Recomendaciones SER sobre la gestión de riesgo del tratamiento con FAME biológicos o sintéticos dirigidos en pacientes con artritis reumatoide / Recommendations by the Spanish Society of Rheumatology on risk management of biological treatment and JAK inhibitors in patients with rheumatoid arthritis

Objetivo: Elaborar recomendaciones basadas en la evidencia disponible y el consenso de expertos, para la gestión del riesgo del tratamiento biológico y los inhibidores de las JAK en pacientes con artritis reumatoide. Métodos: Se identificaron preguntas clínicas de investigación relevantes para el objetivo del documento. Estas preguntas fueron reformuladas en formato PICO (paciente, intervención, comparación, outcome o desenlace) por un panel de expertos, seleccionados en base a su experiencia en el área. Se realizó una revisión sistemática de la evidencia, graduándose de acuerdo a los criterios GRADE (Grading of Recommendations Assessment, Development, and Evaluation). A continuación, se formularon las recomendaciones específicas. Resultados: Se propusieron por el panel de expertos 6preguntas PICO en base a su relevancia clínica y a la existencia de información reciente referentes al riesgo de aparición de infecciones graves, el riesgo de reactivación del virus de la hepatitisB, el riesgo de reactivación del virus varicela-zoster, el riesgo de aparición de cáncer de piel (melanoma y no melanoma) o hematológico, el riesgo de aparición de enfermedad tromboembólica y el riesgo de progresión del virus del papiloma humano. Se formularon un total de 29 recomendaciones, estructuradas por pregunta, basadas en la evidencia encontrada y el consenso de los expertos. Conclusiones: Se presentan las recomendaciones SER sobre la gestión del riesgo del tratamiento con terapias biológicas e inhibidores de las JAK en la artritis reumatoide.(AU)

Objective: To present recommendations based on the available evidence and the consensus of experts, for risk management of biological treatment and JAK inhibitors in patients with rheumatoid arthritis. Methods: Clinical research questions relevant to the purpose of the document were identified. These questions were reformulated in PICO format (patient, intervention, comparison, outcome) by a panel of experts, selected based on their experience in the area. A systematic review of the evidence was carried out, grading according to the GRADE criteria (Grading of Recommendations Assessment, Development, and Evaluation). Specific recommendations were then formulated. Results: Six PICO questions were proposed by the panel of experts based on their clinical relevance and the existence of recent information regarding the risk of occurrence of serious infections, the risk of reactivation of the hepatitisB virus, the risk of reactivation of the virus varicella-zoster, the risk of appearance of skin (melanoma and non-melanoma) or hematological cancer, the risk of appearance of thromboembolic disease and the risk of progression of the human papilloma virus. A total of 29 recommendations were formulated, structured by question, based on the evidence found and the consensus of the experts. Conclusions: The SER recommendations on risk management of treatment with biologic therapies and JAK inhibitors in rheumatoid arthritis are presented.(AU)

Recommendations by the Spanish Society of Rheumatology on risk management of biological treatment and JAK inhibitors in patients with rheumatoid arthritis.

OBJECTIVE: To present recommendations based on the available evidence and the consensus of experts, for risk management of biological treatment and JAK inhibitors in patients with rheumatoid arthritis. METHODS: Clinical research questions relevant to the purpose of the document were identified. These questions were reformulated in PICO format (patient, intervention, comparison, outcome or outcome) by a panel of experts, selected based on their experience in the area. A systematic review of the evidence was carried out, grading according to the GRADE criteria (Grading of Recommendations Assessment, Development, and Evaluation). Specific recommendations were then formulated. RESULTS: 6 PICO questions were proposed by the panel of experts based on their clinical relevance and the existence of recent information regarding the risk of occurrence of serious infections, the risk of reactivation of the hepatitis B virus, the risk of reactivation of the virus varicella-zoster, the risk of appearance of skin (melanoma and non-melanoma) or haematological cancer, the risk of appearance of thromboembolic disease and the risk of progression of the human papilloma virus. A total of 28 recommendations were formulated, structured by question, based on the evidence found and the consensus of the experts. CONCLUSIONS: The SER recommendations on risk management of treatment with biologic therapies and JAK inhibitors in rheumatoid arthritis are presented.

Adverse events: an expensive and avoidable hospital problem.

INTRODUCTION: Adverse healthcare-related events (AE) entail reduced patient safety. Estimating their frequency, characteristics, avoidability and impact is a means to identify targets for improvement in the quality of care. METHODS: This was a descriptive observational study conducted within the Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD). The study was conducted in a high-complexity hospital in May 2019 through a two-phase electronic medical record review: (1) AE screening and epidemiological and clinical data collection and (2) AE review and classification and analysis of their impact, avoidability, and associated costs. RESULTS: A total of 636 patients were studied. The prevalence of AE was 12.4%. Death during the stay was associated with the presence of AE (OR [CI95%]: 2.15 [1.07 to 4.52]) versus absence and emergency admission (OR [CI95%]: 17.11[6.63 to 46.26]) versus scheduled. A total of 70.2% of the AEs were avoidable. Avoidable AEs were associated with the presence of pressure ulcers (OR [CI95%]: 2.77 [1.39 to 5.51]), central venous catheter (OR [CI95%]: 2.58 [1.33 to 5.00]) and impaired mobility (OR [CI95%]: 2.24[1.35 to 3.71]), versus absences. They were associated too with the stays in the intensive care unit (OR [CI95%]: 2.75 [1.07 to 7.06]) versus medical service. AEs were responsible for additional costs of €909,716.8 for extra days of stay and €12,461.9 per patient with AE. CONCLUSIONS: The prevalence of AEs was similar to that found in other studies. AEs led to worse patient outcomes and were associated with the patient's death. Although avoidable AEs were less severe, their higher frequency produced a greater impact on the patient and healthcare system.Key messagesAdverse events are one of the main problems in healthcare delivery and patients who suffer from at least one AE are double as likely to die during hospitalization.Avoidable adverse events are the most frequent in health care and they are a good target where achieve improvement areas that allow getting optimal patient safety and quality of care levels.Patients hospitalized in the ICU, with the previous presence of pressure ulcers, central venous catheter, or impaired mobility were associated with the development of avoidable AE, so optimal management of these patients would reduce the impact of AE.

Surgical Error Compensation Claims as a Patient Safety Indicator: Causes and Economic Consequences in the Murcia Health System, 2002 to 2018.

OBJECTIVES: Compensation claims are a useful source of information on patient safety research. The purpose of this study was to determine the main causes of surgical compensation claims and their financial impact on the health system. METHODS: A descriptive observational study with analytical components was carried out on compensation claims brought against the surgical area of the Murcia Health System between 2002 and 2018. We analyzed the frequency, causes, consequences, locations and surgical settings of these claims, the time of judicial procedure, and compensation adjusted to the Consumer Price Index. RESULTS: There were 1172 compensation claims. "orthopedic surgery and traumatology" (27.4%), "gynecology and obstetrics" (25.7%), and "general surgery" (17.2%) were the main surgical settings involved. The most frequent causes were surgical error (42.4%) and treatment error (30.9%). The main sequelae were musculoskeletal (20.0%), neurological (17.7%), and obstetric (17.7%). The average time from incident to resolution of claims was 6.3 years. A total of 20.1% of these claims were successful, particularly those involving retained surgical foreign bodies (71.4% successful claims; P < 0.001). The total compensation paid was €56,338,247 (an average of €17,207 per claim). Compensation was higher in cases with respiratory sequelae (median, 131,600; P = 0.033), death (75,916; P < 0.001), and neurological (60,000; P = 0.024). CONCLUSIONS: Compensation claims associated with surgical procedures are made on a variety of grounds. They are drawn-out proceedings, and patients are only successful in 20% of cases.

Recommendations for prevention of infection in systemic autoimmune rheumatic diseases.

OBJECTIVES: To develop recommendations for the prevention of infection in adult patients with systemic autoimmune rheumatic diseases (SARD). METHODS: Clinical research questions relevant to the objective of the document were identified by a panel of experts selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network criteria. Specific recommendations were made. RESULTS: Five questions were selected, referring to prevention of infection by Pneumocystis jirovecii with trimethoprim/sulfamethoxazole, primary and secondary prophylactic measures against hepatitis B virus, vaccination against human papillomavirus, vaccination against Streptococcus pneumoniae and vaccination against influenza virus, making a total of 18 recommendations, structured by question, based on the evidence found for the different SARD and/or expert consensus. CONCLUSIONS: There is enough evidence on the safety and efficacy of vaccinations and other prophylactic measures against the microorganisms reviewed in this document to specifically recommend them for patients with SARD.

Recommendations for prevention of infection in systemic autoimmune rheumatic diseases. / Recomendaciones SER sobre prevención de infección en enfermedades reumáticas autoinmunes sistémicas.

OBJECTIVES: To develop recommendations for the prevention of infection in adult patients with systemic autoimmune rheumatic diseases (SARD). METHODS: Clinical research questions relevant to the objective of the document were identified by a panel of experts selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network criteria. Specific recommendations were made. RESULTS: Five questions were selected, referring to prevention of infection by Pneumocystis jirovecii with trimethoprim/sulfamethoxazole, primary and secondary prophylactic measures against hepatitis B virus, vaccination against human papillomavirus, vaccination against Streptococcus pneumoniae and vaccination against influenza virus, making a total of 18 recommendations, structured by question, based on the evidence found for the different SARD and/or expert consensus. CONCLUSIONS: There is enough evidence on the safety and efficacy of vaccinations and other prophylactic measures against the microorganisms reviewed in this document to specifically recommend them for patients with SARD.

Estimation of the Overuse of Preoperative Chest X-rays According to "Choosing Wisely", "No Hacer", and "Essencial" Initiatives: Are They Equally Applicable and Comparable?

BACKGROUND: Overuse reduces the efficiency of healthcare systems and compromises patient safety. Different institutions have issued recommendations on the indication of preoperative chest X-rays, but the degree of compliance with these recommendations is unknown. This study investigates the frequency and characteristics of the inappropriateness of this practice. METHODS: This is a descriptive observational study with analytical components, performed in a tertiary hospital in the Community of Madrid (Spain) between July 2018 and June 2019. The inappropriateness of preoperative chest X-ray tests was analyzed according to "Choosing Wisely", "No Hacer" and "Essencial" initiatives and the cost associated with this practice was estimated in Relative Value and Monetary Units. RESULTS: A total of 3449 preoperative chest X-ray tests were performed during the period of study. In total, 5.4% of them were unjustified according to the "No Hacer" recommendation and 73.3% according to "Choosing Wisely" and "Essencial" criteria, which would be equivalent to 5.6% and 11.8% of the interventions in which this test was unnecessary, respectively. One or more preoperative chest X-ray(s) were indicated in more than 20% of the interventions in which another chest X-ray had already been performed in the previous 3 months. A higher inappropriateness score was also recorded for interventions with an American Society of Anesthesiologists (ASA) grade ≥ III (16.5%). The Anesthesiology service obtained a lower inappropriateness score than other Petitioning Surgical Services (57.5% according to "Choosing Wisely" and "Essencial"; 4.1% according to "No Hacer"). Inappropriate indication of chest X-rays represents an annual cost of EUR 52,122.69 (170.1 Relative Value Units) according to "No Hacer" and EUR 3895.29 (2276.1 Relative Value Units) according to "Choosing Wisely" or "Essencial" criteria. CONCLUSIONS: There was wide variability between the recommendations that directly affected the degree of inappropriateness found, with the main reasons for inappropriateness being duplication of preoperative chest X-rays and the lack of consideration of the particularities of thoracic interventions. This inappropriateness implies a significant expense according to the applicable recommendations and therefore a high opportunity cost.

[Binge drinking: the challenges of definition and its impact on health.] / Episodios de consumo intensivo de alcohol "Binge drinking": retos en su definición e impacto en salud.

Heavy episodic drinking, or binge drinking, is a drinking pattern characterized by the intake of large amounts of alcohol in a short period of time, which often leads to alcohol intoxication. There is no consensus on its operational definition, finding large methodological differences between studies in estimating the amount of alcohol consumed, as well as in defining the occasion of drinking and the reference time period. Keep in mind that most drinkers with this pattern have a low risk total average alcohol consumption. Therefore, actively detecting binge drinking is essential to be able to identify and classify all risk drinkers and characterize the global impact of alcohol consumption on health, society or the economy. Its negative effects affect the drinker himself (intoxication, cardiovascular diseases, dependence, neurocognitive and developmental disorders, among others), but also causes harm to others (accidents, violence, harmful effects on fetal and perinatal neuronal development). These effects can be acute or chronic, even among those who adopt binge drinking sporadically. Different thresholds or ways of characterizing this pattern of alcohol consumption could more adequately predict each of the associated acute and chronic effects, especially if we consider the intensity and frequency of the episodes. However, the absence of a safe threshold for alcohol consumption, both regularly and occasionally, is clear; Any intake with a binge drinking pattern, regardless of the threshold we establish, carries significant risks, not only for the health of the drinker, but also for the people around them.

El patrón de episodios de consumo intensivo de alcohol o binge drinking, se caracteriza por la ingesta de grandes cantidades de alcohol concentrada en un corto espacio de tiempo, que comporta con frecuencia una intoxicación alcohólica. No existe consenso en su definición operativa, hallando entre los estudios grandes diferencias metodológicas en la estimación de la cantidad de alcohol consumido, así como en la definición de la ocasión de bebida y el periodo temporal de referencia. Hay que tener en cuenta que una mayoría de los bebedores con este patrón tienen un consumo de alcohol promedio total de bajo riesgo. Por ello, detectar de forma activa el patrón de consumo intensivo episódico, resulta fundamental para poder identificar y clasificar a todos los bebedores de riesgo y caracterizar el impacto global del consumo de alcohol en la salud, la sociedad o la economía. Sus efectos negativos afectan al propio bebedor (intoxicación, enfermedades cardiovasculares, dependencia, alteraciones neurocognitivas y de maduración entre otros), pero también potencialmente a terceras personas (accidentes, violencia, efectos perjudiciales en el desarrollo neuronal fetal y perinatal). Estos efectos se pueden manifestar de forma aguda, pero también crónica, incluso entre los que adoptan el binge drinking de forma esporádica. Distintos umbrales o formas de caracterizar este patrón de consumo de alcohol podrían predecir de forma más adecuada cada uno de los efectos agudos y crónicos asociados, especialmente si consideramos la intensidad y la frecuencia con que se adopta. No obstante, resulta clara la ausencia de un umbral seguro de consumo de alcohol, tanto de forma regular como puntual; cualquier ingesta con un patrón binge drinking, con independencia del umbral que establezcamos, comporta riesgos importantes, no solo para la salud del bebedor, sino también para las personas de su entorno.

Mascarillas como equipo de protección individual durante la pandemia de COVID-19: cómo, cuándo y cuáles deben utilizarse / Masks as personal protective equipment in the COVID-19 pandemic: How, when and which should be used

ANTECEDENTES Y OBJETIVO: Durante la pandemia COVID-19 se ha producido un aumento de la demanda de mascarillas por parte de profesionales sanitarios y de la población general. En este contexto, se hace necesario sintetizar las características y las indicaciones de uso de los distintos tipos de mascarillas existentes. MATERIAL Y MÉTODOS: Se consultaron y recopilaron las diferentes recomendaciones difundidas por instituciones de reconocido prestigio, como la Organización Mundial de la Salud, The European Centre for Disease Prevention, The Centre for Evidence-Based Medicine o el Ministerio de Sanidad del Gobierno de España. RESULTADOS: Las instituciones consultadas aconsejan reservar las mascarillas filtering face piece (FFP) para el personal sanitario, especialmente en la realización de procedimientos generadores de aerosoles (PGA) (protección mínima de FFP2), y plantean posibles sistemas de reutilización durante épocas de escasez. Asimismo, se recomienda el uso de mascarillas quirúrgicas en profesionales que no realicen PGA y en población sintomática, existiendo variación en las indicaciones de uso para población general sana. CONCLUSIÓN: En situaciones de escasez de equipos de protección individual por pandemia de COVID-19 se debe establecer una priorización y racionalización de uso de cada tipo de mascarilla en función del usuario y de la actividad a realizar

BACKGROUND AND OBJECTIVE: In the COVID-19 pandemic, the demand of masks has been increased by health professionals and the general population. In this context, it is necessary to summarize the features and indications of the different types of masks. MATERIAL AND METHODS: To consult and to compile the different recommendations disseminated by prestigious institutions such as the World Health Organization, the European Center for Disease Prevention, the Center for Evidence-Based Medicine, or the Ministry of Health of the Government of Spain has been reviewed. RESULTS: The institutions consulted recommend reserving FFP respirators for healthcare workers, especially when carrying out aerosol-generating procedures (AGPs) (minimum FFP2 protection) and consider some reutilization systems during times of scarcity. The use of surgical masks is recommended to professionals who do not perform AGPs and to the symptomatic population but exist variations in its indications intended for the general healthy population. CONCLUSION: In the context of shortage of personal protective equipment due to the COVID-19 pandemic, a prioritization and rationalization of the use of each type of mask should be established according to the user and the activity performed

[Masks as personal protective equipment in the COVID-19 pandemic: How, when and which should be used]. / Mascarillas como equipo de protección individual durante la pandemia de COVID-19: cómo, cuándo y cuáles deben utilizarse.

BACKGROUND AND OBJECTIVE: In the COVID-19 pandemic, the demand of masks has been increased by health professionals and the general population. In this context, it is necessary to summarize the features and indications of the different types of masks. MATERIAL AND METHODS: To consult and to compile the different recommendations disseminated by prestigious institutions such as the World Health Organization, the European Center for Disease Prevention, the Center for Evidence-Based Medicine, or the Ministry of Health of the Government of Spain has been reviewed. RESULTS: The institutions consulted recommend reserving FFP respirators for healthcare workers, especially when carrying out aerosol-generating procedures (AGPs) (minimum FFP2 protection) and consider some reutilization systems during times of scarcity. The use of surgical masks is recommended to professionals who do not perform AGPs and to the symptomatic population but exist variations in its indications intended for the general healthy population. CONCLUSION: In the context of shortage of personal protective equipment due to the COVID-19 pandemic, a prioritization and rationalization of the use of each type of mask should be established according to the user and the activity performed.

Low-Value Clinical Practices: Knowledge and Beliefs of Spanish Surgeons and Anesthetists.

OBJECTIVES: To know the frequency and causes of low value surgical practices, according to the opinion of surgeons and anesthetists, and to determine their degree of knowledge about the Spanish "Choosing wisely" initiative. METHODS: Cross-sectional observational study, based on a self-administered online questionnaire through an opportunistic sample of 370 surgeons and anesthetists from three Spanish regions, contacted through Scientific Societies. The survey took part between July and December 2017. RESULTS: A patient profile requesting unnecessary practices was identified (female, 51-65 years old and unaffiliated disease). The frequency of requests was weekly or daily for 50.0% of the professionals, of whom 15.1% acknowledged succumbing to these pressures. To dissuade the patient, clinical reasons (47%) were considered the most effective. To increase control and safety in the case was the main reason to indicate them. The greatest responsibility for overuse was attributed to physicians, defensive medicine and mass media. Assessing professionals' knowledge on unnecessary practices, an average of 5 correct answers out of 7 was obtained. Some 64.1% of the respondents were unaware of the Spanish "Choosing wisely" initiative. CONCLUSIONS: Low value surgical practices are perceived as a frequent problem, which requires an approach entailing intervention with patients and the media as well as professionals. Increase awareness on unnecessary surgical practices, and how to avoid them remain essential.

How Much of Root Cause Analysis Translates into Improved Patient Safety: A Systematic Review.

OBJECTIVES: The aim of this systematic review was to consolidate studies to determine whether root cause analysis (RCA) is an adequate method to decrease recurrence of avoidable adverse events (AAEs). METHODS: A systematic search of databases from creation until December 2018 was performed using PubMed, Scopus and EMBASE. We included articles published in scientific journals describing the practical usefulness in and impact of RCA on the reduction of AAEs and whether professionals consider it feasible. The Mixed Methods Appraisal Tool was used to assess the quality of studies. RESULTS: Twenty-one articles met the inclusion criteria. Samples included in these studies ranged from 20 to 1,707 analyses of RCAs, AAEs, recommendations, audits or interviews with professionals. The most common setting was hospitals (86%; n = 18), and the type of incident most analysed was AAEs, in 71% (n = 15) of the cases; 47% (n = 10) of the studies stated that the main weakness of RCA is its recommendations. The most common causes involved in the occurrence of AEs were communication problems among professionals, human error and faults in the organisation of the health care process. Despite the widespread implementation of RCA in the past decades, only 2 studies could to some extent establish an improvement in patient safety due to RCAs. CONCLUSIONS: RCA is a useful tool for the identification of the remote and immediate causes of safety incidents, but not for implementing effective measures to prevent their recurrence.

Risk Analysis for Patient Safety in Surgical Departments: Cross-Sectional Design Usefulness.

(1) Background: Identifying and measuring adverse events (AE) is a priority for patient safety, which allows us to define and prioritise areas for improvement and evaluate and develop solutions to improve health care quality. The aim of this work was to determine the prevalence of AEs in surgical and medical-surgical departments and to know the health impact of these AEs. (2) Methods: A cross-sectional study determining the prevalence of AEs in surgical and medical-surgical departments was conducted and a comparison was made among both clinical areas. A total of 5228 patients were admitted in 58 hospitals in Argentina, Colombia, Costa Rica, Mexico, and Peru, within the Latin American Study of Adverse Events (IBEAS), led by the Spanish Ministry of Health, the Pan American Health Organization, and the WHO Patient Safety programme. (3) Results: The global prevalence of AEs was 10.7%. However, the prevalence of AEs in surgical departments was 11.9%, while in medical-surgical departments it was 8.9%. The causes of these AEs were associated with surgical procedures (38.6%) and nosocomial infections (35.4%). About 60.6% of the AEs extended hospital stays by 30.7 days on average and 25.8% led to readmission with an average hospitalisation of 15 days. About 22.4% resulted in death, disability, or surgical reintervention. (4) Conclusions: Surgical departments were associated with a higher risk of experiencing AEs.

Episodios de consumo intensivo de alcohol "binge drinking": retos en su definición e impacto en salud / Binge drinking: the challenges of definition and its impact on health

El patrón de episodios de consumo intensivo de alcohol o binge drinking, se caracteriza por la ingesta de grandes cantidades de alcohol concentrada en un corto espacio de tiempo, que comporta con frecuencia una intoxicación alcohólica. No existe consenso en su definición operativa, hallando entre los estudios grandes diferencias metodológicas en la estimación de la cantidad de alcohol consumido, así como en la definición de la ocasión de bebida y el periodo temporal de referencia. Hay que tener en cuenta que una mayoría de los bebedores con este patrón tienen un consumo de alcohol promedio total de bajo riesgo. Por ello, detectar de forma activa el patrón de consumo intensivo episódico, resulta fundamental para poder identificar y clasificar a todos los bebedores de riesgo y caracterizar el impacto global del consumo de alcohol en la salud, la sociedad o la economía. Sus efectos negativos afectan al propio bebedor (intoxicación, enfermedades cardiovasculares, dependencia, alteraciones neurocognitivas y de maduración entre otros), pero también potencialmente a terceras personas (accidentes, violencia, efectos perjudiciales en el desarrollo neuronal fetal y perinatal). Estos efectos se pueden manifestar de forma aguda, pero también crónica, incluso entre los que adoptan el binge drinking de forma esporádica. Distintos umbrales o formas de caracterizar este patrón de consumo de alcohol podrían predecir de forma más adecuada cada uno de los efectos agudos y crónicos asociados, especialmente si consideramos la intensidad y la frecuencia con que se adopta. No obstante, resulta clara la ausencia de un umbral seguro de consumo de alcohol, tanto de forma regular como puntual; cualquier ingesta con un patrón binge drinking, con independencia del umbral que establezcamos, comporta riesgos importantes, no solo para la salud del bebedor, sino también para las personas de su entorno

Heavy episodic drinking, or binge drinking, is a drinking pattern characterized by the intake of large amounts of alcohol in a short period of time, which often leads to alcohol intoxication. There is no consensus on its operational definition, finding large methodological differences between studies in estimating the amount of alcohol consumed, as well as in defining the occasion of drinking and the reference time period. Keep in mind that most drinkers with this pattern have a low risk total average alcohol consumption. Therefore, actively detecting binge drinking is essential to be able to identify and classify all risk drinkers and characterize the global impact of alcohol consumption on health, society or the economy. Its negative effects affect the drinker himself (intoxication, cardiovascular diseases, dependence, neurocognitive and developmental disorders, among others), but also causes harm to others (accidents, violence, harmful effects on fetal and perinatal neuronal development). These effects can be acute or chronic, even among those who adopt binge drinking sporadically. Different thresholds or ways of characterizing this pattern of alcohol consumption could more adequately predict each of the associated acute and chronic effects, especially if we consider the intensity and frequency of the episodes. However, the absence of a safe threshold for alcohol consumption, both regularly and occasionally, is clear; Any intake with a binge drinking pattern, regardless of the threshold we establish, carries significant risks, not only for the health of the drinker, but also for the people around them

Root Cause? Yes of course … but then what?

[EXCERPT]. Analyzing the causes of unsafe care can reduce the number of ‘near misses’ (incidents that may cause harm to patients) and adverse events (that actually produce harm). This is an important mandate for health care organizations committed to providing a safe environment for patients. Although guaranteeing absolute safety in all interventions is not always possible, hospitals and other health care institutions implement safety practices and surveillance methods to understand how these unsafe incidents occur. In many cases, these incidents were not generated by a single cause; and remote causes are as significant as more proximate ones...

Low-value clinical practices and harm caused by non-adherence to 'do not do' recommendations in primary care in Spain: a Delphi study.

OBJECTIVE: To determine the non-adherence to the primary care 'do not do' recommendations (DNDs) and their likelihood to cause harm. DESIGN: Delphi study. SETTING: Spanish National Health System. PARTICIPANTS: A total of 128 professionals were recruited (50 general practitioners [GPs], 28 pediatricians [PEDs], 31 nurses who care for adult patients [RNs] and 19 pediatric nurses [PNs]). INTERVENTIONS: A selection of 27 DNDs directed at GPs, 8 at PEDs, 9 at RNs and 4 at PNs were included in the Delphi technique. A 10-point scale was used to assess whether a given practice was still present and the likelihood of it causing of an adverse event. MAIN OUTCOME MEASURE: Impact calculated by multiplying an event's frequency and likelihood to cause harm. RESULTS: A total of 100 professionals responded to wave 1 (78% response rate) and 97 of them to wave 2 (97% response rate). In all, 22% (6/27) of the practices for GPs, 12% (1/8) for PEDs, 33% (3/9) for RNs and none for PNs were cataloged as frequent. A total of 37% (10/27) of these practices for GPs, 25% (2/8) for PEDs, 33% (3/9) for RNs and 25% (1/4) for PNs were considered as potential causes of harm. Only 26% (7/27) of the DNDs for GPs showed scores equal to or higher than 36 points. The impact measure was higher for ordering benzodiazepines to treat insomnia, agitation or delirium in elderly patients (mean = 57.8, SD = 25.3). CONCLUSIONS: Low-value and potentially dangerous practices were identified; avoiding these could improve care quality.

[Patient Safety Culture and teaching: an ins- trument to evaluate knowledge and perceptions among different health professionals of the Madrid Region health system]. / Cultura de Seguridad del Paciente y Docencia: un instrumento para evaluar conocimientos y percepciones en profesionales del sistema sanitario de la Comunidad de Madrid

OBJECTIVE: The patient safety culture (PSC) in health institutions depends on various organizational and human factors. Our aim was to evaluate, as a teaching strategy, the knowledge in patient safety and perceptions about the PSC. METHODS: A convenience sample, with 122 health professionals from Regional Minister of Health's patient safety courses attendees in 2015. Be- fore each course, were delivered a knowledge questionnaire about patient safety (own elaboration) and a validated PSC questionnaire (estimating 3 dimensions: managerial support, perception of safety and expectations / actions). Valuations on CSP were recategorized in positive, negative and neutral, identifying strengths (greater than or equal to 75% of positive evaluations) and opportunities for improvement (greater than or equal to 50% of negative evaluations). At the end of each course an anonymous satisfaction questionnaire was delivered. RESULTS: 60% responded correctly to questions about knowledge in patient safety, identifying areas for improvement in safe practices (hand hygiene and microorganisms resistant to antibiotics, with 66% and 61% of incorrect answers, respectively), and in management of health risks (investigation and identification of adverse events, with 62% and 56% of incorrect answers, respectively). 80% considered the institutional PSC positive, and the perception of safety as an opportunity for improvement (63.9% of negative evaluations). Thus, 88% admitted worrying about patient safety only after adverse incidents, and 65% felt afraid to talk about them. The satisfaction with the teaching methodology was 9.3 points out of 10. CONCLUSIONS: The overall assessment of PSC was mostly positive, identifying specific areas for improvement that allowed orienting the training in patient safety, motivating the participants and suggesting intervention strategies to improve patient safety in our organizations.

OBJETIVO: La cultura de seguridad del paciente (CSP) en las instituciones sanitarias depende de diversos factores organizativos y humanos. Nuestro objetivo fue evaluar, como estrategia docente, los conocimientos y percepciones sobre la CSP. METODOS: Muestra de conveniencia, con 122 profesionales sanitarios y no sanitarios, que asistieron en 2015 a cursos sobre seguridad del paciente organizados por la Consejería de Sanidad de Madrid. Antes de cada curso, autocompletaron un cuestionario de conocimientos sobre seguridad del paciente (elaboración propia) y otro cuestionario validado sobre CSP (estimando 3 dimensiones: apoyo directivo, percepción de seguridad y expectativas/ acciones). Las valoraciones sobre la CSP se recategorizaron en positivas, negativas y neutras, identificando fortalezas (mayor o igual al 75% de valoraciones positivas) y oportunidades de mejora (mayor o igual al 50% de valoraciones negativas). Al finalizar cada curso, cumplimentaron un cuestionario anónimo de satisfacción. RESULTADOS: El 60% respondió correctamente a las preguntas sobre conocimientos en seguridad del paciente, identificando áreas de mejora en prácticas seguras (higiene de manos y microorganismos resistentes a antibióticos, con 66% y 61% de respuestas incorrectas, respectivamente), y en gestión de riesgos sanitarios (investigación e identificación de eventos adversos, con el 62% y 56% de respuestas incorrectas, respectivamente). El 80% consideró positiva la CSP institucional, y la percepción de seguridad como oportunidad de mejora (63,9% de valoraciones negativas). Así, el 88% reconocía preocuparse por la seguridad del paciente sólo tras incidentes adversos, y el 65% sentía miedo a hablar sobre estos. La satisfacción con la metodología docente fue de 9,3 puntos sobre 10. CONCLUSIONES: La valoración global de la CSP fue mayoritariamente positiva, identificándose áreas de mejora específicas utilizadas como estrategia docente para ilustrar conceptos, motivar a los participantes y sugerir estrategias de intervención para mejorar la cultura de seguridad del paciente en nuestras organizaciones.

Cultura de Seguridad del Paciente y Docencia: un instrumento para evaluar conocimientos y percepciones en profesionales del sistema sanitario de la Comunidad de Madrid / Patient Safety Culture and teaching: an instrument to evaluate knowledge and perceptions among different health professionals of the Madrid Region health system

Fundamentos: La cultura de seguridad del paciente (CSP) en las instituciones sanitarias depende de diversos factores organizativos y humanos. Nuestro objetivo fue evaluar, como estrategia docente, los conocimientos y percepciones sobre la CSP. Métodos: Muestra de conveniencia, con 122 profesionales sanitarios y no sanitarios, que asistieron en 2015 a cursos sobre seguridad del paciente organizados por la Consejería de Sanidad de Madrid. Antes de cada curso, autocompletaron un cuestionario de conocimientos sobre seguridad del paciente (elaboración propia) y otro cuestionario validado sobre CSP (estimando 3 dimensiones: apoyo directivo, percepción de seguridad y expectativas/acciones). Las valoraciones sobre la CSP se recategorizaron en positivas, negativas y neutras, identificando fortalezas (≥75% de valoraciones positivas) y oportunidades de mejora (≥50% de valoraciones negativas). Al finalizar cada curso, cumplimentaron un cuestionario anónimo de satisfacción. Resultados: El 60% respondió correctamente a las preguntas sobre conocimientos en seguridad del paciente, identificando áreas de mejora en prácticas seguras (higiene de manos y microorganismos resistentes a antibióticos, con 66% y 61% de respuestas incorrectas, respectivamente), y en gestión de riesgos sanitarios (investigación e identificación de eventos adversos, con el 62% y 56% de respuestas incorrectas, respectivamente). El 80% consideró positiva la CSP institucional, y la percepción de seguridad como oportunidad de mejora (63,9% de valoraciones negativas). Así, el 88% reconocía preocuparse por la seguridad del paciente sólo tras incidentes adversos, y el 65% sentía miedo a hablar sobre estos. La satisfacción con la metodología docente fue de 9,3 puntos sobre 10. Conclusiones: La valoración global de la CSP fue mayoritariamente positiva, identificándose áreas de mejora específicas utilizadas como estrategia docente para ilustrar conceptos, motivar a los participantes y sugerir estrategias de intervención para mejorar la cultura de seguridad del paciente en nuestras organizaciones

Background: The patient safety culture (PSC) in health institutions depends on various organizational and human factors. Our aim was to evaluate, as a teaching strategy, the knowledge in patient safety and perceptions about the PSC. Methods: A convenience sample, with 122 health professionals from Regional Minister of Health's patient safety courses attendees in 2015. Before each course, were delivered a knowledge questionnaire about patient safety (own elaboration) and a validated PSC questionnaire (estimating 3 dimensions: managerial support, perception of safety and expectations / actions). Valuations on CSP were recategorized in positive, negative and neutral, identifying strengths (≥75% of positive evaluations) and opportunities for improvement (≥50% of negative evaluations). At the end of each course an anonymous satisfaction questionnaire was delivered. Results: 60% responded correctly to questions about knowledge in patient safety, identifying areas for improvement in safe practices (hand hygiene and microorganisms resistant to antibiotics, with 66% and 61% of incorrect answers, respectively), and in management of health risks (investigation and identification of adverse events, with 62% and 56% of incorrect answers, respectively). 80% considered the institutional PSC positive, and the perception of safety as an opportunity for improvement (63.9% of negative evaluations). Thus, 88% admitted worrying about patient safety only after adverse incidents, and 65% felt afraid to talk about them. The satisfaction with the teaching methodology was 9.3 points out of 10. Conclusions: The overall assessment of PSC was mostly positive, identifying specific areas for improvement that allowed orienting the training in patient safety, motivating the participants and suggesting intervention strategies to improve patient safety in our organizations