Julian Librero

Navarrabiomed · Methodology Unit

BACKGROUND The win ratio analysis method might provide new insight on the impact of positive end-expiratory pressure (PEEP) on clinical outcomes. OBJECTIVE The aim is to re-analyse the results of the ’Re-evaluation of the effects of high PEEP with recruitment manoeuvres vs. low PEEP without recruitment manoeuvres during general anaesthesia for sur...

Purpose External beam radiation therapy has grown significantly, incorporating advanced techniques like intensity modulation or stereotactic treatments, which enhance precision and accuracy. Nevertheless, variability in target volume delineation by radiation oncologists remains a challenge, influencing dose distribution. This study analyzes an onli...

Background The influence of high positive end-expiratory pressure (PEEP) with recruitment maneuvers on the occurrence of postoperative pulmonary complications after surgery is still not definitively established. Bayesian analysis can help to gain further insights from the available data and provide a probabilistic framework that is easier to interp...

Background Socioeconomic status (SES) factors often result in profound health inequalities among populations, and their impact may differ between sexes. The aim of this study was to estimate and compare the effect of socioeconomic status indicators on incident cardiovascular disease (CVD)-related events among males and females with type 2 diabetes...

ORIGINAL Características epidemiológicas, clínicas y funcionales de los pacientes mayores de 75 años ingresados en un hospital terciario durante la primera ola pandémica por SARS-CoV-2 información del artículo Historia del artículo: Recibido el 10 de agosto de 2023 Aceptado el 7 de noviembre de 2023 Palabras clave: SARS-CoV-2 Anciano Estado funcion...

Background: The objective of the present study is to analyze the epidemiological, clinical and functional characteristics of patients admitted to the University Hospital of Navarra due to SARS-CoV-2 infection, as well as the predictors of mortality, during the first wave of the pandemic caused by this virus. Methodology: An observational, retros...

Social inequalities influence population health outcomes and well-being. The aim of the study was to analyze the association between the main demographic, social, and economic determinants and the outcomes related to COVID-19 infection and severity and COVID-19 vaccination. A population-based cohort study was carried out including the Navarre (Spai...

Background There is strong evidence supporting the association between environmental factors and increased risk of non-affective psychotic disorders. However, the use of sound statistical methods to account for spatial variations associated with environmental risk factors, such as urbanicity, migration, or deprivation, is scarce in the literature....

Background: Using the frequentist approach, a recent meta–analysis of three randomized clinical trials in patients undergoing intraoperative ventilation during general anesthesia for major surgery failed to show the benefit of ventilation that uses high positive end–expiratory pressure with recruitment maneuvers when compared to ventilation that us...

(1) Background and aim: This study aimed to investigate the impact of prehabilitation on the postoperative outcomes of heart transplantation and its cost-effectiveness. (2) Methods: This single-center, ambispective cohort study included forty-six candidates for elective heart transplantation from 2017 to 2021 attending a multimodal prehabilitation...

Introduction Transcutaneous auricular vagus nerve stimulation (taVNS) is a neuromodulatory technique that stimulates the auricular branch of the vagus nerve. The modulation of the locus coeruleus-norepinephrine (LC-NE) network is one of the potential working mechanisms of this method. Our aims were 1-to investigate if short and single applications...

Background and purpose: We aimed to determine whether an extended oral antibiotic prophylaxis protocol may reduce the rate of surgical site infection (SSI) in patients undergoing instrumented spinal fusion. Patients and methods: This retrospective cohort study comprise 901 consecutive patients subjected to spinal fusion between September 2011 an...

Introduction: COVID-19 induces coagulopathy associated with an increase of thromboembolic events. Due to the lack of agreement on recommendations for thromboprophylactic management, the aim of this study was to study the dosages of LMWH used in critically ill COVID-19 patients assessing the effect on their outcome. Metohds: We evaluated data of...

Background One of the main drawbacks in constructing a classification model is that some or all of the covariates are categorical variables. Classical methods either assign labels to each output of a categorical variable or are summarised measures (frequencies and percentages), which can be interpreted as probabilities. Methods We adopted a novel m...

Purpose The CArdiovascular Risk in patients with DIAbetes in Navarra (CARDIANA cohort) cohort was established to assess the effects of sociodemographic and clinical variables on the risk of cardiovascular events in patients with type 1 (T1D) or type 2 (T2D) diabetes, with a special focus on socioeconomic factors, and to validate and develop cardiov...

Debridement, antibiotics and implant retention (DAIR) remains a commonly utilized technique in the treatment of acute prosthetic joint infections despite its inconsistent outcomes. The performance of a second DAIR after a failed first debridement is controversial as outcomes are uncertain and the final prognosis in the event of failure may be unfav...

Objective To provide new evidence on how tonsils surgery in children has geographically varied over time in the context of the Spanish National Health System. Design Observational ecological spatiotemporal study on geographical variations in medical practice, using linked administrative datasets, including virtually all surgeries performed from 20...

Background: Using the frequentist approach, a recent meta–analysis of three randomized clinical trials in patients undergoing intraoperative ventilation during general anesthesia for major surgery failed to show the benefit of ventilation that uses high positive end–expiratory pressure with recruitment maneuvers when compared to ventilation that us...

Given the variable success of the debridement, antibiotics and implant retention (DAIR) procedure in patients with acute prosthetic joint infection (PJI), an accurate selection of candidates is critical. In this study, we set about calculating the predictive value of a novel algorithm for predicting outcome following DAIR developed by Shohat et al....

Background Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult’s population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown effectiveness for reducing fall rates, evidence around their pu...

Background and objectives: It is reported that ABO antibodies have a role in COVID-19 infection and severity; however, ABO antibody titres vary with advanced age. The aim was to analyse the association between ABO blood group and risk of COVID-19 infection and complications in elderly patients, and to contrast this data with findings in the overal...

Since the early 2000’s, the Atlas of Variations in Medical Practice in the Spanish National Health System (namely, Atlas VPM) has been analysing and informing unwarranted variations in health care provision and outcomes in the Spanish Health System. Atlas VPM covers a two-fold perspective: a geographic one, where unwarranted variations would reflec...

Several authors have studied the potential of sentinel lymph node (SLN) tumor burden as prognostic factor but the microscopic classifications used in different study groups were variable. We examined the prognostic role of tumor burden in SLN on melanoma specific-survival and competing causes of death. We also analysed clinical and histological fac...

In this study, we analyzed the effectiveness of statin therapy for the primary prevention of cardiovascular disease (CVD) in low- and medium-risk patients. Using observational data, we estimated effectiveness by emulating a hypothetical randomized clinical trial comparing statin initiators with statin non-initiators. Two approaches were used to adj...

Background High intraoperative PEEP with recruitment manoeuvres may improve perioperative outcomes. We re-examined this question by conducting a patient-level meta-analysis of three clinical trials in adult patients at increased risk for postoperative pulmonary complications who underwent non-cardiothoracic and non-neurological surgery. Methods Th...

RESUMEN Introducción: Los pacientes COVID-19 presentan una coagulopatía caracterizada por una elevada incidencia de complicaciones tromboembólicas. Ante la controversia existente sobre el manejo de la tromboprofilaxis, se llevó a cabo un estudio con el objetivo de analizar el efecto de las diferentes dosis de heparina de bajo peso molecular (HBPM)...

Background Corticosteroids are the cornerstone of the treatment of patients with COVID-19 admitted to hospital. However, whether corticosteroids can prevent respiratory worsening in hospitalized COVID-19 patients without oxygen requirements is currently unknown. Aims To assess the efficacy of methylprednisolone pulses (MPP) in hospitalized COVID-1...

Since the beginning of the COVID-19 pandemic, the ABO blood group has been described as a possible biological marker of susceptibility for the disease. This study evaluates the role of ABO group on the risk of SARS-CoV-2 infection and related complications in a population-based cohort including 87,090 subjects from the Navarre population (Northern...

Background Solitary pulmonary nodule (SPN) is a common finding in routine clinical practice when performing chest imaging tests. The vast majority of these nodules are benign, and only a small proportion are malignant. The application of predictive models of nodule malignancy in routine clinical practice would help to achieve better diagnostic mana...

Objectives The aim of this study is to assess the effectiveness and safety of glucocorticoid infusion pulse therapy to improve the clinical outcomes of patients with COVID-19 pneumonia with elevated inflammatory biomarkers. Trial design A parallel-group quadruple-blind (participant, intervention provider, outcome assessor and data manager), random...

Cardiovascular disease (CVD) is the most common cause of morbidity and mortality among patients with type 2 diabetes (T2D). Physical activity (PA) is one of the few modifiable factors that can reduce this risk. The aim of this study was to estimate to what extent PA can contribute to reducing CVD risk and all-cause mortality in patients with T2D. I...

Several studies have identified a possible association between ABO blood group and COVID‐19. However, studies are of variable quality and results are inconsistent. The aim of this systematic review was to synthesize the evidence on the association between ABO and the risk of COVID‐19 infection and prognosis. Searches were conducted in PubMed, MedRx...

Aims: To identify all cardiovascular disease risk prediction models developed in patients with type 2 diabetes or in the general population with diabetes as a covariate updating previous studies, describing model performance and analysing both their risk of bias and their applicability. Methods: A systematic search for predictive models of cardi...

Background Electrical auricular vagus nerve stimulation (taVNS) is an emerging therapy. Stimuli are transported to brainstem nuclei, whereby its multiple projections reach to many subcortical and cortical areas, thus allowing the neuromodulation of several systemic physiological processes. We aim to define the best auricular target for taVNS throug...

(1) Background: Attention deficit hyperactivity disorder (ADHD) constitutes one of the leading mental health and behavioral disorders in childhood and adolescence. The main objective of this study was to analyze the time trend in the incidence of ADHD diagnoses in Navarre (Spain) from 2003 to 2019 in children and adolescents from 5 to 19 years old....

Background The preventive role of an intraoperative recruitment manoeuvre plus open-lung approach (RM+OLA) ventilation on postoperative pulmonary complications (PPC) remains unclear. We aimed at investigating whether an intraoperative open-lung condition reduces the risk of developing a composite of PPCs. Methods Post-hoc analysis of two randomise...

Background: Solitary Pulmonary Nodule (SPN) is a common finding in routine clinical practice when performing chest imaging tests. The vast majority of these nodules are benign, and only a small proportion are malignant. Facing clinical experience as a guide for decision-making in the management of SPN, the application of predictive models of malign...

OBJECTIVE To analyze the effects of a tailored exercise intervention in acutely hospitalized oldest old diabetic patients. RESEARCH DESIGN AND METHODS This is an ancillary analysis of a randomized controlled trial. 103 acutely hospitalized older adults (mean age ~87 years) with type II diabetes were randomized to an intervention (exercise, n=54) or...

Purpose To analyze the epidemiological characteristics of heart failure (HF) and estimate the burden of the disease on the health service by means of real world data (RWD). Patients and methods All patients discharged from any Basque Health Service hospital after a first admission for HF between 2011 and 2015. Data sources Databases of our health...

Objectives To develop a mortality-predictive model for correct identification of patients with non-cancer multiple chronic conditions who would benefit from palliative care, recognise predictive indicators of death and provide with tools for individual risk score calculation. Design Retrospective observational study with multivariate logistic regr...

The World Health Organization considers the non-adherence to medication a significant issue with global impact, especially in chronic conditions such as type 2 diabetes. We aim to study antidiabetic treatment initiation, add-on, treatment switching, and medication persistence. We conducted an observational study on 4247 individuals initiating antid...

Objective To evaluate the association between use of benzodiazepines and incident dementia. Methods Analytical prospective nested case-control study for which the Spanish database for pharmacoepidemiological research in primary care (BIFAP) of the Spanish Agency of Medicines and Medical Devices (AEMPS) was used. A total of 15,212 subjects diagnose...

Little is understood about the symptom network structure of psychotic disorders. In the current study we aimed to examine the network structure of psychotic symptoms in a broad and transdiagnostic sample of subjects with psychotic disorders (n=2240) and to determine whether network structure parameters vary across demographic, sampling method and c...

Background: Postoperative pulmonary complications (PPCs) negatively affect morbidity, healthcare costs and postsurgical survival. Preoperative and intraoperative peripheral oxyhemoglobin saturation (SpO2) levels are independent risk factors for postoperative pulmonary complications (PPCs). The airtest assesses the value of SpO2 while breathing roo...

Background: We aimed to examine whether using a high fraction of inspired oxygen (FIO2) in the context of an individualised intra- and postoperative open-lung ventilation approach could decrease surgical site infection (SSI) in patients scheduled for abdominal surgery. Methods: We performed a multicentre, randomised controlled clinical trial in...

Resumen Numerosos estudios han analizado el efecto de diversas variables del alumnado sobre su rendimiento escolar, así como sobre los resultados en las pruebas de diagnóstico de las diferentes Comunidades Autónomas. Sin embargo, el mes de nacimiento todavía no se contempla como variable en muchos de los estudios, obviando el hecho de que en las au...

Resumen Numerosos estudios han analizado el efecto de diversas variables del alumnado sobre su rendimiento escolar, así como sobre los resultados en las pruebas de diagnóstico de las diferentes Comunidades Autónomas. Sin embargo, el mes de nacimiento todavía no se contempla como variable en muchos de los estudios, obviando el hecho de que en las au...

Aims: The main objective was to assess, using real-practice primary care records, the degree of control of cardiovascular risk factor targets. Records were stratified by the presence of previous history or cardiovascular disease (CVD), and sex differences in the fulfillment profile were analyzed. Methods: This is a cross-sectional population-bas...

Background: Beta blockers, ACE Inhibitors, and ARM are the treatments with IA degree of recommendation for secondary prevention in patients with CHF. However, the literature suggests that these therapies are not always prescribed in our hospitals and, mainly, that patients adherence is far from optimal. Additionally, first prescription adherence is...

Objective The two main surgical treatments for abdominal aortic aneurysm (AAA) are open surgical repair (OSR) and endovascular aneurysm repair (EVAR). The aim of this study was to analyze variation among Spanish hospitals in the use of OSR or EVAR for AAA. A secondary aim was to assess changes in preferences for these two procedures over time. Met...

Objective: The aim of this clinical trial is to examine whether it is possible to reduce postoperative complications using an individualized perioperative ventilatory strategy versus using a standard lung-protective ventilation strategy in patients scheduled for thoracic surgery requiring one-lung ventilation. Design: International, multicenter,...

In this paper, we explore the impact of birth month on the academic achievement in Spanish Language and Mathematics of primary students in grades 2, 4, and 6 in Cantabria County, in the academic years of 2009-2014. The findings show that students born in late-autumn months scored lower than their classmates, suffering, therefore, from the disadvant...

Background and objective To assess the effect of home based telehealth or structured telephone support interventions with respect to usual care on quality of life, mortality and healthcare utilization in elderly high-risk multiple chronic condition patients. Patients and methods 472 elderly high-risk patients with plurimorbidity in the region of V...

Introduction The current health information systems offer an opportunity to implement advanced methodology to generate evidence within the context of the healthcare activity. This evidence could complement that of the clinical trials, often challenged due to poor external validity. This use of real world data (RWD) has also its limitations, mainly...

Introduction The current Health Information Systems offer an opportunity to implement advanced methodology to generate evidence within the context of the healthcare activity. This evidence could complement that of the clinical trials, often challenged due to poor external validity. This use of real world data (RWD) has also its limitations, mainly...

In this study, we aim to assess the impact that the introduction of our strategy in chronic patients with multiple pathologies has had regarding health-related resources use. Our strategy is based on an integrated care model with case management methodology, reinforcing the primary care role with the support of a referral specialist and a hospital...

Little is known about the contextual variability in osteoporosis medication utilization. Our aims were 1) to describe variations in utilization and spending on osteoporotic medication between the Primary Care Health Zones (PHZ) of the Valencia region, Spain, 2) to analyze observed variations using Small Area Variation Analysis methods, and 3) to qu...

Maps of indirect standardized drug utilization ratios of osteoporosis medication use among women ≥ 50 years by Primary Healthcare Zones in the region of valencia, 2009. (DOCX)

Spearman correlations between Primary Healthcare Zones indirect standardized drug utilization ratios of the osteoporosis medication (Valencia region, 2009). (DOCX)