Differences in Perception of Healthcare Management between Patients and Professionals.

Patient perception and the organizational and safety culture of health professionals are an indirect indicator of the quality of care. Both patient and health professional perceptions were evaluated, and their degree of coincidence was measured in the context of a mutual insurance company (MC Mutual). This study was based on the secondary analysis of routine data available in databases of patients' perceptions and professionals' evaluations of the quality of care provided by MC Mutual during the period 2017-2019, prior to the COVID-19 pandemic. Eight dimensions were considered: the results of care, coordination of professionals, trust-based care, clinical and administrative information, facilities and technical means, confidence in diagnosis, and confidence in treatment. The patients and professionals agreed on the dimension of confidence in treatment (good), and the dimensions of coordination and confidence in diagnosis (poor). They diverged on confidence in treatment, which was rated worse by patients than by professionals, and on results, information and infrastructure, which were rated worse by professionals only. This implies that care managers have to reinforce the training and supervision activities of the positive coincident aspects (therapy) for their maintenance, as well as the negative coincident ones (coordination and diagnostic) for the improvement of both perceptions. Reviewing patient and professional surveys is very useful for the supervision of health quality in the context of an occupational mutual insurance company.

Underestimation of invasive breast carcinoma in patients with initial diagnosis of ductal carcinoma in situ: Size matters.

BACKGROUND: The aim of our study was to identify those patients with preoperative diagnosis of ductal carcinoma in situ (DCIS) and high risk of upstaging to invasive breast carcinoma (IBC), in whom sentinel lymph node biopsy (SLNB) should be considered. MATERIALS AND METHODS: One-hundred and five DCIS patients treated with breast-conserving surgery (BCS) or mastectomy were studied. Preoperative features of the tumours were analyzed to investigate its association with underestimation of IBC on final pathology. RESULTS: Overall, the underestimation rate of IBC was 16.2%. The underestimation rate was highest in lesions with initial size >2 cm compared with those with size ≤2 cm (26.8% vs. 4.1%, respectively; p < 0.003). Eighty-eight patients (83.8%) underwent concurrent SLNB and only one case had lymph node involvement (1.1%). CONCLUSIONS: SLNB should be considered in DCIS patients receiving BCS with lesions greater than 2 cm since approximately one in four will harbour an IBC.

Infraestimación de carcinoma infiltrante de mama en pacientes con diagnóstico inicial de carcinoma ductal in situ: el tamaño importa / Underestimation of invasive breast carcinoma in patients with initial diagnosis of ductal carcinoma in situ: Size matters

Introducción: El objetivo de nuestro estudio consistió en identificar aquellas pacientes con diagnóstico preoperatorio de carcinoma ductal in situ (CDIS) y alto riesgo de presentar un carcinoma infiltrante en la lesión, en las que se debería considerar realizar una biopsia selectiva de ganglio centinela (BSGC). Métodos: Se estudiaron 105 pacientes con CDIS tratadas mediante cirugía conservadora o mastectomía. Se analizaron las características preoperatorias de los tumores para investigar su asociación con la infraestimación de carcinoma infiltrante. Resultados: El porcentaje global de infraestimación de carcinoma infiltrante fue del 16,2%. El porcentaje de infraestimación fue mayor en las lesiones con un tamaño inicial superior a 2 cm en comparación con las lesiones con un tamaño igual o menor a 2 cm (26,8% vs. 4,1%, respectivamente; p < 0,003). Se realizó la BSGC en 88 pacientes (83,8%), encontrándose afectación ganglionar en un solo caso (1,1%). Conclusiones: En pacientes con diagnóstico inicial de CDIS tratadas mediante cirugía conservadora, se debería considerar realizar una BSGC cuando el tamaño de la lesión es superior a 2 cm, ya que uno de cada cuatro casos albergará la presencia de un carcinoma infiltrante. (AU)

Introduction: The aim of our study was to identify those patients with preoperative diagnosis of ductal carcinoma in situ (DCIS) and high risk of upstaging to invasive breast carcinoma (IBC), in whom sentinel lymph node biopsy (SLNB) should be considered. Methods: One-hundred and five DCIS patients treated with breast-conserving surgery (BCS) or mastectomy were studied. Preoperative features of the tumors were analyzed to investigate its association with underestimation of IBC on final pathology. Results: Overall, the underestimation rate of IBC was 16.2%. The underestimation rate was highest in lesions with initial size >2 cm compared with those with size ≤2 cm (26.8% vs. 4.1%, respectively; p < 0.003). Eighty-eight patients (83.8%) underwent concurrent SLNB and only one case had lymph node involvement (1.1%). Conclusions: SLNB should be considered in DCIS patients receiving BCS with lesions greater than 2 cm since approximately one in four will harbor an IBC. (AU)

Sutura laparoscópica mecanizada con FlexDex Surgical System® para ubicaciones anatómicamente difíciles / Robotic-like suturing with FlexDex Surgical System® for difficult laparoscopic suture

El campo de la cirugía laparoscópica ha experimentado un crecimiento exponencial en los últimos años. A pesar de los grandes avances en este campo, las herramientas laparoscópicas estándar no han logrado su desarrollo óptimo, presentando ciertas deficiencias en lo que a movilidad y ergonomía se refiere. La cirugía robótica ha intentado aportar soluciones a estos problemas, sin embargo, existen inconvenientes, entre los que se encuentran su elevado coste, escasa disponibilidad y la necesidad de capacitación específica, lo que condiciona su rentabilidad y generalización de uso. Presentamos los resultados de una serie clínica prospectiva de 20 casos, en los que se ha testado la seguridad, eficacia y ergonomía de FlexDex® para la realización de suturas intracorpóreas laparoscópicas. El resultado muestra una herramienta segura y funcional que ofrece control y precisión en su manejo, además de mejorar la ergonomía del cirujano. Este dispositivo supone una alternativa que combina la precisión y el rango de movimientos de la cirugía robótica, con la mayor disponibilidad de la laparoscopia convencional. (AU)

The field of laparoscopic surgery has experienced an exponential growth in recent years. Despite great progress in this field, standard laparoscopic tools have not been optimally developed and still has some deficiencies when it comes to mobility and ergonomics. Robotic surgery has attempted to solve these problems by improving the articulation of surgical instruments. However, it presents a series of disadvantages, among which are its high cost, low availability and the need of a specific training, which conditions its profitability and hinders a widespread use. We present the results of a prospective clinical series of 20 cases in which the safety, efficacy and ergonomics of FlexDex® have been tested for performing laparoscopic intracorporeal sutures. The result is a safe and functional tool that offers both control and precision in its handling, while improves the ergonomics of the surgeon. This device represents an alternative that combines the precision and range of movements of robotic surgery with the greater availability of conventional laparoscopy. (AU)

Underestimation of invasive breast carcinoma in patients with initial diagnosis of ductal carcinoma in situ: Size matters. / Infraestimación de carcinoma infiltrante de mama en pacientes con diagnóstico inicial de carcinoma ductal in situ: el tamaño importa.

INTRODUCTION: The aim of our study was to identify those patients with preoperative diagnosis of ductal carcinoma in situ (DCIS) and high risk of upstaging to invasive breast carcinoma (IBC), in whom sentinel lymph node biopsy (SLNB) should be considered. METHODS: One-hundred and five DCIS patients treated with breast-conserving surgery (BCS) or mastectomy were studied. Preoperative features of the tumors were analyzed to investigate its association with underestimation of IBC on final pathology. RESULTS: Overall, the underestimation rate of IBC was 16.2%. The underestimation rate was highest in lesions with initial size >2 cm compared with those with size ≤2 cm (26.8% vs. 4.1%, respectively; p < 0.003). Eighty-eight patients (83.8%) underwent concurrent SLNB and only one case had lymph node involvement (1.1%). CONCLUSIONS: SLNB should be considered in DCIS patients receiving BCS with lesions greater than 2 cm since approximately one in four will harbor an IBC.

Robotic-like suturing with FlexDex Surgical System® for difficult laparoscopic suture. / Sutura laparoscópica mecanizada con FlexDex Surgical System® para ubicaciones anatómicamente difíciles.

The field of laparoscopic surgery has experienced an exponential growth in recent years. Despite great progress in this field, standard laparoscopic tools have not been optimally developed and still has some deficiencies when it comes to mobility and ergonomics. Robotic surgery has attempted to solve these problems by improving the articulation of surgical instruments. However, it presents a series of disadvantages, among which are its high cost, low availability and the need of a specific training, which conditions its profitability and hinders a widespread use. We present the results of a prospective clinical series of 20 cases in which the safety, efficacy and ergonomics of FlexDex® have been tested for performing laparoscopic intracorporeal sutures. The result is a safe and functional tool that offers both control and precision in its handling, while improves the ergonomics of the surgeon. This device represents an alternative that combines the precision and range of movements of robotic surgery with the greater availability of conventional laparoscopy.

Trombosis del tronco celíaco como presentación de la arteritis de Takayasu / Celiac trunk thrombosis as a presentation of Takayasu arteritis

No disponible

Intervention for Smokers through New Communication Technologies: What Perceptions Do Patients and Healthcare Professionals Have? A Qualitative Study.

BACKGROUND: The use of information and communication technologies (ICTs) in the health service is increasing. In spite of limitations, such as lack of time and experience, the deployment of ICTs in the healthcare system has advantages which include patient satisfaction with secure messaging, and time saving benefits and utility for patients and health professionals. ICTs may be helpful as either interventions on their own or as complementary tools to help patients stop smoking. OBJECTIVES: To gather opinions from both medical professionals and smokers about an email-based application that had been designed by our research group to help smoking cessation, and identify the advantages and disadvantages associated with interventions based on the utilization of ICTs for this purpose. METHODS: A qualitative, descriptive-interpretative study with a phenomenological perspective was performed to identify and interpret the discourses of the participating smokers and primary healthcare professionals. Data were obtained through two techniques: semi-structured individual interviews and discussion groups, which were recorded and later systematically and literally transcribed together with the interviewer's notes. Data were analyzed with the ATLAS TI 6.0 programme. RESULTS: Seven individual interviews and four focal groups were conducted. The advantages of the application based on the email intervention designed by our research group were said to be the saving of time in consultations and ease of access for patients who found work timetables and following a programme for smoking cessation incompatible. The disadvantages were thought to be a lack of personal contact with the healthcare professional, and the possibility of cheating/ self-deception, and a greater probability of relapse on the part of the smokers. CONCLUSIONS: Both patients and healthcare professionals viewed the email-based application to help patients stop smoking as a complementary aid to face-to-face consultations. Nevertheless, ICTs could not substitute personal contact in the smoking cessation programme.

Actitudes de los españoles frente a los espacios libres de humo de tabaco / Spanish opinions on tobacco smoke-free areas

Objetivo: Conocer las cifras de fumadores pasivos, los lugares donde con más frecuencia se produce la exposición al humo de tabaco (HT), la opinión de fumadores y no fumadores sobre estos espacios y la influencia que pueden ejercer sobre el tabaquismo. Diseño: Estudio observacional descriptivo y transversal de una muestra de conveniencia. Emplazamiento: Multicéntrico, centros de salud (CS) españoles. Participantes: 9.733 mayores de 16 años usuarios y trabajadores de los CS que en abril de 2008 acudieron a dichos centros. Mediciones principales: Condición de fumador, sexo, profesión y opinión que les merece la exposición al HT. Resultados: Se consideran fumadores pasivos en lugares públicos el 42,4% de los encuestados y en lugares cerrados el 96,8%. El 91,8% consideran que el HT es perjudicial para los no fumadores, el 70,3% que los espacios libres de humos de tabaco (ELHT) son buenos para no empezar a fumar y el 71,8% para dejar de fumar. El 81,1% prefieren ELHT. Están más expuestos al HT en el coche (79,8%) y cafeterías (34,7%). Son los no fumadores, tanto hombres como mujeres, los que significativamente comparten estas opiniones (p<0,05). Conclusiones: En conjunto, los encuestados se consideran fumadores pasivos, piensan que los espacios sin humo disminuyen la incidencia de tabaquismo, favorecen que se deje de fumar y además, los prefiere para vivir. Esto hace recapacitar sobre la necesidad de instar a los gobiernos a establecer medidas legislativas que promuevan ELHT, dadas las preferencias de la mayor parte de la población(AU)

Objective: To determine the number of passive smokers, the environments where exposure to second-hand smoke (SHS) is higher, the opinion of smokers and non-smokers with regard to these spaces and their influence on smoking. Design: Descriptive and cross-sectional observational study of a convenience sample. Location: Multi-centre, Spanish Health-care Centres. Participants: A total of 9733 people older than 16 years who were seen or were working in Spanish Health-care Centres in April 2008. Main measurements: Smoker condition, gender, profession and their opinion with regard to second-hand smoke (SHS) exposure. Results: A total of 42.4% of participants considered themselves second-hand (passive) smokers in public places and 96.8% in indoor areas. Almost all of them (91.8%) considered SHS exposure harmful for non-smokers, Smoke-free environments were considered to be good for discouraging people from starting to smoke (70.3%), and for quitting smoking (71.8%). Smoke-free environments were preferred by 81.1%. They felt more exposed SHS inside a car (79.8%) and in cafes (34.7%). Non-smokers, both men and women, shared these opinions significantly (P<.05). Conclusions: Altogether, those surveyed considered themselves as second-hand smokers and think that smoke-free environments reduce the impact of smoking and help in quitting smoking. Besides, they prefer living in those environments. Considering the preferences of most of the population, this stresses the need to urge governments to establish legislative measures promoting smoke-free environments(AU)

[Spanish opinions on tobacco smoke-free areas]. / Actitudes de los españoles frente a los espacios libres de humo de tabaco.

OBJECTIVE: To determine the number of passive smokers, the environments where exposure to second-hand smoke (SHS) is higher, the opinion of smokers and non-smokers with regard to these spaces and their influence on smoking. DESIGN: Descriptive and cross-sectional observational study of a convenience sample. LOCATION: Multi-centre, Spanish Health-care Centres. PARTICIPANTS: A total of 9733 people older than 16 years who were seen or were working in Spanish Health-care Centres in April 2008. MAIN MEASUREMENTS: Smoker condition, gender, profession and their opinion with regard to second-hand smoke (SHS) exposure. RESULTS: A total of 42.4% of participants considered themselves second-hand (passive) smokers in public places and 96.8% in indoor areas. Almost all of them (91.8%) considered SHS exposure harmful for non-smokers, Smoke-free environments were considered to be good for discouraging people from starting to smoke (70.3%), and for quitting smoking (71.8%). Smoke-free environments were preferred by 81.1%. They felt more exposed SHS inside a car (79.8%) and in cafes (34.7%). Non-smokers, both men and women, shared these opinions significantly (P<.05). CONCLUSIONS: Altogether, those surveyed considered themselves as second-hand smokers and think that smoke-free environments reduce the impact of smoking and help in quitting smoking. Besides, they prefer living in those environments. Considering the preferences of most of the population, this stresses the need to urge governments to establish legislative measures promoting smoke-free environments.

[Correlation between carbon-monoxide levels in exhaled air and nicotine-dependence measurements systems (DSM-IV, Fagerström test and ARU-SMQ-9) in adolescent smokers]. / Correlación entre los valores de monóxido de carbono en el aire espirado y los sistemas de medición de dependencia nicotínica DSM-IV, test de Fagerström y ARUSMQ-9 en adolescentes fumadores.

BACKGROUND AND OBJECTIVE: If we are capable of 1) determining the correlation, in young smokers, between carbon-monoxide levels in exhaled air (CO) and carboxihemoblobine (COHb) (cooximetrically determined) and 2) adapting the versions of the nosologic criteria DSM-IV for nicotine-depencence (DSM-IVa), Fagerström Test (FTNDa), and ARU-SMQ-9a Test to adolescents, then we may be able to establish how useful such tests are to measure nicotine-ependences in adolescents. SUBJECTS AND MEHTOD: Cross-sectional, observation-based study carried out in 41 schools. 2,647 students aged 10 to 17 years were surveyed. The size of the sample was calculated for eacha nd using the equation of finite population. For each age, the sample was stratified according to sex and type of school. Schools and students were chosen by using the table of random numbers. Teenagers filled up a questionnaire which included DSM-IVa, FTNDa, and ARU-SMQ-9a and were subsequently given a cooximery. RESULTS: 23.1% were smokers. The correlation between the levels of CO and the nicotine-dependence tests was: DSM-IVa rho o = 0.3390 (p = 0.0000); FTNDa rho o = 0.5853 (p 0 0.000); ARU-SMQ-9a rho o = 0.4670 (p = 0.000). The correlation with the levels of carboxihemoglobine was: DSM-IVa rho o = 0.3369 (p = 0.000); FTNDa *o = 0.5498 (p = 0-000); ARU-SMQ-9a rho o = 0.4460 (p 0 0-000). The study was based on 583 smoking scholars who underwent the cooximetry. CONCLUSIONS: The correlation between DSM-IVa, FTNDa, and ARU-SMQ-9a and the levels of CO and COHb in young smokers is low but meaninful. In our opinion, research to find new, simple, cheap, and easily-accessible tools allowing the correct diagnosis and follow-up of young smokers must continue.