Papers by Jesús Díez-manglano
Geriatrics & Gerontology International, Dec 7, 2017
Aim: To determine whether answering three questions erroneously ("what is the date today?," "when... more Aim: To determine whether answering three questions erroneously ("what is the date today?," "when were you born?" and "how old are you?") allows for the detection of advanced cognitive impairment in polypathological patients. Methods: A cross-sectional study of patients admitted to the internal medicine and geriatrics departments was carried out. Advanced cognitive impairment was diagnosed when patients made 7-10 errors in the Short Portable Mental Status Questionnaire. Results: We included 441 polypathological patients, 330 of them from the internal medicine departments and 111 from the geriatrics department. Their mean age was 80.8 years (8.9 years). Of them, 141 (32.0%) answered one question incorrectly, 58 (13.1%) answered two and 89 (20.2%) answered all three questions incorrectly. The prevalence of advanced cognitive impairment was 27.7%. The sensitivity, specificity, and positive and negative predictive values of the test were 0.705, 0.991, 0.966 and 0.898, respectively. The accuracy of the test was 0.912. The area under the receiver operating characteristic curve was 0.947, 95% CI 0.923-0.970. Conclusions: The three questions test has very good specificity and positive predictive value, and it can be used for the screening of advanced cognitive impairment in polypathological patients. Geriatr Gerontol Int 2017; ••: ••-••.
International Journal of Chronic Obstructive Pulmonary Disease, Nov 1, 2020
Purpose: To determine whether chronic obstructive pulmonary disease (COPD) is a risk factor for h... more Purpose: To determine whether chronic obstructive pulmonary disease (COPD) is a risk factor for hip fracture and identify other factors associated with hip fracture. Patients and Methods: Observational nested case-control study was conducted in Aragon, Spain in 2010. We included COPD patients aged >40 years, in the EpiChron cohort. Each COPD patient was matched for age, sex, and number of comorbidities with a control subject without COPD. Patients with an existing diagnosis of osteoporosis and those with hip fracture before 2011 were excluded. We collected baseline demographic, comorbidity, and pharmacological treatment data. During a 5-year follow-up period, we recorded the incidence of hip fracture. A logistic regression model was constructed to identify factors associated with hip fracture. Results: The study population consisted of 26,517 COPD patients and the same number of controls (median [interquartile range] age, 74 [17] years; women, 24.7%). Smoking and heart failure were more frequent in COPD patients, and obesity, hypertension, diabetes, dyslipidemia, stroke, arthritis, and visual or hearing impairment were less frequent (all p<0.001). Consumption of benzodiazepines (p=0.037), bronchodilators (p<0.001), and corticosteroids (p<0.001) was higher in the COPD group, while that of beta-blockers and thiazides was lower (both p<0.001). During follow-up, 898 (1.7%) patients experienced hip fracture, with no differences observed between COPD and control patients. Multivariate analysis revealed that independent of COPD status, age, female sex, chronic liver disease, heart failure, and benzodiazepine use were independently associated with a higher risk of hip fracture, and obesity with a lower risk. In COPD patients, use of inhaled anticholinergics was independently associated with hip fracture (OR, 1.390; 95% CI 1.134-1.702; p=0.001). Conclusion: COPD is not a risk factor for a hip fracture within 5 years. The association between the use of inhaled anticholinergics and risk of hip fracture warrants further study.
Revista clínica española, Oct 1, 2018
Objective: To determine the complexity of the therapeutic regimen for polypathological patients h... more Objective: To determine the complexity of the therapeutic regimen for polypathological patients hospitalised in internal medicine departments. Methods: A multicentre observational study included polypathological patients hospitalised in internal medicine departments. Patients who were readmitted or died were excluded. Data were collected on age, sex, residence, disease, Charlson, Barthel and Lawton-Brody indices, Pfeiffer questionnaire, Gijón scale, number of hospitalisations in the previous year, delirium, need for and availability of caregivers and the PROFUND index score. We calculated the therapeutic complexity with the Medication Regimen Complexity Index (MRCI). We considered a therapeutic regimen complex when the MRCI score was in the fourth quartile. To determine the factors associated with complexity, we constructed a logistic regression model. Results: We included 233 polypathological patients, 52.9% of whom were women, with a mean age of 79.8 (SD: 8.6) years. The mean number of drugs consumed was 8.4 (SD: 3.3). The mean MRCI score was 30 (SD: 15.2). The MRCI score by quartiles was 0-20, 20.5-30, 30.5-42, 42.5-80. The respiratory diseases (OR: 4.185; 95% CI: 2.015-8.693; p < .001) were independently associated with increased therapeutic complexity, and the neurological diseases with permanent mental deficiency (OR: 0.265; 95% CI: 0.085-0.828; p = .022) were associated with less complexity. Conclusions: Patients with comorbidities are polymedicated and have complex therapeutic drug regimens. Respiratory diseases determine greater therapeutic complexity, while cognitive impairment determines a lower therapeutic complexity.
European Journal of Internal Medicine, 2018
Objectives: Atrial fibrillation (AF) has been associated with higher mortality. We aimed to ident... more Objectives: Atrial fibrillation (AF) has been associated with higher mortality. We aimed to identify the baseline predictors of in-hospital mortality among elderly patients with non-valvular AF (NVAF) hospitalised for any reason. Methods: Observational, prospective and multicentre study was carried out on patients with NVAF over the age of 75, who had been admitted for any acute medical condition to Internal Medicine departments in Spain. Results: We evaluated 804 patients with a mean age of 85 ± 5.1 years, of which 53.9% were females. During the hospitalization 10.1% (n = 81) of the patients died. The patients who died were older, had a greater percentage of institutionalization, worse previous basic functional status (Barthel Index), worse cognitive performance at admission and greater proportion of frailty and sarcopenia. Logistic regression multivariate analysis identified that the strongest determinants of in-hospital mortality were the baseline functional status (Barthel Index) (OR for total dependency 4.73, 95% CI 2.32-9.63), and admissions for stroke (OR 3.55, 95% CI 1.41-8.90) and acute renal failure (OR 1.93, 95% CI 1.12-3.32). Conclusion: The overall in-hospital mortality of elderly patients with NVFA is high. Among all factors evaluated in the global geriatric assessment the baseline functional status was the strongest predictor for in-hospital mortality on this population.
Journal of Pain and Symptom Management, Mar 1, 2014
Context. Efforts in developing useful tools to properly identify the end-of-life trajectory of pa... more Context. Efforts in developing useful tools to properly identify the end-of-life trajectory of patients with advanced medical diseases have been made, but the calibration and/or discriminative power of these tools has not been optimal. Objectives. Our objective was to develop a new, reliable prognostic tool to identify the probability of death within six months in patients with chronic medical diseases. Methods. This was a multicenter, prospective, observational study in 41 Spanish hospitals, which included 1778 patients with one or more of the following: advanced conditions such as heart failure, respiratory failure, chronic renal failure, chronic liver disease, and/or chronic neurological disease. All patients were followed over six months. Each factor independently associated with death in the derivation cohort (884 patients from eastern areas of Spain) was assigned a prognostic weight, and the score was calculated by summing up the factors. The score's accuracy in the validation cohort (894 patients from western areas of Spain) was assessed by analyzing its calibration and discriminative power; we also calculated sensitivity, specificity, and positive and negative predictive values. Results. Mortality in the derivation/validation cohorts was 37.6%/37.7%, respectively. We identified six independent predictors of mortality ($85 years, three points; New York Heart Association Class IV/Stage 4 dyspnea on the modified Medical Research Council, 3.5 points; anorexia, 3.5 points; presence of pressure ulcer(s), three points; Eastern Cooperative Oncology Group
Medicina Clinica, Sep 1, 2017
Cómo citar este artículo: Díez-Manglano J, et al. Efectividad de una intervención simple sobre el... more Cómo citar este artículo: Díez-Manglano J, et al. Efectividad de una intervención simple sobre el tratamiento de las agudizaciones de la enfermedad pulmonar obstructiva crónica y de sus comorbilidades cardiovasculares: estudio COREPOC. Med Clin (Barc). 2017.
Revista Clinica Espanola, Oct 1, 2018
Paciente pluripatológico; Complejidad terapéutica; Medication regimen complexity index; Polifarma... more Paciente pluripatológico; Complejidad terapéutica; Medication regimen complexity index; Polifarmacia Resumen Objetivo: Determinar la complejidad del régimen terapéutico en pacientes pluripatológicos hospitalizados en servicios de medicina interna. Métodos: En un estudio observacional multicéntrico se incluyeron pacientes pluripatológicos hospitalizados en servicios de medicina interna. Se excluyeron los reingresos y los fallecidos. Se recogieron datos de edad, sexo, residencia, patología, índices de Charlson, Barthel y Lawton-Brody, cuestionario de Pfeiffer, escala de Gijón, número de ingresos en el año previo, delirium, necesidad y disponibilidad de cuidador y puntuación en el índice PROFUND. Se calculó la complejidad terapéutica con el Medication Regimen Complexity Index (MRCI). Se consideró un régimen terapéutico complejo cuando la puntuación en el MRCI estaba en el cuarto cuartil. Para determinar los factores asociados con la complejidad se construyó un modelo de regresión logística. Resultados: Se incluyeron 233 pacientes pluripatológicos; el 52,9%, mujeres; edad media (desviación estándar): 79,8 (8,6) años. El consumo medio de fármacos fue 8,4 (3,3). La puntuación media (desviación estándar) en el MRCI fue 30 (15,2). La puntuación por cuartiles del MRCI fue 0-20, 20,5-30, 30,5-42, 42,5-80. Las enfermedades respiratorias (OR: 4,185; IC 95%: 2,015-8,693; p< 0,001) se asociaron de forma independiente con mayor complejidad terapéutica, y las enfermedades neurológicas con déficit mental permanente (OR; 0,265; IC 95%: 0,085-0,828; p = 0,022) se asocian con menor complejidad. Conclusiones: Los pacientes pluripatológicos están polimedicados y tienen regímenes terapéuticos de medicación complejos. Las enfermedades respiratorias determinan una mayor complejidad, y el deterioro cognitivo, una menor complejidad terapéutica.
Revista Clinica Espanola, Apr 1, 2005
Objetivo. Los bloqueadores beta (BB) han demostrado ser eficaces en el tratamiento de la insufici... more Objetivo. Los bloqueadores beta (BB) han demostrado ser eficaces en el tratamiento de la insuficiencia cardíaca congestiva (ICC). Este estudio lleva a cabo un análisis económico de añadir BB al tratamiento convencional de la ICC. Material y método. Se incluyen estudios aleatorizados, con grupo control y doble ciego, que incluyeron 1.647 pacientes en tratamiento con bisoprolol, 3.034 con carvedilol, 2.432 con metoprolol y 6.807 con placebo. Se valoran los costes directos del tratamiento BB y de cada episodio de hospitalización. El coste-efectividad se valora como coste en euros por muerte evitada y el beneficio-coste como la diferencia entre costes de hospitalización y costes del BB. El estudio se realiza desde la perspectiva de un tercer pagador. Resultados. Se incluyen 2 estudios con bisoprolol, 6 con carvedilol y 5 con metoprolol con un seguimiento medio de 13,5 meses. Carvedilol evita un 5,07% de las muertes por año de tratamiento y es más eficaz que bisoprolol (3,82% de muertes evitadas) y metoprolol (3,03%). El ratio costeefectividad (coste por muerte evitada y año) fue 10.832 € para bisoprolol, 17.516 € para carvedilol y 16.664 € para metoprolol. El ratio coste-efectividad incremental de usar carvedilol oscila entre 12.631 € y 86.610 € por vida salvada. Todos los BB generan ahorro en los costes de hospitalización, pero sólo bisoprolol tiene un beneficio neto. El índice beneficio-coste es 1,13 para bisoprolol, 0,26 para carvedilol y 0,59 para metoprolol. Conclusiones. El uso de BB en el tratamiento de la ICC es una alternativa eficaz y coste-efectiva. Carvedilol es la alternativa más eficaz y bisoprolol la más coste-efectiva y con mayor beneficio-coste.
Journal of Clinical Medicine, Aug 18, 2020
Background: The presence of oxidative stress, telomere shortening, and apoptosis in polypathologi... more Background: The presence of oxidative stress, telomere shortening, and apoptosis in polypathological patients (PP) with sarcopenia and frailty remains unknown. Methods: Multicentric prospective observational study in order to assess oxidative stress markers (catalase, glutathione reductase (GR), total antioxidant capacity to reactive oxygen species (TAC-ROS), and superoxide dismutase (SOD)), absolute telomere length (aTL), and apoptosis (DNA fragmentation) in peripheral blood samples of a hospital-based population of PP. Associations of these biomarkers to sarcopenia, frailty, functional status, and 12-month mortality were analyzed. Results: Of the 444 recruited patients, 97 (21.8%), 278 (62.6%), and 80 (18%) were sarcopenic, frail, or both, respectively. Oxidative stress markers (lower TAC-ROS and higher SOD) were significantly enhanced and aTL significantly shortened in patients with sarcopenia, frailty or both syndromes. No evidence of apoptosis was detected in blood leukocytes of any of the patients. Both oxidative stress markers (GR, p = 0.04) and telomere shortening (p = 0.001) were associated to death risk and to less survival days. Conclusions: Oxidative stress markers and telomere length were enhanced and shortened, respectively, in blood samples of polypathological patients with sarcopenia and/or frailty. Both were associated to decreased survival. They could be useful in the clinical practice to assess vulnerable populations with multimorbidity and of potential interest as therapeutic targets.
PubMed, Jul 1, 1993
Objective: To find the attitude of Residential Interns (RI) to the diagnosis and initiation of tr... more Objective: To find the attitude of Residential Interns (RI) to the diagnosis and initiation of treatment for Arterial Hypertension (AH). Design: Crossover study. Setting: Tertiary hospital in Zaragoza's Health Area III. Participants: 60 RIs selected by means of stratified random sampling. An open-reply questionnaire administered in writing on an individual basis during the second term of 1991. Results: 28% of RIs (17 RIs) used the figures 140/90 mmHg to diagnosis AHT. 70% (42 RIs) made three measurements before making a diagnosis. 13% (8 RIs) took therapeutic measures when systolic pressure (SP) was above 140 mmHg and 30% (18 RIs) when the figures were above 160 mmHg. Diastolic pressure (DP) above 90 mmHg was a signal that treatment was needed for 43% (26 RIs); and figures above 95 mmHg for 31% (19 RIs). There were no differences for the doctor's age, gender, specialty, year of graduation or year of residency. Conclusions: The RIs used figures recommended by bodies such as the WHO or the Spanish Society for the Fight against AHT, to diagnose AHT. They made the diagnosis after three measurements. They started treatment, which is usually hygiene-dietetic measures to begin with, according to the DP.
Spanish journal of medicine, Aug 31, 2022
Galicia Clínica, 2000
El crecimiento de la población anciana y el aumento de las enfermedades crónicas hacen que el int... more El crecimiento de la población anciana y el aumento de las enfermedades crónicas hacen que el internista sea un médico cada vez más necesario en el contexto actual y que será imprescindible en el contexto sanitario del futuro | 125 |
Revista Clinica Espanola, May 1, 2017
Medicina Clínica (english Edition), Sep 1, 2017
Background and objective: To determine the effectiveness of a simple educational intervention to ... more Background and objective: To determine the effectiveness of a simple educational intervention to improve the management of cardiovascular comorbidities in patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (COPD). Material and methods: Multicenter study participated in by 26 hospital centers. A panel of experts elaborated a set of recommendations about diagnostic and therapeutic management of acute exacerbation of COPD and cardiovascular comorbidities (coronary artery disease, atrial fibrillation, heart failure and diabetes). The recommendations were graduated as indispensable, advisable and outstanding. Compliance with recommendations were assessed in the discharge letter for COPD patients hospitalized with acute exacerbation in Internal Medicine departments. The protocols to treat the comorbidities in COPD were explained in a clinical session. After 6 months' compliance with recommendations they were reassessed. Results: A total of 390 cases before and after the intervention were assessed. There was significant progress in 53% of cases. The improvement was greater in cases referred to general management and COPD management (66.7 and 76.9%, respectively), and lower in cases referred to ischemic heart disease (11.1%) and none in those referred to coronary artery disease. After the intervention, the adherence to overall and indispensable recommendations was higher (p = 0.020 and p = 0.017, respectively) and a trend to improve was observed in advisable (p = 0.058) and outstanding recommendations (p = 0.063). Conclusions: A simple intervention can improve the management of lung disease in COPD patients with an acute exacerbation, but has less effect on the management of comorbidities.
Revista Clinica Espanola, Oct 1, 2017
Medicina integral: Medicina preventiva y asistencial en atención primaria de la salud, 1994
Medicina Clinica, Sep 1, 2013
Medicina Clinica, Dec 1, 2022
Revista clínica española, 2021
Palavras-chave: Boas práticas; Consenso; Cuidados em fim de vida; Guia para a prática clínica.
Revista Clinica Espanola, Oct 1, 2011
Osteoporosis is a frequent comorbidity in patients with chronic obstructive pulmonary disease (CO... more Osteoporosis is a frequent comorbidity in patients with chronic obstructive pulmonary disease (COPD). We have studied the risk of major osteoporotic fracture and hip fracture in patients with COPD. A multicenter cross-sectional study was performed in Spain in 26 hospitals of 16 regional communities. Patients diagnosed with COPD who required admission to the Internal Medicine Service due to exacerbation of their respiratory disease were enrolled. COPD was confirmed by post-bronchodilator spirometry in stable state: maximum expiratory volume in the first second (FEV₁) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 80% of the theoretical value and quotient FEV(1)/FVC &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.70 and percent predicted after the administration of a bronchodilator. Dyspnea was evaluated with the modified Medical Research Council (mMRC) dyspnea scale. The principal variable was the likelihood of fracture evaluated with the FRAX® tool for the Spanish population. Three hundred and ninety two patients, 347 (88%) men, with a mean (SD) age of 73.7 (8.9) years and a mean FEV₁ of 1.23 liters (43.3% of predicted) were enrolled. Only 37 patients (9.4%), 27 men and 10 women had been diagnosed previously of osteoporosis. Overall, 1.8% (95% CI: 0.9-3.6) had a 10-year probability of major osteoporotic fracture ≥ 20% and 49.7% (95% CI: 44.8-54.7) had a probability of hip fracture ≥ 3%. No relationship was observed between the probability of fracture and GOLD stage or mMRC dyspnea scale. The diagnosis of osteoporosis is uncommon in our COPD patients. However, half of them have a high probability of a hip fracture in the next 10 years.
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Papers by Jesús Díez-manglano