Jesús Tornero Molina

Hospital Civil de Guadalajara, Guadalajara, Jalisco, Mexico

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Publications (18)6.27 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To describe the optimal therapeutic strategy for use of methotrexate in RA patients over the initial dose, route of administration, dose increase and decrease, patient monitoring, and use of folic/folinic acid. Eleven clinical experts proposed some questions to be solved. A systematic literature search was conducted. The contents were selected in a work session and subsequently validated via email to establish the level of agreement. The initial dose of methotrexate should not be <10mg/week, preferably orally, but considering the parenteral route as an alternative due to compliance, non effectiveness of treatment or gastrointestinal side effects, polypharmacy, obesity (if required doses are >20mg/week), patient preference, very active disease or to avoid administration errors. Changing to a parenteral administration is proposed when the oral route is not effective enough, gastrointestinal toxicity appears, there is non-compliance or due to cost-effectiveness reasons before using more expensive drugs. On the contrary, due to patient preferences, intolerance to injections, dose reduction <7.5mg/week, non effectiveness of the route, poor compliance or gastrointestinal side effects. There should be a rapid dose escalation if inadequate responses occurr up to 15-20 or even 25mg/week in about 8 weeks, with increments of 2.5-5mg. The reduction will be carried out according to the dose the patient had, with decreases of 2.5-5mg every 3-6 months. Patient monitoring should be performed every 1-1.5 months until stability and then every 1-3 months. This document pretends to solve some common clinical questions and facilitate decision-making in RA patients treated with methotrexate.
    Reumatologia clinica. 04/2014;
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    ABSTRACT: Objectives To describe the optimal therapeutic strategy for use of methotrexate in RA patients over the initial dose, route of administration, dose increase and decrease, patient monitoring, and use of folic/folinic acid. Material and method Eleven clinical experts proposed some questions to be solved. A systematic literature search was conducted. The contents were selected in a work session and subsequently validated via email to establish the level of agreement. Results The initial dose of methotrexate should not be < 10 mg/week, preferably orally, but considering the parenteral route as an alternative due to compliance, non effectiveness of treatment or gastrointestinal side effects, polypharmacy, obesity (if required doses are > 20 mg/week), patient preference, very active disease or to avoid administration errors. Changing to a parenteral administration is proposed when the oral route is not effective enough, gastrointestinal toxicity appears, there is non-compliance or due to cost-effectiveness reasons before using more expensive drugs. On the contrary, due to patient preferences, intolerance to injections, dose reduction < 7.5 mg/week, non effectiveness of the route, poor compliance or gastrointestinal side effects. There should be a rapid dose escalation if inadequate responses occurr up to 15-20 or even 25 mg/week in about 8 weeks, with increments of 2.5-5 mg. The reduction will be carried out according to the dose the patient had, with decreases of 2.5-5 mg every 3-6 months. Patient monitoring should be performed every 1-1.5 months until stability and then every 1-3 months. Conclusions This document pretends to solve some common clinical questions and facilitate decision-making in RA patients treated with methotrexate.
    Reumatología Clínica. 01/2014;
  • J. Tornero Molina, J. Vidal Fuentes
    Medicine - Programa de Formación Médica Continuada Acreditado 08/2013; 8(28):1476–1480.
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    ABSTRACT: Due to the increasing use of biologic therapy in rheumatic diseases and the importance of its risk management, the Spanish Society of Rheumatology (SER) has promoted the development of recommendations based on the best evidence available. These recommendations should be a reference to rheumatologists and those involved in the treatment of patients who are using, or about to use biologic therapy irrespectively of the rheumatic disease. Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and degree of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through a Delphi technique. Evidence from previous consensus and clinical guidelines was used. We have produced recommendations on risk management of biologic therapy in rheumatic patients. These recommendations include indication risk management, risk management before the use of biologic therapy, risk management during follow-up, attitude to adverse events, and attitude to special situations. We present the SER recommendations related to biologic therapy risk management.
    Reumatología clinica. 09/2011; 7(5):284-98.
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    ABSTRACT: Objetivo Servir de referencia para reumatólogos e implicados en el tratamiento de la artritis reumatoide que vayan a utilizar o consideren la utilización de terapias biológicas en su manejo. Métodos Las recomendaciones se emitieron siguiendo la metodología de grupos nominales y basadas en revisiones sistemáticas. El nivel de evidencia y el grado de recomendación se clasificaron según el modelo del Center for Evidence Based Medicine de Oxford y el grado de acuerdo se extrajo por técnica Delphi. Resultados Se realizan recomendaciones sobre el uso de los siete agentes biológicos disponibles para la artritis reumatoide en la actualidad en nuestro país. El objetivo del tratamiento es lograr la remisión de la enfermedad lo más precozmente posible. Se revisan las indicaciones y matizaciones del uso de terapias biológicas y cuál debe ser la evaluación previa y la vigilancia del paciente con estos fármacos. Conclusiones Se presentan las actualizaciones a las recomendaciones SER para el uso de terapias biológicas en pacientes con artritis reumatoide.
    Reumatología clínica, ISSN 1699-258X, Vol. 6, Nº. 1, 2010, pags. 23-36. 01/2010;
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    ABSTRACT: Objective To provide a reference to rheumatologists and to those involved in the treatment of RA who are using, or about to use biologic therapy.Methods Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and grade of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique.ResultsWe have produced recommendations on the use of the seven biologic agents available for RA in our country. The objective of treatment is to achieve the remission of the disease as quickly as possible. Indications and nuances regarding the use of biologic therapy were reviewed as well as the evaluation that should be performed prior to administration and the follow up of patients undergoing this therapy.Conclusions We present an update on the SER recommendations for the use of biologic therapy in patients with RA.
    Reumatología Clínica. 01/2010; 6(1):23–36.
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    ABSTRACT: Objectives To describe the clinical and epidemiological characteristics of patients included in the National Register of Paget's disease.MethodsA Register of patients with Paget disease (PD), radiologically confirmed, and pertaining to 25 hospitals was analysed. Clinical and epidemiological data were collected, including age, sex, date and presentations at time of diagnosis, treatment, quality of life (QL) (EuroQol 5D) and perceived health, environmental factors (profession, history of measles, contact with animals, dairy consumption, housing conditions, place of birth and address) and family history (PD history, origin of the ancestors, number of children). We conducted a statistical description of the data.ResultsThe register included 602 patients with an average age of 62±11 years and a predominance of male (55%). Of the patients included, 79% showed symptoms at the time of diagnosis, mainly pain (83%); 82% had received treatment, mainly bisphosphonates (47% more than one drug). Despite treatment, a significant proportion had limitations in their QL, especially related to pain (64%), mobility (47%) and anxiety/depression (33%). Most of the patients had been exposed to situations which were considered as risk factors. Of the patients included, 14% had family history of PD and 1.5% had children with PD. The ancestors of the familial cases came more frequently from Avila, Salamanca, La Coruña and Malaga.Conclusions The pain and the limitation of mobility decrease the QL of patients with PD despite treatment. Frequently, patients have a history of exposure to risk factors.
    Reumatología Clínica. 01/2009; 5(3):109–114.
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    ABSTRACT: OBJECTIVE: To developed standards for quality of care and processing times in rheumatology. MATERIALS AND METHODS: After a systematic review of the literature, a working group of 10 rheumatologists and 2 methodologists selected 164 indicators of quality of care and processing times. A panel of 65 experts rated the indicators following a Delphi methodology. RESULTS: Among the most important of the 164 standards obtained were: maximum number of inhabitants per rheumatologist (40,000-50,000); minimum number of rheumatologists in a Rheumatology Unit (3); duration of the first visit (30 minutes) and successive visits (19 minutes), ratio of successive/first visits (3.2); a rheumatologist should receive no more than 5 first visits/day and no more than 11 successive visits/day, and should spend no more than 5 hours on patients visits/day nor more than 4 days/week; the maximum waiting time for first visits should not exceed 4 weeks; the time needed to visit hospitalised patients (43 minutes on admission, 17 minutes for daily visit and 40 minutes at discharge); and time to carry out some of the most frequent procedures in rheumatology (12 minutes for arthrocentesis and infiltrations and 17 minutes for synovial fluid analysis). CONCLUSIONS: This study establishes basic standards for quality of care, organisation and process times. It is a useful tool for organizing a Rheumatology Unit which can facilitate dialogue with health administrators and help improve the quality of rheumatology care.
    Reumatologia clinica. 09/2007; 3(5):218-225.
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    ABSTRACT: Objective To developed standards for quality of care and processing times in rheumatology. Materials and methods After a systematic review of the literature, a working group of 10 rheumatologists and 2 methodologists selected 164 indicators of quality of care and processing times. A panel of 65 experts rated the indicators following a Delphi methodology. Results Among the most important of the 164 standards obtained were: maximum number of inhabitants per rheumatologist (40,000-50,000); minimum number of rheumatologists in a Rheumatology Unit (3); duration of the first visit (30 minutes) and successive visits (19 minutes), ratio of successive/first visits (3.2); a rheumatologist should receive no more than 5 first visits/day and no more than 11 successive visits/day, and should spend no more than 5 hours on patients visits/day nor more than 4 days/week; the maximum waiting time for first visits should not exceed 4 weeks; the time needed to visit hospitalised patients (43 minutes on admission, 17 minutes for daily visit and 40 minutes at discharge); and time to carry out some of the most frequent procedures in rheumatology (12 minutes for arthrocentesis and infiltrations and 17 minutes for synovial fluid analysis). Conclusions This study establishes basic standards for quality of care, organisation and process times. It is a useful tool for organizing a Rheumatology Unit which can facilitate dialogue with health administrators and help improve the quality of rheumatology care.
    Reumatología Clínica. 09/2007; 3(5):218–225.
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    ABSTRACT: To evaluate the efficacy and tolerability of aceclofenac, 200 mg/day, and paracetamol, 3000 mg/day, in the treatment of osteoarthritis (OA) of the knee. This was a double-blind, parallel-group, multicentre clinical trial involving patients with symptomatic OA of the knee, conducted in Spain. Patients were randomly allocated to aceclofenac 100 mg twice daily (n=82) or paracetamol 1000 mg three times daily (n=86). Patients were assessed at baseline and 6 weeks. Primary efficacy measures were severity of pain (visual analogue scale, VAS), Lequesne OA knee index, and patient's and physician's global assessment of disease activity. Severity of knee pain at rest or walking, stiffness, knee swelling and tenderness, and assessment of health-related quality of life (Health Assessment Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form 36) were included as secondary endpoints. Both treatment groups showed significant improvement compared with their baseline values in the four primary endpoints. Mean between-treatment differences favoured aceclofenac over paracetamol on pain (VAS, 7.64 mm [95% confidence interval (CI), 0.44-14.85 mm]), Lequesne OA index (1.41 [95% CI, 0.45-2.36]), and patient's (0.33 [95% CI, 0.06-0.61]) and physician's (0.23 [95% CI, 0.01-0.47]) global assessments. Adverse events were similar for both drugs (paracetamol, 29% patients vs aceclofenac, 32%; P=0.71). Four patients withdrew in each group due to adverse events. Patients tended to prefer aceclofenac to paracetamol (P=0.001), and more treated with paracetamol withdrew from the study due to lack of efficacy (n=8 vs n=1, P=0.035, for paracetamol and aceclofenac, respectively). At 6 weeks, patients with symptomatic OA of the knee showed a greater improvement in pain and functional capacity with aceclofenac than paracetamol with no difference in tolerability.
    Osteoarthritis and Cartilage 09/2007; 15(8):900-8. · 4.26 Impact Factor
  • Reumatología Clínica 03/2006; 2S2:S52-9.
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    ABSTRACT: To establish the prevalence and characteristics of rheumatologic pain in Spanish adult population cared in specialized rheumatology offices. Cross selection study in a population of patients cared in rheumatology offices of public Spanish hospitals. 1,134 patients selected through random sampling based on waiting lists of patients, during a period of 1 week, in rheumatology offices of each participating hospital. MAIN OUTCOMES OF THE STUDY: Reason behind the consultation (a new patient [NP] or a patient for revision [RP]), characteristics of the patient (sex, age, habits [alcohol/tobacco], marital status), location, type, intensity, duration, tolerance and management of pain; treatment (pharmacological or non-pharmacological) carried out; satisfaction with the treatment; and association with fibromyalgia. The prevalence of pain in NP was 98.6% and in RP 95.1%, with a global prevalence of 96%, predominating mainly in adult sedentary women with fibromyalgia. The frequency of acute pain was 20.9% and this of chronic pain 79.1% [corrected] The prevalence of fibromyalgia was 12% (2.2% in men, and 15.5% in women). The most prevalent pattern of current dominant pain was this of the mechanical type. More frequent associated pathologies were: hypertension (21.7%), depression (14.4%), gastrointestinal diseases (13.8%) and anxiety (13.4%). All variables analyzed in the study showed changes according to age, sex, and type of patient (NP or RP). Most used treatment was pharmacological; more than 57.6% of patients were receiving NSAIDs. In NP, medical prescriber of the treatment was first the general practitioner (56.1%) followed by the rheumatologist (14.1%); in PR the first one was the rheumatologist (69.9%) followed by the general practitioner (16.5%). Our results show that the prevalence of the rheumatologic pain is very high, predominating mainly in adult women with fibromyalgia. Pain location, intensity, and type, associated pathology, and treatment vary according to age, sex, and type of patient. The most commonly used drugs for pain management were NSAIDs (58%); opiodes were only used in 6.4% of patients even though pain was intense in more than two-thirds.
    Revista Clínica Española 05/2005; 205(4):157-63. · 2.01 Impact Factor
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    ABSTRACT: Objective To establish the prevalence and characteristics of rheumatologic pain in Spanish adult population cared in specialized rheumatology offices. Desing Cross selection study in a population of patients cared in rheumatology offices of public Spanish hospitals. Subjects 1,134 patients selected through random sampling based on waiting lists of patients, during a period of 1 week, in rheumatology offices of each participating hospital. Main outcomes of the study Reason behind the consultation (a new patient [NP] or a patient for revision [RP]), characteristics of the patient (sex, age, habits [alcohol/tobacco], marital status), location, type, intensity, duration, tolerance and management of pain; treatment (pharmacological or non-pharmacological) carried out; satisfaction with the treatment; and association with fibromyalgia. Results The prevalence of pain in NP was 98.6% and in RP 95.1%, with a global prevalence of 96%, predominating mainly in adult sedentary women with fibromyalgia. The frequency of acute pain was 80% and this of chronic pain 20%. The prevalence of fibromyalgia was 12% (2.2% in men, and 15.5% in women). The most prevalent pattern of current dominant pain was this of the mechanical type. More frequent associated pathologies were: hypertension (21.7%), depression (14.4%), gastrointestinal diseases (13.8%) and anxiety (13.4%). All variables analyzed in the study showed changes according to age, sex, and type of patient (NP or RP). Most used treatment was pharmacological; more than 57.6% of patients were receiving NSAIDs. In NP, medical precriber of the treatmen was first the general practitioner (56.1%) followed by the rheumatologist (14.1%); in PR the first one was the rheumatologist (69.9%) followed by the general practitioner (16.5%). Conclusions Our results show that the prevalence of the rheumatologic pain is very high, predominating mainly in adult women with fibromyalgia. Pain location, intensity, and type, associated pathology, and treatment vary according to age, sex, and type of patient. The most commonly used drugs for pain management were NSAIDs (58%); opiodes were only used in 6.4% of patients even though pain was intense in more than two-thirds.
    Revista Clinica Espanola - REV CLIN ESPAN. 01/2005; 205(4):157-163.
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    Reumatología Clínica. 2.
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    ABSTRACT: To describe the clinical and epidemiological characteristics of patients included in the National Register of Paget's disease. A Register of patients with Paget disease (PD), radiologically confirmed, and pertaining to 25 hospitals was analysed. Clinical and epidemiological data were collected, including age, sex, date and presentations at time of diagnosis, treatment, quality of life (QL) (EuroQol 5D) and perceived health, environmental factors (profession, history of measles, contact with animals, dairy consumption, housing conditions, place of birth and address) and family history (PD history, origin of the ancestors, number of children). We conducted a statistical description of the data. The register included 602 patients with an average age of 62±11 years and a predominance of male (55%). Of the patients included, 79% showed symptoms at the time of diagnosis, mainly pain (83%); 82% had received treatment, mainly bisphosphonates (47% more than one drug). Despite treatment, a significant proportion had limitations in their QL, especially related to pain (64%), mobility (47%) and anxiety/depression (33%). Most of the patients had been exposed to situations which were considered as risk factors. Of the patients included, 14% had family history of PD and 1.5% had children with PD. The ancestors of the familial cases came more frequently from Avila, Salamanca, La Coruña and Malaga. The pain and the limitation of mobility decrease the QL of patients with PD despite treatment. Frequently, patients have a history of exposure to risk factors.
    Reumatología Clínica 5(3):109-14.
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    A. Alonso Ruiz, J. Vidal Fuentes, Jesús Tornero Molina
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    ABSTRACT: Objetivo: Elaborar estándares de calidad asistencial y de tiempos de los procesos reumatológicos. Material y métodos: Tras una revisión sistemática de la literatura un grupo de trabajo, constituido por 10 reumatólogos y 2 metodólogos, ha seleccionado 164 indicadores de calidad y de tiempos de proceso. Un panel de 65 expertos los ha puntuado mediante metodología Delphi. Resultados: Entre los 164 estándares obtenidos destacan: número máximo de habitantes por reumatólogo (40.000-50.000); número mínimo de reumatólogos en una unidad de reumatología (3); tiempo de duración de la primera consulta (30 min) y la sucesiva (19 min), relación sucesiva/primera consulta (3,2); un reumatólogo no debe atender más de 5 primeras visitas/día y no más de 11 consultas sucesivas/día, no debe pasar consulta más de 5 h/día, ni más de 4 días/semana; el tiempo máximo de espera para la primera consulta no será superior a 4 semanas; el tiempo necesario para la visita de pacientes ingresados (43 min al ingreso, 17 min la visita diaria y 40 min el alta); tiempo para la realización de las técnicas más frecuentes en reumatología (12 min para artrocentesis e infiltraciones y 17 min para análisis del líquido sinovial). Conclusiones: Este estudio fija estándares básicos de calidad, organización y tiempo, y es un instrumento útil para la organización de una unidad de reumatología, ya que facilita el diálogo con los gestores sanitarios y contribuye a mejorar la calidad de la práctica reumatológica.
    Reumatología clínica, ISSN 1699-258X, Vol. 3, Nº. 5, 2007, pags. 218-225.
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    ABSTRACT: To provide a reference to rheumatologists and to those involved in the treatment of RA who are using, or about to use biologic therapy. Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and grade of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. We have produced recommendations on the use of the seven biologic agents available for RA in our country. The objective of treatment is to achieve the remission of the disease as quickly as possible. Indications and nuances regarding the use of biologic therapy were reviewed as well as the evaluation that should be performed prior to administration and the follow up of patients undergoing this therapy. We present an update on the SER recommendations for the use of biologic therapy in patients with RA.
    Reumatología clinica. 6(1):23-36.
  • Medicine - Programa de Formación Médica Continuada Acreditado 8(33):1743–1748.

Publication Stats

81 Citations
6.27 Total Impact Points

Institutions

  • 2009–2014
    • Hospital Civil de Guadalajara
      Guadalajara, Jalisco, Mexico
  • 2005–2013
    • University of Alcalá
      Cómpluto, Madrid, Spain
  • 2011
    • University of Santiago de Compostela
      Santiago, Galicia, Spain
  • 2007–2011
    • Hospital Universitario de Guadalajara
      Guadalajara, Castille-La Mancha, Spain