Antimicrobial stewardship in hospitals: Expert recommendation guidance document for activities in specific populations, syndromes and other aspects (PROA-2) from SEIMC, SEFH, SEMPSPGS, SEMICYUC and SEIP / Programas de optimización del uso de antimicrobianos en hospitales: guía de recomendaciones de expertos para actividades en poblaciones específicas, síndromes y otros aspectos (PROA-2) de la SEIMC, SEFH, SEMPSPGS y SEIP

In 2012, The Spanish Societies of Infectious Diseases and Clinical Microbiology (SEIMC), Hospital Pharmacy (SEFH), and Preventive Medicine, Public Health and Healthcare Management (SEMPSGS) lead a consensus document including recommendations for the implementation of antimicrobial stewardship (AMS) programs (AMSP; PROA in Spanish) in acute care hospitals in Spain. While these recommendations were critical for the development of these programs in many centres, there is a need for guidance in the development of AMS activities for specific patient populations, syndromes or other specific aspects which were not included in the previous document or have developed significantly since then. The objective of this expert recommendation guidance document is to review the available information about these activities in these patient populations or circumstances, and to provide guidance recommendations about them. With this objective the SEIMC, SEFH, SEMPSPGS, the Spanish Society of Intensive Care Medicine (SEMICYUC) and the Spanish Pediatric Infectious Disease Society (SEIP) selected a panel of experts who chose the different aspects to include in the document. Because of the lack of high-level evidence in the implementation of the activities, the panel opted to perform a narrative review of the literature for the different topics for which recommendations were agreed by consensus. The document was open to public consultation for the members of these societies for their comments and suggestions, which were reviewed and considered by the panel.(AU)

En 2012, las Sociedades Españolas de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Farmacia Hospitalaria (SEFH) y Medicina Preventiva, Salud Pública y Gestión Sanitaria (SEMPSPGS) lideraron un documento de consenso que incluía recomendaciones para la implementación de Programas de optimización del uso de antimicrobianos (PROA) en hospitales de agudos en España. Si bien estas recomendaciones fueron críticas para el desarrollo de estos programas en muchos centros, actualmente es necesario establecer unas guías para la implementación de las actividades de los PROA en determinadas poblaciones de pacientes, síndromes clínicos y otros aspectos específicos que no se incluyeron en el documento previo o que desde entonces se han desarrollado significativamente. El objetivo de esta guía de recomendaciones de expertos es revisar la información disponible acerca de esas actividades en estas poblaciones o circunstancias de pacientes y proporcionar unas recomendaciones que sirvan de guía sobre ellas. Con este objetivo, la SEIMC, la SEFH y la SEMPSPGS, así como la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) y la Sociedad Española de Infectología Pediátrica (SEIP), seleccionaron un panel de expertos que eligieron los diferentes aspectos a incluir en el documento. Debido a la ausencia de evidencia de alto nivel en la implementación de las diferentes actividades, el panel optó por realizar una revisión narrativa de la literatura de los diferentes aspectos, en los que las recomendaciones se acordaron por consenso. El documento se abrió para consulta pública a los miembros de estas sociedades para sus comentarios y sugerencias, que fueron revisadas y consideradas por el panel.(AU)

Antimicrobial stewardship in hospitals: Expert recommendation guidance document for activities in specific populations, syndromes and other aspects (PROA-2) from SEIMC, SEFH, SEMPSPGS, SEMICYUC and SEIP.

In 2012, The Spanish Societies of Infectious Diseases and Clinical Microbiology (SEIMC), Hospital Pharmacy (SEFH), and Preventive Medicine, Public Health and Healthcare Management (SEMPSGS) lead a consensus document including recommendations for the implementation of antimicrobial stewardship (AMS) programs (AMSP; PROA in Spanish) in acute care hospitals in Spain. While these recommendations were critical for the development of these programs in many centres, there is a need for guidance in the development of AMS activities for specific patient populations, syndromes or other specific aspects which were not included in the previous document or have developed significantly since then. The objective of this expert recommendation guidance document is to review the available information about these activities in these patient populations or circumstances, and to provide guidance recommendations about them. With this objective the SEIMC, SEFH, SEMPSPGS, the Spanish Society of Intensive Care Medicine (SEMICYUC) and the Spanish Pediatric Infectious Disease Society (SEIP) selected a panel of experts who chose the different aspects to include in the document. Because of the lack of high-level evidence in the implementation of the activities, the panel opted to perform a narrative review of the literature for the different topics for which recommendations were agreed by consensus. The document was open to public consultation for the members of these societies for their comments and suggestions, which were reviewed and considered by the panel.

Normative data for 102 Spanish remote associate problems and age-related differences in performance / Datos normativos para 102 problemas de asociados remotos en español y diferencias relacionadas con la edad en la ejecución

The Remote Associates Test (RAT) is a measure developed by Mednick (1962) which is used to assess the convergent thinking component of creativity. This study presents a normative database in Spanish including 102 problems based on the RAT. Three sets of problems were built according to the type of between-word associations: semantic, compound, and two-word expressions. These problems were administered to a sample of 309 elementary, high-school, and university students. The results show good internal consistency as well as good convergent validity with insight problems, and discriminant validity using Guilford's Alternative Uses Test. In addition, the results indicate age-related differences in the ability to solve the different types of problems

El Test de Asociados Remotos (RAT) es una medida desarrollada por Mednick (1962) que se utiliza para evaluar el componente de pensamiento convergente de la creatividad. Este estudio presenta una base de datos normativa en español que incluye 102 problemas basados en asociados remotos. Se construyeron tres conjuntos de problemas según el tipo de asociaciones entre palabras: asociados semánticos, palabras compuestas y expresiones de dos palabras. Estos problemas se administraron a una muestra de 309 estudiantes de primaria, secundaria y universidad. Los resultados muestran una buena consistencia interna así como una buena validez convergente con problemas tipo insight y una validez discriminante con la Prueba de Usos Alternativos de Guilford. Además, los resultados indican diferencias relacionadas con la edad en la capacidad para resolver los diferentes tipos de problemas

Ensayo de neutralización in vitro de aplicación en la evaluación de inmunógenos contra la hepatitis A, obtenidos mediante la tecnología de expresión en fagos filamentosos / In vitro neutralization assay to evaluate new hepatitis A vaccine candidates

La inmunidad contra el virus de la hepatitis A (VHA) se debe en primera instancia a la inducción de anticuerpos neutralizantes. Disponer de ensayos de neutralización es indispensable para evaluar nuevos candidatos vacunales contra este patógeno. En el presente trabajo se desarrolló un ensayo de neutralización in vitro que permitió evaluar la inmunogenicidad de mimotopos del VHA obtenidos mediante la tecnología de expresión en fagos al ser inmunizados ratones Balb/c. Diferentes diluciones de anticuerpos se incubaron con 10³ o 10² Dosis Infecciosas en Cultivo de Tejidos 50 por ciento (DICT50) del clon citopàtico HM175/18f de VHA, y se inocularon en placas con células FRhK4. Después de 7 días de incubación el título neutralizante se determinó como el recíproco de la dilución del suero capaz de reducir la multiplicación viral al 50 por ciento. Tanto 10³ como 10² DICT50 fueron neutralizadas por el anticuerpo monoclonal 7E7 y los sueros humanos (A12 y A31) positivos a anticuerpos anti-VHA. Los controles negativos del ensayo no neutralizaron al virus. Los títulos neutralizantes de los sueros de ratones inmunizados con fagos portadores de mimotopos de VHA oscilaron entre 4 y 16, mientras que los sueros preinmunes y los de ratones inmunizados con fago salvaje M13 no neutralizaron la infectividad viral. Este ensayo de neutralización resultó adecuado para la evaluación de los inmunógenos propuestos(AU)

Immunity to hepatitis A virus (HAV) is in first instance due to neutralizing antibodies. Neutralization assays are essential to evaluate new candidate vaccines against this pathogen. In this paper, an in vitro neutralization assay to evaluate HAV vaccine candidates using phage-display technology is described. 10³ and 10² DICT50 of HAV were incubated with different antibodies preparations and were inoculated onto plates with FRhK4 cells. After seven days of incubation, the neutralizing titer was determined as reciprocal of the serum dilution reducing HAV growth (inhibition of CPE) by 50 percent. 10³ and 10² DICT50 were neutralized by 7E7 anti-HAV monoclonal antibody and anti-VHA positive human sera (A12 and A31). Negative controls of the assay did not neutralize viral infectivity. Sera from mice immunized with phages displaying VHA mimotopes had neutralizing titers from 4-16. Neither negative control nor pre-immune and sera from mice immunized with M13 wild type phage neutralized HAV. A simple and faster in vitro neutralization assay was developed to evaluate new HAV vaccine candidates(AU)

Clinical inertia in diagnosis and treatment of hypertension in primary care: quantification and associated factors.

OBJECTIVES: The objective of the present study was to quantify both diagnostic and therapeutic inertia in hypertension and to identify patient-associated variables. PATIENTS AND METHODS: Cross-sectional, multicenter study of 35 424 subjects carried out in 428 health centers and/or primary care clinics in the Valencian Community, Spain, in a preventive activity conducted during 2003 and 2004. Diagnostic inertia was identified when a patient without known hypertension had high blood pressure (BP) but was labeled "normal" by the medical staff, and therapeutic inertia when treatment was not modified for a hypertensive patient on the presence of high BP values. Bivariate and multivariate statistical analyses were performed to identify patient's characteristics associated with inertia. RESULTS: Diagnostic inertia was present in 32.5% (95% CI 31.4-33.6) and therapeutic inertia in 37.0% (95% CI 35.6-38.5) of the cases. Both were more frequent in cases of isolated systolic or diastolic high BP. In the multivariate models, the factors associated with diagnostic inertia were type-2 diabetes (p=0.041), non-smoking (p=0.004), previous coronary heart disease (p=0.001), BP values (p<0.001) and body mass index (p=0.031), whereas for therapeutic inertia they were type-2 diabetes (p=0.003), previous coronary heart disease (p=0.016) or stroke (p<0.001) and BP values (p<0.001). CONCLUSIONS: Clinical inertia, either diagnostic or therapeutic, was present in one of every three cases of high BP. The most frequent factors associated with clinical inertia were the presence of associated conditions, which requires lower BP goals and the BP values.

[Evaluation of a new infusion kit. A study of cases and controls]. / Evaluación de un nuevo equipo de infusión. Un estudio de casos y controles.

Since prevention and control of hospital-generated infections comprises one of the priorities in today's hospitals, the authors analyze how two infusion kits function; one kit is the classical version normally used in the hospital where this study took place and the other is a new kit which incorporates a security system. After carrying out a statistical and cost analysis, the authors conclude that the new perfusion system is cost effective, providing, among other factors, a savings of 62.083 Euro per hospitalized patient.

Are we really seeing the total costs of surgical site infections? A Spanish study.

To identify overall costs generated by surgical site infections (SSI) patients, including indirect costs. A prospective study of case series of patients who have undergone major surgical treatment was undertaken. Patients who suffered SSI were compared with controls (nested case-control design). Centers for Disease Control and Prevention definitions were followed and SSI established. Overall costs and indirect related morbidity/mortality costs were estimated. The study was performed in a general, tertiary hospital (Valencia, Spain) for 4.5 years. Surgical site infections patients were 9.02% of the total people who underwent surgery. Their stays were prolonging by 14 days, and resources were used more intensely and for longer periods than in controls. Excess hospital costs were $10,232 per patient of which 37% corresponded to prolonged stays. Health costs only accounted for 10% of overall costs; $97,433 per patient including indirect social costs. Studies merely assessing excess costs due to prolonged stays of SSI patients do not reflect the entire scenario as they simply represent 35% of real hospital costs. A comprehensive appraisal shows that total healthcare expenditures represent a tenth of overall costs, which strengthens the claims that investment in preventing SSI would be highly cost-effective.

Medida del resultado de las intervenciones sanitarias en España: una aproximación mediante el análisis temporal y espacial de la mortalidad evitable entre 1986-2001 / Health system interventions assessment in Spain: an approach through the analysis of the time trends and the geographical variability of avoidable mortality between 1986 -2001

Fundamento: Muchos estudios proponen la mortalidad evitable(ME) como indicador para monitorizar los servicios de salud aunquesu generalización está limitada por el gran número de listas de causasutilizadas. El objetivo es analizar la evolución temporal del período1986-2001 y la distribución geográfica de la mortalidad evitable utilizandouna lista de causas consensuada.Métodos: Se analiza la mortalidad evitable global (ME) y agrupadaen causas ISAS (intervenciones de los servicios sanitarios) ycausas IPSI (políticas intersectoriales). Se analiza la evolución temporalajustando una recta de regresión de Poisson o un modelo deregresión de Joinpoint, según el caso, y se estima el porcentaje decambio anual (PCA). Para la distribución geográfica se calculan losíndices de mortalidad estandarizada (IME) por provincia y la razónde mortalidad comparativa (RMC) de cada provincia entre la primeray la segunda parte del periodo temporal.Resultados: Entre 1986-2001 la mortalidad evitable se redujo(PCA -1,68; IC:-1,99 a -1,38) algo más que la no-evitable (PCA -1,28; IC:-1,40 a -1,17). La mayor disminución se observó en la mortalidadpor causas ISAS (PCA del -2,77; IC: -2,89, -2,65) mientrasque la mortalidad por causas IPSI aumentó entre 1986-1990 (PCAdel 4,86; IC: 3,32 y 6,41), se mantiene constante de 1990-1995 (PCAdel -0,03; IC: -2,32 y 2,31) y disminuyó de 1995-2001 (PCA del -3,57; IC: -4,72 y -2,40). Conclusiones: Durante el período estudiado la mortalidad evitableha tenido una reducción mayor que la no evitable y se observandiferencias importantes entre provincias que sería necesario monitorizarpara tratar de identificar posibles disfunciones en los serviciossanitarios. La mortalidad es superior por causas ISAS en la zona surde España y por causas IPSI en algunas provincias costeras y estepatrón no varió mucho en el período analizado

Background: Many studies have proposed Avoidable Mortality(ME) to monitor the performance of health services although itsusefulness is limited by the multiplicity of the avoidable mortalitylists being used. Time trends from 1986-2001 and the geographicaldistribution of avoidable mortality by provinces, are presented forSpain.Methods: An Avoidable Mortality consensus list is being used.It includes avoidable mortality through the intervention of healthservices (ISAS in Spanish) and through health policy interventions(IPSI in Spanish). Time trends are analyzed adjusting Poisson orJoinpoint regression models and the annual percentages of change(APC) are estimated. Changes in geographical distribution betweenthe first half of the analysed period and the second are tested bymeans of standard mortality ratios (SMR) and comparative mortalityrates (CMR) for each province.Results: Between 1986 and 2001 avoidable mortality decreased(APC: -1.68; CI: -1.99 and -1.38) slightly more than non-avoidablemortality (APC: -1.28; CI: -1.40 and -1.17). Higher reduction wasobserved for ISAS mortality (APC: -2.77; CI: -2.89 and -2.65) andan irregular trend for IPSI (between 1986-1990 increase APC: 4.86;CI: 3.32 and 6.41, between 1990-95 stabilization APC: -0.03; CI: -2.32 and 2.31 and finally 1995-2001 decrease APC: -3.57; CI: -4.72and -2.40). Conclusions: Avoidable mortality decreased more than nonavoidable mortality and important geographical variability can beobserved among provinces which should be monitored in order toidentify the health services weaknesses. The higher ISAS mortalitywas observed in southern provinces and the higher IPSI mortality insome areas on the coast. The pattern is somewhat similar for bothanalyzed periods

Influence of social factors on avoidable mortality: a hospital-based case-control study.

OBJECTIVE: The effect of socioeconomic factors on avoidable mortality at an individual level is not well known, since most studies showing this association are based on aggregate data. The purpose of this study was to determine socioeconomic differences between those patients who die of avoidable causes and those who do not die. METHODS: A matched case-control study was carried out regarding in-hospital avoidable mortality (Holland's medical care indicators) that occurred in a university hospital serving a Spanish-Mediterranean population during a 30-month period. RESULTS: We studied 82 cases of death from avoidable causes and 300 controls matched on medical care indicators and age. The variables that showed a statistically significant association with in-hospital avoidable mortality were number of diagnoses (the greater the number, the higher the risk), length of stay (patients staying seven or more days presented a lower risk), and education. Those patients with low and middle educational levels showed a greater risk of avoidable mortality (adjusted odds ratio=3.57 and 2.82, respectively) than those patients with higher levels of education. CONCLUSIONS: Consistent with the findings of studies based on aggregate data, our case-control analyses indicated that among several socioeconomic variables studied, educational level was significantly associated with the risk of in-hospital avoidable mortality, regardless of age and medical care indicators. Patients with low levels of education (<6 years of schooling) were at highest risk for in-hospital avoidable mortality, followed by those with middle levels of education (7-10 years of schooling).