[Introduction of an accreditation system for hospital informed consent forms]. / Introducción de un sistema de acreditación para los documentos de consentimiento informado hospitalario.

OBJECTIVE: To describe an accreditation system for informed consent forms (ICF) in a tertiary hospital, as an intervention to improve their quality, and to check the improvements achieved. MATERIAL AND METHODS: Following an external evaluation of the ICF quality in a public hospital in Murcia (Spain), an accreditation committee set the ICF requirements and associated procedures. Effectiveness is assessed by comparing two external evaluations carried out by the EMCA Program (2011 and 2013) and based on 19 criteria and a sample of 60 ICF for every public hospital in Murcia Region. RESULTS: To be accredited, every ICF must meet the 19 external criteria plus 5 based on legibility, readability and scientific and technical validity. A form to fill in the contents of every ICF was agreed, which would be reviewed, approved and validated for five years. Before the implementation, 8.2 defects/ICF were detected. The accreditation system obtained an 89% improvement (0.9 defects/ICF) and achieved significant improvements in 18 criteria, 16 of which are benchmarked. DISCUSSION: The accreditation system achieved a substantial improvement in the ICF (obtaining a better result in external evaluations) and guarantees their contents, legibility and readability. This system needs to be extended to other hospitals, since it is not clear whether common ICFs would be suitable. However, this improvement is structural and does not guarantee that the overall information/consent procedure is done properly, thus complementary strategies for measurement and improvement are required.

[Formal quality assessment of informed consent documents in 9 hospitals]. / Evaluación de la calidad formal de los documentos de consentimiento informado en 9 hospitales.

INTRODUCTION: Informed consent forms are very important in the process of medical information. The aim of this study is to design reliable formal quality criteria of these documents and their application in the evaluation of those used in the hospitals of a regional health service. MATERIAL AND METHODS: Criteria have been designed from the analysis of existing regulations, previous studies and consultation with key experts. The interobserver concordance was assessed using the kappa index. Criteria evaluation was performed on 1425 documents of 9 hospitals. RESULTS: A total of 19 criteria used in the evaluation of the quality of informed consent forms have been obtained. Kappa values were higher than 0,60 in 17 of them and higher than 0,52 in the other 2. The average number of defects per document was 7.6, with a high-low ratio among hospitals of 1.84. More than 90% of the documents had defects in the information on consequences and contraindications, and in about 90% it did not mention the copy to the patient. More than 60% did not comply with stating the purpose of the procedure, a statement of having understood and clarified doubts, and the treatment options. CONCLUSIONS: A tool has been obtained to reliably assess the formal quality of the informed consent forms. The documents assessed have a wide margin for improvement related to giving a copy to the patient, and some aspects of the specific information that patients should receive.

[Tuberculous infection in schoolchildren in the 1st year of basic general education in the Murcia region (1985-1992)]. / Infección tuberculosa en escolares de 1st de EGB de la región de Murcia (1985-1992).

OBJECTIVE: To find the evolution of the prevalence of tubercular infection. DESIGN: Study of the tendency of the findings from crossover surveys carried out during the last 7 years. SETTING: First-year EGB students from public and private schools in the Autonomous Community of Murcia. INTERVENTION: Performing the Mantoux intradermoreaction test with 2 UT of PPDRT23/TWEEN80 for the first 5 years and 5 UT of PPDCT68/TWEEN80 the last 2, with any induration over 5 mm. being considered positive. A clinical study of school students found positive and of their family contacts. RESULTS: Coverage was established at about 80% (71,520 tests studied), with prevalence diminishing from 0.97% to 0.44%, this establishing a downward tendency (p < 0.001). 6.5% of the tuberculin-test positive students (21) and 2.8% of the family contacts (34) were diagnosed with tuberculosis. CONCLUSIONS: At the moment we lack data to suggest an increase in endemic tuberculosis among the school population. The results mentioned justify tuberculosis surveys of school students, although low prevalence suggests that the age at which it is performed should be raised.

Lactancia materna en la Región de Murcia. ¿Seguimos con el problema? / Maternal breastfeeding in the Region of Murcia, does the

Objetivo: Conocer la prevalencia y la duración de la lactancia materna (LM) en la Región de Murcia. Método: Estudio transversal (junio de 2007), mediante encuestas a madres de niños menores de 24 meses realizadas en centros de vacunación. El ámbito de estudio estuvo comprendido por 77 zonas de salud de 6 áreas sanitarias de la región, y el muestreo fue proporcional al número de niños nacidos en el área. Se recogieron datos sociosanitarios del niño, de la madre y de la alimentación del niño. Se calculó la prevalencia de LM según las categorías definidas por la Organización Mundial de Salud (OMS) y se estudiaron los motivos de no iniciar y de abandonar la LM. Resultados: Se obtuvieron datos de 1.836 niños, con una tasa de respuesta del 95,2%. Al alta del hospital, un total de 1.643 niños (89,7%) fueron alimentados con LM; de éstos, el 76,7% (n= 1.405) lo hicieron sin suplementos nutritivos. Al tercer mes mantenían la LM completa el 44,4% y al sexto mes el 36,3%. La mediana de duración de LM exclusiva fue de 75 días y para la LM parcial de 129 días. Los motivos de no alimentar con LM fueron: enfermedad/ingreso (46,7%), falta de leche (28,6%) y decisión de la madre (19,3%). Entre las causas de abandono, cabe citar las siguientes: hipogalactia e insaciabilidad (29,3%) y escasa ganancia de peso (11%). Las variables que mostraron una asociación estadísticamente significativa (p <0,05) con la LM fueron el peso del niño, el tipo de parto y el área sanitaria, y, en relación con la madre, la edad, la paridad, la actividad laboral, el lugar de procedencia y el nivel de estudios. Conclusiones: Las cifras de LM en la Región de Murcia son similares a las de nuestro entorno, pero se alejan de las recomendadas por la OMS (AU)

Title: Maternal breastfeeding in the Region of Murcia, does the problem persist? Objective: To study the prevalence and duration of maternal breastfeeding (MB) in the Region of Murcia. Methods: Cross-sectional study (June, 2007). Mothers of infants under 24 months old were surveyed in immunization centers. The study was conducted through the 77 health zones of the 6 health areas of the Region. The sample size was proportion alto the number of newborns in these areas. Breast-fed baby, mother and child feeding social and health data were collected. The MB prevalence was calculated in accordance with the categories defined by the World Health Organization (WHO) and the reasons for not starting and for stopping MB were studied. Results: Data from 1,836 infants (response rate of 95.2%) has been obtained. Upon hospital discharge, the percentage of children fed with MB was of 89.7% (1,643), 76.7% (1,405) of which were breastfed without nourishing supplements. 44.4%of infants exclusively MB at 3 months and 36.3% at 6 months. The median duration of exclusive MB was of 75 days and of129 days for partial MB. The reasons for not being fed by MB were: disease/admission (46.7%), lack of milk (28.6%), and mother’s decision (19.3%). The reasons for discontinuing breastfeeding were: hypogalactia and insatiable appetite (29.3%), and not to put on weight (11%). The variables that showed statistically significant association (p < 0.05) regarding MB were child weight, type of childbirth, and health area, and, regarding the mother, age, parity, occupation, place of origin, and education. Conclusions: The MB figures in the Region of Murcia are similar to those in our environment, but are far from those recommended by the WHO (AU)