The Evaluation of Family Support Programmes in Spain. An Analysis of their Quality Standards / La evaluación de los programas de apoyo familiar en España. Un análisis de sus estándares de calidad

Since the well-known publication of the Society for Prevention Research about standards for evidence related to research on prevention interventions, a rigorous evaluation is considered one of the main requirements for evidence-based programmes. Despite their importance, many programmes do not include evaluation designs that meet the most widely agreed quality standards. The aim of this study was to examine the evaluation processes of fifty-seven Spanish programmes identified in the context of the COST European Family Support Network. The obtained results provide a fairly positive picture of the quality of programme evaluation standards, although more designs that include a control group, follow-up evaluations assessing long-term effects, and the evaluation of child and indirect outcomes are needed. The results are discussed from a comprehensive and plural perspective of evaluation which, in addition to methodological rigor, considers the usefulness, feasibility, and ethical rigor of evaluation research.(AU)

A partir de las propuestas de la Society for Prevention Research sobre los estándares de evidencia necesarios para las intervenciones preventivas, contar con una evaluación rigurosa se considera como uno de los principales requisitos de los programas basados en la evidencia. A pesar de su importancia, muchos programas de apoyo familiar no cuentan con diseños de evaluación que cumplan con los estándares de calidad más consensuados. El objetivo de este artículo fue analizar los procesos de evaluación de cincuenta y siete programas españoles identificados en el marco del proyecto COST European Family Support Network. Los resultados obtenidos muestran una imagen bastante positiva de los estándares de calidad que caracterizan la evaluación de los programas, aunque es necesario ampliar el número de diseños que incluyan grupos de comparación, que contemplen medidas de los efectos en el bienestar infantil y que lleven a cabo evaluaciones de seguimiento para medir los efectos a largo plazo de las intervenciones. Se analizan los resultados desde un enfoque plural de la evaluación, que además del rigor metodológico considera la necesidad de tener en cuenta la utilidad, la viabilidad y el rigor ético de las investigaciones de evaluación.(AU)

Análisis de la implementación del “Programa de tratamiento a familias con menores en situación de riesgo o desprotección en Andalucía”. Valoración de las y los profesionales / Analysis of the implementation of the Programme for Families involved in the Andalusian Child Welfare System. Assessment of the professionals

Se presentan los resultados de la valoración de las/os profesionales del Programa de tratamiento a familias con menores en situación de riesgo o desprotección en Andalucía a partir de la información de las/os 479 profesionales que componen los 147 Equipos de Tratamiento Familiar. Se analizó la fidelidad al programa, algunas dimensiones actitudinales relacionadas con esta (motivación, percepción de utilidad y eficacia, satisfacción con el equipo de trabajo) y la relación de dichas variables con los años de experiencia y el perfil profesional. Además, se examinaron las propuestas de cambio dirigidas a mejorar el programa. Se combinó el análisis cualitativo y cuantitativo de la información a partir de un cuestionario con preguntas abiertas y cerradas. Los resultados evidenciaron una valoración positiva del programa por parte de las/os profesionales, tanto en términos generales como atendiendo a distintas dimensiones específicas. Además, la voz de las/os profesionales puso de manifiesto aspectos, tanto internos como externos al programa, susceptibles de mejora. Entre los aspectos internos destacó la modificación del manual del programa, la temporalización, la revisión de los perfiles profesionales y la formación continua. A nivel externo, señalaron la necesidad de mejorar los canales de coordinación y comunicación, y los procesos de supervisión (AU)

This study covers the implementation analysis of the Programme for Families involved in the Andalusian Child Welfare System from the perspective of a sample of 479 front-line practitioners from 147 family treatment services. Firstly, the fidelity to the programme, some related attitudinal variables (motivation, perception of utility and effectiveness, satisfaction with the teamwork), as well as the relationship of these variables with both practitioners’ experience and professional profile were analysed. Secondly, proposals for change suggested by the practitioners in order to improve the functioning of the programme were described. A combination of qualitative and quantitative analyses of the information from a questionnaire that included both open- and closed-ended questions was followed. The results showed that practitioners positively rated the programme, both in general terms and in specific implementation variables. They also highlighted several aspects that could be improved, including both program-related aspects included (as the modification of the program manual, the timing, the professional profiles and an ongoing training) and other aspects external to the program (as the need to improve and facilitate coordination and communication channels, and supervision processes). (AU)

Indicadores asistenciales y estándares de calidad asistencial para la psicología clínica en los centros de salud mental del Sistema Madrileño de Salud evaluados por sus profesionales / Care indicators and standards of quality of care for clinical psychology in the mental health centers of the Madrid Health System evaluated by their professionals

La disponibilidad en España de indicadores y estándares de calidad asistencial para Psicología Clínica en el Sistema Nacional de Salud es limitada. En este trabajo analizamos indicadores y estándares asistenciales ambulatorios informados por 107 Facultativos de Psicología Clínica en Centros de Salud Mental del Servicio Madrileño de Salud, a través de una encuesta online completada en 2021. El tiempo medio para la primera consulta normal en adultos fue de 4 meses y 5 en infanto-juvenil. El tiempo medio entre sesiones en ambos fueron 7 semanas. El número medio de pacientes nuevos semanales es de 8 y 6 en adultos e infanto-juvenil y de pacientes diarios fue de 9 y 8 respectivamente. La carga media total es 328 pacientes en adultos y 280 en infanto-juvenil. Sin embargo, los encuestados creen que la carga de pacientes activos debería ser 74, sin superar los 150 y un máximo de 6 al día. La mayoría de los psicólogos/as clínicos/as propone aumentar el número de plazas PIR y apoya la creación de Servicios de Psicología Clínica. La carga asistencial supera las recomendaciones de otros expertos. Se concluye que es imprescindible aumentar la ratio de psicólogos/as clínicos/as para alcanzar los estándares recomendados (AU)

Sleeve gastrectomy as a surgical technique in bariatric surgery: Results of safety and effectiveness.

INTRODUCTION: The aim of this study is to evaluate the safety and effectiveness results of sleeve gastrectomy as a bariatric technique. METHODS: Observational follow-up study of a cohort of patients who underwent sleeve gastrectomy in our center between 2008 and 2017. A total of 223 patients were included: 166 as a primary technique (group 1) and 57 as a hypothetical first stage (group 2). RESULTS: In group 1, the postoperative morbidity is 12.6%, with a fistula rate of 4.2%; 5.4% required reoperation and mortality was 0.6%. In group 2, postoperative morbidity is 14%, with a fistula rate of 5.3%; 10.5% required reoperation and mortality was 5.3%. In group 1, 79.6% and 62.5% of patients at 2 and 5 years respectively managed to achieve a % EBMIL > 50%. In group 2, the second stage was completed only in 8 patients (14.0%). Of the patients who did not complete the second stage, 32.2% and 5.9% achieved a % EEBMIL > 100% at 2 and 5 years. Analyzing those who completed the second stage, the mean EEBMIL% was 90.5% and 93.4% at 2 and 5 years. CONCLUSIONS: Sleeve gastrectomy is a safe technique in patients with BMI < 45 and effective in terms of weight loss in the short-medium term. In patients with BMI > 55, a preoperative optimization aimed at reducing morbidity and mortality is necessary, as well as adequately planning the second stage, without which it is clearly insufficient.

Implementación de un centro de referencia regional en cirugía pancreática. Experiencia tras 631 procedimientos / Implementation of a regional reference center in pancreatic surgery. Experience after 631 procedures

Introducción: El objetivo principal de este estudio es determinar si la Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante Hepático del Hospital Universitario de Badajoz cumple los estándares de calidad exigidos por la comunidad científica a los centros de referencia de cirugía pancreática (CP) en términos de resultados perioperatorios. Los objetivos secundarios consisten en comparar las diferentes técnicas de CP realizadas en función de la morbimortalidad postoperatoria precoz y analizar el impacto de las resecciones extendidas en dichos términos. Método: Estudio descriptivo, retrospectivo y unicéntrico, correspondiente al periodo 2006-2019. Se compararon los resultados obtenidos con los estándares de calidad propuestos por Bassi et al. y Sabater et al., exigidos a los centros de referencia en cirugía pancreática. La muestra se dividió según técnica quirúrgica y se compararon en términos de morbimortalidad postoperatoria precoz, estudiando el impacto de las resecciones vasculares y viscerales extendidas. Se incluyeron todos los pacientes sometidos a cirugía pancreática en nuestra unidad por patología pancreática, maligna y benigna, desde que ésta se implementó como centro de referencia. Se excluyeron las realizadas de urgencia. Resultados: Se analizaron 631 pacientes. Los valores obtenidos en los estándares de calidad se encuentran en rango. La cirugía más frecuente fue duodenopancreatectomía cefálica, la cual asoció mayor tasa de morbimortalidad perioperatoria (p ≤ 0,05). Las resecciones vasculares añadidas impactaron en el grupo de duodenopancreatectomía cefálica asociando mayor estancia media (p = 0,01) y mayor tasa de reintervención (p = 0,02). Conclusiones: La experiencia acumulada permite cumplir con los estándares de calidad exigidos, así como realizar resecciones extendidas a la pancreatectomía con buenos resultados en términos de morbimortalidad postoperatoria. (AU)

Introduction: The main objective of this study is to determine if our unit meets the quality standards required by the scientific community from the reference centers for pancreatic surgery in terms of peri-operative results. The secondary objectives are to compare the different pancreatic surgery techniques performed in terms of early post-operative morbidity and mortality and to analyze the impact of the resections added in these terms. Method: Descriptive, retrospective and single-center study, corresponding to the period 2006-2019. The results obtained were compared with the proposed quality standards, by Bassi et al. and Sabater et al., required from the reference centers in pancreatic surgery. The sample was divided according to surgical technique and compared in terms of early post-operative morbidity and mortality, studying the impact of extended vascular and visceral resections. All patients undergoing pancreatic surgery in our unit due to pancreatic, malignant and benign pathology were included, since it was implemented as a reference center. Emergency procedures were excluded. Results: 631 patients were analyzed. The values ??obtained in the quality standards are in range. The most frequent surgery was cephalic duodenopancreatectomy, which associated higher peri-operative morbidity and mortality rates (p ≤ 0.05). The extended vascular resections impacted the cephalic duodenopancreatectomy group, associating a longer mean stay (p = 0.01) and a higher rate of re-interventions (p = 0.02). Conclusions: The experience accumulated allows to meet the required quality standards, as well as perform extended resections to pancreatectomy with good results in terms of post-operative morbi-mortality.

Implementation of a regional reference center in pancreatic surgery. Experience after 631 procedures.

INTRODUCTION: The main objective of this study is to determine whether our unit meets the quality standards required by the scientific community from the reference centers for pancreatic surgery in terms of peri-operative results. The secondary objectives are to compare the different pancreatic surgery techniques performed in terms of early post-operative morbidity and mortality and to analyze the impact of the resections added in these terms. METHOD: Descriptive, retrospective and single-center study, corresponding to the period 2006-2019. The results obtained were compared with the proposed quality standards, by Bassi et al. and Sabater et al., required from the reference centers in pancreatic surgery. The sample was divided according to surgical technique and compared in terms of early post-operative morbidity and mortality, studying the impact of extended vascular and visceral resections. All patients undergoing pancreatic surgery in our unit due to pancreatic, malignant and benign pathology were included, since it was implemented as a reference center. Emergency procedures were excluded. RESULTS: 631 patients were analyzed. The values ​​obtained in the quality standards are in range. The most frequent surgery was pancreaticoduodenectomy, which associated higher peri-operative morbidity and mortality rates (P ≤ .05). The extended vascular resections impacted the pancreaticoduodenectomy group, associating a longer mean stay (P = .01) and a higher rate of re-interventions (P = .02). CONCLUSIONS: The experience accumulated allows to meet the required quality standards, as well as perform extended resections to pancreatectomy with good results in terms of post-operative morbidity and mortality.

Estándares de calidad en un seguimiento a pacientes ancianos con insuficiencia cardiaca e importante comorbilidad

Resumen: Introducción: Los pacientes con insuficiencia cardiaca (IC) seguidos por los servicios de medicina interna son más ancianos y presentan más comorbilidades asociadas. Por ello presentan un riesgo elevado de ingreso hospitalario y de mortalidad. En este estudio se evaluaron los objetivos alcanzados en términos de ingresos, visitas a urgencias y mortalidad, así como la actividad realizada para conseguirlos, en una unidad dirigida a este perfil de pacientes y caracterizada por una atención integral y continuada (programa UMIPIC). Métodos: Se analizaron retrospectivamente los datos de los 329 pacientes con IC atendidos en la unidad de IC, modelo UMIPIC, del servicio de Medicina Interna del Hospital de Lugo. Se recogieron desde enero del 2020, hasta diciembre 2020 los ingresos por IC y totales, las visitas a urgencias por IC y totales, la mortalidad, las consultas realizadas, y los rescates realizados en régimen de hospital de día (HDD). Resultados: Se recogieron 108 ingresos, 40 por IC y 68 por otras causas, 99 visitas a urgencias, 25 por IC y 74 por otras causas. Se produjeron 57 fallecimientos, 37 fueron en el hospital (15 por IC, 12 por otras causas) y 20 fueron extra-hospitalarios. Se realizaron 1179 consultas médico-enfermería, 1554 consultas de enfermería exclusiva y se realizaron 406 tratamientos en HDD. Conclusiones: Los estándares de actividad y resultados conseguidos pueden ser orientativos de la actividad a desarrollar en una unidad de IC modelo UMIPIC.

Abstract: Introduction: Patients with heart failure (HF) followed by internal medicine services are older and have more associated comorbidities. For this reason, they present a high risk of hospital admission and mortality. In this study, the objectives achieved in terms of admissions, emergency room visits and mortality, as well as the activity carried out to achieve them, were evaluated in a unit aimed at this patient profile and characterized by comprehensive and continuous care (UMIPIC program). Methods: The data of the 329 patients with HF treated in the HF unit, model UMIPIC, of the Internal Medicine service of the Hospital de Lugo, were retrospectively analyzed. From January 2020, to December 2020, total and HF admissions, total and HF emergency visits, mortality, consultations made, and rescues performed in a day hospital (HDD) were collected. Results: 108 admissions were collected, 40 for HF and 68 for other causes, 99 visits to the emergency room, 25 for HF and 74 for other causes. There were 57 deaths, 37 were in the hospital (15 due to HF, 12 due to other causes) and 20 were extra-hospital. 1179 medical-nursing consultations were carried out, 1554 exclusive nursing consultations and 406 treatments were carried out in HDD. Conclusions: The activity standards and results achieved can be indicative of the activity to be carried out in an IC model UMIPIC unit.

Resumo: Introdução: Pacientes com insuficiência cardíaca (IC) acompanhados por serviços de medicina interna são mais velhos e apresentam mais comorbidades associadas. Portanto, apresentam alto risco de admissão hospitalar e mortalidade. Neste estudo, os objetivos alcançados em termos de internações, atendimentos de emergência e mortalidade, bem como a atividade desenvolvida para os atingir, foram avaliados numa unidade dirigida a este perfil de doente e caracterizada por um atendimento integral e contínuo (programa UMIPIC). Métodos: Foram analisados ​​retrospectivamente os dados dos 329 pacientes com IC atendidos na unidade de IC, modelo UMIPIC, do serviço de Clínica Médica do Hospital de Lugo. No período de janeiro de 2020 a dezembro de 2020, foram coletadas internações totais e por IC, atendimentos totais e de emergência por IC, mortalidade, consultas realizadas e resgates realizados em regime de hospital-dia (HDD). Resultados: foram coletadas 108 internações, sendo 40 por IC e 68 por outras causas, 99 visitas ao pronto-socorro, 25 por IC e 74 por outras causas. Ocorreram 57 óbitos, 37 foram hospitalares (15 por IC, 12 por outras causas) e 20 extra-hospitalares. Foram realizadas 1179 consultas médico-enfermagem, 1554 consultas exclusivas de enfermagem e 406 atendimentos em HDD. Conclusões: Os padrões de atividade e os resultados alcançados podem ser indicativos da atividade a ser desenvolvida numa unidade IC modelo UMIPIC.

Implementation of a regional reference center in pancreatic surgery. Experience after 631 procedures. / Implementación de un centro de referencia regional en cirugía pancreática. Experiencia tras 631 procedimientos.

INTRODUCTION: The main objective of this study is to determine if our unit meets the quality standards required by the scientific community from the reference centers for pancreatic surgery in terms of peri-operative results. The secondary objectives are to compare the different pancreatic surgery techniques performed in terms of early post-operative morbidity and mortality and to analyze the impact of the resections added in these terms. METHOD: Descriptive, retrospective and single-center study, corresponding to the period 2006-2019. The results obtained were compared with the proposed quality standards, by Bassi et al. and Sabater et al., required from the reference centers in pancreatic surgery. The sample was divided according to surgical technique and compared in terms of early post-operative morbidity and mortality, studying the impact of extended vascular and visceral resections. All patients undergoing pancreatic surgery in our unit due to pancreatic, malignant and benign pathology were included, since it was implemented as a reference center. Emergency procedures were excluded. RESULTS: 631 patients were analyzed. The values ??obtained in the quality standards are in range. The most frequent surgery was cephalic duodenopancreatectomy, which associated higher peri-operative morbidity and mortality rates (p ≤ 0.05). The extended vascular resections impacted the cephalic duodenopancreatectomy group, associating a longer mean stay (p = 0.01) and a higher rate of re-interventions (p = 0.02). CONCLUSIONS: The experience accumulated allows to meet the required quality standards, as well as perform extended resections to pancreatectomy with good results in terms of post-operative morbi-mortality.

Evaluation results of national hospital accreditation program in Iran: The view of hospital managers.

BACKGROUND: Accreditation programs have a crucial role in improving the safety and effectiveness of hospital services. Many factors contribute to achieve accreditation goals. This study evaluated the national Iranian hospital accreditation program from the view of hospital managers in Iran. METHODS: The study was conducted in 2015 using a validated questionnaire designed to collect feedback concerning accreditation processes and impacts. In total, 547 managers were surveyed using a stratified random sampling method. A 5-degree scale Likert from totally disagree=1 to totally agree=5 has been used for the evaluation. Descriptive and inferential statistics were used to analyze the data. RESULTS: Approximately half of hospital managers were satisfied with the accreditation standards and surveying methods. The reason for their dissatisfaction was the high number of measures (2.38). The main challenges to the accreditation method were reported inadequate surveyor training (2.94) their satisfaction with the infrastructure was low because of a lack of hospital resources. Nonetheless, the accreditation program was perceived as being successful in improving patient safety (3.80), patient compliance (3.72), and error reduction (3.53). CONCLUSION: An effective accreditation program requires reducing the number of standards and making them clearer as well as the infrastructure for the implementation of accreditation such as sufficient and sustainable funds, enough human resources and equipment should be provided. Appropriate surveyors should be selected and trained professionally to ensure inter-rater reliability among them.

Sleeve gastrectomy as a surgical technique in bariatric surgery: Results of safety and effectiveness. / Gastrectomía vertical como técnica quirúrgica en cirugía bariátrica: análisis de resultados de seguridad y efectividad.

INTRODUCTION: The aim of this study is to evaluate the safety and effectiveness results of sleeve gastrectomy as a bariatric technique. METHODS: Observational follow-up study of a cohort of patients who underwent sleeve gastrectomy in our center between 2008 and 2017. A total of 223 patients were included: 166 as a primary technique (group 1) and 57 as a hypothetical first stage (group 2). RESULTS: In group 1, the postoperative morbidity is 12.6%, with a fistula rate of 4.2%; 5.4% required reoperation and mortality was 0.6%. In group 2, postoperative morbidity is 14%, with a fistula rate of 5.3%; 10.5% required reoperation and mortality was 5.3%. In group 1, 79.6% and 62.5% of patients at 2 and 5 years respectively managed to achieve a % EBMIL>50%. In group 2, the second stage was completed only in 8 patients (14.0%). Of the patients who did not complete the second stage, 32.2% and 5.9% achieved a % EEBMIL>100% at 2 and 5 years. Analyzing those who completed the second stage, the mean EEBMIL% was 90.5% and 93.4% at 2 and 5 years. CONCLUSIONS: Sleeve gastrectomy is a safe technique in patients with BMI<45 and effective in terms of weight loss in the short-medium term. In patients with BMI>55, a preoperative optimization aimed at reducing morbidity and mortality is necessary, as well as adequately planning the second stage, without which it is clearly insufficient.

First proposal of quality indicators and standards and recommendations to improve the healthcare in the Spanish National Registry of Hip Fracture.

BACKGROUND: The Spanish National Hip Fracture Registry (or Registro Nacional de Fractura de Cadera, RNFC) is a database of hip fracture patients admitted to Spanish hospitals. Its goals include assessment and continuous improvement of the care process. OBJECTIVES: To (1) establish a series of indicators, (2) evaluate their initial fulfillment, (3) propose quality standards, (4) suggest recommendations to facilitate standards compliance, and (5) monitor the indicators. METHOD: The indicators fulfilled the criteria of (1) evaluating the process or outcome, (2) being clinically relevant for patients, (3) being modifiable through changes in healthcare practice, and (4) being considered important by the RNFC participants. The first quartile obtained by the group of hospitals in each of the respective variables was proposed as the standard. The Indicators Advisory Committee (IAC) elaborated a list of recommendations for each indicator, based on the available evidence. RESULTS: Seven indicators were chosen. These indicators (its baseline compliance vs. the standard to be reached, respectively) were: the proportion of patients receiving surgery within 48h (44% vs. 63%), mobilized the first postoperative day (56% vs. 86%), with antiosteoporotic medication at discharge (32% vs. 61%), with calcium supplements at discharge (46% vs. 77%), with vitamin D supplements at discharge (67% vs. 92%), who developed pressure ulcers during hospitalization (7.2% vs. 2.1%) and with independent mobility at 30 days (58% vs. 70%). The IAC has established 25 recommendations for improving care. CONCLUSION: The indicators and standards chosen are presented, as well as the list of recommendations. This process completes the first step to improve quality of care. The results will be evaluated 6 months after implementing the recommendations.

Outcome quality standards in pancreatic oncologic surgery in Spain. / Estándares de calidad en la cirugía oncológica pancreática en España.

INTRODUCTION: To establish quality standards in oncologic surgery is a complex but necessary challenge to improve surgical outcomes. Unlike other tumors, there are no well-defined quality standards in pancreatic cancer. The aim of this study is to identify quality indicators in pancreatic oncologic surgery in Spain as well as their acceptable limits of variability. METHODS: Quality indicators were selected based on clinical practice guidelines, consensus conferences, reviews and national publications on oncologic pancreatic surgery between the years 2000 and 2016. Variability margins for each indicator have been determined by statistical process control techniques and graphically represented with the 99.8 and 95% confidence intervals above and below the weighted average according to sample size. RESULTS: The following indicators have been determined with their weighted average and acceptable quality limits: resectability rate 71% (>58%), morbidity 58% (<73%), mortality 4% (<10%), biliary leak 6% (<14%), pancreatic fistula rate 18% (<29%), hemorrhage 11% (<21%), reoperation rate 11% (<20%) and mean hospital stay (<21 days). CONCLUSIONS: To date, few related series have been published, and they present important methodological limitations. Among the selected indicators, the morbidity and mortality quality limits have come out higher than those obtained in international standards. It is necessary for Spanish pancreatic surgeons to adopt homogeneous criteria regarding indicators and their definitions to allow for the comparison of their results.

Barriers to and facilitators of implementing quality standards in Hospital Day Care Units in Rheumatology: Qualitative approach to the VALORA study. / Barreras y facilitadores en la implantación de estándares de calidad en las unidades de hospital de día reumatológicas. Análisis cualitativo del proyecto VALORA.

OBJECTIVE: To identify barriers and facilitators in the implementation of quality standards in hospital day care units (HDCU) in rheumatology. MATERIAL AND METHODS: We analyzed appraisals of HDCU in terms of standards for structure, processes and results. The qualitative approach was conducted through 13 discussion groups created by rheumatology health professionals (7), nursing professionals (4) and HDCU patients (2). The recruitment of informants was done through purposive sampling, attending to variables that form the perceptions of the HDCU. Data analysis was performed using a descriptive-interpretive method. RESULTS: The specialization of the HDCU and specific training in rheumatology for nursing are perceived as the main facilitator for the implementation of standards. Conversely, the delay in the availability of medicines at the HDCU is identified as a barrier that prolongs patient stay and wastes resources. Differences in local regulations are perceived as a potential barrier to equitable access to medicines. The patients gave higher ratings to the care received than to structural variables or those related to process. CONCLUSIONS: The findings of this study suggest that improvements in the implementation of quality standards in HDCU may include three levels of action: the HDCU, the hospital and a third related to local regulations to access to medicines.

Variability in Rheumatology day care hospitals in Spain: VALORA study. / Variabilidad en los hospitales de día de Reumatología en España: proyecto VALORA.

OBJECTIVE: To describe the variability of the day care hospital units (DCHUs) of Rheumatology in Spain, in terms of structural resources and operating processes. MATERIAL AND METHODS: Multicenter descriptive study with data from a self-completed questionnaire of DCHUs self-assessment based on DCHUs quality standards of the Spanish Society of Rheumatology. Structural resources and operating processes were analyzed and stratified by hospital complexity (regional, general, major and complex). Variability was determined using the coefficient of variation (CV) of the variable with clinical relevance that presented statistically significant differences when was compared by centers. RESULTS: A total of 89 hospitals (16 autonomous regions and Melilla) were included in the analysis. 11.2% of hospitals are regional, 22,5% general, 27%, major and 39,3% complex. A total of 92% of DCHUs were polyvalent. The number of treatments applied, the coordination between DCHUs and hospital pharmacy and the post graduate training process were the variables that showed statistically significant differences depending on the complexity of hospital. The highest rate of rheumatologic treatments was found in complex hospitals (2.97 per 1,000 population), and the lowest in general hospitals (2.01 per 1,000 population). The CV was 0.88 in major hospitals; 0.86 in regional; 0.76 in general, and 0.72 in the complex. CONCLUSIONS: there was variability in the number of treatments delivered in DCHUs, being greater in major hospitals and then in regional centers. Nonetheless, the variability in terms of structure and function does not seem due to differences in center complexity.

Exploración de una herramienta para evaluar si se aplican cuidados del neurodesarrollo en unidades neonatales

Introducción: El Protocolo de Atención Neonatal Integral (ANI) es una normativa nacional para los cuidados del neurodesarrollo y la atención centrada en la familia. Objetivo: Explorar un instrumento de evaluación del cumplimiento del protocolo en unidades neonatales de 3 hospitales maternoinfantiles de Paraguay. Material y Método: Estudio prospectivo, descriptivo, transversal. Se diseñó el "Instrumento de evaluación del desempeño en la aplicación del Protocolo ANI" con estándares de calidad de atención y criterios objetivos de verificación de cumplimiento. La información se obtuvo por observación directa; entrevistas al personal de salud, madres y familiares de bebés internados; revisión de registros clínicos, en dos guardias distintas en cada hospital. Resultados: Instrumento diseñado con meta de 80% de cumplimiento. Porcentaje de cumplimiento de cada estándar por hospital identificados como 1°, 2°, 3°: Acceso irrestricto de madres, padres o tutores y participación en los cuidados: 50%, 75%, 25%. Información, educación y comunicación: 30%, 59%, 53%. Contacto piel a piel: 0%, 0%, 0%. Manejo integral del dolor: 12,5%, 25%, 12,5%. Medidas ambientales para disminuir estrés y procurar confort: 33%, 33%, 25%. Atención individualizada según sueño: 50%, 50%, 0%. Prevención de Retinopatía del Prematuro: 55%, 44%, 66%. Lactancia y nutrición precoz: 66%, 50%, 33%. Registros clínicos completos, métodos diagnósticos auxiliares: 0%, 50%, 50%. Albergue: 38%, 71%, 57%. Capacitación de 80% del personal asistencial: 75%, 25%, 25%. Total de cumplimiento: 1° 37%, 2° 44%, 3° 31,5%. Conclusiones: El instrumento aplicado fue pertinente y aceptado. Ningún Hospital cumple con la meta del 80%. Recomendación: Monitorear sistemáticamente la implementación de normativas.

Introduction: The Comprehensive Neonatal Care Protocol (CNCP) is a national standard for neurodevelopmental and family-centered care. Objective: To explore an instrument to evaluate compliance with the protocol in the neonatal units of 3 maternal-infant hospitals in Paraguay. Materials and Methods: This was a prospective, descriptive and cross-sectional study. The "Performance Evaluation Instrument in the Application of the CNCP Protocol" was designed with standards of quality of care and objective criteria to verify compliance. The information was obtained by direct observation, interviews with health personnel, mothers and relatives of hospitalized infants and review of clinical records during two different shifts at each hospital. Results: The instrument was designed with an 80% compliance goal. The percentages of compliance of each standard per hospital were identified as 1st, 2nd and 3rd: Unrestricted access of mothers, parents or guardians and participation in care: 50%, 75%, 25%. Information, education and communication: 30%, 59%, 53%. Skin-to-skin contact: 0%, 0%, 0%. Comprehensive pain management: 12.5%, 25%, 12.5%. Environmental measures to reduce stress and seek comfort: 33%, 33%, 25%. Individualized care according to sleep: 50%, 50%, 0%. Prevention of Retinopathy of Prematurity: 55%, 44%, 66%. Breastfeeding and early nutrition: 66%, 50%, 33%. Complete clinical records, ancillary diagnostic methods: 0%, 50%, 50%. Hostel: 38%, 71%, 57%. Training of 80% of care staff: 75%, 25%, 25%. Total compliance: 1st: 37%, 2nd: 44%, 3rd: 31.5%. Conclusions: The instrument applied was pertinent and accepted. No Hospital meets the 80% goal. Recommendation: Systematically monitor the implementation of regulations.

Factibilidad económica en el marco de la certificación internacional del nuevo Hospital Militar - ejército de Nicaragua

El presenta documento, análisis de factibilidad financiera para determinar, deacuerdo a la situación actual del Hospital Militar Escuela Alejandro Dávila Bolaños(HMEADB), las posibilidades económicas para realizar el proceso de acreditacióninternacional de la calidad del servicio en salud, en algunos servicios del hospitalmilitar que iniciará operaciones en el transcurso del año 2015, con base en losestándares de la Joint Commission International (JCI) y la OrganizaciónInternacional de Estandarización (ISO).En el trabajo, se llegó a la conclusión que el HMEADB está en capacidad de iniciarel proceso de certificación con la JCI, no obstante, es necesario que transcurran almenos 4 años de funcionamiento para que el nuevo hospital logre crear las basesestructurales (infraestructura, equipamiento), funcionales y de experiencia humanaque posibiliten lograr los estándares básicos, centrados en el paciente, y degestión de la organización sanitaria, premisa indispensable para alcanzar laacreditación internacional correspondiente.

Evaluación de la calidad de la atención de enfermería en pacientes oncológicos tratados con quimioterapia / Evaluation of quality of the nursing care in oncology patients treated with chemotherapy

Se efectuó un estudio descriptivo y transversal en el Departamento de Quimioterapia ambulatoria del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde julio hasta septiembre del 2013, a fin de evaluar la calidad de la atención de enfermería, así como el nivel de satisfacción de quienes la recibieron. La muestra estuvo constituida por 300 pacientes oncológicos tratados con antineoplásicos y 3 profesionales de enfermería, que laboraban en el mencionado Departamento. Se constató que la calidad de la atención de dichos profesionales en su dimensión trato humano y nivel de atención fue buena, así como el nivel de satisfacción de quienes la recibieron resultó favorable(AU

A descriptive and cross sectional study was carried out in the Department of ambulatory Chemotherapy of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from July to September, 2013, in order to evaluate the quality of the nursing care, as well as the level of satisfaction from those who received it. The sample was constituted by 300 oncology patients treated with antineoplastic drugs and 3 nursing professionals who worked in the mentioned department. It was verified that the quality of care of these professionals in its dimension, human treatment and level of care was good, as well as the satisfaction level of those who received it was favorable(AU)

Microbiological and physicochemical analysis of yateí (Tetragonisca angustula) honey for assessing quality standards and commercialization / Análisis microbiológico y fisicoquímico de la miel de yateí (Tetragonisca angustula) para la evaluación de estándares de calidad y comercialización

Due to the interest in the production and trading of yateí (Tetragonisca angustula) honey in the province of Misiones, Argentina, in this work we assessed microbiological and physicochemical parameters in order to contribute to the elaboration of standards for quality control and promote commercialization. Results showed that yateí honey samples had significantly different microbiological and physicochemical characteristics in comparison to established quality standards for Apis mellifera honey. Thus, we observed that values for pH (3.72), glucose (19.01 g/100 g) and fructose (23.74 g/100 g) were lower than A. mellifera quality standards, while acidity (79.42 meq/kg), moisture (24%), and mould and yeast count (MY) (3.02 log CFU/g) were higher. The acid content was correlated with glucose (R²=0.75) and fructose (R²=0.68) content, and also with mould and yeast counts (R²=0.45) to a lesser extent. The incidence of microorganisms in yateí honey samples reached 42.85% and 39% for Clostridium sulfite-reducers and Bacillus spp., respectively. No C. botulinum or B. cereus cells were detected. Enterococcus spp. and Staphylococcus spp. incidence was similar (ca. 7.14%), whereas Escherichia coli and Salmonella spp. were not detected. We conclude that the microbiological and physicochemical properties of yateí honey are different from those of A. mellifera honey; hence, different quality standards could be implemented to promote its commercialization.

Debido al interés en la producción y comercialización de la miel de yateí (Tetragonisca angustula) en la provincia de Misiones, Argentina, en este trabajo se evaluaron parámetros microbiológicos y fisicoquímicos con el fin de contribuir con la elaboración de normas para el control de calidad y promover su comercialización. Los resultados demostraron que los parámetros analizados en esta miel (n = 28) diferían significativamente de los valores aceptables establecidos para la miel de Apis mellífera. En comparación, se observó que los valores de pH (3,72) y de concentración de glucosa (19,01 g/100 g) y fructosa (23,74 g/100 g) eran más bajos, mientras que los valores de acidez (79,42 meq/kg) y humedad (24 %), al igual que el recuento de hongos y levaduras (HyL) (3,02 log UFC/g), eran más altos. La acidez mostró una correlación inversamente proporcional con el contenido de glucosa (R² = 0,75) y fructosa (R² = 0,68), y directamente proporcional con el recuento de HyL, aunque en este caso la correlación fue menor (R² = 0,45). En lo que respecta a los parámetros microbiológicos, se observó 42,85 % de Clostridium sulfito-reductores y 39 % de Bacillus spp., y no se detectó presencia de C. botulinum ni de B. cereus. Enterococcus spp. y Staphylococcus spp. se encontraron en una proporción similar (ca. 7,14 %), mientras que Escherichia coli y Salmonella spp. no fueron detectados. Concluimos que las propiedades microbiológicas y fisicoquímicas de la miel de yateí difieren de las de la miel de A. mellifera, por lo cual sería oportuno establecer normas de calidad diferentes para facilitar su comercialización.

Microbiological and physicochemical analysis of yateí (Tetragonisca angustula) honey for assessing quality standards and commercialization / Análisis microbiológico y fisicoquímico de la miel de yateí (Tetragonisca angustula) para la evaluación de estándares de calidad y comercialización

Due to the interest in the production and trading of yateí (Tetragonisca angustula) honey in the province of Misiones, Argentina, in this work we assessed microbiological and physicochemical parameters in order to contribute to the elaboration of standards for quality control and promote commercialization. Results showed that yateí honey samples had significantly different microbiological and physicochemical characteristics in comparison to established quality standards for Apis mellifera honey. Thus, we observed that values for pH (3.72), glucose (19.01 g/100 g) and fructose (23.74 g/100 g) were lower than A. mellifera quality standards, while acidity (79.42 meq/kg), moisture (24%), and mould and yeast count (MY) (3.02 log CFU/g) were higher. The acid content was correlated with glucose (R²=0.75) and fructose (R²=0.68) content, and also with mould and yeast counts (R²=0.45) to a lesser extent. The incidence of microorganisms in yateí honey samples reached 42.85% and 39% for Clostridium sulfite-reducers and Bacillus spp., respectively. No C. botulinum or B. cereus cells were detected. Enterococcus spp. and Staphylococcus spp. incidence was similar (ca. 7.14%), whereas Escherichia coli and Salmonella spp. were not detected. We conclude that the microbiological and physicochemical properties of yateí honey are different from those of A. mellifera honey; hence, different quality standards could be implemented to promote its commercialization.(AU)

Debido al interés en la producción y comercialización de la miel de yateí (Tetragonisca angustula) en la provincia de Misiones, Argentina, en este trabajo se evaluaron parámetros microbiológicos y fisicoquímicos con el fin de contribuir con la elaboración de normas para el control de calidad y promover su comercialización. Los resultados demostraron que los parámetros analizados en esta miel (n = 28) diferían significativamente de los valores aceptables establecidos para la miel de Apis mellífera. En comparación, se observó que los valores de pH (3,72) y de concentración de glucosa (19,01 g/100 g) y fructosa (23,74 g/100 g) eran más bajos, mientras que los valores de acidez (79,42 meq/kg) y humedad (24 %), al igual que el recuento de hongos y levaduras (HyL) (3,02 log UFC/g), eran más altos. La acidez mostró una correlación inversamente proporcional con el contenido de glucosa (R² = 0,75) y fructosa (R² = 0,68), y directamente proporcional con el recuento de HyL, aunque en este caso la correlación fue menor (R² = 0,45). En lo que respecta a los parámetros microbiológicos, se observó 42,85 % de Clostridium sulfito-reductores y 39 % de Bacillus spp., y no se detectó presencia de C. botulinum ni de B. cereus. Enterococcus spp. y Staphylococcus spp. se encontraron en una proporción similar (ca. 7,14 %), mientras que Escherichia coli y Salmonella spp. no fueron detectados. Concluimos que las propiedades microbiológicas y fisicoquímicas de la miel de yateí difieren de las de la miel de A. mellifera, por lo cual sería oportuno establecer normas de calidad diferentes para facilitar su comercialización.(AU)

Evaluación de la calidad de la atención de enfermería en pacientes oncológicos tratados con quimioterapia / Evaluation of quality of the nursing care in oncology patients treated with chemotherapy

Se efectuó un estudio descriptivo y transversal en el Departamento de Quimioterapia ambulatoria del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde julio hasta septiembre del 2013, a fin de evaluar la calidad de la atención de enfermería, así como el nivel de satisfacción de quienes la recibieron. La muestra estuvo constituida por 300 pacientes oncológicos tratados con antineoplásicos y 3 profesionales de enfermería, que laboraban en el mencionado Departamento. Se constató que la calidad de la atención de dichos profesionales en su dimensión trato humano y nivel de atención fue buena, así como el nivel de satisfacción de quienes la recibieron resultó favorable.

A descriptive and cross sectional study was carried out in the Department of ambulatory Chemotherapy of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, from July to September, 2013, in order to evaluate the quality of the nursing care, as well as the level of satisfaction from those who received it. The sample was constituted by 300 oncology patients treated with antineoplastic drugs and 3 nursing professionals who worked in the mentioned department. It was verified that the quality of care of these professionals in its dimension, human treatment and level of care was good, as well as the satisfaction level of those who received it was favorable.