[Stress echocardiography with dipyridamole/atropine in the detection of myocardial ischemia: a comparison with thallium-201 scintigraphy and an angiographic correlation].
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Adult↗
Biomedical subjects
V Gil
Publications and source records attributed to V Gil.
[Validity of 6 indirect methods to assess treatment compliance in arterial hypertension].
BACKGROUND: For adequate control of high blood pressure (HBP) the therapy indicated must be correct, with effective medication which must be taken as required. At a collective level methods to evaluate patients' compliance of the above are necessary since without the same the efficacy of the drugs cannot be determined. In this study methods allowing the clinic to easily quantify patient fulfillment were sought. METHODS: Six indirect methods were used to evaluate therapeutic compliance: 1) self communicated compliance (SC), 2) appointment attendance (AA), 3) degree el control obtained in the blood pressure (DC), 4) Morinsky and Green tests (M-G), 5) patient's knowledge of the disease (PK) and 6) doctor's judgement on patient's compliance (DJ). All the above were applied to 152 hypertense patients randomly selected from the Health Centers of Alfaz and Alicante (Spain). Concordance with the compliance obtained from the "counting of tablets" in the patient's home and by surprise were evaluated by double entry tables. RESULTS: The SC is the method which obtains greatest specificity (96.7%), exactness (73%), probability of low compliance (88%) and percent of probability of low compliance (11.3%). The PK had greatest sensitivity (83.3%) and greater probability of high compliance (83.6%) and percentage of probability of high compliance (0.3%). The SC (23.1%), AA (1.3%) and the DJ (7.5%), overestimate good compliance. The M-G test (7.9%) and the PK (20.4%) overestimate had compliance. CONCLUSIONS: In this study self communicated compliance and patient's knowledge of disease were the methods which provided the best indicators of validity to measure therapeutic compliance in high blood pressure in outpatients, although there is the inconvenience of significantly over and under estimating good and bad compliance.
Evaluation Studies as Topic↗
[An opinion/satisfaction survey on 2 models of clinical histories used in primary care].
OBJECTIVE: We aimed to discover the opinion of primary care doctors regarding the structure, usefulness and problems when using two models of clinical records employed consecutively in the same health centres. DESIGN: A double crossover study. An opinion poll (with 22 closed questions and one open), filled out in 1988 (evaluating the type A clinical record) and then in 1992 (for type B), was used. Chi squared statistical analysis with Yates corrections and Fisher test. SETTING AND PARTICIPANTS: Staff doctors and third-year family and community medicine interns at their teaching centres in Alicante province. In 1988, 49 doctors took part, and in 1992, 68: 70 and 75% respectively of the target group. RESULTS: The new record was an improvement over the earlier one. It was broader and corresponded more closely to the actual case. But problems of completion and legibility persisted, as did the difficulties in filling out socio-economic data and work/school history. Model B favoured use by all the team members. It was better for new patients and when doing later checks, although it did not avoid the accumulation of inactive documentation. The need for specific documents for preventive activities was detected. Computerisation would improve manageability. For both models lack of time was the main reason for under-recording. CONCLUSIONS: The new model is better than the earlier one but is lacking in the areas of manageability and difficulty in retrieving information. The methodology employed shows its use for evaluating health-care innovations and detecting insufficiencies, as well as allowing user-satisfaction to be more easily identified.
Attitude of Health Personnel↗
[An analysis of domiciliary medical care in 7 health centers of Alicante Province].
OBJECTIVE: To know the characteristics of medical care at home done by the doctor and to what extent it is justified. DESIGN: An observational, descriptive-prospective study. Form filled out by the doctor after completing the visit. SETTING: Outpatients, 7 hospitals in area 17 of the Valencian Community. PATIENTS: 188 different patients attended in February 1993 by 15 family doctors. The statistical tests used were ji-squared test, Student's t-test and Anova. MEASUREMENTS AND MAIN RESULTS: An average of 0.4 visits/doctor/day were made. Less than 2 hours/week/doctor were needed. 80.5% of the cases were resolved using usual means available in the doctors emergency briefcase. 64.5% of the patients attended were over the age of 65.66% of the visits were considered to be justified. CONCLUSIONS: 66% of medical care at home was considered justified and did not require excessive time. Elderly patients are the ones who most require medical care at home.
Adult↗
[Factors involved in the hypertensive patient non-compliance with treatment].
BACKGROUND: It is impossible to evaluate the therapeutic efficacy in hypertension without knowing the compliance of the treatment. The lack of compliance does not allow therapeutic efficacy to be achieved. This study evaluates possible factors involved in the non compliance of treatment in hypertensive patients and the characteristics defining the non compliant patient. METHODS: The control technique was tablet counting. The study was carried out in 157 hypertensive patients belonging to the Centro de Carrús (Elche-Alicante, Spain). RESULTS: 53.3% of the sample were shown to follow the therapy. 45.2% of patients not fulfilling the treatment believed that they were doing it correctly. Non compliance was found to be associated to the following factors: hypertensive patients of older age (p = 0.0054), low cultural level (p = 0.0027), bad knowledge of the disease (p = 0.0166), recent or lengthy knowledge of the disease (p = 0.00677), presence of other associated chronic diseases (p = 0.003), bad control of blood pressure (p = 0.0108), receiving more than two drugs for treatment (p = 0.0071), carrying out more than two medication intakes per day (p = 0.00309), saying that the diet is not well followed (p = 0.0187) and performing other associated pharmacologic treatments (p = 0.0024). CONCLUSIONS: Non compliance is a very frequent fact in patients with hypertension. Knowledge and evaluation of the factors involved in non compliance allows identification and intervention in patients who do not take the medication.
Adult↗
Pleural thickening in patients with pleural tuberculosis.
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Adult↗
[Influence of the place of measurement and of the person who performs it on the control and diagnosis of arterial hypertension].
The use of ambulatory monitorization of blood pressure has shown the importance of the alarm reaction or white coat reaction and its conditioning factors in some patients. The influence of place (medical facility or home) and person who performs the procedure (doctor or nurse) on the taking of blood pressure is studied with regard to degree of control and/or disease diagnosis. The design is descriptive with a cross-section analysis. The sample is made up of 100 people-50 with hypertension and 50 who came to the center for reasons unrelated to blood pressure and were selected at random. Of the results obtained, the findings below are noteworthy. The number of controlled hypertension cases is fewer in the medical consultation (18 percent) or with nursing staff (22 percent) than in the patients' homes, whether the procedure is performed by the doctor (54 percent) or by the nurse (58 percent) (p = 0.000004). In the group of individuals who sought consultation, the number of hypertension cases detected by random measurements is fewer in the medical consultation (66 percent) than by the nursing staff (48 percent) and lowers significantly at home (p = 0.000001), whether taken by the doctor (22 percent) or by the nurse (20 percent). It is confirmed that figures for blood pressure at home are lower than those registered in the consultation, be they taken by the doctor or the nurse. We believe that the elevation in blood pressure is not exclusively attributable to the doctor and suggest that place where the procedure is performed is more important than the person who performs the procedure.
Aged↗
[Validity of epidemiologic criteria in the detection of hypertension].
We wish to find out the quality of the diagnostic test commonly used in epidemiological studies to detect hypertension, and in so doing, we study the validity of epidemiological criteria in the detection of hypertension (diagnostic test) and compare the diagnostic thresholds of the World Health Organization (WHO) and the Joint National Committee (JNC). Two methods of detection for arterial hypertension are used in this study of 674 people. One is population-based (mobile unit), and the other is opportunistic sampling. (systematic measurements of blood pressure in medical consultations). As a test of certainty, clinical confirmation is performed. The methodology of Haynes and Sackett is used in the validation study. The epidemiological criteria obtains a sensibility of 90.4 percent and a specificity of 94.4 percent with the diagnostic thresholds of WHO, and a sensibility of 97 percent and a specificity of 81.2 percent with those of JNC, which are defined as effective methods of screening in the detection of hypertension. The excess prevalence of HBP obtained using the diagnostic criteria of WHO is 4.5 percent (that is to say of 12.2 percent of the cases of hypertension found by the epidemiological criteria, that figure decreases to 7.7% percent with clinical confirmation). With the JNC criteria, it is 14.5 percent (from 34.1 percent, it goes to 19.6 percent). This excess can be used to adjust numbers found in epidemiological studies to their real values.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Results of 5 campaigns to detect previously unidentified cases of hypertension].
OBJECTIVE: To find the efficacy of two methods of detecting previously unknown hypertension--systematic taking of blood pressure (ST) and the Mobile Unit (MU)--and to evaluate the over-diagnosis of arterial hypertension (AHT) in crossover studies which only use epidemiological criteria (EC). DESIGN: A descriptive study with population and opportunist strategies. An operative MU team attended commercial and work centres within the chosen area. ST looked for AHT in patients attending Health Centre clinics. INTERVENTION: EC in screening, in line with WHO guidelines and clinical confirmation (CC) in the Health Centres. SETTING: MU in the catchment areas of Novelda, Carrús and C. Jardin Health areas. ST in the San Miguel de Salinas and C. Jardin Health Centres. PATIENTS: 1654 people over 19 with the MU and 4138 through ST. RESULTS: Both methods discovered more hypertension in men (MU p = 0.009 and ST p = 0.000) and in the 20 to 39 age group (MU p = 0.000 and ST p = 0.000). EC led to over-diagnosis (5.8% MU and 6.3% ST); greater in men (6.6% and 6.5%) and +/- 60 years old (8.7% and 7.5%). Positive predictive values obtained were 59.8% with MU and 47.4% with ST. CONCLUSIONS: Both methods are useful ways of identifying people suffering hypertension: both young people and men. But CC is essential in order to make a real diagnosis of AHT. Out of every 10 people detected by using EC, only 5 were confirmed by ST and 6 by MU. This information must be borne in mind when evaluating the the prevalence of AHT in epidemiological studies.
Adult↗
[Indicators of follow-up activities undertaken by an arterial hypertension unit over a 5 year period].
OBJECTIVE: To assess the efficacy and effectiveness of an AHT programme by means of indicators which analyse the coverage, results and attendance. SETTING: AHT unit at the Health Centre in Novelda, Alicante. DESIGN: A quasi-experimental design of internal comparison with temporal series. The years analysed were 1985, '87, '88 and '90. The following were assessed: support, therapeutic compliance, risk level, weight, monitoring, visits per year, therapy, risk factors. PATIENTS: A cohort of 266 hypertense patients (175 women and 91 men). MEASUREMENTS AND MAIN RESULTS: The Unit significantly increased the number of patients being monitored and treated (WHO 46.7% and JNC 9.1%), but never exceeded 60%. Serious risk was eliminated and moderate risk went down (27.7%). Visits to the Centre were reduced by 2.8 per year. Of risk factors, weight did not go down, but hypercholesterolaemia diminished by 48.4%, hypertriglyceridaemia by 9.8%, hyperglycaemia by 4.4%, hyperuricaemia by 7.9% and tobacco addiction by 19.9%. CONCLUSIONS: These figures contain extremely interesting information. They reveal the achievements and difficulties of clinical practice and point to practical strategies.
Adult↗
[The benefits of auditing clinical histories. Our experience over 5 years].
OBJECTIVE: To evaluate how our clinical records (CR) are filled in and to observe the impact of measures taken to correct faults found over a five-year follow-up period. DESIGN: Three descriptive studies (auditing methodologies) on representative samples of CR selected at random. Four quality indicators were fixed: internal communication (i.e. legibility and comprehensibility), external communication, manageability and the quality of the activity at attendances measured by the SOAP. The optimum standards (OS) were agreed by the team (technique of nominal group). SETTING: "Florida" Health Centre, Alicante. PATIENTS AND OTHERS PARTICIPANTS: Periodic team meetings to analyse results and agree activities. In 1986, N of CR = 367; in 1988, 370; and in 1990, 372. MAIN MEASUREMENTS AND RESULTS: During the follow-up period, the filling-in of all the variables, except the address, the test carried out and blood pressure, improved. But the following did not reach the OS: code, affiliation, origin, instruction, habits, allergies, working activity, socio-economic data, age and gender, family/personal background, test carried out, blood pressure and analytical data. The following all reached the OS: legibility, which went up from 88% to 96.5%, comprehensibility from 62 to 75.3%, external communication from 81 to 88.9%, manageability from 53 to 79.6% and SOAP from 62 to 82.5%. CONCLUSIONS: Auditing allows the level of the filling-in of the CR to be measured. Deficiencies which appear to be due to the design of the record itself can be detected. The efficacy of corrective measures to improve records can also be assessed.
Communication↗
[A four year study of therapeutical observation of patients with hypertension].
We attempt to quantify compliance with hypotension medication regimens in 620 patients with hypertension at the Centros de Salud (community health centers) of Novelda and Elche (in the province of Alicante) and to assess the impact of a mixed-strategy health education program. The method used to evaluate compliance is the self-communicated interview as indicated by Haynes-Sackett. The intervention consisted of individualized instruction, family support, educational leaflets, and written instructions. Among the results obtained, we emphasize the following. First, 64% completed the treatment as prescribed, 16% stopped taking the medication, and 20% followed the regimen in a sporadic fashion, lack of motivation and forgetfulness being the main reasons cited for the latter. Second, 27% of the patients with hypertension--among them, primarily young people and men--do not visit the center for monitoring. Third, the health education program is responsible for a significant increase in blood pressure measurements and in therapeutic compliance, also reducing the number of drop-outs. Fourth, 26% did not come to the unit at the end of the study period (four years) despite phone calls and house visits as reminders.
Adult↗
[Combined infarction: angiography and electrocardiographic diagnosis].
Combined infarction can be defined as the presence of ST segment elevation simultaneously in anterior and inferior leads. Their possible anatomical and physiopathological causes are suggested. Four cases of combined infarction, three of them in previously asymptomatic patients are presented, with their electrocardiographic and angiocoronarography patterns. Acute phase and 24 hours ECG ST changes are analysed and the possibility of an indirect approach to the angiographic diagnosis, is discussed.
Adult↗
[Ibopamine in the treatment of congestive heart failure. Multicenter follow-up study].
OBJECTIVE: To assess safety and efficacy of ibopamine, 200 mg TID, added to conventional treatment of congestive heart failure. DESIGN: A prospective, longterm, open study over two years (1986-88). A multicenter trial. SETTING: Outpatients of Departments of Internal Medicine of S. Francisco Xavier Hospital and Sta. Maria Hospital, and Departments of Cardiology of Sta. Cruz Hospital and Hospital Militar Principal, Lisbon. PATIENTS AND METHODOLOGY: 63 patients, 49 males from 34 to 80 years (m = 55.6 +/- 11.36) and 14 females from 41 to 80 years (m = 63 +/- 10.2), with congestive heart failure, NYHA class II in 52 patients (82.5%) and NYHA class III in 11 patients (17.5%) with a mean disease duration of 47.9 months entered into the study. Digoxin, diuretics, nitrates and antiarrhythmic drugs were allowed as concomitant therapy. Patients carried out clinical examination, ECG and laboratory tests monthly and X-Ray at the beginning and at the end of each year of the study. RESULTS: 42 patients completed one year of treatment and 20/42 continued for an additional year, 17 patients completed this second year of follow-up. From the 42 patients who completed the first year period, the NYHA class changed from II to I in 17/38 from II to III in 2/38 patients from III to II in 3/4 patients, and from III to IV in one patient. Twenty patients dropped during the first year of treatment. Six for non-compliance (less than 80% of the treatment). Two were submitted to cardiac valve surgery. Seven had cardiovascular clinical events: one ventricular tachycardia, one atrial fibrillation, one pulmonary edema, one patient had no therapeutic effect, two patients had anxiety and fatigue and one patient died suddenly. One diabetic patient had uncontrolled hyperglycemia. One patient had gastric ulcer. Two had nausea and vomiting. Dysrhythmia and nausea and vomiting were the only clinical events, considered, respectively, possibly related and related, to ibopamine. During the second year of treatment 9/11 patients were stabilized in NYHA class I and 6/9 in NYHA class II, one patient changed from class II to class I, and one patient changed from class I to class II of the NYHA. Three patients did not complete the second year of treatment; one due to abnormal creatininemia; one for probable pulmonary embolism with CHF worsening; the third died suddenly. None of these events was considered related to ibopamine. Heart rate, arterial pressure, laboratory values and cardiothoracic index did not vary over the two years of the study. CONCLUSIONS: This has been the first study with data from patients treated with 200 mg TID of ibopamine during two years. Ibopamine has been shown to be a safe and useful drug added to conventional treatment of cardiac heart failure. Clinical events were few and well controlled after ibopamine interruption.
Adult↗
[Contribution of the electrocardiogram to the diagnosis of localization and extension of coronary lesions in patients with acute myocardial infarct].
UNLABELLED: With the purpose of evaluating the contribution of the ECG to the localization and extension of coronary artery lesions, 85 patients with the first acute myocardial infarction treated with thrombolysis, 79 males and 6 females (mean age 53.9 years), were studied, and the ECG changes at 3.5 and 24 hours correlated with the coronary angiographic findings before discharge. Patients were divided in two groups--Group A with anterior infarction (48 pts) and Group B with inferior infarction (37 pts). RESULTS: A) Returning of the ST downslope to baseline in inferior and anterior leads, respectively in anterior and inferior infarction at 24 h ECG, excluded associated LAD or RCA/CX lesions with a sensitivity (S) of 93% and 87% and aspecificity (E) of 60% and 58%, with a positive predictive value (PPV) of 62% and 77% and a negative predictive value of 86% and 85% respectively. All patients with anterior infarction had LAD stenosis. B) ST upslope bigger than 5 mm in V2-V3 or its presence in D-I or aVL associated to any precordial leads, diagnosed proximal LAD lesions with S of 82% and 73% and E of 75% and 73% respectively. The left axis deviation was present in 6 of 7 patients and pointed to proximal lesion. C) In Group B patients, RCA lesion was related to ST downslope in D-I, S = 77%, E = 37.5%, PVV = 80% and NPV = 33.5%, and the proximal localization (ratio between ST downslope in V2 and ST upslope in aVF) inferior to 0.5 mm with S and NPV = 80% and E and PPV = 100%. The presence of an isoelectrical ST in D-I in association with ST upslope in V5-V6 is related to CX with S and NPV = 100%, E = 85% and PPV = 25%. In conclusion, these results suggest that a careful analysis of ECG changes in patients with first acute myocardial infarction, can provide important information regarding the infarct related artery, localization of the stenosis and the presence of associated coronary artery disease, with implications in the risk stratification before hospital discharge.
Adult↗
Respiratory, muscular, and overall perceptions of effort: the influence of hypoxia and muscle mass.
Overall, respiratory and peripheral muscular perceptions of exercise have been examined in 16 subjects (eight men and eight women), each performing four types of exercise (two-leg, one-leg, arm + shoulder, and arm ergometry) under both normoxic and hypoxic (12% oxygen) conditions. Subjects could distinguish ratings for the three types of sensation. Both overall and peripheral muscular perceptions associated with a given oxygen intake or power output increased more than respiratory perceptions as the volume of active muscle was decreased. Hypoxia tended to increase both overall and respiratory perceptions for a given absolute oxygen consumption. Cross-modal comparisons suggested an average overall RPE of close to 13 units at 70% of a task and environment-specific peak oxygen intake, irrespective of exercise conditions, but the SD of individual responses varied by at least +/- 2 units about this average. Peripheral muscular sensations dominated small muscle tasks, but the peripheral muscular RPE became relatively consistent when related to external work rate per liter of active muscle. Respiratory perceptions provided some guide to the intensity of physical activity with a given mode of exercise and fixed environmental conditions. However, if respiratory RPE is used to "fine-tune" cross-modal exercise prescriptions, account must be taken of the distorting influence of active muscle volume and of hypoxia.
Adult↗
[Cardiovascular risk factors in the working population of Alicante].
The aim of the present study was to evaluate the prevalence of certain cardiovascular risk factors in the population of Asepeyo-Elche. The study sample was a working population of 697 persons (71.8% males and 28.2% females) with ages ranging from 15 to 65 years (mean age 34.7 +/- 13.2 years), seen during the first 6 months of 1990 in the health care center of Asepeyo-Elche. The evaluated cardiovascular risk factors and their prevalence rates were: hypertension (14.2%), hypercholesterolemia (18.5%), smoking (52.5%), hyperglycemia (3.5%), obesity (28.2%) and sedentariness (80.3%). We conclude that in our working population the prevalence rates of some cardiovascular risk factors are high and that intervention programs to modify the diet and lifestyle are mandatory to prevent the pathogenetic consequences of these factors.
Age Factors↗
Detection of rejection after heart transplantation. A computerized precordial mapping experience.
A low-cost modular compact personal computer-based system for surface precordial mapping (SPM) developed by the authors was used to detect rejection periods, documented by endomyocardial biopsy (EB), in heart transplant patients on cyclosporine A therapy. Data were collected with a matrix of 35 Ag-AgCl electrodes positioned over the precordio with anatomical references within 12 hours of EB. For each acquisition the authors computed the root mean square waveform from all signals collected to assess the accuracy of the maximum value of the RMS waveform (mRMS) parameter to detect rejection episodes. A mRMS variation of 20% in consecutive mapping acquisitions was the decision criterion. In EB, only presence or absence of acute rejection was considered. Eleven heart transplant patients were studied and 46 acquisitions were done. The mRMS obtained with SPM showed a sensitivity of 69% and a specificity of 91%, with a positive predictive value of 75% and negative value of 88%. The results indicate that surface precordial mapping may be promising for monitoring rejection.
Adolescent↗