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Publications (6)5.18 Total impact

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    ABSTRACT: Hospital-acquired pneumonia (HAP) is one of the leading nosocomial infections and is associated with high morbidity and mortality. Numerous studies on HAP have been performed in intensive care units (ICUs), whereas very few have focused on patients in general wards. This study examined the incidence of, risk factors for, and outcomes of HAP outside the ICU. An incident case-control study was conducted in a 600-bed hospital between January 2006 and April 2008. Each case of HAP was randomly matched with 2 paired controls. Data on risk factors, patient characteristics, and outcomes were collected. The study group comprised 119 patients with HAP and 238 controls. The incidence of HAP outside the ICU was 2.45 cases per 1,000 discharges. Multivariate analysis identified malnutrition, chronic renal failure, anemia, depression of consciousness, Charlson comorbidity index ≥3, previous hospitalization, and thoracic surgery as significant risk factors for HAP. Complications occurred in 57.1% patients. The mortality attributed to HAP was 27.7%. HAP outside the ICU prevailed in patients with malnutrition, chronic renal failure, anemia, depression of consciousness, comorbidity, recent hospitalization, and thoracic surgery. HAP in general wards carries an elevated morbidity and mortality and is associated with increased length of hospital stay and increased rate of discharge to a skilled nursing facility.
    American journal of infection control 11/2013; · 3.01 Impact Factor
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    ABSTRACT: To analyse the results obtained in the diagnosis and staging of lung cancer (LC) by a Lung Cancer Rapid Diagnosis Unit (LC-RDU) in which real-time endobronchial ultrasound-guided transbronchial needle aspiration (RT-EBUS guided-TBNA) is performed as part of the clinical evaluation of the patient prior to treatment. A four year observational study was conducted on a group of patients evaluated due to suspicion of LC in an LC-RDU. The times and the techniques required for the diagnosis and identifying the level of the disease in the initial staging were recorded. Out of a total of 678 patients seen in the LC-RDU, the diagnosis in 352 was confirmed in one or more histopathology samples. In 170 patients (48.2%) the diagnosis was made with biopsies and/ or cytology samples obtained by fibrobronchoscopy, and RT-EBUS guided-TBNA confirmed the clinical suspicion in 70 patients (19.9%). In the 280 patients with SCLC, 166 RT-EBUS guided-TBNA were performed for staging (59.3%), and in 105 of them the technique only showed local disease (37.5%). Therapeutic surgery was performed on 83 of these patients, and was radical in 73 cases (87.9%). In half of the patients referred to the LC-RDU due to suspected LC, the diagnosis was confirmed in 75% of cases using endoscopic techniques. RT-EBUS guided-TBNA was the diagnostic technique in 20% of the cases, for staging in more than half of them, and led to reduced waiting times for the diagnosis and starting treatment.
    Archivos de Bronconeumología 09/2010; 46(12):640-5. · 2.17 Impact Factor
  • American Thoracic Society 2010 International Conference, May 14-19, 2010 • New Orleans; 05/2010
  • American Thoracic Society 2010 International Conference, May 14-19, 2010 • New Orleans; 05/2010
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    ABSTRACT: ObjectiveTo analyse the results obtained in the diagnosis and staging of lung cancer (LC) by a Lung Cancer Rapid Diagnosis Unit (LC-RDU) in which real-time endobronchial ultrasound-guided transbronchial needle aspiration (RT-EBUS guided-TBNA) is performed as part of the clinical evaluation of the patient prior to treatment.MethodA four year observational study was conducted on a group of patients evaluated due to suspicion of LC in an LC-RDU. The times and the techniques required for the diagnosis, the treatment period and the level of the disease in the initial staging were recorded.ResultsOut of a total of 678 patients seen in the LC-RDU, the diagnosis in 352 was confirmed in one or more histopathology tests. In 170 patients (48.2%) the diagnosis was made with biopsies and/ or cytology samples obtained by fibrobronchoscopy, and RT-EBUS guided-TBNA confirmed the clinical suspicion in 70 patients (19.9%). In the 280 patients with NSCLC, 166 RT-EBUS guided-TBNA were performed for staging (59.3%), and in 105 of them the technique only showed local disease (37.5%). Eighty-three of these patients underwent therapeutic surgery, which was radical in 73 cases (87.9%).ConclusionIn half of the patients referred to the LC-RDU due to suspected LC, the diagnosis was confirmed in 75% of cases using endoscopic techniques. RT-EBUS guided-TBNA, which was the diagnostic technique in 20% of the cases and for staging in more than half of them, led to reduced waiting times to diagnosis and onset to treatment.ResumenObjetivoAnalizar los resultados conseguidos en diagnóstico y estadificación del cáncer de pulmón (CP) por una unidad de diagnóstico rápido de cáncer de tórax (UDR-CT) que incorpora la ultrasonografía endobronquial con punción transbronquial aspirativa en tiempo real (USEB-PTBA-tr) a la evaluación clínica del paciente previa al tratamiento.MétodoSe ha realizado un estudio observacional del conjunto de pacientes valorados por sospecha diagnóstica de CP en una UDR-CT durante cuatro años, registrando los tiempos y la técnica requeridos para el diagnóstico, el tiempo para el tratamiento, y el grado de identificación de enfermedad en estadio inicial.ResultadosSeiscientos setenta y ocho pacientes fueron atendidos en la UDR-CT, en 352 casos el diagnóstico fue confirmado en una o más muestras anatomopatológicas. En 170 pacientes el diagnóstico se obtuvo con biopsias y/o citologías obtenidas por fibrobroncoscopia (48,2%), la USEB-TTBA-rt confirmó la sospecha clínica en 70 pacientes (19,9%). En 280 pacientes afectos de carcinoma de pulmón no célula pequeña (CPNCP) se practicaron 166 USEB-PRBA-tr de estadificación (59,3%) y en 105 de ellos la técnica mostró únicamente enfermedad local (37,5%). En 83 de estos pacientes se procedió a cirugía terapéutica, que fue radical en 73 casos (87,9%).ConclusiónEn la mitad de pacientes remitidos a la UDR-CT por sospecha de CP el diagnóstico se confirma, por técnicas endoscópicas en tres cuartas partes de los casos. La USEB-TTBA-rt es la técnica diagnóstica en una quinta parte de los casos y de estadificación en más de la mitad de ellos, y permite reducir los tiempos de espera hasta el diagnóstico y el inicio de tratamiento.
    Archivos de Bronconeumología ((English Edition)). 01/2010;
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    ABSTRACT: Background: The aim of this study was to determine the incidence, and the risk and prognostic factors of HAP in adult patients admitted to general hospitalization wards. Methods: A prospective, longitudinal study was conducted in a 525 adult-bed University Germans Trias i Pujol hospital to identify the cases of HAP in general hospitalization wards. HAP was identified by active surveillance based on daily review of chest x-ray reports. The intrinsic and extrinsic risk factors of the patients for HAP were collected on review of the clinical charts as were the clinical and microbiological characteristics and the outcome. Results: From January 2006 to April 2008, 119 patients with HAP were included. The incidence of HAP outside the ICU was 2.45 cases /1000 discharges. Most cases occurred in medical wards (62.2%) and previous hospital stay was >5 days in 83.2% of the cases. The mean age was 70±14.4 yr and 74.8% of the patients were males. The most frequent underlying diseases were neoplasms (44.5%) and chronic pulmonary diseases (39.6%), being ultimately or rapidly fatal in 64.7% of the cases. Etiological diagnosis was obtained in 35.3% of the cases. Empirical antibiotic therapy was considered adequate in 88.8% of the episodes. Clinical complications occurred in 57% (mainly respiratory failure in 53%) with 10% of the patients requiring ICU admission. Mortality was 32.7% (27.7% attributed to pneumonia). On univariate analysis, the risk of aspiration (48.5% vs 24.7%), a fatal or ultimately fatal disease (90.9% vs 51.9%), an inappropriate empirical antibiotic therapy (24.2% vs 5.2%) and the presence of complications (97% vs 40.3%) were associated with evolution to death related to HAP (p≤0,01). Conclusions: HAP in general wards usually had a late onset, and prevailed in medical wards and in older patients with severe comorbidity. The severity of the underlying disease, the presence of complications and an inappropriate empirical antibiotic therapy were associated with a poor prognosis.
    Infectious Diseases Society of America 2008 Annual Meeting; 10/2008