Tobacco cessation among smokers under substance use treatment for alcohol and/or cannabis: study protocol and pilot study.

BACKGROUND: Approximately 80% of people with a substance use disorder (SUD) are smokers. Starting SUD treatment offers the opportunity to also quit smoking. The ACT-ATAC project aims to identify the predictors associated with smoking cessation among persons treated for alcohol and/or cannabis use disorder in Barcelona. This manuscript reports its methodology and the experience of carrying it out during the COVID-19 pandemic. METHODS: Mixed methods project with three substudies. Substudy 1 (S1) comprises heterogeneous discussion groups among clinicians. S2 has two prospective cohorts composed of smokers under treatment for alcohol and/or cannabis use disorder and the clinicians in charge of these patients. Participating smokers will be followed for 12 months and interviewed about their substance use and the tobacco cessation services received using the Spanish version of the users' Knowledge, Attitudes, and Services (S-KAS) scale. The clinicians will be asked about their self-reported practices in smoking cessation using the Knowledge, Attitudes, and Practices (S-KAP) scale. S3 comprises heterogeneous discussion groups with smokers. Data will be triangulated using qualitative and quantitative analyses. To facilitate the recruitment process, the researchers have introduced several strategies (design clear protocols, set monthly online meetings, extend the project, provide gift cards, etc.). DISCUSSION: The results of S1 were used to develop the questionnaires. S2 required some adjustments due to the COVID-19 pandemic, particularly the follow-up interviews being conducted by phone instead of face-to-face, and the recruitment rhythm was lower than expected. Recruitment will last until reaching at least 200-250 users. The fieldwork could not have been possible without the collaboration of the ACT-ATAC team and the introduction of several strategies. Trial registration The ACT-ATAC project has been successfully registered at Clinicaltrials.gov [NCT04841655].

Análisis bioquímico como método eficiente para aumentar la seguridad de la nutrición parenteral en neonatos / Biochemical test as an efficient system to improve safety in parenteral nutrition for premature infants

Objetivo: Se describe el proceso de validación del control bioquímico de las bolsas de nutrición parenteral para verificar la correcta composición de ingredientes críticos antes de la administración, así como su impacto en la seguridad tras dos años desde la implantación en una población de recién nacidos prematuros. Método: Para la validación de la técnica se usaron 35 muestras de nutrición parenteral sin lípidos, que se procesaron en el laboratorio de Urgencias, siguiendo los procedimientos rutinarios utilizados para medir las concentraciones de glucosa y electrolitos en plasma y orina. Para analizar su impacto en la seguridad se realizaron análisis pre y post implantación mediante análisis modal de falla, efectos y criticidad. También se evaluaron los resultados fuera de rango y sus potenciales repercusiones en la seguridad del paciente. Resultados: El análisis de regresión no muestra error sistemático de medida para glucosa, calcio y potasio; en cambio, para el sodio y el magnesio sí existe un error sistemático, por lo que ambos fueron descartados para los análisis rutinarios. Los resultados del análisis modal de fallos y efectos, atribuibles a la implantación del control bioquímico, mostraron una disminución del riesgo del proceso del 11%. Se analizaron 1.734 nutriciones, correspondientes a 218 neonatos prematuros; se encontraron 58 (3,3%) resultados fuera del rango de aceptación, de los cuales 7 se consideraron errores de preparación potencialmente peligrosos. Conclusiones: El control bioquímico de glucosa y electrolitos es un método eficiente y reproducible que evita que posibles errores de preparación afecten al paciente

Objective: The biochemical test validation process of parenteral nutrition bags is described to verify the correct composition of critical compounds before its administration, as well as its impact on safety after two years since its implantation in a population of premature infants. Method: For the validation of the technique, 35 samples of parenteral nutrition without lipids were processed by the emergency laboratory, following the routine procedures used to measure the concentrations of glucose and electrolytes in plasma and urine. To analyze its impact on safety, pre-implantation and post-implantation risk analysis was carried out using failure mode, effects and criticality analysis (FMECA). Likewise, all out-of-range results and their potential repercussions on patient safety were evaluated. Results: Regression analysis showed no systematic measurement error for glucose, calcium and potassium; however, there is a constant systematic error for sodium and magnesium, thus both were discarded for routine analysis. Failure mode, effects and criticality analysis results showed a decrease in the risk of the process of 11% for the biochemical test. We tested 1,734 parenteral nutritions from 218 premature neonates; 58 (3.3%) results were out of the acceptance range, and 7 were considered to be potentially dangerous compounding errors. Conclusions: The biochemical test of glucose and electrolytes is an efficient and reproducible method that prevents possible compounding errors from reaching the patient

Chronic and integrated care in Catalonia.

INTRODUCTION: The Chronicity Prevention and Care Programme set up by the Health Plan for Catalonia 2011-2015 has been an outstanding and excellent opportunity to create a new integrated care model in Catalonia. People with chronic conditions require major changes and transformation within the current health and social system. The new and gradual context of ageing, increase in the number of chronic diseases and the current fragmented system requires this transformation to be implemented. METHOD: The Chronicity Prevention and Care Programme aims to implement actions which drive the current system towards a new scenario where organisations and professionals must work collaboratively. New tools should facilitate this new context- or work-like integrated health information systems, an integrative financing and commissioning scheme and provide a new approach to virtual care by substituting traditional face-to-face care with transfer and shared responsibilities between patients, citizens and health care professionals. RESULTS: It has been observed some impact reducing the rate of emergency admissions and readmission related to chronic conditions and better outcome related to better chronic disease control. Some initiative like the Catalan Expert Patient Program has obtained good results and an appropriate service utilization. DISCUSSION: The implementation of a Chronic Care Program show good results but it is expected that the new integrated health and social care agenda could provoke a real change and transformation. Some of the results related to better health outcomes and a decrease in avoidable hospital admissions related to chronic conditions confirm we are on the right track to make our health and social system more sustainable for the decades to come.

Knowledge, opinions and behaviours related to food and nutrition in Catalonia, Spain (1992-2003).

OBJECTIVES: The main purpose of this study was to evaluate the modification of knowledge, opinions and attitudes to healthy eating, weight perception and dieting practices and preventive habits over a 10-year trend in the Catalan population from 1992 to 2003. DESIGN: Two cross-sectional surveys were carried out in Catalonia, Spain, during 1992-93 and 2002-03. SUBJECTS: In all, 2361 individuals in the ENCAT 1992-93 nutritional survey and 2061 individuals in the ENCAT 2002-03 health survey. The subjects' ages ranged from 10 to 75 years old. RESULTS: Lettuce and carrots, fish and olive oil were chosen as the healthiest foods in the two Catalan Nutritional Surveys. Although some improvement was reported, a high percentage of the population still thought that bread (31%), potatoes (23%) or olive oil (19%) should be moderated to prevent high blood cholesterol, especially among the youngest individuals. The perception of being overweight increased among males and decreased among females. There was an increase in the percentage of the population following a diet (from 13% to 17%). An increase in the consumption of iodine-enriched salt (from 26% to 40%) was observed as well as of diet supplements, especially among females (from 6% to 13%). The prevalence of males with diabetes increased from 3.4% to 4.5% and the number of individuals with diabetes not following any treatment decreased. CONCLUSION: The Catalan population has improved their knowledge of healthy food and health-related attitudes. Nutrition policy should focus on young adults as a key age group for primary prevention of future nutrition-related chronic diseases.