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Papers by Marien Gonzalez Lorenzo

Research paper thumbnail of Comparative Efficacy and Safety of Vaccines to Prevent Seasonal Influenza: A Systematic Review and Network Meta-Analysis

Research paper thumbnail of The revised Cochrane risk-of-bias tool for randomised trials (RoB 2) showed low inter-rater reliability and challenges in its application

Journal of Clinical Epidemiology

Research paper thumbnail of Quality assessment versus risk of bias in systematic reviews: AMSTAR and ROBIS had similar reliability but differed in their construct and applicability

Journal of Clinical Epidemiology

Research paper thumbnail of Loss of Response to Vedolizumab and Ability of Dose Intensification to Restore Response in Patients With Crohn’s Disease or Ulcerative Colitis: A Systematic Review and Meta-analysis

Clinical Gastroenterology and Hepatology

Research paper thumbnail of Minor differences were found between AMSTAR 2 and ROBIS in the assessment of systematic reviews including both randomized and non-randomized studies

Journal of Clinical Epidemiology

Research paper thumbnail of Adverse effects of immunotherapies for multiple sclerosis: a network meta-analysis

Research paper thumbnail of Efficacy of virtual reality exposure therapy

International Journal of Clinical and Health Psychology, 2011

Research paper thumbnail of Efficacy of virtual reality exposure therapy combined with two pharmacotherapies in the treatment of agoraphobia

International Journal of Clinical and Health Psychology, 2011

Currently, some psychopharmacological treatments, cognitivebehavioral therapies (CBT), and a comb... more Currently, some psychopharmacological treatments, cognitivebehavioral therapies (CBT), and a combination of both are considered effective treatments for agoraphobia. Among psychological treatments, new therapeutic alternatives such as virtual reality exposure treatment (VRET) have been developed. The aim of this experimental study was to evaluate the ef¿ cacy of VRET combined with two antidepressant drugs (venlafaxine and paroxetine) in a sample of agoraphobia patients (N = 64), using a virtual system consisting of seven scenarios. Five types of treatment were compared: four combined treatment groups and one psychopharmacological treatment. Measures were taken at pre-treatment, posttreatment, and six-month follow-up; agoraphobia and anxiety measures were used as dependent variables. Results showed that all groups were statistically effective, both at post-treatment and six-month follow-up. However, based on clinical ef¿ cacy, results showed that combined treatment groups including VRET appeared to be better than traditional techniques at decreasing agoraphobia and anxiety measures and keeping them lower over time. Int J Clin Health Psychol, Vol. 11. Nº 2 190 GONZALEZ LORENZO et al. Ef¿ icacy of virtual reality exposure therapy and agoraphobia KEY WORDS. Agoraphobia. Virtual reality. Cognitive-behavioral treatment. Pharmacological treatment. Experimental study.

Research paper thumbnail of Tyrosine kinase inhibitors for unresectable hepatocellular carcinoma in adults

Research paper thumbnail of Treatment Preferences in Patients with Knee or Hip Osteoarthritis: An Overview

Osteoarthritis - Diagnosis, Treatment and Surgery, 2012

Research paper thumbnail of Patient empowerment as a component of health system reforms: rights, benefits and vested interests

Internal and Emergency Medicine, 2012

Different strategies have been developed across countries to foster citizens' and patients' invol... more Different strategies have been developed across countries to foster citizens' and patients' involvement, from health policies to patients' active participation in decisions regarding their health. The spectrum varies from systems where patients lead the reform of health care services, to others where a paternalistic approach still limits patients' autonomy in decision-making. This paper describes: (1) different interventions for involving patients;

Research paper thumbnail of Mental health professionals' attitudes to partnership in medicine taking: a validation study of the Leeds Attitude to Concordance Scale II

Pharmacoepidemiology and Drug Safety, 2012

To explore psychiatrists&... more To explore psychiatrists' attitudes toward concordance by validating the Leeds Attitude to Concordance Scale II (LATCon II) in a Spanish sample. This was a cross-sectional survey. An opportunistic sample of 125 psychiatrist and 100 psychiatry registrars attending a national conference completed the LATCon II questionnaire and sociodemographic and professional data. The principal component analysis of the LATCon II items was performed. Associations with sociodemographic and mental health professional variables were calculated. Principal component analysis yielded three components labeled "communication/empathy," "shared control," and "eventual paternalistic style." Women obtained significantly lower scores than men on the second component. Mental health professional variables were not related to attitude to concordance. Psychiatrists show a favorable attitude to involve patients in a process of reciprocal communication, where patients' preferences, values, and expectations are considered, but they are more cautious in their attitude to sharing decisions with patients. There is scope for the different kinds of research in this area: studying sex-based differences in psychiatrists' attitudes to concordance and also exploring the gap in mental health care between patients' and professionals' views of shared decision making. Only in this way can the real partnership for shared decision making be fully understood.

Research paper thumbnail of Patient Involvement and Shared Decision-Making in Mental Health Care

Current Clinical Pharmacology, 2011

There is growing interest in shared decision-making (SDM) in which the provider and patient go th... more There is growing interest in shared decision-making (SDM) in which the provider and patient go through each phase of the decision-making process together, share treatment preferences, and reach an agreement on treatment choice. Although a majority of the research evaluating SDM has been conducted under "physical" health conditions, patients' participation and SDM for mental health conditions has received increasing interest since the mid 1990s. SDM in mental health care can be more complex than in general health care because that several patient characteristics, health care provider, and system level factors may hinder normalization and implementation of this model into clinical practice. To date, in comparison with other health problems, there are few studies which have assessed SDM in this context. In spite of that, evidence points favorably towards the inclusion of SDM in mental health treatment decisions, given that the majority of patients with mental illness prefer to be involved in the process and wish to have information. However, more studies are needed to provide evidence about the impact of SDM on treatment compliance and health care outcomes. In this overview, the authors present the current state and the future perspectives of SDM in mental health.

Research paper thumbnail of Decision aids for patients facing health treatment or screening decisions: systematic review

BMJ, 1999

Objective To conduct a systematic review of randomised trials of patient decision aids in improvi... more Objective To conduct a systematic review of randomised trials of patient decision aids in improving decision making and outcomes. Design We included randomised trials of interventions providing structured, detailed, and specific information on treatment or screening options and outcomes to aid decision making. Two reviewers independently screened and extracted data on several evaluation criteria. Results were pooled by using weighted mean differences and relative risks. Results 17 studies met the inclusion criteria. Compared with the controls, decision aids produced higher knowledge scores (weighted mean difference = 19/100, 95% confidence interval 14 to 25); lower decisional conflict scores (weighted mean difference = − 0.3/5, − 0.4 to − 0.1); more active patient participation in decision making (relative risk = 2.27, 95% confidence interval 1.3 to 4); and no differences in anxiety, satisfaction with decisions (weighted mean difference = 0.6/100, − 3 to 4), or satisfaction with the decision making process (2/100, − 3 to 7). Decision aids had a variable effect on decisions. When complex decision aids were compared with simpler versions, they were better at reducing decisional conflict, improved knowledge marginally, but did not affect satisfaction. Conclusions Decision aids improve knowledge, reduce decisional conflict, and stimulate patients to be more active in decision making without increasing their anxiety. Decision aids have little effect on satisfaction and a variable effect on decisions. The effects on outcomes of decisions (persistence with choice, quality of life) remain uncertain.

Research paper thumbnail of Shared decision making in Spain: current state and future perspectives

Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 2011

In the last two decades there has been a growing recognition in the Spanish National Health Syste... more In the last two decades there has been a growing recognition in the Spanish National Health System (NHS) of the importance of considering patients' values and preferences in clinical decisions. Patient participation in shared decision making (SDM) is gaining importance as a suitable approach to patient-health professional communication and decision making in Spain. In addition, the NHS is funding the development of patients' decision aids (PtDAs) for shared decision making (SDM) by Health Technology Assessment Agencies. However, the NHS has still not incorporated reforms in law that includes SDM and PtDAs as a key component of health care services and professional curricula, nor is there a standardised implementation of interventions to support decisions in routine care. Most patients are not very familiar with their rights to be kept informed and participate in their own health care decisions. Most professionals are not familiar with or educated about patients' rights to be kept informed and participate in health care decisions either. The future of SDM in Spain is promising. The next course of action should be to maintain the production and adaptation of high-quality PtDAs while at the same time reinforcing effective dissemination strategies among patients and training programmes for professionals focused on SDM.

Research paper thumbnail of Adaptation and validation study of the Beliefs about Medicines Questionnaire in psychiatric outpatients in a community mental health setting

Human Psychopharmacology: Clinical and Experimental, 2011

The present study aims to establish the factor structure and reliability of the Spanish version o... more The present study aims to establish the factor structure and reliability of the Spanish version of the Beliefs about Medicines Questionnaire (BMQ), adapted to psychiatric medication, and to analyze the potential differences between psychiatric outpatients, medical students, and psychology students. The BMQ was tested on a sample of 405 psychiatric outpatients, 216 medical students, and 222 psychology students. Students completed only the BMQ-General scale, adapted for psychiatric medication, and patients completed also the BMQ-Specific scale. For the BMQ-General scale adapted items, the analysis shows a two-factor structure similar to that described for the Spanish validation of the original instrument, but when samples are analyzed separately, relevant differences are observed in the composition of the factor structures. Furthermore, the resulting scales show a medium-low internal consistency. For BMQ-Specific scale items, the results replicate previous data. Medical students tend to consider psychiatric medication as less harmful and less likely to be overprescribed than psychology students, with patients' scores in the middle of both groups. The BMQ-Specific scale has satisfactory psychometric properties for use in psychiatric outpatients in a community mental health setting. The adapted Spanish BMQ-General scale for psychotropics identified three different structures of the factors for each of the three samples studied.

Research paper thumbnail of Impacto de la obesidad en la calidad de vida relacionada con la salud. Revista Española de Obesidad

Revista Espanola de Obesidad

In the last two decades, the interest in studying the impact of obesity in health-related quality... more In the last two decades, the interest in studying the impact of obesity in health-related quality of life (HRQL) has gradually increased. Obesity-specific instruments have been developed. Those together with generic HRQOL measures are frequently applied in clinical trials and other studies. The aim of this study is to analyze the current state of knowledge on HRQL in obesity. Fundamental concepts are presented on QOL, and instruments for HRQL measurement and key findings in comparative studies on HRQOL in overweight people are described.

Research paper thumbnail of Comparative Efficacy and Safety of Vaccines to Prevent Seasonal Influenza: A Systematic Review and Network Meta-Analysis

Research paper thumbnail of The revised Cochrane risk-of-bias tool for randomised trials (RoB 2) showed low inter-rater reliability and challenges in its application

Journal of Clinical Epidemiology

Research paper thumbnail of Quality assessment versus risk of bias in systematic reviews: AMSTAR and ROBIS had similar reliability but differed in their construct and applicability

Journal of Clinical Epidemiology

Research paper thumbnail of Loss of Response to Vedolizumab and Ability of Dose Intensification to Restore Response in Patients With Crohn’s Disease or Ulcerative Colitis: A Systematic Review and Meta-analysis

Clinical Gastroenterology and Hepatology

Research paper thumbnail of Minor differences were found between AMSTAR 2 and ROBIS in the assessment of systematic reviews including both randomized and non-randomized studies

Journal of Clinical Epidemiology

Research paper thumbnail of Adverse effects of immunotherapies for multiple sclerosis: a network meta-analysis

Research paper thumbnail of Efficacy of virtual reality exposure therapy

International Journal of Clinical and Health Psychology, 2011

Research paper thumbnail of Efficacy of virtual reality exposure therapy combined with two pharmacotherapies in the treatment of agoraphobia

International Journal of Clinical and Health Psychology, 2011

Currently, some psychopharmacological treatments, cognitivebehavioral therapies (CBT), and a comb... more Currently, some psychopharmacological treatments, cognitivebehavioral therapies (CBT), and a combination of both are considered effective treatments for agoraphobia. Among psychological treatments, new therapeutic alternatives such as virtual reality exposure treatment (VRET) have been developed. The aim of this experimental study was to evaluate the ef¿ cacy of VRET combined with two antidepressant drugs (venlafaxine and paroxetine) in a sample of agoraphobia patients (N = 64), using a virtual system consisting of seven scenarios. Five types of treatment were compared: four combined treatment groups and one psychopharmacological treatment. Measures were taken at pre-treatment, posttreatment, and six-month follow-up; agoraphobia and anxiety measures were used as dependent variables. Results showed that all groups were statistically effective, both at post-treatment and six-month follow-up. However, based on clinical ef¿ cacy, results showed that combined treatment groups including VRET appeared to be better than traditional techniques at decreasing agoraphobia and anxiety measures and keeping them lower over time. Int J Clin Health Psychol, Vol. 11. Nº 2 190 GONZALEZ LORENZO et al. Ef¿ icacy of virtual reality exposure therapy and agoraphobia KEY WORDS. Agoraphobia. Virtual reality. Cognitive-behavioral treatment. Pharmacological treatment. Experimental study.

Research paper thumbnail of Tyrosine kinase inhibitors for unresectable hepatocellular carcinoma in adults

Research paper thumbnail of Treatment Preferences in Patients with Knee or Hip Osteoarthritis: An Overview

Osteoarthritis - Diagnosis, Treatment and Surgery, 2012

Research paper thumbnail of Patient empowerment as a component of health system reforms: rights, benefits and vested interests

Internal and Emergency Medicine, 2012

Different strategies have been developed across countries to foster citizens' and patients' invol... more Different strategies have been developed across countries to foster citizens' and patients' involvement, from health policies to patients' active participation in decisions regarding their health. The spectrum varies from systems where patients lead the reform of health care services, to others where a paternalistic approach still limits patients' autonomy in decision-making. This paper describes: (1) different interventions for involving patients;

Research paper thumbnail of Mental health professionals' attitudes to partnership in medicine taking: a validation study of the Leeds Attitude to Concordance Scale II

Pharmacoepidemiology and Drug Safety, 2012

To explore psychiatrists&... more To explore psychiatrists' attitudes toward concordance by validating the Leeds Attitude to Concordance Scale II (LATCon II) in a Spanish sample. This was a cross-sectional survey. An opportunistic sample of 125 psychiatrist and 100 psychiatry registrars attending a national conference completed the LATCon II questionnaire and sociodemographic and professional data. The principal component analysis of the LATCon II items was performed. Associations with sociodemographic and mental health professional variables were calculated. Principal component analysis yielded three components labeled "communication/empathy," "shared control," and "eventual paternalistic style." Women obtained significantly lower scores than men on the second component. Mental health professional variables were not related to attitude to concordance. Psychiatrists show a favorable attitude to involve patients in a process of reciprocal communication, where patients' preferences, values, and expectations are considered, but they are more cautious in their attitude to sharing decisions with patients. There is scope for the different kinds of research in this area: studying sex-based differences in psychiatrists' attitudes to concordance and also exploring the gap in mental health care between patients' and professionals' views of shared decision making. Only in this way can the real partnership for shared decision making be fully understood.

Research paper thumbnail of Patient Involvement and Shared Decision-Making in Mental Health Care

Current Clinical Pharmacology, 2011

There is growing interest in shared decision-making (SDM) in which the provider and patient go th... more There is growing interest in shared decision-making (SDM) in which the provider and patient go through each phase of the decision-making process together, share treatment preferences, and reach an agreement on treatment choice. Although a majority of the research evaluating SDM has been conducted under "physical" health conditions, patients' participation and SDM for mental health conditions has received increasing interest since the mid 1990s. SDM in mental health care can be more complex than in general health care because that several patient characteristics, health care provider, and system level factors may hinder normalization and implementation of this model into clinical practice. To date, in comparison with other health problems, there are few studies which have assessed SDM in this context. In spite of that, evidence points favorably towards the inclusion of SDM in mental health treatment decisions, given that the majority of patients with mental illness prefer to be involved in the process and wish to have information. However, more studies are needed to provide evidence about the impact of SDM on treatment compliance and health care outcomes. In this overview, the authors present the current state and the future perspectives of SDM in mental health.

Research paper thumbnail of Decision aids for patients facing health treatment or screening decisions: systematic review

BMJ, 1999

Objective To conduct a systematic review of randomised trials of patient decision aids in improvi... more Objective To conduct a systematic review of randomised trials of patient decision aids in improving decision making and outcomes. Design We included randomised trials of interventions providing structured, detailed, and specific information on treatment or screening options and outcomes to aid decision making. Two reviewers independently screened and extracted data on several evaluation criteria. Results were pooled by using weighted mean differences and relative risks. Results 17 studies met the inclusion criteria. Compared with the controls, decision aids produced higher knowledge scores (weighted mean difference = 19/100, 95% confidence interval 14 to 25); lower decisional conflict scores (weighted mean difference = − 0.3/5, − 0.4 to − 0.1); more active patient participation in decision making (relative risk = 2.27, 95% confidence interval 1.3 to 4); and no differences in anxiety, satisfaction with decisions (weighted mean difference = 0.6/100, − 3 to 4), or satisfaction with the decision making process (2/100, − 3 to 7). Decision aids had a variable effect on decisions. When complex decision aids were compared with simpler versions, they were better at reducing decisional conflict, improved knowledge marginally, but did not affect satisfaction. Conclusions Decision aids improve knowledge, reduce decisional conflict, and stimulate patients to be more active in decision making without increasing their anxiety. Decision aids have little effect on satisfaction and a variable effect on decisions. The effects on outcomes of decisions (persistence with choice, quality of life) remain uncertain.

Research paper thumbnail of Shared decision making in Spain: current state and future perspectives

Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 2011

In the last two decades there has been a growing recognition in the Spanish National Health Syste... more In the last two decades there has been a growing recognition in the Spanish National Health System (NHS) of the importance of considering patients' values and preferences in clinical decisions. Patient participation in shared decision making (SDM) is gaining importance as a suitable approach to patient-health professional communication and decision making in Spain. In addition, the NHS is funding the development of patients' decision aids (PtDAs) for shared decision making (SDM) by Health Technology Assessment Agencies. However, the NHS has still not incorporated reforms in law that includes SDM and PtDAs as a key component of health care services and professional curricula, nor is there a standardised implementation of interventions to support decisions in routine care. Most patients are not very familiar with their rights to be kept informed and participate in their own health care decisions. Most professionals are not familiar with or educated about patients' rights to be kept informed and participate in health care decisions either. The future of SDM in Spain is promising. The next course of action should be to maintain the production and adaptation of high-quality PtDAs while at the same time reinforcing effective dissemination strategies among patients and training programmes for professionals focused on SDM.

Research paper thumbnail of Adaptation and validation study of the Beliefs about Medicines Questionnaire in psychiatric outpatients in a community mental health setting

Human Psychopharmacology: Clinical and Experimental, 2011

The present study aims to establish the factor structure and reliability of the Spanish version o... more The present study aims to establish the factor structure and reliability of the Spanish version of the Beliefs about Medicines Questionnaire (BMQ), adapted to psychiatric medication, and to analyze the potential differences between psychiatric outpatients, medical students, and psychology students. The BMQ was tested on a sample of 405 psychiatric outpatients, 216 medical students, and 222 psychology students. Students completed only the BMQ-General scale, adapted for psychiatric medication, and patients completed also the BMQ-Specific scale. For the BMQ-General scale adapted items, the analysis shows a two-factor structure similar to that described for the Spanish validation of the original instrument, but when samples are analyzed separately, relevant differences are observed in the composition of the factor structures. Furthermore, the resulting scales show a medium-low internal consistency. For BMQ-Specific scale items, the results replicate previous data. Medical students tend to consider psychiatric medication as less harmful and less likely to be overprescribed than psychology students, with patients' scores in the middle of both groups. The BMQ-Specific scale has satisfactory psychometric properties for use in psychiatric outpatients in a community mental health setting. The adapted Spanish BMQ-General scale for psychotropics identified three different structures of the factors for each of the three samples studied.

Research paper thumbnail of Impacto de la obesidad en la calidad de vida relacionada con la salud. Revista Española de Obesidad

Revista Espanola de Obesidad

In the last two decades, the interest in studying the impact of obesity in health-related quality... more In the last two decades, the interest in studying the impact of obesity in health-related quality of life (HRQL) has gradually increased. Obesity-specific instruments have been developed. Those together with generic HRQOL measures are frequently applied in clinical trials and other studies. The aim of this study is to analyze the current state of knowledge on HRQL in obesity. Fundamental concepts are presented on QOL, and instruments for HRQL measurement and key findings in comparative studies on HRQOL in overweight people are described.