Improving low-value clinical practices in Murcia: a healthcare management area in Spain.

The 'do not do' (DND) movement looks for improving patient safety and reducing health spending by decreasing the prevalence of unnecessary clinical practices through building and launching 'do not do' recommendations, although the impact is generally low. The objective of this study is to improve the quality of care and safety of patients assigned to a health management area by reducing the prevalence of DND practices. Quasi-experimental before and after study carried out in a Spanish health management area of 264 579 inhabitants, 14 primary care teams, and a 920-bed third level reference hospital. The study included the measurement of a set of 25 valid and reliable indicators on DND prevalence from different clinical areas previously designed, considering acceptable prevalence values of less than 5%. For those indicators that exceeded this value, a bunch of interventions was implemented: (i) inclusion in the annual objectives of the clinical units involved; (ii) discussion of results in a general clinical session; (iii) educational outreach visits to the clinical units involved; and (iv) detailed feedback reports. A second evaluation was subsequently carried out. In the first evaluation, 12 DNDs (48%) showed prevalence values below 5%. In the second evaluation, nine DND of the remaining 13 (75%) improved results, reaching five of them (42%) prevalence values below 5%. Thus, a total of 17 of the 25 DNDs initially evaluated (68%) achieved this goal. Reducing the prevalence of low-value clinical practices in a healthcare organization makes it necessary to turn them into easily measurable indicators and carry out multicomponent interventions. Among these, it seems essential that the professionals involved are informed and that training activities are carried out on-site. Improvement cycles are emerging as a useful tool to do this.

Diagnosis and clinical management of thrombotic thrombocytopenic purpura (TTP): a consensus statement from the TTP Catalan group.

Thrombotic thrombocytopenic purpura (TTP) is a low prevalence disease characterized by severe deficiency of the enzyme ADAMTS13, leading to the development of thrombotic microangiopathy (TMA) and often resulting in severe organ disfunction. TTP is an extremely serious condition and, therefore, timely and appropriate treatment is critical to prevent life-threatening complications.Over the past 25 years, significant advances in the understanding of the pathophysiology of immune TTP have led to the development of readily available techniques for measuring ADAMTS13 levels, as well as new drugs that are particularly effective in the acute phase and in preventing relapses. These developments have improved the course of the disease.Given the complexity of the disease and its various clinical and laboratory manifestations, early diagnosis and treatment can be challenging.To address this challenge, a group of experienced professionals from the Catalan TTP group have developed this consensus statement to standardize terminology, diagnosis, treatment and follow up for immune TTP, based on currently available scientific evidence in the field. This guidance document aims to provide healthcare professionals with a comprehensive tool to make more accurate and timely diagnosis of TTP and improve patient outcomes.

Sleep characteristics of the parents of children admitted to a pediatric intensive care unit: risk factors and repercussion on their daily life activities.

OBJECTIVE: to analyze the sleep characteristics of the parents of children admitted to a pediatric intensive care unit (PICU), the possible risk factors and impact of sleep quality on their daily life activities. METHODS: Parents of children admitted to PICU for at least 48 h filled in a survey. Demographic data, sleep characteristics before and during admission and its impact on daily life activities measured by the FOSQ-10 questionnaire, were collected. RESULTS: 100 surveys from parents of 53 children admitted to the PICU were collected. Most children (74%) were cardiac patients. 55% of them had had previous PICU admissions. 45% of parents lived in a different city. They spent a median of 14 h a day (IQR 12-16) at the hospital and 89.2% did not attend work. Parents had significantly worse subjective sleep quality (p = 0.001), less sleeping hours/day (p = 0.001), more difficulty falling asleep (p = 0.001) and more night arousals (p = 0.001) during PICU admission than before. 77% of parents also had a bad FOSQ-10 score. Perceived sleep quality and FOSQ-10 score had a good correlation (p = 0.00, Kappa 0.43). Significant risk factors were living in a different city (p = 0.03), programmed admissions (p = 0.001), previous PICU admissions (p = 0.001), prolonged PICU length of stay (p = 0.03) and longer distance from home (p = 0.03). CONCLUSIONS: Three quarters of the parents of children admitted to PICU suffer from sleep disorders, which negatively affects their personal lives. Perceived sleep quality had a good correlation with FOSQ-10 score. Institutional support is needed to optimize parents' resting conditions during their child's hospitalization.