low in four and high in one). Hyperthyroidism was confirmed in only 3 patients (6%) after high FT4 levels were detected. Although the frequency of hyperthyroidism in the sample studied is higher than that described for the general population, the systematic investigation of thyroid dysfunction in all patients with difficult-to-manage asthma does not appear justified given that disease could be demonstrated in only some of those who were clinically suspected of thyroid disease.

Adult↗
PubMed1998

Medical personnel and patient skill in the use of metered dose inhalers: a multicentric study. CESEA Group.

The objective was to evaluate the correctness of the inhalation technique in a nationwide sample of patients and medical personnel, in order to define targeted educational goals. A total of 1,640 volunteers (746 patients, 466 nurses and 428 physicians) were evaluated. Only 9% of patients, 15% of nurses and 28% of physicians showed a correct inhalation technique. Physicians performed significantly better (mean score 77 +/- 23) than nurses (71 +/- 22) and patients (62 +/- 26). Scores in general practitioners and pediatricians were significantly lower than those of chest physicians and allergists. In conclusion, proper use of metered dose inhalers (MDI) in patients and medical personnel is still faulty. Despite the physician's awareness of the importance of a correct inhalation technique in the use of MDI, this study shows severe deficiencies, showing the need for substantial changes in educational efforts, and particularly addressed to general practitioners.

Adult↗
PubMed1998

Costs of asthma according to the degree of severity.

An increase in asthma-related morbidity and mortality has been reported recently, resulting in a substantial increase in the economic impact of this condition. Little information is available relating to the costs of asthma depending on the degree of severity of the disease. Total, direct and indirect costs generated by asthma patients who sought medical care for asthma control over a one-year period in a northern area of Spain were determined. Data were obtained from the patients themselves and severity of illness was classified into mild, moderate and severe according to the International Consensus Report on Diagnosis and Treatment of Asthma, 1992. The average total annual asthma-derived cost was estimated at US$2,879 per patient, with averages of US$1,336 in mildly asthmatic patients, US$2,407 in moderate asthma and US$6,393 in severe asthma. At all levels of severity, indirect costs were twice as high as direct costs, and at the same degree of severity, direct costs due to medication and hospitalization were higher among females than males. A minority of severe asthmatics incurred some 41% of the total costs. The cost of asthma was surprisingly high and varied substantially depending on the degree of severity of the disease. Further knowledge of the costs of asthma across various levels of severity will contribute to a better characterization of optimal intervention strategies for asthma care.

Adolescent↗
PubMed1997

Chronic obstructive pulmonary disease stage and health-related quality of life. The Quality of Life of Chronic Obstructive Pulmonary Disease Study Group.

BACKGROUND: The American Thoracic Society recently recommended that chronic obstructive pulmonary disease be staged on the basis of the percentage of predicted FEV1. OBJECTIVE: To examine 1) the relation between the american Thoracic Society system for staging chronic obstructive pulmonary disease and health-related quality of life and 2) the effect of self-reported comorbid conditions on health-related quality of life. DESIGN: Cross-sectional study. SETTING: Outpatient clinics of respiratory departments of four hospitals and one primary health care center in spain. PATIENTS: 321 consecutive male patients with chronic obstructive pulmonary disease. MEASUREMENTS: Functional respiratory impairment, FEV1, respiratory symptoms, and health-related quality of life. Respiratory symptoms and health-related quality of life were measured by using the Spanish version of the St. George's Respiratory Questionnaire and the Nottingham Health Profile. RESULTS: Patient scores on the St. George's Respiratory Questionnaire were moderately to strongly associated with disease staging (r = 0.27 to 0.51). Compared with reference values, values for health-related quality of life for patients with stage I disease were substantially higher on the St. George's Respiratory Questionnaire (6 and 34; p < 0.001) and values for impairment were significantly greater in stage 1 patients with comorbid conditions (19 and 36; P = 0.001). At least one concomitant chronic condition was found in 84% of study patients. Comorbid conditions only partly influenced the observed pattern of deterioration of health-related quality of life with worsening stages of disease. CONCLUSION: Staging criteria for chronic obstructive pulmonary disease based on percentage of predicted FEV1 separated groups of patients with varying degrees of impairment in health-related quality of life. Contrary to expectations, even patients with mild disease showed substantially compromised health-related quality of life. Comorbid conditions influenced the relation between chronic obstructive pulmonary disease and health-related quality of life.

Comorbidity↗
PubMed1997

[Clinical characteristics and morbidity in stable asthma. A descriptive analysis of asthma in a Mediterranean community].

UNLABELLED: Scarce clinical and epidemiological data related to asthma are available in Spain. OBJECTIVES: a) to determine the severity of disease and morbidity among symptomatic asthmatics, and b) to determine whether international recommendations for the treatment of asthma are being followed. A prospective descriptive study enrolling asthmatics older than 14 years of age who experienced symptoms within the past year. The study was performed in the Osona district, a semi-rural area north of Barcelona. Spirometric tests were given and case histories taken, including symptoms caused by the disease. The international guidelines analyzed were those published in 1992 by the National Institutes of Health for the International Consensus Report on Diagnosis and Treatment of Asthma. We studied 333 patients; 214 (64%) were women and 119 (36%) men. Asthma was mild in 140 (42%), moderate in 116 (35%) and severe in 77 (23%). The need for short-term oral corticosteroids, visits to primary care physicians, and missed work days were all significantly greater among patients with severe asthma than for those with mild or moderate asthma. However, 23% of the patients with mild asthma missed work at least once. Drugs used were beta-adrenergic agonists of short duration of effect (76%) and inhaled corticosteroids (66%). CONCLUSIONS: a) in most symptomatic asthma patients, disease is mild; b) although patients with severe asthma have higher rates or morbidity, patients with mild disease also have marked symptoms; c) the drugs used for treatment are in compliance with the 1992 international guidelines.

Adolescent↗
PubMed1997

[Health workers' knowledge and skills regarding the use of the Turbuhaler inhaler].

The aim of this study was to evaluate health care workers' theoretical knowledge and skill in managing the dry powder Turbuhaler. We studied 118 individuals in three groups: 50 nurses, 34 medical residents and 34 staff physicians. Theoretical knowledge was evaluated by a questionnaire specifically designed for the purpose. Skill in managing the device was analyzed by evaluating a practical demonstration of the inhaling technique generally recommended, using a placebo inhaler. Six percent of staff physicians, 3% of the residents and 2% of the nurses answered the theoretical questionnaire correctly. Twenty-one percent of the staff physicians, 15% of the residents and 6% of the nurses inhaled correctly. However, when skill in managing the inhaler was evaluated against the maneuvers recommended by the manufacturer (which do not oblige exhaling before inhaling through the device and then holding the breath), there was significant improvement: 41% of the staff physicians, 23% of the residents, and 20% of the nurses inhaled correctly. We can conclude by saying that: a) our health care workers' general knowledge about how to handle the Turbuhaler device is deficient; b) the proportion of correct inhalation maneuvers observed doubles when these are assessed according to the manufacturer's recommendations, and c) health care workers should receive specific training in the inhalation techniques required for using the various devices usually prescribed.

Clinical Competence↗
PubMed1997

Hyaluronic acid suppresses fibronectin fragment mediated cartilage chondrolysis: II. In vivo.

Intra-articular sodium hyaluronic acid (HA) has been used as a treatment intervention in the management of osteoarthritis. It has been observed that HA can coat the articular surface, and thus, has been suggested to provide a possible prophylactic barrier for the articular cartilage. In an accompanying manuscript (Homandberg et al.), we report that a commercially available high-molecular-weight HA (approximately 800-kDa, ARTZ, Seikagaku Corp.) can partially block fibronectin fragment (Fn-f)-mediated cartilage injury in vitro. Herein we report a study of the effects of intra-articular HA on an in vivo animal model of Fn-f-mediated cartilage injury. Rabbit knees were injected with Fn-f, and after 1 week, the cartilage proteoglycan (PG) content had decreased to 59 +/- 8% of control. In sharp contrast, PG content in knees receiving pre-treatment with HA followed by Fn-f injection had only decreased to 85 +/- 27% of control (P < 0.01). Similarly, the PG content in knees receiving an injection of Fn-f, followed by an injection of HA were significantly higher (74 +/- 18% of control) than Fn-f injured knees with no treatment (P < 0.02). Intra-articular HA alone had no effect on cartilage PG content. The results in this study suggest that HA is effective in partially preventing Fn-f mediated cartilage injury, most likely by coating the articular surface. Further, HA treatment after Fn-f injury may facilitate restoration of matrix components.

Animals↗