Measuring patient safety climate in operating rooms: Validation of the Spanish version of the hospital survey on patient safety.

OBJECTIVE: The measurement of patient safety climate within hospitals, and specifically in operating rooms is a basic tool for the development of the patient's safety policy. There are no validated Spanish versions of instruments to measure safety climate. The objective of this research was to validate the Spanish version of the Hospital Survey on Patient Safety (HSOPS®), with the addition of a module for surgical units, to evaluate the patient safety climate in operating rooms. METHODS: Survey validation study. The Hospital Survey on Patient Safety (HSOPS®) was applied to health workers from 6 acute general hospitals, from Medellín (Colombia), with surgical procedures greater than 300 per month, 18 items were added considered specific for Operating Rooms. For construct validation, an exploratory factor analysis (EFA) was used, utilizing principal components as the extraction method. Reliability was evaluated with Cronbach's α. RESULTS: A 10 dimensions model was obtained with EFA, most of the dimensions of the original questionnaire were conserved, although the factorial structure was not reproduced. Two new dimensions emerged from the added items. The Cronbach's α ranged between 0.66 and 0.87. Conclusions: We found the HSOPS questionnaire is valid and reliable for measuring patient safety climate in Spanish speaking Latin American countries. Two additional dimensions are proposed for Operating Rooms.

Study of the factors influencing the preparation of advance directives.

The aim of the study is to analyze the factors influencing the decision to prepare advance directives (AD) related to socio-demographic situation, health status, degree of dependence, healthcare characteristics and psychosocial aspects. This is a case-control study conducted using a personal interview. We compared 123 subjects who had completed AD with 123 subjects who had not and who belonged to two health centers in the Albacete Health District. Study variables included self-perceived health, functional status, morbidity, socio-demographic characteristics, use of health services, attitudes toward AD and psychosocial aspects. We found a predominance of women (64.2%) among those who prepared AD, with a mean age of 53.3 years. Preparing AD was associated with secondary or higher education (OR=2.5), a lifestyle other than living with a partner and with children (OR=2.5), chronic medication use (OR=3.2), higher than average number of specialist visits (OR=4.0), a longer-term relationship with the family physician (OR=3.5), a family history of having AD (OR=17.3) and with lower levels of social interaction (OR=3.0). The results suggest that several factors, resulting from both the socio-demographic situation and health or functional status, can affect the decision to formalize AD.

Factors associated with parietal cell autoantibodies in the general population.

The presence in serum of parietal cell autoantibodies (PCA) is a characteristic of autoimmune gastritis. We determined the prevalence of PCA in the general population and investigate their association with type 2 diabetes, insulin resistance and lifestyle factors related with autoimmune gastritis. A cross-sectional study was performed, involving 429 individuals enrolled in a cohort study of the general population of the Canary Islands. All participants underwent physical examination, provided a blood sample and responded to a questionnaire regarding health and lifestyle factors. Serum concentrations of PCA, soluble CD40 ligand (sCD40L), C-peptide and glucose (to determine insulin resistance) were measured. The association of PCA with the other factors was determined with bivariate analysis, and logistic regression models were used to adjust the associations for age and sex. The prevalence of PCA was 7.8% (95% CI=10.3-5.3). The factors associated with PCA were female sex (p=0.032), insulin resistance (p=0.016), menopause (p=0.029) and sCD40L (p=0.019). Alcohol consumption (p=0.006) and smoking (p=0.005) were associated with low prevalences of PCA. After adjustment for age and sex, the association with PCA was confirmed for smoking (OR=0.1 [0.0-0.9]), alcohol consumption (OR=0.3 [0.1-0.9]), insulin resistance (OR=2.4 [1.1-4.9]), female sex (OR=2.4 [1.1-5.3]), sCD40L (OR=3.7 [1.2-11.4]) and menopause (OR=5.3 [1.2-23.3]). In conclusion, smoking and alcohol consumption acted as protective factors against the appearance of PCA in the general population, whereas female sex, menopause, insulin resistance and elevated serum sCD40L were risk markers for PCA. In patients who smoke or drink alcohol, clinicians should be cautious when using PCA to rule out autoimmune gastritis.

[Current clinical practice guidelines in type 2 diabetes: how should they be applied in primary care?]. / Guías actuales de práctica clínica en la diabetes mellitus tipo 2: ¿cómo aplicarlas en atención primaria?

Clinical practice guidelines should be drawn up with systematic methodology based on the best available evidence. Recommendations should be based on evaluation of the overall quality of the evidence and grading of the strength of recommendations. Consensus documents combine a review of the evidence with expert opinion in an attempt to reach some agreement in areas of uncertainty due to the lack of conclusive proof. The debate aroused by new treatments stimulates the production of documents advocating their use even when there are few long-term studies on their safety and efficacy. There are several methodologically rigorous international guidelines on diabetes (NGC, NICE, SIGN, CAD, ADA). The most recent debate has centered on the ADA-EASD treatment algorithm. In Spain, the production of clinical practice guidelines with analysis of the evidence and grading of recommendations remains scarce, although the most recent published guidelines show greater rigor. More common is the drafting of consensus documents by scientific societies with the aim of combining external evidence with experience and reflection. In Spain there are also organisms (such as GuíaSalud or Fisterra) that facilitate free access to guidelines drawn up by Spanish groups.

[Diabetes mellitus and cardiovascular risk. Is integrated therapy of type 2 diabetes and cardiovascular risk factors necessary?]. / La diabetes mellitus y el riesgo cardiovascular. ¿Es necesario el tratamiento integral de la diabetes mellitus tipo 2 y los factores de riesgo cardiovascular?

Cardiovascular disease (CVD) is the first cause of death in the Spanish population among both diabetics and non-diabetics. In diabetes, CVD is between 2 and 4 times more frequent, earlier and more aggressive. With current measures, approximately 50% of CVD can be prevented. The risk factors for CVD in diabetes are hypertension, dyslipidemia, smoking, obesity and sedentariness. More than 80% of patient with type 2 diabetes have hypertension and dyslipidemia and approximately 15% continue to smoke. However, all these factors are controlled in at least 10%. Although dyslipidemia is the most influential and least treated factor, the greatest benefit for CVD prevention is obtained with integrated intervention on all risk factors, reducing blood pressure to below 140/80 mmHg, low-density lipoprotein cholesterol (LDL-c) to below 100 mg/dl, encouraging smoking cessation, regular physical activity and maintaining a healthy weight (BMI < 25 kg/m²). In secondary prevention or persons with microvascular disease, the targets may be stricter (blood pressure 130/80 mmHg and LDL-c 80 mg/dl). Drug treatment should always include an angiotensin converting-enzyme inhibitor or an angiotensin II receptor antagonist and a statin. Aspirin should be reserved for patients in secondary prevention or with very high CV risk. Consequently, interventions should be prioritized according to the foreseeable risk for each patient, which can be estimated through the SCORE scale or other scales such as Regicor or UKPDS, with a SCORE > 5% indicating high risk. These high-risk patients should receive personalized care.