Análisis de la calidad de derivaciones urgentes desde Atención Primaria al Hospital

Derivació urgent, Atenció Primària, Atenció EspecialitzadaDerivación urgente, Atención Primaria, Atención EspecializadaUrgent derivation, Primary Care, Specialized CareSe evalua la calidad, adecuación y concordancia diagnóstica de las derivaciones a urgencias desde atención primaria (AP) al hospital y el grado de mención de la valoración recibida en AP en los informes de alta del hospital. Se debe concienciar a los profesionales de la importancia del informe de derivación como instrumento de comunicación entre niveles asistenciales. Es necesario disponer de parámetros de calidad establecidos y estandarizados que nos permitan hacer comparaciones y facilitar el enfoque de acciones de mejora.S'avalua la qualitat, adequació i concordança diagnòstica de les derivacions a urgències des d'atenció primària (AP) a l'hospital i el grau de menció de la valoració rebuda en AP en els informes d'alta de l'hospital. S'ha de conscienciar als professionals de la importància de l'informe de derivació com a instrument de comunicació entre nivells assistencials. Cal disposar de paràmetres de qualitat establerts i estandarditzats que ens permetin fer comparacions i facilitar l'enfocament d'accions de millora.The quality, adequacy and diagnostic agreement of the referrals to the emergency department from primary care (PC) to the hospital and the degree of mention of the assessment received in PC in hospital discharge reports are evaluated. Professionals must be made aware of the importance of the referral report as an instrument of communication between levels of care. It is necessary to have established and standardized quality parameters that allow us to make comparisons and facilitate the focus of improvement action

The Roadmap for Implementing Value-Based Healthcare in European University Hospitals—Consensus Report and Recommendations

Expert recommendation; Patient-reported outcomes; Quality in healthcareRecomendación experta; Resultados informados por el paciente; Calidad en la asistencia sanitariaRecomanació experta; Resultats informats pel pacient; Qualitat en l'assistència sanitàriaObjectives Value-based healthcare (VBHC) aims at improving patient outcomes while optimizing the use of hospitals’ resources among medical personnel, administrations, and support services through an evidence-based, collaborative approach. In this article, we present a blueprint for the implementation of VBHC in hospitals, based on our experience as members of the European University Hospital Alliance. Methods The European University Hospital Alliance is a consortium of 9 large hospitals in Europe and aims at increasing the quality and efficiency of care to ultimately drive better outcomes for patients. Results The blueprint describes how to prepare hospitals for VBHC implementation; analyzes gaps, barriers, and facilitators; and explores the most effective ways to turn patient pathways into a process that results in high-value care. Using a patient-centric approach, we identified 4 core minimum components that must be established as cornerstones and 7 organizational enablers to waive the barriers to implementation and ensure sustainability. Conclusion The blueprint guides through pathway implementation and establishment of key performance indicators in 6 phases, which hospitals can tailor to their current status on their way to implement VBHC

Traducción y adaptación transcultural al español, catalán y gallego de la escala Hopkins Symptom Checklist-25 para la detección de depresión en Atención Primaria

Altres ajuts: Este trabajo recibió financiación de la Sociedad Española de Medicina de Familia y Comunitaria (semFYC) al resultar ganador de una ayuda para la realización de tesis doctorales Isabel Fernández 2019. Este proyecto ha recibido una beca de la Fundación Instituto Universitario de Investigación en Atención Primaria de Salud Jordi Gol i Gurina (IDIAP Jordi Gol 7Z19/019) para la capacitación en investigación y realización del doctorado en Atención Primaria y otra beca de la cátedra de la Universidad Autónoma de Barcelona-Novartis de investigación en Medicina Familiar y Comunitaria, ambas en la convocatoria 2019. Estas ayudas han sido otorgadas a la autora M. Rodríguez-Barragán.Describir el proceso de traducción y adaptación transcultural de la escala Hopkins Symptom Checklist-25 (HSCL-25) al español, catalán y gallego. Traducción, adaptación transcultural y análisis de la comprensibilidad mediante entrevistas cognitivas. Unidades de Investigación de Atención Primaria de Barcelona y Vigo. Médicos de familia y pacientes de Atención Primaria. Siguiendo las guías de la International Society for Pharmacoeconomics and Outcomes Research (ISPOR), se realizaron: 1) traducción directa; 2) estudio piloto basado en metodología Delphi con médicos de familia; 3) retrotraducción; 4) análisis de equivalencias; 5) análisis de comprensibilidad de las versiones obtenidas en español, catalán y gallego mediante entrevista cognitiva en una muestra de pacientes, y 6) armonización transcultural. En el estudio Delphi participaron 73 médicos de familia. El consenso se estableció en la primera ronda para la traducción española y catalana, y en la segunda ronda para la gallega. Las retrotraducciones fueron similares en los 3 idiomas. Todas las versiones fueron equivalentes entre ellas y respecto a la versión original inglesa. En la entrevista cognitiva participaron 10 pacientes por cada idioma, sin que se modificara la redacción de los ítems. Las traducciones de la escala HSCL-25 en español, catalán y gallego son equivalentes semántica y conceptualmente a la versión original. Las traducciones son comprensibles y bien aceptadas por los pacientes

Performance of comprehensive risk adjustment for the prediction of in-hospital events using administrative healthcare data: The queralt indices

Background: Accurate risk adjustment is crucial for healthcare management and benchmarking. Purpose: We aimed to compare the performance of classic comorbidity functions (Charlson's and Elixhauser's), of the All Patients Refined Diagnosis Related Groups (APR-DRG), and of the Queralt Indices, a family of novel, comprehensive comorbidity indices for the prediction of key clinical outcomes in hospitalized patients. Material and Methods: We conducted an observational, retrospective cohort study using administrative healthcare data from 156,459 hospital discharges in Catalonia (Spain) during 2018. Study outcomes were in-hospital death, long hospital stay, and intensive care unit (ICU) stay. We evaluated the performance of the following indices: Charlson's and Elixhauser's functions, Queralt's Index for secondary hospital discharge diagnoses (Queralt DxS), the overall Queralt's Index, which includes pre-existing comorbidities, in-hospital complications, and principal discharge diagnosis (Queralt Dx), and the APR-DRG. Discriminative ability was evaluated using the area under the curve (AUC), and measures of goodness of fit were also computed. Subgroup analyses were conducted by principal discharge diagnosis, by age, and type of admission. Results: Queralt DxS provided relevant risk adjustment information in a larger number of patients compared to Charlson's and Elixhauser's functions, and outperformed both for the prediction of the 3 study outcomes. Queralt Dx also outperformed Charlson's and Elixhauser's indices, and yielded superior predictive ability and goodness of fit compared to APR-DRG (AUC for in-hospital death 0.95 for Queralt Dx, 0.77- 0.93 for all other indices; for ICU stay 0.84 for Queralt Dx, 0.73- 0.83 for all other indices). The performance of Queralt DxS was at least as good as that of the APR-DRG in most principal discharge diagnosis subgroups. Conclusion: Our findings suggest that risk adjustment should go beyond pre-existing comorbidities and include principal discharge diagnoses and in-hospital complications. Validation of comprehensive risk adjustment tools such as the Queralt indices in other settings is needed

Changes in malaria epidemiology in a rural area of Cubal, Angola

Scarce information about malaria epidemiology in Angola has been published. The objective of this study is to describe the epidemiology of malaria at the Hospital Nossa Senhora da Paz (Cubal, Angola) and the fatality rate due to malaria (total and in children under five years) in the last five years. A retrospective, observational study was performed at the Hospital Nossa Senhora da Paz, a 400-bed rural hospital located in Benguela Province of Angola. The study population included all patients who attended the hospital from January 2009 to December 2013. Outcome variables were calculated as follows: the percentage of malaria cases (number of positive thick blood films, divided by the total thick blood films performed); the percentage of in-patients for malaria (number of in-patients diagnosed with malaria, divided by the total number of in-patients); and, the fatality rate (number of deaths due to malaria divided by the number of positive thick blood films). Overall, 23,106 thick blood films were performed, of which 3,279 (14.2%) were positive for Plasmodium falciparum infection. During this five-year period, a reduction of 40% (95% CI 37-43%, p < 0.001) in the malaria-positive slides was detected. Distribution of positive-malaria slides showed a seasonal distribution with a peak from December to March (rainy season). An average annual reduction of 52% (95% CI 50-54%, p < 0.001) in the admissions due to malaria was observed. The overall fatality rate due to malaria was 8.3%, and no significant differences in the annual fatality rate were found (p = 0.553). A reduction in the number of malaria cases and the number of admissions due to malaria has been observed at the Hospital Nossa Senhora da Paz, during the last five years, and incidence along the study period showed a seasonal distribution. All this information could be useful when deciding which malaria control strategies have to be implemented in this area

Added value of patient-reported outcome measures (PROMs) after an acute stroke and early predictors of 90 days PROMs

Outcomes; Stroke; Value based health careResultats; Ictus; Atenció de la salut basada en valorsResultados; Ictus; Atención de la salud basado en valoresIntroduction Value-based health care represents a patient-centered approach by valuing Patient-Reported Outcome Measures (PROMs). Our aim was to describe the additional value of PROMs after an acute stroke over conventional outcome measures and to identify early predictors of poor PROMs. Methods Acute stroke patients discharged from a tertiary care hospital followed by a web/phone-based PROMs collection program in the post hospitalization phase. Main PROMs involve anxiety and depression (HADS) (each defined by HADS ≥ 10) and global physical (PHY-) and mental (M-) health (PROMIS-10). PROMIS cut-off raw values of normality were: PHY-PROMIS ≥ 13 and M-PROMIS ≥ 11. An overall health status (OHS) from 0 to 100 was also determined. PROMs related to the different modified Rankin Scale (mRS) grades were defined. Early predictors of PROMs were evaluated. Results We included 1321 stroke patients, mean age 75 (± 8.6) and 55.7% male; 77.7% returned home. Despite a favorable mRS at 3 months (< 3), a relevant rate of patients considered without symptoms or with mild disability showed unfavorable results in the measured PROMs (8% unfavorable OHS, 15% HAD-depression, 12.1% HAD-anxiety, 28.7% unfavorable M-PROMIS and 33.1% unfavorable PHY-PROMIS results). Along follow-up, only PHY-PROMIS and OHS showed significant improvement (p < 0.01 and 0.03, respectively). The multivariate analysis including discharge variables showed that female sex, higher discharge mRS and discharge to socio-rehabilitation-center (SRC) were independent predictors of unfavorable results in PROMs (p < 0.01). When adding 7 days PROMs results, they emerged as the strongest predictors of 3 months PROMs. Conclusions A high proportion of stroke patients show unfavorable results in PROMs at 3 months, even those with favorable mRS, and most results obtained by PROMs during follow-up continued to indicate alterations. Female sex, mRS and discharge to SRC predicted unfavorable results in PROMs, but the strongest predictors of 3 months PROMs were the results of the 7 days PROMs

Reactogenicity to the mRNA-1273 Booster According to Previous mRNA COVID-19 Vaccination

COVID-19-vaccination; Adverse reactions; Booster doseVacunación de COVID-19; Reacciones adversas; Dosis de refuerzoVacunació de COVID-19; Reaccions adverses; Dosi de reforçThe objective of this study was to assess the local and systemic adverse reactions after the administration of a COVID-19 mRNA-1273 booster between December 2021 and February 2022 by comparing the type of mRNA vaccine used as primary series (mRNA-1273 or BNT162b2) and homologous versus heterologous booster in health care workers (HCW). A cross-sectional study was performed in HCW at a tertiary hospital in Barcelona, Spain. A total of 17% of booster recipients responded to the questionnaire. The frequency of reactogenicity after the mRNA-1273 booster (88.5%) was similar to the mRNA-1273 primary doses (85.8%), and higher than the BNT162b2 primary doses (71.1%). The reactogenicity was similar after receiving a heterologous booster compared to a homologous booster (88.0% vs. 90.2%, p = 0.3), and no statistically significant differences were identified in any local or systemic reactions. A higher frequency of medical leave was identified in the homologous booster dose group vs. the heterologous booster dose group (AOR 1.45; 95% CI: 1.00–2.07; p = 0.045). Our findings could be helpful in improving vaccine confidence toward heterologous combinations in the general population and in health care workers

Spatial Pattern of Tree Species of Ecological Importance and its Relationship with Altitude, Slope and Rainfall in Tropical Humid Forests of the Colombian Pacific

Identificar los factores y mecanismos que promueven y mantienen la alta diversidad y los patrones de distribución espacial de las especies de plantas en los bosques tropicales, ha sido objeto de debates y discusiones. Así, el presente estudio evalúa el efecto de la topografía (altitud, pendiente) y la precipitación (precipitación promedio anual, número de días de precipitación) sobre el patrón espacial de especies arbóreas de importancia ecológica. Para ello se emplearon los datos generados del censo de especies arbóreas (DAP > 10 cm) en once parcelas permanentes cuadradas de una hectárea establecidas por USAID-CONIF en el 2014 en las localidades de Chontadural- Mutatá (Antioquia), Pizarro, Río Pepé, Cantón San Pablo (Chocó), Bahía Málaga, Bajo Calima, Río Cajambre (Buenaventura), Acapa y Bajo Mira – Frontera (Nariño). Se seleccionaron las especies con mayor valor de importancia ecológica - IVI, más abundantes y con presencia en al menos dos parcelas. Para identificar el patrón de distribución espacial (aleatorio, agregado, disperso) de las especies seleccionadas, se emplearon las funciones L(d) de K-Ripley, G(r) de distribución de distancias al vecino más cercano, g(r) de correlación par, la varianza relativa (VR) y el coeficiente de variación (CV). Para cuantificar el efecto de la altitud, la pendiente, la precipitación y los días de precipitación promedio anual sobre los patrones de distribución identificados en cada especie, se empleó la regresión logística binomial. De 602 especies registradas en los censos, fueron seleccionadas siete (Brosimum utile, Campnosperma panamense, Oenocarpus bataua, Pourouma bicolor, Pentaclethra macroloba, Symphonia globulifera y Welfia regia y) por presentar mayores valores de importancia ecológica entre 1.09 y 2.30 y estar representadas en al menos dos parcelas. Para estas especies se identificó el patrón aleatorio y agregado sin predominio de alguno de estos. En la correlación de las abundancias de las especies y los factores ecológicos evaluados, la precipitación promedio anual y el número de días de precipitación promedio anual no presentaron relación; mientras que la altitud y la pendiente presentaron relaciones significativas negativas con la abundancia de seis de las siete especies seleccionadas (C. panamense, O. bataua, P. macroloba, P. bicolor, S. globulifera y W. regia). Por último, los modelos de regresión logística binomial mostraron que los patrones de distribución en agregados de las especies analizadas, presentaron mayor relación con la altitud y la pendiente principalmente, con probabilidades de riesgo positivas o negativas de que se presente este patrón agregado de acuerdo a la especie. Estos resultados cobran importancia ya que indican que la estructura de las poblaciones (abundancia y patrones de distribución) de las especies con mayor peso ecológico identificadas en los bosques húmedos tropicales del Pacífico Colombiano, depende de las variables topográficas altitud y pendiente. Así, en las medidas de conservación de estas especies (especialmente de aquellas con alguna categoría de amenaza), se debe tener en cuenta la inclusión de la mayor heterogeneidad ambiental posible dentro de las áreas protegidas.Identifying the factors and mechanisms that promote and maintain the high diversity and patterns of spatial distribution of plant species in tropical forests, has been the subject of debate and discussion. Thus, the present study evaluates the effect of topography (altitude, slope) and precipitation in the spatial pattern of tree species of ecological importance. For this purpose, the data generated from the census of tree species (DBH> 10 cm) were used in eleven permanent plots of one hectare established by USAID-CONIF in 2014 in the towns of Chontadural- Mutatá (Antioquia), Pizarro, Río Pepé, Canton San Pablo (Chocó), Bahía Málaga, Bajo Calima, Cajambre River (Buenaventura), Acapa and Bajo Mira - Frontera (Nariño). The species with the highest value of ecological importance (IVI), most abundant and with presence in at least two plots, were selected. In order to identify the spatial distribution pattern (random, aggregate, dispersed) of the selected species, the functions L (d) of K-Ripley, G (r) of distance distribution to the nearest neighbor, g Pair correlation and coefficient of variation (CV). The binomial logistic regression was used to quantify the effect of altitude, slope, precipitation and average annual precipitation days on the distribution patterns identified in each species. Of the 602 species registered in the censuses, seven were selected (Brosimum utile, Camnosperma panamense, Pourouma bicolor, Pentaclethra macroloba, Symphonia globulifera, Welfia regia and Oenocarpus bataua) for presenting higher values of ecological importance between 1.09 and 2.30 and being represented in at least of the parcels. For these species the random and aggregate pattern was identified without any predominance of these. In the correlation of the abundances of the species and the ecological factors evaluated, the average annual precipitation and the number of days of average annual precipitation were not related; While the altitude and slope had significant negative relationships with the abundance of six of the seven species selected (C. panamense, O. bataua, P. macroloba, P. bicolor, S. globulifera and W. regia). Finally, binomial logistic regression models showed that the aggregate distribution patterns of the analyzed species had a higher relationship with altitude and slope mainly, with positive or negative risk probabilities of this aggregate pattern being presented according to the species. These results are important since they indicate that the structure of the populations (abundance and distribution patterns) of the species with greater ecological weight identified in the tropical humid forests of the Colombian Pacific, depends on the topographic variables, altitude and slope. Thus, in the conservation measures of these species (especially those with some category of threat), the inclusion of the greatest possible environmental heterogeneity within the protected areas must be taken into account.USAID-BIOREDD+ Seccional Colombi

Vaccination of patients with inflammatory bowel disease: Practical recommendations Vacunación de pacientes con enfermedad inflamatoria intestinal: Recomendaciones prácticas

Patients with inflammatory bowel disease (IBD) have a greater risk of infection associated with the endogenous immunosuppression brought about by their underlying disease as well as the exogenous immunosuppression resulting from their therapies. In the last few years guidelines and consensus papers have been issued on the indication of vaccines for these patients as primary prevention of infection. However, vaccine coverage is low, likely because the risk for infection and both safety and efficacy concerns regarding vaccines are scarcely perceived in such cases. The available scientific evidence shows that immunization is safe for most preparations, and bears no association with an increased risk for disease activity. This paper reviews the available scientific literature, and provides recommendations on the vaccination of adults with IBD.Los pacientes con enfermedad inflamatoria intestinal (EII) tienen un mayor riesgo de infecciones, asociado tanto a la inmunosupresión endógena condicionada por su enfermedad de base, como a la exógena generada por los tratamientos que reciben. En los últimos años se han publicado guías y documentos de consenso sobre indicaciones de vacunación en estos pacientes, como medida de prevención primaria de infecciones. Sin embargo, las coberturas vacunales alcanzadas son bajas, probablemente por la falta de percepción del riesgo de infección y las dudas sobre la seguridad y eficacia de las vacunas en estos casos. La evidencia científica disponible muestra que la inmunización es segura para la mayoría de preparados y no se asocia a un incremento del riesgo de actividad de la enfermedad. En este documento se revisa la literatura científica disponible y se presentan unas recomendaciones de vacunación para pacientes adultos con EII

Análisis de la calidad de derivaciones urgentes desde Atención Primaria al Hospital

Derivació urgent, Atenció Primària, Atenció EspecialitzadaDerivación urgente, Atención Primaria, Atención EspecializadaUrgent derivation, Primary Care, Specialized CareSe evalua la calidad, adecuación y concordancia diagnóstica de las derivaciones a urgencias desde atención primaria (AP) al hospital y el grado de mención de la valoración recibida en AP en los informes de alta del hospital. Se debe concienciar a los profesionales de la importancia del informe de derivación como instrumento de comunicación entre niveles asistenciales. Es necesario disponer de parámetros de calidad establecidos y estandarizados que nos permitan hacer comparaciones y facilitar el enfoque de acciones de mejora.S'avalua la qualitat, adequació i concordança diagnòstica de les derivacions a urgències des d'atenció primària (AP) a l'hospital i el grau de menció de la valoració rebuda en AP en els informes d'alta de l'hospital. S'ha de conscienciar als professionals de la importància de l'informe de derivació com a instrument de comunicació entre nivells assistencials. Cal disposar de paràmetres de qualitat establerts i estandarditzats que ens permetin fer comparacions i facilitar l'enfocament d'accions de millora.The quality, adequacy and diagnostic agreement of the referrals to the emergency department from primary care (PC) to the hospital and the degree of mention of the assessment received in PC in hospital discharge reports are evaluated. Professionals must be made aware of the importance of the referral report as an instrument of communication between levels of care. It is necessary to have established and standardized quality parameters that allow us to make comparisons and facilitate the focus of improvement action