In the past Javier Ena has collaborated on articles with Teresa Lozano. One of their most recent publications is Clinical Urology: Original ArticleRisk Factors for Acquisition of Urinary Tract Infections Caused by Ciprofloxacin Resistant Escherichia Coli. Which was published in journal The Journal of Urology.

More information about Javier Ena research including statistics on their citations can be found on their Copernicus Academic profile page.

Javier Ena's Articles: (4)

Clinical Urology: Original ArticleRisk Factors for Acquisition of Urinary Tract Infections Caused by Ciprofloxacin Resistant Escherichia Coli

ABSTRACTFrom January 1990 to December 1992, ciprofloxacin resistant Escherichia coli was isolated in 125 of 1,946 urine cultures (6.4%) with more than 10 sup 5 colony-forming units per ml. To determine the risk factors for acquisition of urinary tract infections caused by ciprofloxacin resistant E. coli a retrospective chart review was done. Data from 54 patients with urinary tract infections caused by ciprofloxacin resistant E. coli were compared with 51 controls matched by temporal occurrence and randomly selected among 540 patients with urinary tract infections caused by ciprofloxacin susceptible E. coli. Patients had greater proportions of asymptomatic bacteriuria or lower urinary tract symptoms (85% versus 61%, p = 0.01) and of relapse (22% versus 0%, p = 0.001) than controls. Urinary tract abnormalities (odds ratio 7.98, 95% confidence interval 2.7 to 3.1, p <0.001), patient age 65 years or older (odds ratio 6.48, 95% confidence interval 2.2 to 19.1, p <0.001), previous treatment with quinolones (odds ratio 19.09, 95% confidence interval 2.2 to 166.5, p = 0.008) and urinary catheterization (odds ratio 2.92, 95% confidence interval 1.1 to 8.5, p = 0.048) were independently associated with infections caused by ciprofloxacin resistant strains. Our results suggest that patients with urological abnormalities previously treated with quinolones are especially prone to urinary tract infection caused by ciprofloxacin resistant strains.

Long-term improvements in insulin prescribing habits and glycaemic control in medical inpatients associated with the introduction of a standardized educational approach

AbstractBackgroundWe carried out an educational strategy to increase physician adherence to 8 recommendations for inpatient evaluation and management of diabetes endorsed by the American Diabetes Association.MethodsWe evaluated physician attitude, barriers and facilitators to incorporate the proposed recommendations into clinical practice. We analyzed the impact of the educational strategy on process-of-care and outcome variables in 138 patients with type 2 diabetes discharged from the internal medicine department before the intervention, at 3-month and at 9-month after the intervention.ResultsAfter the educational intervention there was a high motivation of physicians to adhere to the proposed recommendations. The intervention caused a significant reduction of insulin administered by sliding scale (50% vs. 7% vs. 3%, P = 0.000), and in the median pre-discharge glycaemic values (185 mg/dL vs. 153 mg/dL vs. 161 mg/dL, P = 0.005), in the three periods, respectively. The use basal-bolus-correction insulin dosage increased in postintervention periods (17% vs. 85% vs. 99%, P = 0.004). Hypoglycaemia (glycaemia <60 mg/dL) episodes were similar among the three periods (0.30% vs. 0.70% vs. 1.07%, P = 0.10). The intervention required improvements to promote haemoglobinA1c ordering on admission and diabetes intensification therapy at discharge when needed.ConclusionOur educational strategy improved physician adoption of practice guidelines.

Artículo originalEvaluación de los pacientes con dolor torácico agudo de origen incierto mediante la determinación seriada de los valores de proteína C reactiva de alta sensibilidadEvaluation of Patients With Acute Chest Pain of Uncertain Origin by Means of Serial Measurement of High-Sensitivity C-Reactive Protein

Introducción y objetivosInvestigamos la utilidad de 2 medidas seriadas de proteína C reactiva de alta sensibilidad (PCR-as) para evaluar el dolor torácico en pacientes con electrocardiograma no diagnóstico y marcadores de daño miocárdico normales. Partimos de la hipótesis de que la concentración de PCR-as se incrementaría si los síntomas fueran causados por daño endotelial coronario o rotura de placa arteriosclerótica.MétodosEstudiamos a 468 pacientes consecutivos atendidos en urgencias con dolor torácico, 191 con diagnóstico no concluyente. En esta población determinamos la PCR-as en el momento del ingreso en urgencias y a las 24 h. Seguimos el protocolo de tratamiento del dolor torácico con sospecha de origen coronario. Cualquier incremento de la PCR-as a las 24 h en relación con la basal se consideró un resultado positivo.ResultadosEn total, 38 (20%) pacientes fueron diagnosticados de dolor torácico coronario. La diferencia de PCR-as (PCR-as a las 24 h menos PCR-as basal en urgencias) mostró una sensibilidad del 95% (intervalo de confianza [IC] del 95%, 81-98%), una especificidad del 40% (IC del 95%, 32-47%), una razón de probabilidad positiva de 1,57 (IC del 95%, 1,33-1,83), una razón de probabilidad negativa de 0,13 (IC del 95%, 0,04-0,44) y área bajo la curva receptor-operador de 0,77 (IC del 95%, 0,69-0,85). A los 30 días no hubo eventos cardiacos en los pacientes con diferencia negativa del valor de PCR-as.ConclusionesLa diferencia de PCR-as resulta útil como herramienta diagnóstica en los pacientes con dolor torácico agudo de probable origen isquémico. Los resultados negativos se asocian con un bajo riesgo de isquemia coronaria significativa y permitirían dar de alta de forma segura a los pacientes desde el servicio de urgencias.

Original ArticleManagement of patients with type 2 diabetes and multiple chronic conditions: A Delphi consensus of the Spanish Society of Internal Medicine

AbstractAimsTo develop consensus-based recommendations for the management of chronic complex patients with type 2 diabetes mellitus using a two round Delphi technique.MethodsExperts from the Diabetes and Obesity Working Group (DOWG) of the Spanish Society of Internal Medicine (SEMI) reviewed MEDLINE, PubMed, SCOPUS and Cochrane Library databases up to September 2014 to gather information on organization and health care management, stratification of therapeutic targets and therapeutic approach for glucose control in chronic complex patients with type 2 diabetes mellitus.A list of 6 recommendations was created and rated by a panel of 75 experts from the DOWG by email (first round) and by open discussion (second round). A written document was produced and sent back to DOWG experts for clarification purposes.ResultsA high degree of consensus was achieved for all recommendations summarized as 1) there is a need to redesign and test new health care programs for chronic complex patients with type 2 diabetes mellitus; 2) therapeutic targets in patients with short life expectancy should be individualized in accordance to their personal, clinical and social characteristics; 3) patients with chronic complex conditions and type 2 diabetes mellitus should be stratified by hypoglycemia risk; 4) age and specific comorbidities should guide the objectives for glucose control; 5) the risk of hypoglycemia should be a key factor when choosing a treatment; and 6) basal insulin analogs compared to human insulin are cost-effective options.ConclusionThe assessment and recommendations provided herein represent our best professional judgment based on current data and clinical experience.

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