BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma
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Humans , Male , Female , Child, Preschool , Child , Asthma/diagnosis , Asthma/prevention & control , Asthma/epidemiology , Respiratory Function Tests/methods , Mexico/epidemiology
BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma.
Asthma/diagnosis , Asthma/prevention & control , Child , Child, Preschool , Female , Humans , Male , Mexico
Objetivo: Conocer el grado de cumplimiento (GC) de la higiene de manos (HM), sus factores determinantes y su evolución en el tiempo en un servicio de urgencias (SU). Método: Estudio transversal desarrollado entre 2005 y 2010 en el SU del Hospital General Universitario de Alicante. Un observador evaluó la realización de la HM según los 5 momentos de la Organización Mundial de la Salud (OMS). El estudio de asociación entre las variables explicativas (edad, sexo, disponer de solución alcohólica en formato de bolsillo, asistencia a sesiones formativas, conocer (..) (AU)
Objective: To determine the degree of compliance with hand hygiene measures, predictors, and change over time in an emergency department. Methods: Cross-sectional study between 2005 and 2010 in the emergency department of Hospital General Universitario de Alicante, Spain. An observer assessed staff compliance with the World Health Organization's 5-moments approach to hand hygiene. We also studied the association between compliance and such potential predictors as age, sex, availability of pocket-sized alcohol hand rubs, and attendance at training sessions; the Χ² test was used to compare compliance between the 2005-2007 and 2008-2010 periods. A multivariate logistic regression model was then constructed. Results: Compliance was observed in 41.1% in the 2005-2007 period and 42.3% in the 2008-2010 period. Hygiene at the moment before touching a patient improved significantly (16.3% in 2005-2007 and 29.8% in 2008-2010). The moment of best compliance was after touching patient surroundings (67.1% in 2008-2010). Factors associated with hand hygiene compliance changed over time with the exception of a stable association in both periods between hygiene at the moment before touching a patient and the availability of pocket-sized alcohol hand rubs. Conclusions: Emergency departments should seek improvements in hygiene by providing training on the importance of hand hygiene before a patient is touched, particularly before clean/aseptic procedures, and by promoting the use of pocket-sized alcohol rubs (AU)
Humans , Hand Disinfection/standards , Emergency Medical Services/standards , Cross Infection/prevention & control , Universal Precautions/trends
Objetivo: Evaluar un programa de prevención de exposiciones accidentales a fluidos biológicos basado en la mejora del grado de cumplimiento (GC) de las Precauciones Estándar (PE). Material y métodos: Intervenciones: primera (realización sesiones de actualización y reparto de trípticos informativos), y segunda (reparto de trípticos). Indicadores: Nivel de Conocimientos (NC), medido con un cuestionario de cinco preguntas, se consideró inadecuado cuando se fallaban tres o más preguntas; GC de PE medido en cuatro áreas (Higiene Manos -HM-, utilización de guantes -UG-, utilización adecuada métodos barrera -UAMB- y manejo adecuado objetos cortantes -MAOC-; Incidencia de inoculaciones y de exposiciones de mucosas a fluidos corporales. Resultados. La frecuencia de cuestionarios inadecuados paso del 54,6% al 23,3%(<0.001). La frecuencia HM pasó del 53,5% al 58,2%(<0,01), la UG del 78,7% al 84,6%(0,058), el UAMB del 53,8% al 55.5%(N.S.) y el MAOC del 52,9% al 54,0%(N.S.). La Incidencia inoculaciones paso del 5,53% al 4,98%(N.S.) y las exposiciones de mucosas del 0,95% al 0,81%(N.S.). Conclusiones: El programa ha mejorado los conocimientos del personal sobre PE, y el GC de PE y ha disminuido la incidencia exposiciones accidentales a fluidos biológicos aunque no de manera estadísticamente significativa (AU)
Introduction: The aim is to evaluate a program of prevention of accidental exposure to biological fluids based on the improvement of the compliance to Standard Precautions (SP). Methods: Interventions: first (update sessions and distributing pamphlets), and second (distributing pamphlets). Indicators: Level of knowledge (LK), measured with a 5-item questionnaire, with three or more incorrect answers considered inadequate; Compliance to SP measured in four areas (Hand Hygiene Hands -HH-, utilization of gloves - GU-, suitable utilization methods barrier - SUMB - and suitable managing cutting objects - SMCO-; Incident of percutaneus injuries and of exposure of mucous to corporal fluids. Results: The frequency of inadequate questionnaires I happen from 54,6 % to 23,3 % (<0.001). The frequency HH happened from 53,5 % to 58,2 % (<0,01), the GU of 78,7 % to 84,6 % (0,058), the SUMB of 53,8 % to 55.5 % (N.S.) and the SMCO of 52,9 % to 54,0 % (N.S.). The Incident percutaneus injuries from 5,53 % to 4,98 % (N.S.) and the exposure of mucous from 0,95 % to 0,81 % (N.S.). Conclusion: The program has improved in the knowledge of the personnel on SP, and has improved SP compliance and the Incident has diminished accidental exhibitions to biological fluids though not in a statistically significant way (AU)
Humans , Male , Female , Health Risk , Occupational Risks , Biological Products/adverse effects , Containment of Biohazards/adverse effects , Primary Prevention/methods , Health Surveillance/trends , Biological Pollutants , Containment of Biohazards/adverse effects , Containment of Biohazards/prevention & control , Surveys and Questionnaires
