Factors influencing witnesses' perception of patient safety during pre-hospital health care from emergency medical services: A multi-center cross-sectional study.

AIM: To determine the factors related with the perception of feeling safe during pre-hospital emergency care. METHODS: A multi-centred, cross-sectional study. Data collection from April 2021 to March 2022, in the Centro de Emergencias Sanitarias 061 (Andalusia, Spain). INCLUSION CRITERIA: witnesses of health care by emergency medical services. EXCLUSION CRITERIA: minors, or communication barriers. OUTCOME VARIABLE: Witness Perceived Safety Scale ESPT10. The variables studied were related with sociodemographic data, the request for health care, the patient, the hospital transfer and patient safety incidents. A multivariate linear regression model was constructed for the dependent variable. The study followed STROBE statement. RESULTS: Responses were obtained from 1400 witnesses. The linear regression model showed that the score on the scale increased as the witnesses felt more satisfied (B = 1.302; p < 0.001). On the contrary, the score was lower when the witness reported a patient safety incident (B = -2.856; p < 0.001 and B = -3.166; p < 0.001), or when the assistance took place in a public space (B = -0.722; p = 0.017). CONCLUSIONS: The level of satisfaction, the occurrence of a patient safety incident, and the place of health care are related factors with the perception of the witnesses. The Witness Perceived Safety Scale ESPT10 could be considered a valid and useful patient safety indicator.

Factors related to patients' perception of feeling safe in pre-hospital emergencies: a multicenter cross-sectional study. / Factores relacionados con la percepción de los pacientes de sentirse seguros en emergencias extrahospitalarias: estudio transversal multicéntrico.

OBJECTIVES: To identify factors related to patients' feeling of safety during prehospital emergencies. MATERIAL AND METHODS: Descriptive, multicenter cross-sectional study in the context of "061" emergency response services of Andalusia, Spain. Data were collected from April 2021 to March 2022. Patients attended and transported by emergency responders were eligible for inclusion. Patients were excluded if they were minors or in an altered state of consciousness, or had cognitive impairment or any barrier to communication. We calculated that a minimum sample size of 644 patients would be required. The outcome variable was the score on a 16-item scale of patient-perceived safety (ESP16, as abbreviated in Spanish). Sociodemographic, emergency service response, patient, and hospital transfer variables were studied in relation to ESP16 score. We also collected patient safety incident reports. Multivariate linear regression was used to analyze associations between the independent variables and the dependent outcome variable. Guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) were followed. RESULTS: We received 1756 responses. The mean (SD) ESP16 score was 77.7 (5.6); the median score was 80. The ßô€€ƒ coefficients derived from the linear regression model were as follows for the variables associated with the ESP16 score: 2.799 (P .001) for satisfaction; -6.097 (P .001) for incident reports of errors, falls, harm, or injury; -2.742 (P .001) for reports of any other incident during attendance; 2.538 (P = .001) for use of the transport protocol; 1.157 (P .001) for type of emergency transport used; 0.726 (P = .014) for a cardiology diagnosis; and 1.195 (P = .003) for pain intensity. CONCLUSION: Patients' perception of safety is very high, as reflected by level of satisfaction, incident reports, use of a transport protocol, means of transport used, diagnosis, and pain level.

OBJETIVO: Conocer los factores que se relacionan con la percepción de los pacientes de sentirse seguros en emergencias extrahospitalarias. METODO: Estudio observacional descriptivo, transversal, multicéntrico, en los equipos de emergencias 061 de Andalucía. Se recogieron los datos desde abril 2021 hasta marzo 2022. Criterios de inclusión fueron pacientes asistidos y trasladados por equipos de emergencias, y los criterios de exclusión fueron menores de edad, deterioro cognitivo, alteración de consciencia, o barreras comunicativas. Se calculó un tamaño muestral mínimo de 644 sujetos. La variable resultado fue la puntuación de la Escala de Seguridad Percibida (ESP16). Se estudiaron variables sociodemográficas y relacionadas con la demanda asistencial, el paciente y el traslado. Además, se recogieron notificaciones de incidentes relacionados con la seguridad del paciente (IRSP). Se construyó un modelo de regresión lineal multivariable para la variable dependiente. Se siguieron las recomendaciones STROBE. RESULTADOS: Se obtuvieron 1.756 respuestas. La puntuación media en la ESP16 fue 77,7 (DE 5,6), con mediana de 80. El modelo de regresión lineal mostró que el nivel de satisfacción (B = 2,799; p 0,001), la notificación de error, caída, daño o lesión (B = ­6,097; p 0,001), la notificación de cualquier otro IRSP (B = ­2,742; p 0,001), la transferencia protocolizada (B = 2,538; p = 0,001), el tipo de recurso asistencial (B = 1,157; p 0,001), un diagnóstico final cardiológico (B = 0,726; p = 0,014) y un nivel de dolor intenso (B = 1,195; p = 0,003) influían en la escala ESP16. CONCLUSIONES: La percepción de seguridad del paciente es muy alta, y está condicionada por el nivel de satisfacción, la notificación de IRSP, la transferencia protocolizada, el recurso asistencial, el diagnóstico final y el nivel de dolor.

SEOM-GEIS clinical guideline for gastrointestinal stromal tumors (2022).

Gastrointestinal stromal tumor (GIST) is the most common malignant neoplasm of mesenchymal origin, and a paradigmatic model for a successful rational development of targeted therapies in cancer. The introduction of tyrosine kinase inhibitors with activity against KIT/PDGFRA in both localized and advanced stages has remarkably improved the survival in a disease formerly deemed resistant to all systemic therapies. These guidelines are elaborated by the conjoint effort of the Spanish Society of Medical Oncology (SEOM) and the Spanish Sarcoma Research Group (GEIS) and provide a multidisciplinary and updated consensus for the diagnosis and treatment of GIST patients. We strongly encourage that the managing of these patients should be performed within multidisciplinary teams in reference centers.

Factors influencing the perception of feeling safe in pre-hospital emergency care: A mixed-methods systematic review.

AIMS: To systematically describe the factors influencing the perception of feeling safe among patients receiving pre-hospital emergency care. BACKGROUND: Patient safety is a top priority worldwide. Little is known about how patients perceive safety during emergency health care and what the related factors are. DESIGN: A mixed-methods systematic review. METHODS: Six databases were searched to December 2021. Inclusion criteria were as follows: studies with patients of any age, framed in pre-hospital emergency care settings, referring to patient safety, addressing the perception of safety, and with a quantitative or qualitative research design. Exclusion criteria were as follows: conference records, abstracts, supplements, letters, editorials and reviews. The quality of the evidence was assessed with the Joanna Briggs Institute (JBI) checklists. A convergent integrated approach was followed according to the JBI methodology. The protocol was registered on PROSPERO (CRD42022306337). PRISMA 2020 guidelines were followed in reporting this review. RESULTS: Among the 5223 records identified, the whole texts of 35 articles were reviewed. Ten studies were relevant to the research question. Seven followed a qualitative methodology, with interviews or focus group. Three involved a quantitative methodology, with questionnaires or validated measures. The 74 findings were organised into 11 categories and then grouped into four dimensions: 'receiving a satisfying response from healthcare professionals when I need it', 'EMS personnel's professional competence', 'the variable and unfamiliar settings of pre-hospital emergencies', and 'patients' personal characteristics'. CONCLUSIONS: The perception of safety is influenced by many factors, which can be grouped into four independent dimensions. Quantitative and qualitative studies can provide us with complementary findings. RELEVANCE TO CLINICAL PRACTICE: Awareness of these factors enables us to act upon them. When patients feel safe their health outcomes improve, their anxiety decreases and they collaborate more actively. NO PATIENT OR PUBLIC CONTRIBUTION: Patients and caregivers shared their experiences in the articles included.

Adaption and reliability of the Nutrition Environment Measures for stores (NEMS-S) instrument for use in urban areas of Chile.

OBJECTIVE: To adapt and assess reliability of the Chilean version of Nutritional Environment Measurement for Stores (NEMS-S-CHILE) to measure the food environment of stores in urban areas. DESIGN: NEMS-S-CHILE was the NEMS-S tool adapted to the Chilean food patterns; foods were grouped according to level of processing in (a) unprocessed or minimally processed foods, (b) processed culinary ingredients, (c) processed foods, and (d) ultra-processed foods, and scored according to NEMS-S-CHILE tool. Reliability inter evaluators was measured. SETTING: City of Concepción, Bio-Bio region, Chile. PARTICIPANTS: Seventeen of a total of 25 supermarkets, and 9 out of 10 street markets according to the municipal registry and the street market trade unions, representing 74.3% of both types of food premises in Concepción. RESULTS: Reliability inter evaluators was measured by the following aspects: product availability, price, quality, and variety, through the intraclass correlation coefficient (ICC), percent agreement, and Cohen's kappa analysis. Reliability was high for availability, where the kappa index and ICC were acceptable, ranging from moderate to high (0.42 to 1.00 for the kappa coefficient and 0.65 to 1.00 for ICC), as well as for prices (ICC: 0.65-1.00 ), variety (kappa: 0.76-1.00) and quality (percent agreement: 68.2- 100%). CONCLUSIONS: The adapted instrument, NEMS-S-CHILE, has a high reliability inter evaluators and can be useful to measure the availability of foods by the level of processing according to the prevalent food system in developing countries.

A Growth Modulation Index-Based GEISTRA Score as a New Prognostic Tool for Trabectedin Efficacy in Patients with Advanced Soft Tissue Sarcomas: A Spanish Group for Sarcoma Research (GEIS) Retrospective Study.

The aim of this study was to identify an easily reliable prognostic score that selects the subset of advanced soft tissue sarcoma (ASTS) patients with a higher benefit with trabectedin in terms of time to progression and overall survival. A retrospective series of 357 patients with ASTS treated with trabectedin as second- or further-line in 19 centers across Spain was analyzed. First, it was confirmed that patients with high growth modulation index (GMI > 1.33) were associated with the better clinical outcome. Univariate and multivariate analyses were performed to identify factors associated with a GMI > 1.33. Thus, GEISTRA score was based on metastasis free-interval (MFI ≤ 9.7 months), Karnofsky < 80%, Non L-sarcomas and better response in the previous systemic line. The median GMI was 0.82 (0-69), with 198 patients (55%) with a GMI < 1, 41 (11.5%) with a GMI 1-1.33 and 118 (33.1%) with a GMI > 1.33. The lowest GEISTRA score showed a median of time-to-progression (TTP) and overall survival (OS) of 5.7 and 19.5 months, respectively, whereas it was 1.8 and 3.1 months for TTP and OS, respectively, for the GEISTRA 4 score. This prognostic tool can contribute to better selecting candidates for trabectedin treatment in ASTS.

Development and Validation of a Safety Scale Perceived by the Witness of Prehospital Emergency Care.

OBJECTIVE: The aim of the study was to design and validate a new tool to measure the security perceived by witnesses of patient care and hospital transfers, after requesting urgent assistance via the "061" phone number. METHODS: This is a descriptive observational, cross-sectional, design, and validation study of a scale conducted by telephone interview. Witnesses of urgent assistance and transfers by prehospital emergency medical services in the province of Cadiz, in the south of Spain, were the subjects of study. A questionnaire was designed after focus groups with patients, witnesses, and professionals. It consisted of 10 items, with Likert-type answers, and a range of 0 to 50 points. In addition to basic criteria (frequency of endorsement and ability to discriminate between groups), their validity (content and construct) and reliability (stability and homogeneity) were evaluated. Stability was evaluated by test-retest and homogeneity by means of two properties: internal consistency of items (corrected item-scale correlation coefficient) and internal consistency of the scale (Cronbach α coefficient). RESULTS: A total of 849 questionnaires were obtained, with scores between 0 and 50 points, with an average of 47.31 (median of 50). The exploratory factor analysis detected a component that explained 61.1% of the total variance. The intraclass correlation coefficient was 0.933 with 95% confidence interval between 0.900 and 0.954. The corrected item-scale correlation coefficient was greater than 0.596, and the Cronbach α coefficient was 0.927 (95% confidence interval, 0.919-0.934). CONCLUSIONS: The ESPT10 Witness Perceived Safety Scale is valid and reliable for quantifying the safety perception of witnesses of emergency assistance and transfers.

Feeling safe or unsafe in prehospital emergency care: A qualitative study of the experiences of patients, carers and healthcare professionals.

AIMS AND OBJECTIVES: To determine the feelings of safety among patients taken to hospital after requesting urgent care, based on their experiences and those of their carers and prehospital emergency care professionals. BACKGROUND: Little research has been performed into the perception of safety in prehospital emergency care settings worldwide, from either the perspective of the patients or from that of healthcare professionals. DESIGN: Exploratory qualitative study using focus groups in Spain. METHODS: The participants were patients that requested care through the emergency telephone service, their carers and the professionals of the emergency care teams. The structured sampling design was based on an intentional, nonprobability selection following pragmatic criteria. Seven groups of patients/carers and two groups of professionals were formed (65 participants). The recordings were fully transcribed before their validation and codes were assigned to ensure anonymity. The ATLAS.ti software was used for the analysis. The authors took into account the COREQ checklist for qualitative studies. FINDINGS: Neither group provided a clear definition of the meaning of feeling safe. It appeared easier to give examples that had a positive or negative influence on their perception of feeling safe. During the analysis of the discourse, six categories were detected after grouping the related codes. CONCLUSIONS: For most of the patients' feeling of being safe or very safe arose from the perception of calmness, trust and protection. Defining the perception of safety was not easy. The factors with the greatest effect on feeling safe were related to Information and communication, Person-centred care and Professional competency, without losing sight of other factors such as Accessibility and response times of the emergency teams, Equipment and Healthcare setting. RELEVANCE TO CLINICAL PRACTICE: The findings could be used as a knowledge base in future research and for implementing procedures for improving perceptions of safety among patients.

Randomized phase II study comparing gemcitabine plus dacarbazine versus dacarbazine alone in patients with previously treated soft tissue sarcoma: a Spanish Group for Research on Sarcomas study.

PURPOSE: To assess the activity and toxicity of the combination of gemcitabine plus dacarbazine (DTIC) in patients with advanced soft tissue sarcoma (STS) in a randomized, multicenter, phase II study using DTIC alone as a control arm. PATIENTS AND METHODS: Patients with previously treated advanced STS were randomly assigned to receive either fixed-dose rate gemcitabine (10 mg/m2/min) at 1800 mg/m2 followed by DTIC at 500 mg/m2 every 2 weeks, or DTIC alone at 1200 mg/m2 every 3 weeks. The primary end point of the study was progression-free rate (PFR) at 3 months. RESULTS: From November 2005 to September 2008, 113 patients were included. PFR at 3 months was 56% for gemcitabine plus DTIC versus 37% for DTIC alone (P = .001). Median progression-free survival was 4.2 months versus 2 months (hazard ratio [HR], 0.58; 95% CI, 0.39 to 0.86; P = .005), and median overall survival was 16.8 months versus 8.2 months (HR, 0.56; 95% CI, 0.36 to 0.90; P = .014); both favored the arm of gemcitabine plus DTIC. Gemcitabine plus DTIC was also associated with a higher objective response or higher stable disease rate than was DTIC alone (49% v 25%; P = .009). Severe toxicities were uncommon, and treatment discontinuation for toxicity was rare. Granulocytopenia was the more common serious adverse event, but febrile neutropenia was uncommon. Asthenia, emesis, and stomatitis were the most frequent nonhematologic effects. CONCLUSION: The combination of gemcitabine and DTIC is active and well tolerated in patients with STS, providing in this phase II randomized trial superior progression-free survival and overall survival than DTIC alone. This regimen constitutes a valuable therapeutic alternative for these patients.

[Sterility in drained serums; before their use in emergency wards and in non-hospital emergency use]. / Esterilidad de sueros purgados. Antes de su uso en urgencias y emergencias extrahospitalarias.

The authors detail the characteristics for the sterility of drained serums placed in a mobile emergency service unit and they determine how much time they can maintain optimum conditions for the use of these serums by means of a controlled, random, triple blind clinical test in which the units studied were serums prepared by an infusion system and a three-way valve. Data were gathered during a 12 month study period. The authors designed six operating groups based on their exposure time and where they were kept. These samples totaled 672 units. The authors carried out 12 microbiological cultural analyses for each unit; these analyses were tested for bacteria and fungi, both aerobic and anaerobic. The authors contrasted their hypothesis with a multivariable logistic regression model used as the variable for sterility A value of p < 0.05 was considered to be significant. Results were obtained on 669 serums, 98.82% of samples. Colonization was found in 1.7% of the 8028 cultures analyzed; in only 2 cases was there a register greater than 10 UFC/ml. This colonization corresponded to 103 serums which were then classified as non-sterile. For sterility the logistic regression model did not show any significant association with the various operating groups, which were controlled by means of two possible variable methods. The authors did not find evidence that recently drained serums were different, from the point of view of sterility, than the serums exposed during 24, 48 or 72 hours but, as well as for the groups, the incidences of these serums tripled the risk of colonization. The authors concluded they could use serums prepared previously and these serums sterility were guaranteed to the same degree as recently drained serums.

Physico-chemical stability and sterility of previously prepared saline infusion solutions for use in out-of-hospital emergencies.

OBJECTIVE: The topic of this research was to determine whether out-of-hospital emergency teams could make use of previously prepared saline solutions (SS). The objective was to discover the physical, chemical and sterility characteristics of previously prepared saline infusions stored in ambulances and ascertain how long they remained in optimum condition. METHOD: Randomised clinical trial, triple blind, where study units consisted of saline solutions prepared with an infusion system and a three-way valve. The duration of the study was 12 months. Six intervention groups were designed on the basis of time of exposure and location. Samples consisted of 672 units. Twelve microbiological cultures were made and the pH, density, viscosity and CINa concentration were determined. We compared hypotheses with four models of linear regression for the variables and a model of logistic regression for the variables. A value of P < 0.05 was considered significant. RESULTS: We obtained results from 669 saline solutions (98.82%). Neither multivariant analysis nor ANOVA tests showed any significant association for a power greater than 99% with regard to the physical-chemical characteristics. The model of logistic regression also did not find any significant association for sterility. Colonisation was present in 1.7% of the 8,028 cultures made and more than 5 CFU per millilitre was found in only two cases. CONCLUSION: There is no evidence to suggest that recently prepared saline infusion solutions are any different from a physical-chemical and sterility point of view than those exposed for 24, 48, or 72 h. It was concluded that use can be made of previously prepared saline solutions with a guarantee their stability and sterility.