Papers by Francisco Javier Galindo Ocaña
Síndrome de respuesta inflamatoria sistémica severa: ¿Es comparable a la sepsis severa?
Revista médica de Chile, 1999
... Autor: Hernández Poblete, Glenn; Dougnac L., Alberto; Castro Ormazábal, José; Labarca Mellado... more ... Autor: Hernández Poblete, Glenn; Dougnac L., Alberto; Castro Ormazábal, José; Labarca Mellado,Eduardo; Ojeda M., Mario; Bugedo Tarraza, Guillermo; Castillo Fuenzalida, Luis; Andresen Hernández, Max; Bruhn C., Alejandro; Huidobro M., Luis Felipe; Huidobro M., Rodrigo ...
Resumen: OBJETIVOS GENERALES-Estimar la prevalencia de las interacciones medicamentosas clínicame... more Resumen: OBJETIVOS GENERALES-Estimar la prevalencia de las interacciones medicamentosas clínicamente relevantes, en la población de pacientes pluripatológicos de cuatro centros de salud del área sanitaria de los Hospitales Universitarios Virgen del ...
Revista Clínica Española, 2010
Revista Clínica Española, 2010
Objectives: To determine which social and individual factors may predict adherence to medication ... more Objectives: To determine which social and individual factors may predict adherence to medication in patients with more than two chronic symptomatic diseases (polypathological patients) under polypharmacy. Methods: Cross-sectional observational study. In a primary care area assigned to our teaching hospital 265 patients with multiple chronic diseases and polypharmacy were recruited over a 6 month period. 84 patients with uncompleted data or died before finishing our study were excluded. An structured interview performed by a investigator different from responsible physicians was used. Drug adherence was assessed by a subjective method. Results: Disability measured by Barthel index was was the main predictor of drug adherence. Patients without carer support and Barthel Index lower than 100 showed the poorer drug adherence. In the later group number of drugs also affected adherence. However, in patients with carer available, medication adherence was better, mostly in more disabled ones, and unaffected by other factors. Conclusions: In patients with multiple chronic diseases, social support by a carer may allow disabled patients to overcome the barrier of disability leading to a better drug adherence, even than non-disabled ones. These findings may help to design future prospective studies on medication adherence performed in this peculiar frail population.
eTELEMED 2012, The …, 2012
Polypathological patients have a complex health scenario that is not generally well addressed by ... more Polypathological patients have a complex health scenario that is not generally well addressed by traditional Electronic Health Record systems. In order to treat chronic diseases that these patients have, there is a need for coordination and communication among health personnel of different levels of care (primary care, specialty care, home care) and distinct profiles. Also these healthcare professionals will require to do complex interactions such make shared decisions within their collaborative work. To enhance this coordination among healthcare professionals, we propose the idea of "Clinical Wall" as a 2.0 tool that allows professionals to debate, share knowledge and make decisions based on the clinical patient information.
European Journal of Internal Medicine, 2012
Background: Frail and polypathological patients (PP) are often undertreated with evidence-based c... more Background: Frail and polypathological patients (PP) are often undertreated with evidence-based cardiovascular drugs, as their benefits are uncertain in this population. Objectives: To determine the effects of treatment with renin-angiotensin system blockers/inhibitors (ACEI/ARB), statins and/or beta-blockers on survival rates and functional decline in PP with evidencebased clinical indications for treatment with any of these drug families. Method: Prospective observational multicentre cohort study with a 12-month follow-up period. We selected PP with any condition of the following: chronic heart failure, coronary heart disease, chronic renal disease, cerebrovascular disease, peripheral artery disease, diabetes mellitus with any visceral involvement, hypertension, and dyslipidaemia. Clinical, functional (Barthel index), socio-familial risk data and drug prescriptions were measured at baseline. Multivariate Cox proportional hazards and logistic regression models were used to identify variables independently associated with survival and functional decline. Results: The analysis included 1260 PP. The mean age was 79 ± 9.5 years. The mortality rate was 34.5%. Statin (aHR 0.671; P = 0.001), beta-blocker plus statin (aHR 0.645; P = 0.007), ACEI/ARB plus statin (aHR 0.680; P = 0.002), or combined ACEI/ARB plus statin plus beta-blocker (aHR 0.541; P = 0.000) prescriptions were associated with longer survival times. Additionally, PP whose Barthel index was ≥ 60 showed a lower risk of disability progression if treated with statins (aOR = 0.476; P = 0.000), or their combinations, mainly with ACEI/ARB plus beta-blockers (aOR 0.563; P = 0.031). Conclusions: The prescription of statins, alone or in combination with other drugs, may impact the survival and functional decline in polypathological patients. Further prospective blinded randomised assays are needed to confirm these observations.
Reliability of a short questionnaire for the diagnosis of severe disability in polypathological patients attended in hospital setting
European Journal of Internal Medicine, 2013
A comprehensive evaluation of polypathological patients (PP) should always include a functional e... more A comprehensive evaluation of polypathological patients (PP) should always include a functional evaluation. For this purpose, a modified version of the Barthel Index (BI) is the most applied questionnaire, and it consists of a 10-variable scale. The aim of this study was to develop a screening and confirmation tool to diagnose high disability with the fewest number of dimensions of the BI as possible. This present cross-sectional observational multicentre study included PP attended in 36 Spanish hospitals that were divided into two geographical areas (Western and Eastern). The Western area was considered to be the derivation subgroup of PP, and the Eastern area was the validation subgroup. Complete disability for each item (value of 0) was assessed for the diagnosis of severe disability. Diagnostic validity indices (sensitivity, specificity, negative and positive predictive values [NPV and PPV, respectively], and negative and positive likelihood ratios [NLR and PLR, respectively]) were determined for the derivation subgroup. The dimensions with the best diagnostic validity indices were then used to evaluate the validation subgroup. The analysis included 1521 PP, 753 PP from the Western area and 768 PP from the Eastern area. Needing complete help for bathing showed the highest NPV and lowest NLR in the derivation/validation subgroups (NPV 96.87/95.54, NLR 0.07/0.13). Being disabled for feeding alone showed high PPV and PLR values (PPV 97.97/95.65, PLR 109.25/49.62), as did disability for transfers (PPV 98.48/97.96, PLR 143.36/107.68). In addition, complete disability for feeding and transfers had the best PPV and PLR in both subgroups (PPV 100/100, PLR X/0). A two-dimension mini-Barthel Index may represent a reliable diagnostic test for severe disability in PP.
Caregivers' features and social support in patients with advanced medical diseases
European Journal of Internal Medicine, 2013
Granuloma necrosante extravascular de Churg-Strauss
Actas Dermo-Sifiliográficas, 2001
... En el resto de pruebas complementarias rea-lizadas destacaba una anemia normocítica-normo-cró... more ... En el resto de pruebas complementarias rea-lizadas destacaba una anemia normocítica-normo-crómica, 20.500 leucocitos con una eosinofilia del 50%; GOT, 70 UI/l; GPT, 63 UI/l; FA, 357; LDH, 496; factor reumatoide, 30 UI/ml; ANA negativo, ANCA específico MPO positivo ...
Recalibración del Palliative Prognostic Index en pacientes con enfermedades médicas avanzadas
Revista Clínica Española, 2013
ABSTRACT OBJECTIVE: To analyze the accuracy of the Palliative Prognostic Index (PPI) in patients ... more ABSTRACT OBJECTIVE: To analyze the accuracy of the Palliative Prognostic Index (PPI) in patients with advanced medical diseases and to recalibrate it in order to adapt it to the profile of these patients. METHODS: Multicenter, prospective, observational study that included patients with one or more advanced medical diseases. Calibration (Hosmer-Lemeshow goodness of fit) and discriminative power (ROC and area under the curve [AUC]) of PPI were analyzed in the prediction of mortality at 180 days. Recalibration was carried out by analyzing the scores on the PPI of each quartile upward of dying probability. Accuracy of PPI was compared with that obtained for the Charlson index. RESULTS: Overall mortality of the 1.788 patients was 37.5%. Calibration in the prediction of mortality was good (goodness of fit with P=.21), the prognostic probabilities ranging from 0-0,25 in the first quartile of risk and from 0,48-0,8 in the last quartile. Discriminative power was acceptable (AUC=69; P=.0001). In recalibrated groups, mortality of patients with 0/1-2/2.5-9.5/≥10 points was 13, 23, 39 and 68%, respectively. Sensitivity (S) and negative predicative value (NPF) of the cutoff point above 0 points were 96 and 87%, respectively; while specificity (sp) and positive predictive value (PPV) of the cutoff point above 9.5 points were 95 and 68%. Calibration of the Charlson index was good (P=.2), and its discriminative power (AUC=.52; P=.06) was suboptimal. CONCLUSIONS: PPI can be a useful tool in predicting 6-month survival of patients with advanced medical conditions.
Subcutaneous furosemide as palliative treatment in patients with advanced and terminal-phase heart failure
BMJ Supportive & Palliative Care, 2012
ABSTRACT Between January 2008 and January 2012, we treated 17 elderly patients (34 consecutive ep... more ABSTRACT Between January 2008 and January 2012, we treated 17 elderly patients (34 consecutive episodes; range 1-7 episodes/patient) suffering of decompensated advanced heart failure (DAHF, NYHA class III-IV, mean age 82.94±7 years) with subcutaneous furosemide in their homes, as stated by their preferences, under support of a hospital at home unit working in a urban university hospital. Then these episodes were compared with 63 in 27 patients treated with intravenous furosemide (IVF) on wards. Median number of previous and after intervention hospital admissions, initial, daily and total dose of furosemide and length of stay were analysed. Similar clinical and demographic features were present among both groups. They were all frail polypathological patients (at least two complex chronic diseases) with high degrees of disability and polymedication. We administered a median total dose of 720 [480-1125] mg of SCF vs. 720 [320-1200] mg of IVF per episode (P value = 0.666) and a median initial dose of 160 [120-250] vs. 80 [60-160] (P value = 0.005), respectively. The median length of stay/episode was 12.5 [8-16] vs. 7 [5-12] days (P value = 0.001). Higher initial doses showed fewer days of stay at hospital or hospital at home unit (fig. 1), this dose-effect was less evident among patients treated with IVF. The inverse effect was associated with higher total doses/episode. A 90% of patients (78.6% vs. 96.2%, P value=0.115) died during the period of study, accounting for a median survival time (SCF vs. IVF) of 26.51 [10.8-253.31] vs. 17.67 [8.84-292-58] (P value=0.937) days. Survival analyses showed higher survival times for beta-blocker treated patients (P=0.03) and Barthel index > 40 (P=0.01). 5 relevant local adverse reactions were present among SCF treated patients: hematoma (3), local infection needing oral antibiotics (1) and drip removal (1). Overall satisfaction with home SCF treatment was excellent and well appreciated by the families, who previously did not know about the possibility of being treated at home. Subcutaneous furosemide is a promising and feasible palliative treatment for patients with advanced or terminal decompensated heart failure.
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Papers by Francisco Javier Galindo Ocaña