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Biomedical subjects

F López-Jiménez

Publications and source records attributed to F López-Jiménez.

13 recordsLinked to original sources
PubMed1998

Predictive value of creatine kinase (CK)-MB for diagnosis of acute myocardial infarction after major noncardiac surgery.

BACKGROUND: The aim of this study was to provide insight into the interpretation of CK-MB data after major noncardiac surgery. METHODS: Some 3,321 patients who underwent major non-emergent noncardiac procedures (orthopedic 31%, intrathoracic 12%, vascular 22%, other 35%) were studied. All patients had at least two CK samples measured postoperatively. RESULTS: Acute myocardial infarction was diagnosed in 43 (1.3%) patients using study criteria including CK-MB and electrocardiographic data. All of the various threshold values of peak CK-MB values and peak CK-MB as a percentage of total CK had poor positive predictive values because of high false positive rates and the low rate of acute myocardial infarction. CONCLUSION: These data demonstrate the need for markers of myocardial injury with greater cardiac specificity after noncardiac surgery.

Aged↗
PubMedDate not supplied

Evidence-based medicine.

Explore the source record for details and available documents.

Evidence-Based Medicine↗
PubMedDate not supplied

Update in internal medicine.

More than 500,000 new medical articles are published every year and available time to keep updated is scarcer every day. Nowadays, the task of selecting useful, consistent, and relevant information for clinicians is a priority in many major medical journals. This review has the aim of gathering the results of the most important findings in clinical medicine in the last few years. It is focused on results from randomized clinical trials and well-designed observational research. Findings were included preferentially if they showed solid results, and we avoided as much as possible including only preliminary data, or results that included only non-clinical outcomes. Some of the most relevant findings reported here include the significant benefit of statins in patients with coronary artery disease even with mean cholesterol level. It also provides a substantial review of the most significant trials assessing the effectiveness of IIb/IIIa receptor blockers. In gastroenterology many advances have been made in the H. pylori eradication, and the finding that the cure of H. pylori infection may be followed by gastroesophageal reflux disease. Some new antivirals have shown encouraging results in patients with chronic hepatitis. In the infectious disease arena, the late breaking trials in anti-retroviral disease are discussed, as well as the new trends regarding antibiotic resistance. This review approaches also the role of leukotriene modifiers in the treatment of asthma and discusses the benefit of using methylprednisolone in patients with adult respiratory distress syndrome, among many other advances in internal medicine.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[The seroepidemiology of rubella in a female population of reproductive age in León, Guanajuato].

In order to assess the seroepidemiology of protective antibodies against rubella among women from León, Guanajuato, Mexico, a prospective study was done. The sample consisted in 176 serum samples from urban and rural women at reproductive age, drawn from June 1990 to June 1991. Samples were tested by the classic hemagglutination inhibition method, titers of 1:8 or higher were considered as positive. Global positivity was 71 per cent (125 sera). Seropositivity did not increase with women's age; the lowest values were seen at the rural zones (58.9%). This survey showed a lower seropositivity than the previously reported in Mexico, and confirms data from new official studies. With this information authors suggest that the utility and viability of a national vaccination program should be reviewed and propose that it could be risky that individual clinicians to recommend children vaccination because the lack of coordination could increase adult cases of rubella.

Adolescent↗
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[Clinical interpretation of statistical significance].

In any clinical study which compares versus an established therapy, the results will be expressed in terms of statistical significance. For this reason, it is important that every clinician interested in a judicious interpretation of the scientific literature, understands the origin and interpretation of statistical significance. The present paper addresses physicians attempting to give practical meaning to research results by discriminative and critical reading. The main aim is to explain in a simple way the meaning of the P-value, confidence intervals, and the required number to treat. Using practical examples, the most common mistakes in the interpretation of statistical significance are analyzed. The difference between statistical and clinical significance is emphasized and a new way to express and compare the practical utility of clinical trial results and the required number to treat is given.

Clinical Trials as Topic↗
PubMedDate not supplied

[When should a disease be diagnosed early and whose disease?].

Screening programs may seem useful and effective. However, in many cases the benefit is not clear and may actually do more harm than good. Each time a clinician asks for an early diagnostic test, the scientific evidence and the attributed risks need to be defined. The effectiveness of any early diagnosis test relies on the characteristics of the test itself, the disease to be ruled-out, and the side effects of the test. Such effects may be physical and emotional and the outcomes may be against the well being of the patient. In general, if an early diagnostic test does not lead to improvement in the survival and/or morbidity of patients, its utilization is not justified.

Diagnosis↗
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[Methodologies of publications in the Revista de Investigación Clínica during the last 20 years].

OBJECTIVE: To characterize the clinical research methods published in the Revista de Investigación Clínica for the past 20 years. DESIGN: Comparative study of methods used in the RIC articles published in 3-years periods representing three decades (1972-74, 1982-84, 1992-94). RESULTS: Out of 273 original papers, 218 (80%) were of clinical research. There was an increased percentage of longitudinal vs cross-sectional studies, with cohort and randomized clinical trials showing the largest increase. The total number of research manuscripts also increased. CONCLUSION: The clinical research methods of the papers in the RIC have shown an increased rate of designs with a higher scientific value.

Bibliometrics↗
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[First-line treatment. What is lost by not giving it].

It is highly desirable to give always the best therapeutic alternative. However, the accomplishment of this goal is not always possible, leaving the physician with second, third or no therapeutic choice at all. The reasons for this may be economic, logistic, medical and cultural. In order to know what the patients are losing, we need to test how strong the scientific evidence is for the first choice option, and second, we have to consider the magnitude of improvement on clinical outcomes, comparing the best therapy and the next best available therapy. In many instances, the difference in clinical benefit is small and even negligible.

Choice Behavior↗
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[Measuring the impact of medical interventions at the individual level].

Medical interventions have a variable response among individuals. It is desirable to detect patients who are getting a therapeutic benefit. Any medical intervention has to show a favorable effect in survival and/or control of symptoms in order to be considered useful. In many clinical scenarios, laboratory test results are not enough to be confident of the effectiveness of a treatment. In order to do a clinical evaluation focused on patients' interests, we suggest the use of instruments to measure quality of life. Currently there are quality of life scales that have undergone a rigorous process of validation and reliability. Sub-group analysis is frequently used to predict an individual benefit of medical interventions. In the interpretation of sub-group analysis, it is important to be aware of the risk of misinterpretation, making false positive or false negative conclusions about the effect of the treatment. The N-of-1 trial is a valid scientific alternative to define individual effectiveness of therapy. Defining the degree of therapeutic benefit timely we avoid useless therapies, unnecessary side effects, and sequelae secondary to the lack of opportune treatment.

Clinical Trials as Topic↗
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[Problems and solutions in the interpretation of diagnostic tests].

The interpretation of diagnostic tests has had a remarkable progress in recent years with a tendency towards a more clinical and patient-oriented perspective. Here we emphasize the limitations of using the dichotomy positive/negative testing or cut-off points for normality in many of our medical decisions. We also introduce alternative methods to interpret diagnostic tests, specially in unusual circumstances, i.e., in the development of new diagnostic tests that may be better than the accepted gold standard or when there is no gold standard. Finally we analyze the different interpretations of false negative results that may modify the interpretation of subsequent testing in a patient.

Algorithms↗
PubMedDate not supplied

[Interpretation of negative clinical trials].

Randomized clinical trials without statistically significant differences between treatment groups may provide useful information for clinicians. However, negative trials must be interpreted cautiously, since the absence of evidence of treatment effect is not the same as evidence of absence of treatment effect. Before the reader of a negative article can conclude that one intervention was not better than the other, the potential causes of a negative study should be explored. The objective of this manuscript is to critically describe some of the most common methodological problems that can explain the lack of difference between studied groups in randomized clinical trials.

Data Interpretation, Statistical↗