RECALAD. La asistencia al paciente en las unidades de Aparato Digestivo en el Sistema Nacional de salud. Estudio piloto, 2015 / RECALAD. Patient care at National Health System Digestive Care Units - A pilot study, 2015

Objetivo: elaborar un diagnóstico de situación sobre la asistencia en las unidades de aparato digestivo (UAD) en España. Material y métodos: estudio descriptivo transversal entre las UAD en hospitales generales de agudos del Sistema Nacional de Salud (datos referidos a 2015). Las variables de estudio fueron recogidas mediante un cuestionario sobre su estructura, cartera de servicios, actividad, formación, investigación y buenas prácticas. Asimismo, se analizaron las altas hospitalarias por enfermedades del área de digestivo mediante el Conjunto Mínimo Básico de Datos (2005-2014). Resultados: fueron invitados 209 hospitales, con 55 respuestas (26,3%). El promedio de altas de hospitalización es de 1.139 ± 653 por UAD/año y de 100 ± 66/año por digestólogo dedicado. La tasa de ingresos por mil habitantes y año en UAD en 2014 fue de 280, con una estancia media de 7,4 días. El análisis del CMBD 2005-2014 muestra un progresivo aumento en el número de altas dadas (37% más en 2014 frente a 2005), con una disminución del 28% en la tasa bruta de mortalidad intrahospitalaria (3,7% en 2014) y un ligero descenso (14%) de la estancia media (7,6 días en 2014). Se aprecia notable variabilidad en indicadores de estructura, actividad y resultados. Las tasas de mortalidad y reingresos, así como la estancia media, varían más del 100% entre UAD y existen asimismo notables dispersiones en frecuentación y resultados entre comunidades autónomas. Conclusiones: la encuesta RECALAD 2015 desvela aspectos relevantes sobre la organización, estructura y gestión de las UAD. La notable variabilidad hallada probablemente indica notables diferencias en eficiencia y productividad y, por tanto, un amplio margen de mejora (AU)

Objectives: To reach a situation diagnosis on the status of patient management at digestive care units (DCUs) in Spain. Material and methods: A cross-sectional descriptive study across DCUs in general acute care hospitals within the Spanish National Health System (data referred to 2015). The study variables were collected with a questionnaire including items on structure, services portfolio, activity, education, research, and good practice. Hospital discharge rates for digestive diseases were also assessed using the minimum basic data set (2005-2014). Results: Two hundred and nine hospitals invited, 55 responders (26.3%). Average discharges from hospital were 1,139 ± 653 per DCU/year, and 100 ± 66 per year per dedicated gastroenterologist. In 2014, admission rate to DCUs per 1,000 population and year was 280, with a mean stay of 7.4 days. The analysis of the MBDS for 2005-2014 reveals a progressive increase in the number of discharges (37% more in 2014 versus 2005), with a 28% decrease in hospital gross mortality rate (3.7% in 2014) and a slightly reduced (14%) mean stay (7.6 days in 2014). Considerable variability may be seen in structure, activity, and results indicators. Mortality and readmission rates, as well as mean stay, vary more than 100% amongst DCUs, and major dispersions also exist in frequentation and results amongst autonomous communities. Conclusions: The RECALAD 2015 survey unveiled relevant aspects related to DCUs organization, structure, and management. The notable variability encountered likely reflects relevant differences in efficiency and productivity, and thus points out there is ample room for improvement (AU)

RECALMIN: The association between management of Spanish National Health Service Internal Medical Units and health outcomes.

OBJECTIVE: To investigate the association between management of Internal Medical Units (IMUs) with outcomes (mortality and length of stay) within the Spanish National Health Service. DESIGN: Data on management were obtained from a descriptive transversal study performed among IMUs of the acute hospitals. Outcome indicators were taken from an administrative database of all hospital discharges from the IMUs. SETTING: Spanish National Health Service. PARTICIPANTS: One hundred and twenty-four acute general hospitals with available data of management and outcomes (401 424 discharges). MAIN OUTCOME MEASURES: IMU risk standardized mortality rates were calculated using a multilevel model adjusted by Charlson Index. Risk standardized myocardial infarction and heart failure mortality rates were calculated using specific multilevel models. Length of stay was adjusted by complexity. RESULTS: Greater hospital complexity was associated with longer average length of stays (r: 0.42; P < 0.001). Crude in-hospital mortality rates were higher at larger hospitals, but no significant differences were found when mortality was risk adjusted. There was an association between nurse workload with mortality rate for selected conditions (r: 0.25; P = 0.009). Safety committee and multidisciplinary ward rounds were also associated with outcomes. CONCLUSIONS: We have not found any association between complexity and intra-hospital mortality. There is an association between some management indicators with intra-hospital mortality and the length of stay. Better disease-specific outcomes adjustments and a larger number of IMUs in the sample may provide more insights about the association between management of IMUs with healthcare outcomes.

Fast determination of neonicotinoid insecticides in bee pollen using QuEChERS and ultra-high performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry.

In this study, a new method has been developed to determine seven neonicotinoid insecticides (acetamiprid, clothianidin, dinotefuran, imidacloprid, nitenpyram, thiacloprid and thiamethoxam) in bee pollen using ultra-high performance liquid chromatography coupled to a selective MS detector (qTOF). An efficient sample treatment involving an optimized quick, easy, cheap, effective, rugged and safe method was proposed. In all cases, average analyte recoveries were between 91 and 105%, and no matrix effect was observed. Chromatographic analysis (6.5 min) was performed on a core-shell technology based column (Kinetex® EVO C18 , 50×2.1 mm, 1.7 µm, 100 Å). The mobile phase consisted of 0.1% formic acid in water and 0.1% of formic acid in ACN, with a flow rate of 0.3 mL/min in gradient elution mode. The fully validated method was selective, linear from LOQ to 500 µg/kg, precise and accurate; relative standard deviation and relative error values were below 8%. Low limits LODs and LOQs were obtained, ranging from 0.6 to 1.3 µg/kg (LODs) and 2.1 to 4.0 µg/kg (LOQs). The method was applied to neonicotinoid analysis in several commercial bee pollen samples from different Spanish regions.

Holistic screening of collapsing honey bee colonies in Spain: a case study.

BACKGROUND: Here we present a holistic screening of collapsing colonies from three professional apiaries in Spain. Colonies with typical honey bee depopulation symptoms were selected for multiple possible factors to reveal the causes of collapse. RESULTS: Omnipresent were Nosema ceranae and Lake Sinai Virus. Moderate prevalences were found for Black Queen Cell Virus and trypanosomatids, whereas Deformed Wing Virus, Aphid Lethal Paralysis Virus strain Brookings and neogregarines were rarely detected. Other viruses, Nosema apis, Acarapis woodi and Varroa destructor were not detected. Palinologic study of pollen demonstrated that all colonies were foraging on wild vegetation. Consequently, the pesticide residue analysis was negative for neonicotinoids. The genetic analysis of trypanosomatids GAPDH gene, showed that there is a large genetic distance between Crithidia mellificae ATCC30254, an authenticated cell strain since 1974, and the rest of the presumed C. mellificae sequences obtained in our study or published. This means that the latter group corresponds to a highly differentiated taxon that should be renamed accordingly. CONCLUSION: The results of this study demonstrate that the drivers of colony collapse may differ between geographic regions with different environmental conditions, or with different beekeeping and agricultural practices. The role of other pathogens in colony collapse has to bee studied in future, especially trypanosomatids and neogregarines. Beside their pathological effect on honey bees, classification and taxonomy of these protozoan parasites should also be clarified.

Comprehensive two-dimensional gas chromatography with capillary flow modulation to separate FAME isomers.

A method to separate FAME and the linoleic and linolenic acids isomers by GCxGC using an apparatus equipped with a capillary flow technology (CFT) based modulator and a FID detector has been developed. Four different column combinations (one conventional and three inverted phase sets) were used in these experiments. The conventional set first involved a DB5-MS non-polar column followed by a highly polar HP-INNOWax column in the second dimension. The inverted phase set comprised of a highly polar BPX-70 column in the first dimension and a non-polar ZB5-MS column for the second dimension. Furthermore, the influence of the length of the second dimension column on FAME isomer separation was studied in the inverted phase sets, along with other parameters like the modulation time and column flow. The best results in terms of the time required for the analysis and number of FAME identified with the inverted set were achieved with the shorter second dimension column. After supercritical fluid extraction, the method was applied to identify FAMEs in broccoli leaves from three different cultivars (Naxos, Nubia and Viola).