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  1. Article ; Online: Tools to Reduce Low-Value Care

    Luis Corral-Gudino

    International Journal of Health Policy and Management, Vol 11, Iss 9, Pp 1967-

    Lessons From COVID-19 Pandemic; Comment on “Key Factors that Promote Low-Value Care: Views of Experts From the United States, Canada, and the Netherlands”

    2022  Volume 1970

    Abstract: Based on a summary of interviews with 18 experts, Verkerk et al defined the seven key factors that promoted lowvalue care, which included system, social, and knowledge factors. During the ongoing coronavirus disease 2019 (COVID-19) pandemic, these key ... ...

    Abstract Based on a summary of interviews with 18 experts, Verkerk et al defined the seven key factors that promoted lowvalue care, which included system, social, and knowledge factors. During the ongoing coronavirus disease 2019 (COVID-19) pandemic, these key factors have been influential due to the uncertainty of the disease at the beginning of the pandemic. Globally, several measures have been implemented to reduce low-value care practices and promote high-value care for COVID-19 patients. From huge multicenter, non-industry sponsored or multiplatform trials, to the use of social networks sites is an indispensable and effective way to disseminate medical information. Thanks to these measures, we have transformed a scenario of ignorance into an evidence-based medical scenario in less than a year. Verkerk and colleagues’ proposed key factors are an excellent framework for characterizing and highlighting the lessons that can be learnt from how we have fought against the pandemic and low-value practices.
    Keywords low-value care ; de-implementation ; medical overuse ; overtreatment ; overdiagnosis ; covid-19 ; Public aspects of medicine ; RA1-1270
    Subject code 303
    Language English
    Publishing date 2022-09-01T00:00:00Z
    Publisher Kerman University of Medical Sciences
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Paradoxical Deterioration During Anti-Tuberculous Therapy in Non-HIV-Infected Patients with Pleural Tuberculosis

    Luis Corral-Gudino / Alicia Rivas-Lazamares / Ana Gonzalez-Fernandez / Juan Carlos Hernando-Garcia

    European Journal of Case Reports in Internal Medicine, Vol 3, Iss

    A Pragmatic Approach

    2016  Volume 6

    Abstract: We report a case of paradoxical deterioration. A male patient diagnosed with pleural tuberculosis, but who was not infected with human immunodeficiency virus (HIV), experienced clinical deterioration 3 weeks after the initiation of anti-tuberculous ... ...

    Abstract We report a case of paradoxical deterioration. A male patient diagnosed with pleural tuberculosis, but who was not infected with human immunodeficiency virus (HIV), experienced clinical deterioration 3 weeks after the initiation of anti-tuberculous treatment. After other diagnoses were ruled out, a paradoxical response to treatment was established and the patient was started on systemic corticosteroids. Paradoxical response to treatment should be considered in patients with clinical deterioration after they start on anti-tuberculous treatment.
    Keywords Pleural tuberculosis ; antitubercular agents ; paradoxical response ; Medicine ; R
    Language English
    Publishing date 2016-09-01T00:00:00Z
    Publisher SMC MEDIA SRL
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Use of glucocorticoids megadoses in SARS-CoV-2 infection in a spanish registry

    Cristina Lavilla Olleros / Cristina Ausín García / Alejandro David Bendala Estrada / Ana Muñoz / Philip Erick Wikman Jogersen / Ana Fernández Cruz / Vicente Giner Galvañ / Juan Antonio Vargas / José Miguel Seguí Ripoll / Manuel Rubio-Rivas / Rodrigo Miranda Godoy / Luis Mérida Rodrigo / Eva Fonseca Aizpuru / Francisco Arnalich Fernández / Arturo Artero / Jose Loureiro Amigo / Gema María García García / Luis Corral Gudino / Jose Jiménez Torres /
    José-Manuel Casas-Rojo / Jesús Millán Núñez-Cortés / On behalf of the SEMI-COVID-19 Network

    PLoS ONE, Vol 17, Iss

    SEMI-COVID-19

    2022  Volume 1

    Abstract: Objective To describe the impact of different doses of corticosteroids on the evolution of patients with COVID-19 pneumonia, based on the potential benefit of the non-genomic mechanism of these drugs at higher doses. Methods Observational study using ... ...

    Abstract Objective To describe the impact of different doses of corticosteroids on the evolution of patients with COVID-19 pneumonia, based on the potential benefit of the non-genomic mechanism of these drugs at higher doses. Methods Observational study using data collected from the SEMI-COVID-19 Registry. We evaluated the epidemiological, radiological and analytical scenario between patients treated with megadoses therapy of corticosteroids vs low-dose of corticosteroids and the development of complications. The primary endpoint was all-cause in-hospital mortality according to use of corticosteroids megadoses. Results Of a total of 14,921 patients, corticosteroids were used in 5,262 (35.3%). Of them, 2,216 (46%) specifically received megadoses. Age was a factor that differed between those who received megadoses therapy versus those who did not in a significant manner (69 years [IQR 59–79] vs 73 years [IQR 61–83]; p < .001). Radiological and analytical findings showed a higher use of megadoses therapy among patients with an interstitial infiltrate and elevated inflammatory markers associated with COVID-19. In the univariate study it appears that steroid use is associated with increased mortality (OR 2.07 95% CI 1.91–2.24 p < .001) and megadose use with increased survival (OR 0.84 95% CI 0.75–0.96, p 0.011), but when adjusting for possible confounding factors, it is observed that the use of megadoses is also associated with higher mortality (OR 1.54, 95% CI 1.32–1.80; p < .001). There is no difference between megadoses and low-dose (p .298). Although, there are differences in the use of megadoses versus low-dose in terms of complications, mainly infectious, with fewer pneumonias and sepsis in the megadoses group (OR 0.82 95% CI 0.71–0.95; p < .001 and OR 0.80 95% CI 0.65–0.97; p < .001) respectively. Conclusion There is no difference in mortality with megadoses versus low-dose, but there is a lower incidence of infectious complications with glucocorticoid megadoses.
    Keywords Medicine ; R ; Science ; Q
    Subject code 610
    Language English
    Publishing date 2022-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Polymorphisms in autophagy genes are associated with paget disease of bone.

    Ricardo Usategui-Martín / Judith García-Aparicio / Luis Corral-Gudino / Ismael Calero-Paniagua / Javier Del Pino-Montes / Rogelio González Sarmiento

    PLoS ONE, Vol 10, Iss 6, p e

    2015  Volume 0128984

    Abstract: Paget disease of bone (PDB) is a focal bone disorder affecting the skeleton segmentally. The main alteration resides in osteoclasts that increase in size, number and activity. Many osteoclasts have cytoplasmic inclusions that have been associated with ... ...

    Abstract Paget disease of bone (PDB) is a focal bone disorder affecting the skeleton segmentally. The main alteration resides in osteoclasts that increase in size, number and activity. Many osteoclasts have cytoplasmic inclusions that have been associated with protein aggregates, increasing the evidences of a possible deregulation of autophagy in the development of the PDB. Autophagy starts with encapsulation of the target into a double-membrane-bound structure called an "autophagosome." It has been reported that at least 18 ATG genes (autophagy-related genes) are involved in autophagosome formation. We have studied the distribution of genotypes of the ATG2B rs3759601, ATG16L1 rs2241880, ATG10 rs1864183 and ATG5 rs2245214 polymorphisms in a Spanish cohort of subjects with PDB and compared with healthy subjects. Our results show that being a carrier of the C allele of the ATG16L1 rs2241880 and the G allele of ATG5 rs2245214 polymorphisms were associated with an increased risk of developing PDB, whereas being a carrier of the T allele of ATG10 rs1864183 polymorphism decreased the risk of suffering the disease in our series. This is the first report that shows an association between autophagy and Paget Disease of Bone and requires further confirmation in other series.
    Keywords Medicine ; R ; Science ; Q
    Subject code 616
    Language English
    Publishing date 2015-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Use of glucocorticoids megadoses in SARS-CoV-2 infection in a spanish registry

    Cristina Lavilla Olleros / Cristina Ausín García / Alejandro David Bendala Estrada / Ana Muñoz / Philip Erick Wikman Jogersen / Ana Fernández Cruz / Vicente Giner Galvañ / Juan Antonio Vargas / José Miguel Seguí Ripoll / Manuel Rubio-Rivas / Rodrigo Miranda Godoy / Luis Mérida Rodrigo / Eva Fonseca Aizpuru / Francisco Arnalich Fernández / Arturo Artero / Jose Loureiro Amigo / Gema María García García / Luis Corral Gudino / Jose Jiménez Torres /
    José-Manuel Casas-Rojo / Jesús Millán Núñez-Cortés / SEMI-COVID-19 Network

    PLoS ONE, Vol 17, Iss 1, p e

    SEMI-COVID-19.

    2022  Volume 0261711

    Abstract: Objective To describe the impact of different doses of corticosteroids on the evolution of patients with COVID-19 pneumonia, based on the potential benefit of the non-genomic mechanism of these drugs at higher doses. Methods Observational study using ... ...

    Abstract Objective To describe the impact of different doses of corticosteroids on the evolution of patients with COVID-19 pneumonia, based on the potential benefit of the non-genomic mechanism of these drugs at higher doses. Methods Observational study using data collected from the SEMI-COVID-19 Registry. We evaluated the epidemiological, radiological and analytical scenario between patients treated with megadoses therapy of corticosteroids vs low-dose of corticosteroids and the development of complications. The primary endpoint was all-cause in-hospital mortality according to use of corticosteroids megadoses. Results Of a total of 14,921 patients, corticosteroids were used in 5,262 (35.3%). Of them, 2,216 (46%) specifically received megadoses. Age was a factor that differed between those who received megadoses therapy versus those who did not in a significant manner (69 years [IQR 59-79] vs 73 years [IQR 61-83]; p < .001). Radiological and analytical findings showed a higher use of megadoses therapy among patients with an interstitial infiltrate and elevated inflammatory markers associated with COVID-19. In the univariate study it appears that steroid use is associated with increased mortality (OR 2.07 95% CI 1.91-2.24 p < .001) and megadose use with increased survival (OR 0.84 95% CI 0.75-0.96, p 0.011), but when adjusting for possible confounding factors, it is observed that the use of megadoses is also associated with higher mortality (OR 1.54, 95% CI 1.32-1.80; p < .001). There is no difference between megadoses and low-dose (p .298). Although, there are differences in the use of megadoses versus low-dose in terms of complications, mainly infectious, with fewer pneumonias and sepsis in the megadoses group (OR 0.82 95% CI 0.71-0.95; p < .001 and OR 0.80 95% CI 0.65-0.97; p < .001) respectively. Conclusion There is no difference in mortality with megadoses versus low-dose, but there is a lower incidence of infectious complications with glucocorticoid megadoses.
    Keywords Medicine ; R ; Science ; Q
    Subject code 610
    Language English
    Publishing date 2022-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Evolution of the Use of Corticosteroids for the Treatment of Hospitalised COVID-19 Patients in Spain between March and November 2020

    David Balaz / Philip Erick Wikman-Jorgensen / Vicente Giner Galvañ / Manuel Rubio-Rivas / Borja de Miguel Campo / Mariam Noureddine López / Juan Francisco López Caleya / Ricardo Gómez Huelgas / Paula María Pesqueira Fontán / Manuel Méndez Bailón / Mar Fernández-Garcés / Ana Fernández Cruz / Gema María García García / Nicolás Rhyman / Luis Corral-Gudino / Aquiles Lozano Rodríguez-Mancheño / María Navarro De La Chica / Andrea Torregrosa García / José Nicolás Alcalá /
    Pablo Díaz Jiménez / Leticia Esther Royo Trallero / Pere Comas Casanova / Jesús Millán Núñez-Cortés / José-Manuel Casas-Rojo / on behalf of the SEMI-COVID-19 Network

    Journal of Clinical Medicine, Vol 10, Iss 4610, p

    SEMI-COVID National Registry

    2021  Volume 4610

    Abstract: Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential ... ...

    Abstract Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations. Material and methods: A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID-19 Registry from March to November 2020. Results: CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7–160) vs. 49.3 (16–109) mg/dL; p < 0.001), ferritin (791 (393–1534) vs. 470 (236–996) µg/dL; p < 0.001), D dimer (750 (430–1400) vs. 617 (345–1180) µg/dL; p < 0.001), and lower Sp0 2 /Fi0 2 (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%. Conclusions: Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%.<br />
    Keywords COVID-19 ; corticosteroids ; Spain ; comorbidities ; Medicine ; R
    Subject code 610
    Language English
    Publishing date 2021-10-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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