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Biomedical subjects

M Rué

Publications and source records attributed to M Rué.

At least 37 records · Page 2Linked to original sources
PubMed1997

Comparison of cytospat and pipelle endometrial biopsy instruments.

OBJECTIVE: To compare two endometrial biopsy techniques, based on the quality of material obtained, cost effectiveness, and pain during the procedure. STUDY DESIGN: A single blind, randomized prospective study. RESULTS: A total of 365 women with peri/postmenopausal bleeding were randomized into two groups: 174 biopsied cytospat (C) and 191 biopsied with pipelle (P). Both procedures were then followed by either dilatation and curettage (D&C) or hysterectomy. Pain was evaluated in 379 patients, with the result being better tolerance for P vs. C (3.55 vs. 4.06, P = 0.07). With C, the sensitivity in histological evaluation was 82% for benign endometrium, 60% for endometrial hyperplasia and 60% for corpus uterine neoplasia as compared to the D&C and hysterectomy material. With P the sensitivity was 84, 71 and 60%, respectively for the three diagnoses, as compared to the D&C and hysterectomy material. Insufficient tissue for pathologic evaluation was present in 24% of C, 25% of P and 9.8% of D&C samples. CONCLUSIONS: Cost effectiveness for pipelle is slightly higher than for Cytospat.

Adult↗
PubMed1997

Survival in patients with nosocomial pneumonia: impact of the severity of illness and the etiologic agent.

OBJECTIVE: To assess the impact of severity of illness at different times, using the Mortality Probability Models (MPM II), and the impact of etiologic agent on survival in patients with nosocomial pneumonia. DESIGN: Retrospective, observational study. SETTING: Fourteen-bed medical-surgical intensive care unit (ICU) in a teaching hospital. PATIENTS: Sixty-two patients with nosocomial pneumonia who were receiving early appropriate antibiotic treatment. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Severity of illness at the time of admission to the ICU (M0), 24 hrs after admission (M24), and at the time of pneumonia diagnosis (M1) was determined using MPM II. Bacteriology was established by quantitative cultures from bronchoscopic samples. The outcome measure was the crude mortality rate. The crude mortality rate in the ICU was 59.7%, compared with average predicted mortality rates of 43.5% (M0), 36.4% (M24), and 52.2% (M1). We observed significant differences in mean MPM II determinations between survivors and nonsurvivors at M1 (39.3% vs. 60.9%, p = .001) but not at M0 and M24. In the univariate analysis, the variables most predictive of mortality were the presence of coma (p = .02), inotropic medication use (p = .001), and an MPM II determination of > 50% (p = .001) when pneumonia was diagnosed (M1). Multivariate analysis showed that, in the absence of Pseudomonas aeruginosa, an MPM II determination of > 50% at M1 was associated with a relative risk of death of 4.8. The presence of P. aeruginosa was associated with an increase in the risk of death of 2.6 and 6.36 in both populations with MPM II determinations at M1 of < or = 50% and > 50%, respectively. CONCLUSIONS: Severity of illness when pneumonia is diagnosed is the most important predictor of survival, and this determination should be used for therapeutic and prognostic stratification. In addition, the presence of P. aeruginosa contributed to an excess of mortality that could not be measured by MPM II alone, suggesting the importance of the pathogen in prognosis.

Aged↗
PubMed1997

Assessment of the prognosis of coronary patients: performance and customization of generic severity indexes.

STUDY OBJECTIVE: To assess the prognostic performance of general severity systems (APACHE II [acute physiology and chronic health evaluation], simplified acute physiology score [SAPS II], and mortality probability models [MPM II]) in coronary patients and to derive new customized indexes for coronary patients using a reduced number of variables. DESIGN: Inception cohort. SETTING: Adult medical and surgical ICUs in 17 hospitals in Catalonia and the Balearic Islands. PATIENTS: Four hundred fifty-six patients with acute myocardial infarction. MEASUREMENTS AND RESULTS: The APACHE II, SAPS II, and MPM II variables and survival status at hospital discharge have been collected. Performance of the severity systems was assessed by evaluating calibration and discrimination. Logistic regression was used to customize the MPM II(24) and SAPS II indexes. Discrimination was high enough for all of the models. However, calibration of the MPM II(24) was not as satisfactory as for the other models. The MPM II(24) and SAPS II were both reduced to five variables (MPM II(24 cor:) age, PaO2, continuous vasoactive drugs, urinary output, and mechanical ventilation; SAPS II(cor:) age, PaO2/FI(O2) ratio, systolic BP, Glasgow coma score, and urinary output). Both models showed better calibration and discrimination than the original ones. CONCLUSIONS: Prognostic indexes developed for multidisciplinary patients show good performance when applied to patients with acute myocardial infarction, but customization can reduce the number of variables necessary to compute them without a loss of, and a possible improvement in, prognostic accuracy.

Acute Disease↗
PubMed1996

Lung cancer mortality among males of Catalonia and Spain compared with other European countries between 1975-1977 and 1987-1989.

This study compares the lung cancer mortality rates among males in the years 1975-1977 and 1987-1989 in Catalonia and Spain with other European countries selected for their geographical proximity. Adjusted calculations using the direct method have been made for male lung cancer mortality. Adjusted truncated rates for the age groups 0-44, 45-64 and more than 65 years were also calculated, as well as percent differences between the mortality rates of each period studied. Lung cancer mortality rates for males in Catalonia and Spain show relative increments of 46.58% and 52.41%, respectively. In contrast, lung cancer mortality in countries such as England-Wales and Switzerland have decreased. Moreover, the 0-44 year age group in Catalonia and Spain shows the absolute highest rates in the 1987-1989 period among all the countries analyzed. The marked contrast of the lung cancer mortality rate evolution in Catalonia and Spain compared with some other European countries and the considerable increase of the mortality in younger age groups indicate the need to intensify lung cancer control measures.

Adolescent↗
PubMed1996

Measuring health and health state preferences among critically ill patients.

OBJECTIVE: a) to examine the EuroQol instrument's ability to assess a patient's state of health prior to admission to an ICU; b) to describe a patient's health-related quality of life (HRQoL) before the onset of the condition leading to admission to the ICU, and prior to discharge; c) to compare patients' preferences for a "common core" of EuroQol health states with preferences from healthy individuals. DESIGN: Patients in a step-down unit (SDU) retrospectively rated their health states prior to admission to the ICU, their current states of health and the "common core" of hypothetical EuroQol states of health. Proxies rated the patients' health states prior to admission to the ICU. Patients' preferences for EuroQol states of health were compared with the preferences obtained from a retrospective cohort of healthy individuals. SETTING: An SDU at the University Hospital of Bellvitge, Barcelona, Spain. PATIENTS: 103 critical medical and surgical patients were interviewed. INTERVENTION: The EuroQol questionnaire, a non-disease specific instrument to evaluate HRQoL. MEASUREMENTS AND MAIN RESULTS: Agreement between patients and proxies regarding their prior health state was moderate to good in physical and pain areas (kappa: 0.43-0.58), fair for mood (kappa: 0.38) and almost identical for prior overall health (65.9 vs 66.3). Compared with their prior HRQoL, patients had deteriorated in all physical areas and overall health at discharge from the SDU. Preferences for the worst health states varied significantly between patients and healthy individuals. CONCLUSION: The EuroQol can be reliably used with proxies to determine the state of health of patients prior to admission to the ICU. Preferences between healthy individuals and ICU patients differed.

Adult↗
PubMed1996

Evaluation of outcome for intubated patients with pneumonia due to Pseudomonas aeruginosa.

Thirty consecutively intubated patients with pneumonia due to Pseudomonas aeruginosa (cases) were prospectively observed to establish the attributable mortality rate and the prognostic value of APACHE (Acute Physiological and Chronic Health Evaluation) II scores. Four cases did not receive accurate empirical therapy and were excluded from the study. APACHE II scores were calculated within 24 hours of admission (T0), at the time of the diagnosis of pneumonia (T1), and after 72 hours of therapy (T2). The outcomes for these cases (n = 26) were compared with those for matched controls (n = 52) without pneumonia. Six cases died of causes directly related to pneumonia (group D). Two cases whose conditions clinically improved died of cardiac complications, and 18 cases had clinical resolution (group R); however, only 15 of these cases were alive at discharge. The mean APACHE II score at admission was similar (P > .20) for group R, group D, and controls. In contrast, the mean score at T1 (15.40 +/- 6.07 vs. 20.83 +/- 4.66; P < .05) and the mean score at T2 (10.40 +/- 3.57 vs. 25.50 +/- 3.93; P < .01) differed significantly for groups R and D, respectively. The overall observed and predicted mortality rates among cases and controls were 42.3% and 28.1% and 28.8% and 28.7%, respectively, while the attributable mortality rate among cases was estimated to be 13.5% (95% confidence interval, 1.95%-25.04%). We conclude that the attributable mortality rate among intubated patients with pneumonia due to P. aeruginosa is high. The APACHE II score at admission is not useful as a prognostic factor, while progression of organ dysfunction after the onset of pneumonia is an ominous sign.

Adult↗
PubMed1996

Spinal anesthesia with bupivacaine and fentanyl in geriatric patients.

We assessed the risks and benefits of the administration of fentanyl during spinal anesthesia in the elderly. Forty patients (70-83 yr) undergoing knee or hip replacement were studied. Preoperatively, cognitive function (minimental state examination [MMSE]), associated pathology, medications, and treatment were evaluated. Patients had spinal anesthesia with 12.5 mg bupivacaine plus saline (SS; n = 21) or 25 micrograms fentanyl (FN; n = 19). The number of ailments and drugs per patient were 2.5 and 2.3, respectively; 35%-44% of disorders were untreated, 16%-26% were symptomatic, and 33% were adequately treated. Groups were comparable regarding demographic data and characteristics of the spinal block. Group FN had more pruritus (P < 0.02) and lower SaO2 (P < 0.007), but prevalence of side effects was similar. Pain intensity (visual analog scale [VAS], facial expression test [FET] at the time of analgesia request (TAR) was lower in Group FN (P < 0.01). A poor correlation between VAS and FET (range 0.42-0.58) was obtained. MMSE at hospital discharge was no different from preoperative values. Our results show that 25 micrograms of spinal fentanyl do not modify spinal anesthesia in the elderly, but induces pruritus and O2 desaturation. The decrease in postoperative pain intensity and the preservation of cognitive function would justify the use of spinal fentanyl in the elderly.

Aged↗
PubMed1996

Pneumonia in intubated patients: role of respiratory airway care.

In order to assess potential risk factors for pneumonia within the first 8 d of ventilation, we studied 83 consecutive intubated patients undergoing continuous aspiration of subglottic secretions (CASS). Multivariate analysis showed the protective effect of antibiotic use (relative risk [RR] = 0.10; 95% confidence interval [CI] = 0.01 to 0.71), whereas failure of the CASS technique (RR = 5.29; 95% CI = 1.24 to 22.64) was associated with a greater risk of pneumonia. In addition, there was a trend toward a higher risk of pneumonia (RR = 2.57; 95% CI = 0.78 to 8.03) among patients with persistent intracuff pressures below 20 cm H2O. The remaining factors analyzed were not significant. Failure of CASS did not influence the development of pneumonia among patients undergoing antibiotic treatment (33.0% versus 38.5%, p > 0.20), but was strongly associated with pneumonia (42.1% versus 8.3%, p < 0.01) among intubated patients not receiving antibiotics. When multivariate analysis was repeated in this subpopulation, failure of CASS (RR = 7.52, 95% CI = 1.48 to 38.07) and persistent intracuff pressure below 20 cm H2O (RR = 4.23, 95% CI = 1.12 to 15.92) were factors independently associated with the development of pneumonia. We conclude that leakage of colonized subglottic secretions around the cuff of the endotracheal tube is the most important risk factor for pneumonia within the first 8 d of intubation. This study confirms the importance of maintaining adequate intracuff pressure and effective aspiration of subglottic secretions in preventing pneumonia in intubated patients not receiving antibiotic treatment.

Antibiotic Prophylaxis↗
PubMed1995

Customized probability models for early severe sepsis in adult intensive care patients. Intensive Care Unit Scoring Group.

OBJECTIVE: To develop customized versions of the Simplified Acute Physiology Score II (SAPS II) and the 24-hour Mortality Probability Model II (MPM II) to estimate the probability of mortality for intensive care unit patients with early severe sepsis. DESIGN AND SETTING: Logistic regression models developed for patients with severe sepsis in a database of adult medical and surgical intensive care units in 12 countries. PATIENTS: Of 11,458 patients in the intensive care unit for at least 24 hours, 1130 had severe sepsis based on criteria of the American College of Chest Physicians and the Society of Critical Care Medicine (systemic inflammatory response syndrome in response to infection, plus hypotension, hypoperfusion, or multiple organ dysfunction). RESULTS: In patients with severe sepsis, mortality was higher (48.0% vs 19.6% among other patients) and 28-day survival was lower. The customized SAPS II was well calibrated (P = .92 for the goodness-of-fit test) and discriminated well (area under the receiver operating characteristic [ROC] curve, 0.78). Performance in the validation sample was equally good (P = .85 for the goodness-of-fit test; area under the ROC curve, 0.79). The customized MPM II was well calibrated (P = .92 for the goodness-of-fit test) and discriminated well (area under the ROC curve, 0.79). Performance in the validation sample was equally good (P = .52 for the goodness-of-fit test; area under the ROC curve, 0.75). The models are independent of each other; either can be used alone to estimate the probability of mortality of patients with severe sepsis. CONCLUSIONS: Customization provides a simple technique to apply existing models to a subgroup of patients. Accurately assessing the probability of hospital mortality is a useful adjunct for clinical trials.

Adult↗
PubMed1995

Changes in cancer mortality in Catalonia and Spain (1975-77 and 1987-89). A comparison with other European countries.

Comparisons of cancer mortality in Catalonia and Spain have shown an intermediate position of these areas in relation to the rest of Europe. This study compares the overall cancer mortality in Catalonia and Spain in the periods 1975-77 and 1987-89 in relation to other European countries selected on the basis of geographical proximity and availability of information. Adjusted and truncated cancer mortality rates and relative changes in these rates have been assessed for both sexes. The mortality rate for males in Catalonia, Spain, Italy, Portugal and France has increased from 1975-77 to 1987-89 with relative increments of 13.5%, 13.7%, 10.1%, 9.6% and 4.3% respectively, whereas in Switzerland and England and Wales this rate has decreased. The mortality rate for females showed a slight drop between the two periods in all the studied countries except England and Wales and Portugal. By age groups, in males, the 0-44 year interval in Catalonia, Spain, France and Portugal, in descending order, showed the highest rates. The marked contrast of the evolution of the cancer mortality rate in Catalonia, Spain, Italy, France and Portugal, compared with Switzerland and England and Wales, and especially the considerable increase of the mortality in young people in Catalonia, indicates the extremely urgent need for all countries to adopt the measures to control cancer that have already shown themselves to be effective elsewhere.

Adult↗
PubMed1994

Mortality probability models for patients in the intensive care unit for 48 or 72 hours: a prospective, multicenter study.

OBJECTIVE: To develop models in the Mortality Probability Model (MPM II) system to estimate the probability of hospital mortality at 48 and 72 hrs in the intensive care unit (ICU), and to test whether the 24-hr Mortality Probability Model (MPM24), developed for use at 24 hrs in the ICU, can be used on a daily basis beyond 24 hrs. DESIGN: A prospective, multicenter study to develop and validate models, using a cohort of consecutive admissions. SETTING: Six adult medical and surgical ICUs in Massachusetts and New York adjusted to reflect 137 ICUs in 12 countries. PATIENTS: Consecutive admissions (n = 6,290) to the Massachusetts/New York ICUs were studied. Of these patients, 3,023 and 2,233 patients remained in the ICU and had complete data at 48 and 72 hrs, respectively. Patients < 18 yrs of age, burn patients, coronary care patients, and cardiac surgical patients were excluded. OUTCOME MEASURE: Vital status at the time of hospital discharge. RESULTS: The models consist of five variables measured at the time of ICU admission and eight variables ascertained at 24-hr intervals. The 24-hr model demonstrated poor calibration and discrimination at 48 and 72 hrs. The newly developed 48- and 72-hr models--MPM48 and MPM72--contain the same 13 variables and coefficients as the MPM24. The models differ only in their constant terms, which increase in a manner that reflects the increasing probability of mortality with increasing length of stay in the ICU. These constant terms were adjusted by a factor determined from the relationship between the data from the six Massachusetts and New York ICUs and a more extensive data set, from which the ICU admission Mortality Probability Model (MPM0) and MPM24 were developed. This latter data set was assembled from ICUs in 12 countries. The MPM48 and MPM72 calibrated and discriminated well, based on goodness-of-fit tests and area under the receiver operating characteristic curve. CONCLUSIONS: Models developed for use among ICU patients at one time period are not transferable without modification to other time periods. The MPM48 and MPM72 calibrated well to their respective time periods, and they are intended for use at specific points in time. The increasing constant terms and associated increase in the probability of hospital mortality exemplify a common clinical adage that if a patient's clinical profile stays the same, he or she is actually getting worse.

Adult↗
PubMed1993

[Tendencies of mortality from cardiovascular diseases in Catalonia: 1975-1992].

BACKGROUND: There is an uncertainty of which is going to be the trend of cardiovascular disease in Spain. In the present study cardiovascular disease mortality is described from 1975 to 1992 in Catalonia, and a prediction until 1997 is made, assuming the same trend. Possible causes of this trend are analyzed. METHODS: Deaths from cardiovascular disease, ischaemic heart disease and stroke have been identified from 1975 to 1992. It has been used the direct method for standardization by age and sex, using the European population as the standard population. Logarithmic transformations of the standardized rates were used for each cause of death and for both sexes. Linear regression analysis was used to adjust the evolution of the rates in the time period. RESULTS: There is a reduction of 2.6% and 2.7% by year in rates for cardiovascular diseases mortality for both males and females respectively, a reduction of 1.2% by year in rates for ischaemic heart disease in males and a reduction of 1.8% in females, and a reduction of 4.0% and 4.2% for stroke in males and females respectively. CONCLUSIONS: Trends in cardiovascular disease mortality reveal a decline for both males and females, mostly due to a reduction in stroke mortality; ischaemic heart disease mortality slightly decreased specifically during the period 1983-1992.

Adult↗
PubMed1993

[The Prevalence of pain in hospitalized patients].

BACKGROUND: There are few studies evaluating the presence of pain in hospitalized patients. Different authors have suggested interest in epidemiological studies to establish the characteristics of pain at a hospitalary level. The present study was initiated to determine the prevalence of pain in acute and chronic patients admitted to hospital and to establish the relation of the pain with the prescription of analgesics. METHODS: Pediatric, acute and chronic adult patients pertaining to a hospital in Sabadell (Barcelona) were included in the study. Patients from resuscitation, ICU, neonatology and the emergency wards were excluded. The variables studied were presence of pain and the existence of analgesic prescription. The first was determined by interview with the patient, while the second was obtained directly from the clinical history. RESULTS: Fifty-five percent of the 217 adult patients with acute pathology manifest pain and in 45% of them total analgesics had been prescribed. The prevalence of pain was 61% among the 41 pediatric patients and 35% among the 98 adults with chronic disease. Prescription of analgesics was observed in 51 and 39%, respectively in the above groups of patients. The relation between the presence of pain and antialgic prescription was variable according to the groups. It must be emphasized that 50% of acute adult patients with pain did not have prescription of analgesics. Pain was present in all the pediatric patients with some analgesic prescribed. Sixty-eight percent of the chronic patients with prescribed analgesics also experienced pain. CONCLUSIONS: The prevalence of pain in the hospital environment is high, not only in pediatric but also in adult and geriatric patients. The high number of patients who do not receive analgesics despite pain and those in whom the treatment does not totally eradicate the symptoms is of note. Analgesic therapy must acquire greater revelance in hospitalary assistance.

Acute Disease↗
PubMed1993

[Surveillance of nosocomial infection at a regional++ hospital. Results of incidence and prevalence studies in a 2 years' experience].

BACKGROUND: The most appropriate methods for surveillance of nosocomial infection (NI) in hospitals with less than 250 beds remain to be elucidated. The aims of this study were to investigate the differences between the results found in a study in incidence (IS) and in another concerning prevalence (PS) carried out in a county hospital and study the experience in the application of a collection method of incidental cases through a survey. METHODS: For 2 years IS trimestrally accumulated and simultaneously PS trimestrally were applied for global surveillance and for type of NI as well as for knowing the etiology of the same. In both types of study all the hospital patients were included. RESULTS: The accumulated incidence of patients with NI over the 2 years was 3.9% (3.6 in the first 12 months and 4.1 in the 12 remaining months) and the global prevalence was 7.5%. The global trend of NI was that of an increase in both studies. The most frequent NI in both studies were surgical wound and urinary infection. PS did not detect the least frequent NI. The etiologic agents of NI were similar in both studies. The survey undertaken for the detection of NI demonstrated 61% sensitivity, 98% specificity and a positive prediction value of 94%. CONCLUSIONS: In small hospitals global prevalence studies may be useful for surveillance of the most frequent nosocomial infections. The results obtained by incidence studies were less variable and better reflect the trend of nosocomial infection. A survey used as a study method of incidence for the collection of cases of nosocomial infection loses sensitivity over time.

Cohort Studies↗
PubMedDate not supplied

[Effect of sample design in the analysis of complex surveys. Application to the health survey of Catalonia].

OBJECTIVE: To illustrate the way in which a sample design can be easily incorporated into the statistical analysis of complex surveys to obtain correct estimates. METHODS: A statistical program (STATA) was used to analyze the Catalan Health Survey (Spain) for the year 1994. RESULTS: If the sample design is taken into account, the estimates are unbiased. If only the weights are taken into account, unbiased point estimates are obtained, but the standard errors tend to be underestimated. CONCLUSIONS: The current availability of statistical programs that allow to incorporate easily the sample design should encourage researchers to better analyze their surveys.

Blood Pressure Determination↗