Impact of a colorectal cancer screening program implantation on delays and prognosis of non-screening detected colorectal cancer.

BACKGROUND: The implementation of a colorectal cancer (CRC) screening programme may increase the awareness of Primary Care Physicians, reduce the diagnostic delay in CRC detected outside the scope of the screening programme and thus improve prognosis. AIM: To determine the effect of implementation of a CRC screening programme on diagnostic delays and prognosis of CRC detected outside the scope of a screening programme. METHODS: We performed a retrospective intervention study with a pre-post design. We identified 322 patients with incident and confirmed CRC in the pre-implantation cohort (June 2014 - May 2015) and 285 in the post-implantation cohort (June 2017 - May 2018) in the Cancer Registry detected outside the scope of a CRC screening programme. In each patient we calculated the different healthcare diagnostics delays: global, primary and secondary healthcare, referral and colonoscopy-related delays. In addition, we collected the initial healthcare that evaluated the patient, the home location (urban/rural), and the CRC stage at diagnosis. We determined the two-year survival and we performed a multivariate proportional hazard regression analysis to determine the variables associated with survival. RESULTS: We did not detect any differences in the patient or CRC baseline-related variables. A total of 20.1% of patients was detected with metastatic disease. There was a significant increase in direct referral to colonoscopy from primary healthcare (25.5%, 35.8%; P = 0.04) in the post-implantation cohort. Diagnostic delay was reduced by 24 d (106.64 ± 148.84 days, 82.84 ± 109.31 d; P = 0.02) due to the reduction in secondary healthcare delay (46.01 ± 111.65 d; 29.20 ± 60.83 d; P = 0.02). However, we did not find any differences in CRC stage at diagnosis or in two-year survival (70.3%; P = 0.9). Variables independently associated with two-year risk of death were age (Hazard Ratio-HR: 1.06, 95%CI: 1.04-1.07), CRC stage (II HR: 2.17, 95%CI: 1.07-4.40; III HR: 3.07, 95%CI: 1.56-6.08; IV HR: 19.22, 95%CI: 9.86-37.44; unknown HR: 9.24, 95%CI: 4.27-19.99), initial healthcare consultation (secondary HR: 2.93, 95%CI: 1.01-8.55; emergency department HR: 2.06, 95%CI: 0.67-6.34), hospitalization during the diagnostic process (HR: 1.67, 95%CI: 1.17-2.38) and urban residence (HR: 1.44, 95%CI: 1.06-1.98). CONCLUSION: Although implementation of a CRC screening programme can reduce diagnostic delays for CRC detected in symptomatic patients, this has no effect on CRC stage or survival.

Gold Standard Evaluation of an Automatic HAIs Surveillance System.

Hospital-acquired Infections (HAIs) surveillance, defined as the systematic collection of data related to a certain health event, is considered an essential dimension for a prevention HAI program to be effective. In recent years, new automated HAI surveillance methods have emerged with the wide adoption of electronic health records (EHR). Here we present the validation results against the gold standard of HAIs diagnosis of the InNoCBR system deployed in the Ourense University Hospital Complex (Spain). Acting as a totally autonomous system, InNoCBR achieves a HAI sensitivity of 70.83% and a specificity of 97.76%, with a positive predictive value of 77.24%. The kappa index for infection type classification is 0.67. Sensitivity varies depending on infection type, where bloodstream infection attains the best value (93.33%), whereas the respiratory infection could be improved the most (53.33%). Working as a semi-automatic system, InNoCBR reaches a high level of sensitivity (81.73%), specificity (99.47%), and a meritorious positive predictive value (94.33%).

Perceptions and attitudes of patients and health care workers toward patient empowerment in promoting hand hygiene.

BACKGROUND: Patient empowerment is a component of the World Health Organization's multimodal strategy to improve hand hygiene (HH). Its successful implementation requires knowledge of the perceptions and attitudes of patients and health care workers (HCWs) toward patient empowerment in HH. METHODS: A cross-sectional study, through a self-administered questionnaire of patients and their families and HCWs, was conducted in a 433-bed block of an 850-bed university hospital in Galicia, Spain. RESULTS: A total of 337 patients and their families and 196 HCWs completed the questionnaire. Among patients and their families, 49.9% were willing to remind HCWs about HH. However, only 31.6% of HCWs (41.8% of physicians and 24.8% of nurses) supported patient participation. The most common reason for patients and their families not being willing to ask caregivers to perform HH was fear of causing annoyance or receiving worse treatment as a consequence (76%). The main reasons that physicians disagreed with patient participation was patients' lack of knowledge (40%) and possible negative effects on the HCW/patient relationship (40%). Nurses considered this participation unnecessary (58%). CONCLUSIONS: There were significant differences between patients and their families and HCWs regarding support for patient empowerment in promoting HH. In our setting, a cultural change is needed in the HCW/patient relationship to create a facilitating environment.