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I Marín León

Publications and source records attributed to I Marín León.

14 recordsLinked to original sources
PubMed2001

[Medical history in the assessment of quality of care in ischemic cardiopathy: is it a valid information source?].

OBJECTIVE: To examine the availability of information in the clinical records (CR) to evaluate care quality in ischemic heart disease. MATERIAL AND METHODS: A total of 722 clinical records of patients admitted because of ischemic heart disease were evaluated. Based upon a bibliographic review and the criteria of an expert panel necessary data to evaluate care quality were selected. A CR was considered adequate when at least 80% of data considered necessary by the expert panel were available. RESULTS: 78.5% of CR had adequate data. The elderly, clinical presentation as ischemic equivalent and one of the hospitals studied had most deficient CR. CONCLUSIONS: The CR is valid to retrospectively evaluate medical care. Differences between hospitals were important and should be taken into consideration before studies on clinical quality are performed.

Cross-Sectional Studies↗
PubMed2001

[Hospital discharge reports may be an inadequate source of information to evaluate care quality].

OBJECTIVES: To examine whether there is adequate available information in hospital discharge records (HDR) to retrospectively evaluate the adequacy of medical care to patients suffering from ischemic heart disease (IHD) and to relate care quality to physicians' decisions. MATERIAL AND METHODS: Cross-sectional study in which a total of 690 HDRs of patients admitted to three university teaching hospitals in Seville, Spain, on account of ischemic heart disease. The fulfillment of 15 parameters representing an adaptation to the CMBD regulation to IHD. The criterion of adequate information was set at 80% of data. RESULTS: Only 2.8% of HDRs contains adequate information. According to the analysed data, relevant fulfillment variability was observed. There were significant differences in fulfillment depending upon hospital and type of patient, with more information among younger patients and comorbidity. CONCLUSIONS: HDRs contain inadequate information to evaluate medical care.

Adult↗
PubMed2000

[Mapping the scientific evidence for bedside care to unstable angina. A preliminary step to develop clinical guidelines. The name of the study group CAMBIE Change in the Medical services based on the clinical practice guidelines].

BACKGROUND: The uncertainty in clinical practice arise from the need of physicians to make decisions on a limited ground of knowledges. Guidelines are supposed to facilitate clinical decisions in such circumstances. Sharing knowledges on natural history of diseases and clinical expertise allow to define and array of steps structured on a formal flow-chart. The node of algorithms identifies decisions to analyze. This paper presents a taxonomy of specific questions related to each decision nodes for management of unstable angina and assesses the level of evidence available for each question. MATERIAL AND METHOD: A flow chart diagram display the conceptualized key nodes for clinical management of unstable angina. A set of specific question related to clinical exclusive circumstances, diagnostic approach, utility of diagnostic procedures, definition of prognosis and outcomes was raised for each decision node. From a systematic literature review the best available evidence was gathered. Each recommendation was linked to a level (A-C) of evidence, and to a body of consensus expert panel decisions. RESULTS: 34 decision nodes were identified, related with at least 1 question for appraisal of the best evidence. The solution to these questions yielded 40 recommendations scored by the strength of the evidence available. Five recommendations of diagnostic, 20 at prognostic and 15 at therapeutic step. The strength of evidence was A for 73% of recommendations at therapeutic step versus 40% at the two other steps. CONCLUSIONS: A clinical complex problem can be displayed in a continuous process, to allow identification and appraisal of decisions at different clinical nodes. The work-up to achieve a conceptualization of a clinical problem is the preliminary step to develop clinical practice guidelines. Identification of decision nodes allows to manage uncertainty in a explicit way and make policy statement more acceptable by managers and physicians.

Algorithms↗
PubMed1999

[A reproducibility and validity study of a systematic review on ischemic cardiopathy. The Study Group of the Quality of Care (GRECA)].

BACKGROUND: The systematic literature reviews have been proposed as a method of scientific evidence identification since they protect the final product from the subjectivity of each primary source reviewer. However, it is not known whether the different ways of evidence synthesis accomplish suitable criteria of objectivity, reliability and biases protection so as to be considered scientifically valid. An experiment of reliability and validity of a systematic literature review about coronary heart disease was carried out. MATERIAL AND METHODS: Study of blind concordance between two independent reviewers for the identification, selection, retrieval and quality evaluation of the articles by using the same protocol. The concordance was analysed by the kappa index for two observers in different categories. The validity was evaluated throughout the acceptability of the review users. RESULTS: The concordance for their identification capacity was poor although they used the same key words (869 versus 476). But the concordance improved when considering selection (26.6% versus 29.2%), retrieval (agreement = 76%) classification by kind of article (kappa = 0.60) and scoring by strength of the evidence (kappa = 0.87). The acceptability was high among review users. CONCLUSIONS: It would be assumed that, even under tight rules of performance, the systematic literature reviews are not completely protected against some biases which could damage their validity in a non easily controllable form. The implication of reviewers, experts in documentation and users of the literature, together with pilot studies performed previous to the review, seems to be the best way to yield better results.

Humans↗
PubMed1990

[Atraumatic rupture of the spleen. A proposal of new attitudes. Apropos a case in brucellosis].

A case of spontaneous spleen rupture during acute brucellosis, followed by clinical and ultrasound examinations until the natural resolution of the subcapsular hematoma, is presented. The causes of this complication are reviewed and a new classification is proposed, creating 3 groups of nontraumatic ruptures: spontaneous, with basal splenic disease and associated to other pathology. We highlight the several states of spleen ruptures--some with spontaneous resolution--and the utility of the radiological techniques to carry out a follow-up on them, which can in some cases help avoid surgical intervention.

Adult↗
PubMed1980

[Inferior vena cava syndrome as first manifestation of a non-functioning adrenal carcinoma (author's transl)].

A case is studied of a non-functioning right adrenal carcinoma which is initiated clinically by a compressive syndrome of the inferior vena cava, without other clinical manifestations to suggest the origin of the tumor. The clinical findings are discussed as well as the roentgenographic images, the computerized axial tomography and surgery, which was followed by the death of the patient, with considerations concerning the possible mechanisms that might explain the death. A bibliographic review is conducted on the most outstanding aspect of non-functioning adrenal tumors and the rarity with which they present themselves in this form, of which we have found only one previous report.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

[Europan: the European project for the study of hypocaloric peripheral parenteral nutrition in surgical patients].

This is the first time that a concerted action in the field of biomedicine proposed by Spain has been accepted by the European Communities. The research project, presented by one of the authors under the name of EUROPAN, proposes the study of hypocaloric peripheral parenteral nutrition in surgical patients. At present the concerted actions committee in biology (COMAC-BIO) of the E.C. is financing an exploratory phase in order to elaborate a prospective protocol by means of a workshop that will take place in Madrid in march 13 and 14. Twenty four European experts and several Spanish observers will take part in the meeting. The exploratory phase will conclude in june 1989, date in which it will be submitted for approval to the Commission of the European Communities and their consultative committees. If the concerted action proposal is finally approved, it will have to be executed during the next three years, ending by january 1992. Legal aspects of the E.C. in which this project is considered, as well as scientific, social and organizational goals and actions to be executed are described in this article.

Congresses as Topic↗