Cross-cultural adaptation and psychometric validation of a Spanish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire.

OBJECTIVES: Successful deprescribing depends largely on factors related to the patient. The revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire was developed with the objective of evaluating the beliefs and attitudes of older adults and caregivers towards deprescribing. The present study was designed to validate a Spanish version of the rPATD questionnaire, both the versions for older adults and for caregivers, through a qualitative validation phase and the analysis of its psychometric properties. DESIGN: Cross-sectional validation study. SETTING: Primary care settings in Málaga (Spain). PARTICIPANTS: A sample of 120 subjects (60 patients with polypharmacy and 60 caregivers of patients with polypharmacy) were enrolled in the study. MAIN OUTCOME MEASURES: In the qualitative validation stage, the rPATD questionnaire was translated/back-translated and subjected to a cross-cultural adaptation to evaluate its face validity and feasibility. Next, its psychometric properties were assessed. Confirmatory factor analysis was used to evaluate construct validity. Internal consistency was determined using Cronbach's alpha test. Criterion validity through pre-established hypotheses from the Beliefs about Medicines Questionnaire (BMQ) Specific-Concerns Scale, and test-retest reliability were analysed. RESULTS: Confirmatory factor analysis verified the four-factor structure of the original rPATD questionnaire, with items loading into four factors: involvement, burden, appropriateness and concerns about stopping. The Cronbach's alpha coefficient of the factors ranged from 0.683 to 0.879. The burden, appropriateness and concerns about stopping factors were significantly correlated with the BMQ Specific-Concerns Score, except for the concerns about stopping factor in the older adults' version. The consistency of the items between administration times (test-retest reliability) showed weighted Cohen's kappa values ranging from moderate (>0.4) to very good (>0.8). CONCLUSIONS: The Spanish version of the rPATD questionnaire is a feasible, valid and reliable instrument to evaluate attitudes towards deprescribing in Spanish-speaking patients and caregivers.

De la flora intestinal al microbioma / From the intestinal flora to the microbiome

En el presente artículo, se repasa la historia de la microbiota; se definen los conceptos relacionados de microbiota, microbioma, metagenoma, patobionte, disbiosis, holobionte, filotipo y enterotipo; se presentan algunos de los conocimientos más precisos y actualizados sobre la misma y se repasan sus funciones: metabólicas, nutricionales e inmunomoduladoras. Se comentan, de forma sucinta, aquellas patologías digestivas en cuya patogenia se ha implicado a la microbiota intestinal, incluyendo la enfermedad inflamatoria intestinal, el síndrome del intestino irritable y la enfermedad celiaca, entre otras. Finalmente, se refieren algunos datos destacados y prometedores del trasplante de microbiota fecal en determinados procesos digestivos (AU)

In this article, the history of the microbiota is reviewed and the related concepts of the microbiota, microbiome, metagenome, pathobiont, dysbiosis, holobiont, phylotype and enterotype are defined. The most precise and current knowledge about the microbiota is presented and the metabolic, nutritional and immunomodulatory functions are reviewed. Some gastrointestinal diseases whose pathogenesis is associated with the intestinal microbiota, including inflammatory bowel disease, irritable bowel syndrome and celiac disease, among others, are briefly discussed. Finally, some prominent and promising data with regard to the fecal microbiota transplantation in certain digestive illness are discussed (AU)

From the intestinal flora to the microbiome.

In this article, the history of the microbiota is reviewed and the related concepts of the microbiota, microbiome, metagenome, pathobiont, dysbiosis, holobiont, phylotype and enterotype are defined. The most precise and current knowledge about the microbiota is presented and the metabolic, nutritional and immunomodulatory functions are reviewed. Some gastrointestinal diseases whose pathogenesis is associated with the intestinal microbiota, including inflammatory bowel disease, irritable bowel syndrome and celiac disease, among others, are briefly discussed. Finally, some prominent and promising data with regard to the fecal microbiota transplantation in certain digestive illness are discussed.

Gestión de la endoscopia digestiva de puertas abiertas y calidad asistencial: equipo de mejora con atención primaria / Management of open access gastrointestinal endoscopy and quality of care: collaboration between an improvement team and primary care

Objetivo Creación y puesta en marcha de un equipo de mejora, dentro de un proyecto de mejora de calidad en salud del Gobierno de Aragón, destinado a incrementar la calidad y el grado de idoneidad de las indicaciones de endoscopia digestiva en el sistema de puertas abiertas en un hospital secundario aragonés. Diseño El equipo desarrolló un documento de consenso donde se recogían las indicaciones y cómo hacer un uso adecuado de la endoscopia oral y la colonoscopia, y realizó una serie de reuniones informativas y formativas con todos los médicos de atención primaria implicados sobre el tema. Emplazamiento Centros de salud del Sector I y Hospital Royo Villanova, de Zaragoza. Participantes El equipo de mejora estaba integrado por un digestólogo y 3 médicos de atención primaria, y contó con el apoyo y respaldo de la Gerencia y la Dirección de atención primaria de su sector sanitario. Resultados Se ha conseguido reducir la inadecuación de endoscopia digestiva, particularmente de colonoscopia, del 20 al 11,6%, un importante ahorro en costes sanitarios, reducir significativamente la lista de espera de endoscopia, mejorar la calidad asistencial y seguridad de los pacientes sometidos a dichas exploraciones, mejorar la formación de los médicos de atención primaria en estos temas e implementar la coordinación asistencial atención primaria-especializada. Conclusiones Para que un sistema de endoscopia digestiva de puertas abiertas a atención primaria funcione de forma eficiente es necesaria la creación de un equipo de mejora interdisciplinario y la total implicación de la atención primaria que maneja ese recurso (AU)

Objective To create an improvement team within a healthcare quality improvement project of the Government of Aragon (Spain), aimed at increasing the quality of care and suitability of the indications of gastrointestinal endoscopy in the open access endoscopy system of a secondary hospital in Aragon. Design The team developed a consensus document indicating how to use oral endoscopy and colonoscopy correctly, and held information and training sessions with all the primary care physicians involved in this area. Location Sector I health centers and Royo Villanova Hospital, in Zaragoza. Participants The team consisted of a gastroenterologist and three primary care physicians and, from the outset received the support of the primary care administration and management in the health area. Results Inappropriate use of endoscopy, particularly colonoscopy, was reduced from 20% to 11.6%. Significant savings were achieved in health costs. The endoscopy waiting list was reduced. The quality of care and the safety of patients undergoing these examinations improved. Training of primary care physicians in these procedures was enhanced, and coordination between primary and specialized was implemented. Conclusions To ensure efficient running of an open access gastrointestinal endoscopy system, an interdisciplinary improvement team and the full involvement of the primary care staff managing this resource are required (AU)

[Management of open access gastrointestinal endoscopy and quality of care: collaboration between an improvement team and primary care]. / Gestión de la endoscopia digestiva de puertas abiertas y calidad asistencial: equipo de mejora con atención primaria.

OBJECTIVE: To create an improvement team within a healthcare quality improvement project of the Government of Aragon (Spain), aimed at increasing the quality of care and suitability of the indications of gastrointestinal endoscopy in the open access endoscopy system of a secondary hospital in Aragon. DESIGN: The team developed a consensus document indicating how to use oral endoscopy and colonoscopy correctly, and held information and training sessions with all the primary care physicians involved in this area. LOCATION: Sector I health centers and Royo Villanova Hospital, in Zaragoza. PARTICIPANTS: The team consisted of a gastroenterologist and three primary care physicians and, from the outset received the support of the primary care administration and management in the health area. RESULTS: Inappropriate use of endoscopy, particularly colonoscopy, was reduced from 20% to 11.6%. Significant savings were achieved in health costs. The endoscopy waiting list was reduced. The quality of care and the safety of patients undergoing these examinations improved. Training of primary care physicians in these procedures was enhanced, and coordination between primary and specialized was implemented. CONCLUSIONS: To ensure efficient running of an open access gastrointestinal endoscopy system, an interdisciplinary improvement team and the full involvement of the primary care staff managing this resource are required.