Biomedical subjects
Publications and source records attributed to J Merino Sánchez.
Without a doubt blood pressure autoevaluation facilitates hypertension diagnosis, control and treatment. This also helps research, makes possible costs reduction and is an easy, safe, and useful method. Its use should be favored in the new model of patient-based clinical practice.
The importance of rhythmic activities in humans, and their influence on the diseases are underscored. Clinical chronology is fundamental in order to interpret the physiopathological basis of temporary variations. Knowing the variability of the biological processes also makes it possible improving the effect of drugs utilized and minimize their adverse effects. This is the objective of Chronotherapy. We apply chronology and Chronotherapy in cardiovascular diseases, since many of them adjust their prevalence for specific rhythms. One thinks about the mechanisms or factors that favor cardiovascular diseases, especially those related to the circadian variations of blood pressure. We also review the variations in the pharmacokinetics of the drugs used in the treatment of cardiovascular diseases, delving further into the analysis of its effects according to their administration schedule. We can conclude that the use of those drugs according to the chronological knowledge makes possible to achieve better results in the control of cardiovascular diseases, and a greater safety in its use.
A randomised clinical trial was devised to establish whether telephonic back-up added to educational strategy and improved compliance with antibiotic treatment in acute tonsillitis/pharyngitis compared with educational strategy only. The intervention group was given a telephone call on the fourth day after the start of therapy. There were 64 patients in each group (intervention and control). The criterion for evaluating the compliance was to count the tablets in a spot-check at the patient's house. A tablet count of 80-110% defined good compliance. The effect of the intervention was calculated according to the indicators: absolute risk reduction (ARR), relative risk reduction (RRR) and number needed to treat (NNT). A good compliance percentage was 66.1% (57.7-74.5%) and was significantly higher in the intervention group (78.3%) than in the control group (54.1%) ( P=0.005). Indicators of clinical relevance after the intervention were ARR: 24.2%; RRR: 52.7%; NNT: 4.13. In conclusion telephonic back-up significantly improved the compliance obtained by educational strategy only. It should be used in clinical practice.
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OBJECTIVE: To value the grade of anxiety and psychosomatic semiology in hypertensive patients treated with lercanidipine and to analyse their evolution. A secondary objective is to carry out a pharmacovigilance study with lercanidipine. MATERIAL AND METHODS: Prospective multicentre observational 6 month study in primary hypertensive patients with SBP between 140-180 mm Hg and/or 90-110 mm Hg DBP. After a washout period of 10 days, treatment with 10 mg (1-0-0) lercanidipine is initiated. If BP is not controlled treatment with ramipril 2.5 mg/day is instaured. Clinical check-ups are carried periodically with measurements of BP, Heart Rate, objective valuation of tolerance to the drug and observance. At the initiation and end of the study biochemical check-ups are carried out, the level of anxiety is measured using the STAI questionnaire (Trait subscale) (Evaluation in decatipes 0-4 without ansiety 4-7 moderate ansiety, 7-10 high ansiety) and the psychosomatic profile with a questionnaire designed by this group. (Scale 0-18; 0 large semiology, 18 without semiology). Clinical tolerance to the drug is valued both subjectively and objectively. RESULTS: On included 538 patients. On registred 54 drop out, with side effects (3.75/). Completed the study 484 (237 M, 247 F), 429 of them with Lercanidipine in monotherapy (88.6/). Mean age 60.9 +/- 10.7. Mean BMI 29.1 +/- 5. The grade of anxiety did not alter during the study passing from 4.6 +/- 1.7 at the beginning of the study to 4.5 +/- 1.7 at the end of the study (valuation in decatypes) (ns). The psychosomatic semiology changed favourably from 10.7 +/-4.2 to 12.5 +/- 3.7 (p<0.00005). The evolution according to sex is similar. The mean SBP decreased from 165.6 +/- 12.2 mm Hg to 137.9 +/- 10.4 mm Hg (p<0.00005) and the mean DBP decreased from 96.5 +/- 8.1 mm Hg to 81.0 +/- 6.1 mm Hg (p<0.00005). Clinical tolerance was very good. Biochemical parameters were modified substantially: initial cholesterolemia 227.7 mg/dl and final cholesterolemia 213.6 mg/dl (p<0.00005); initial glucose 108.4 mg/dl and final glucose 105.7 mg/dl (p<0.00005). CONCLUSIONS: The mean level of anxiety in the group studied is confirmed not to vary during the length of the study. Psychosomatic semiology is reduced being statistically significant. Lercanidipine is shown to be very effective as antihypertensive and well tolerated. 164
The acute respiratory distress syndrome (ARDS) is a rare but serious complication of miliary tuberculosis with a mortality rate near 100% when associated with pancytopenia. This association has been rarely reported (eleven cases in a Medline search, 1966-1999). A case is here reported of an HIV-negative patient with miliary tuberculosis which presented as ARDS associated with pancytopenia. This case prompted us to review the literature and risk factors, diagnosis and treatment issues are discussed. In patients with predisposing factors miliary tuberculosis must be considered as a possible cause of ARDS.
OBJECTIVES: To find the non-compliance of patients with Lipaemia with scheduled appointments, to define the profile of non-attending patients and to study the best way of identifying them. DESIGN: Prospective study. SETTING: Primary Care Centres in the province of Alicante. PATIENTS: 107 patients with Lipaemia from five General Medical clinics who received treatment with lipid-lowering drugs. MEASUREMENTS AND MAIN RESULTS: Non-compliance was assessed by reviewing the appointment books. Non-compliant patients were defined as those who had not attended 80-100% of the appointments made in the six months since the beginning of the study. Non-compliance with appointments was 16.8% (CI: 9.7-23.9). In the profile study none of the variables analysed showed significant differences. Of the methods validated, level of knowledge had the highest sensitivity (88.9%: CI 81.9-94.1); and medical judgement the greatest specificity (86.5%: CI 79.5-92.5), with the coefficient for probability of low compliance 2.9 and best Kappa index 0.25. CONCLUSIONS: One out of every six patients with Lipaemia does not attend follow-up appointments. There is no profile of the non-compliant patient. Only medical judgement can be valid for suspecting non-compliance with scheduled appointments.
OBJECTIVE: To know the non-compliance of hypertensive patients with scheduled visits, to define the patient profile, and to study the best method which identifies such patients. PATIENTS AND METHODS: A total of 174 hypertensive patients under pharmacological therapy in the Primary Care setting. Non-compliance with scheduled visits was assessed by review of the appointment book. The characteristics of patients, of the disease, and therapy associated with non-compliance were studied and six indirect methods were validates. RESULTS: The profile of the non-compliant patient corresponded to a housewife or with working activity (p = 0.01), obesity (p = 0.01), anxiety (p = 0.008), moderate-severe cardiovascular risk (p = 0.02), bad control of blood pressure values (p = 0.03), and physician's dependence (p = 0.001). Of the investigated methods, education level (EL) had the highest sensitivity (77.8%) (CI: 65.7%-89.9%) and medical judgement (MJ) the highest specificity (87.6; CI: 81.9%-93.3%), negative predictive value 80.1%, positive predictive value 51.5%, odds ratio of low compliance 3.1 and best Kappa index 0.28. CONCLUSIONS: Factors predicting non-compliance are few but delineate a possible profile. Only MJ is valid to detect non-compliance with scheduled visits.
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OBJECTIVES: To validate six indirect methods for evaluation of therapy compliance with oral hypoglycemic agents: self-reported compliance, attendance to scheduled visits, Morisky-Green test, degree of disease control, medical judgement and level of knowledge on the disease. PATIENTS AND METHODS: The certainty method used was pill counts at patient's home by surprise with a sample of 107 randomly selected patients from three Primary Care Centers in the province of Alicante. RESULTS: SV was the method with the highest specificity (94.2%), likelihood of low compliance (84.2%) and percentage of likelihood of low compliance (5.1). DC assessed by basal blood glucose had the highest sensitivity (81.8%) and DC assessed by glycoxylated hemoglobin the highest likelihood of high compliance (61.1%). CONCLUSIONS: In this study, SV and DC with basal blood glucose were the highest validity indicators and could be used combined in clinical practice to evaluate compliance with oral hypoglycemic agents.
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OBJECTIVE: To analyse frequency of attendance at a Unit of Compliance with Chronic Prescriptions (UCCP) within a Health Centre (HC). DESIGN: A prospective study with a six-year follow-up period 1986-1992. SETTING: The study was carried out at the Florida HC, Alicante, which covers an urban population of about 20,000 inhabitants. PATIENTS AND OTHER PARTICIPANTS: The population under study were those patients who needed pharmacological treatment for a period longer than three months. The criteria of evaluation were: attendances and prescriptions dispensed at the UCCP, patient attendances avoided and time saved in medical consultations. MEASUREMENTS AND MAIN RESULTS: In 1986 there were 8,512 attendances at the UCCP (13.53% of the Centre's total attendance of 62,889), rising in 1992 to 12,884 (20.43% of the Centre's total of 63,078). In 1986 there were 18,000 prescriptions dispensed at the UCCP (16.38% of the Centre's total of 109,900) and in 1992, 41,500 (25.94% of the Centre's total of 160,000). The amount of time for medical consultations saved in the different years of the study ranged between 155 hours in 1986 and 536 in 1992. The index of prescriptions per attendance at the UCCP went up from 2.11 in 1986 to 3.22 in 1992. The index of attendances per patient and year was 12.09 in 1986 and 7.82 in 1992. CONCLUSIONS: A centralized unit for compliance with chronic treatments lessens the frequency of attendance for medical consultations, improves the patient's access renewed treatment and leads to a considerable saving in care time.
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