La opinión de los usuarios como oportunidad de mejora en atención primaria

ObjetivosDeterminar los aspectos del centro de atención primaria (CAP) que desagradan más a los clientes/usuarios, investigar sus determinantes y aplicar la intervención o intervenciones correspondientes.DiseñoEvaluación orientada hacia los resultados. Detección de los motivos de insatisfacción a través de un estudio observacional transversal a partir de una encuesta autocumplimentada en 200 individuos seleccionados mediante muestreo aleatorio por conglomerados. Constitución de un grupo de mejora continua para investigar los factores determinantes de los problemas detectados y sus posibles soluciones.EmplazamientoCAP Rambla, Sant Feliu de Llobregat, del Instituto Catalán de la Salud.Participantes y contextoUsuarios/clientes de la sala de espera del CAP. Grupo de mejora: profesionales del Equipo de Atención Primaria Sant Feliu y del Servicio de Atención Primaria Baix Llobregat Nord.IntervencionesReorganización de las agendas de los médicos de cabecera y disminución de las tareas burocráticas en las consultas.Mediciones principalesVariables sociodemográficas de los encuestados y motivos de insatisfacción de éstos. Se procedió a analizar los determinantes del problema. La variable principal fue la demora de la cita previa.ResultadosEntre los motivos de insatisfacción expresados por los usuarios, el más frecuente fue el tiempo de demora, con un 16% (intervalo de confianza [IC] del 95%, 10,9-21,1). Esta queja se refería tanto a la espera para obtener un visita como al tiempo en la sala de espera. Como determinantes de la demora se identificaron el número elevado de pacientes, la duplicación de visitas, las visitas burocráticas, el número elevado de visitas urgentes y la cita previa insuficiente.ConclusionesLa opinión de los usuarios nos ayuda a conocer en qué medida los servicios públicos de salud están cumpliendo sus expectativas. La mejora de los procesos es un paso fundamental para la mejora continua, pero debe ir acompañada de recursos adecuados a las necesidades de la población.ObjectivesTo determine those aspects of Primary Care Center (PCC) that displeases more the clients/users, to investigate its determinants, and to apply the intervention or corresponding interventions.DesignResults evaluation oriented. Detection of dissatisfaction reasons through cross observational study from survey self-fulfilled on 200 individuals selected through random cluster sampling. A continuous improvement group was implemented in order to the factors causing detected problems and their possible solutions were analyzed.LocationRambla PCC, Sant Feliu de Llobregat. Catalonian Health Institute.Participants and contextUsers/clients of the PCC who were in the waiting room. Improvement Group: Professionals of Sant Feliu Primary Care Team and Baix Llobregat Nord Primary Care Service.InterventionsReorganization of the family doctors’ agendas and reduction of bureaucratic tasks in the physicians’ offices.Principal measurementsRespondents sociodemographic data, and reasons for their dissatisfaction. Determinants of the problem were analyzed. The principal cause of discomfort was the delay of previous appointment.ResultsAmong reasons for discomfort expressed by the users, the most frequent was lag time with 16% (95% CI, 10.9-21.1). This complaint referred both to wait for obtaining visit and to be in the waiting room before being visited. As determinants of delay there were identified a high number of patients, visits duplicity, bureaucratic visits, high number of urgent visits and an insufficient previous appointment visits.ConclusionsPatient's opinions help us to know how public health services are accomplishing their expectations. Process improvement is indispensable in order to provide a quality product, but it must be endowed with resources adequacy to population needs

RNA-Seq, bioinformatic identification of potential microRNA-like small RNAs in the edible mushroom Agaricus bisporus and experimental approach for their validatiol

Although genomes from many edible mushrooms are sequenced, studies on fungal micro RNAs (miRNAs) are scarce. Most of the bioinformatic tools are designed for plants or animals, but the processing and expression of fungal miRNAs share similarities and differences with both kingdoms. Moreover, since mushroom species such as Agaricus bisporus (A. bisporus, white button mushroom) are frequently consumed as food, controversial discussions are still evaluating whether their miRNAs might or might not be assimilated, perhaps within extracellular vesicles (i.e., exosomes). Therefore, the A. bisporus RNA-seq was studied in order to identify potential de novo miRNA-like small RNAs (milRNAs) that might allow their later detection in diet. Results pointed to 1 already known and 37 de novo milRNAs. Three milRNAs were selected for RT-qPCR experiments. Precursors and mature milRNAs were found in the edible parts (caps and stipes), validating the predictions carried out in silico. When their potential gene targets were investigated, results pointed that most were involved in primary and secondary metabolic regulation. However, when the human transcriptome is used as the target, the results suggest that they might interfere with important biological processes related with cancer, infection and neurodegenerative disease

Intrinsic correlation between the fraction of liquidlike zones and the beta relaxation in high-entropy metallic glasses

Lacking the structural information of crystalline solids, the origin of the relaxation dynamics of metallic glasses is unclear. Here, we report the evolution of stress relaxation of high-entropy metallic glasses with distinct ß relaxation behavior. The fraction of liquidlike zones, determined at each temperature by the intensity of stress decay, is shown to be directly related to both the aging process and the spectrum of relaxation modes obtained by mechanical spectroscopy. The results shed light on the intrinsic correlation between the static and dynamic mechanical response in high-entropy and conventional metallic glasses, pointing toward a sluggish diffusion high-entropy effect in the liquid dynamics.Postprint (author's final draft

ESPACIO EUROPEO DE EDUCACIÓN SUPERIOR. Situación actual. Marco legislativo.

Nowadays the number of nursing schools including in their study plans the Practicum subjects are increasing. These subjects are devoted to clinical practice and the majority of practical credits belonging to clinical subjects are concentrated on them. The reasons for it are that these subjects link the learning methodology proposed by the European Space for Higher Education. In the present work, which is a continuation of a previous one published in this journal, we propose a Teaching Project to give the Medical-Surgical Nursing clinical practicum of the study plans for the Registered Nursing degree. Following the same structure of our previous work, we propose a methodology based on the teaching of competences. The program and the system of credits are in line with the ancient Law of University Reform but they are also compatible with convergent method of the European Space for Higher Education. In the same way, we chose this subject on the grounds of its high credit load on the current study plans (being clinical the majority of them). All this make that steps to achieve convergence for this subject could be used for other nursing subject.El objetivo de este artículo es realizar un análisis de la legislación actual y la repercusión del cambio ya iniciado en algunas titulaciones como es el caso de Enfermería en el marco académico de la Educación Superior, reforma importante del Sistema Universitario Español. Para ello se revisa el contenido y análisis de la documentación publicada en el Ministerio de Educación relativa a Educación Superior; la legislación vigente española y la legislación Comunitaria con objeto de aproximar la legislación al marco de los estudios de enfermería

Los recursos humanos para la vigilancia en salud pública en el sistema nacional de salud: necesidad de una nueva política

XLI Reunión anual de la Sociedad Española de Epidemiología (SEE) y XVIII Congresso da Associação Portuguesa de Epidemiología (APE). Porto (Portugal), del 5 al 8 de septiembre de 2023.Antecedentes/Objetivos: La Estrategia de Vigilancia en Salud Pública (VSP) del Sistema Nacional de Salud (SNS) y la Declaración de Zaragoza de 2022 sobre VSP establecen la necesidad de una política de recursos humanos que garantice la efectividad y la calidad de la VSP. Uno de los objetivos de la Estrategia es hacer un análisis de la situación de la VSP, y como parte de este análisis, coordinado por el Ministerio de Sanidad se ha realizado un estudio del marco de recursos humanos y formación con la participación de las CC. AA. y el nivel central. Métodos: Encuesta estructurada a CC. AA., MS e ISCIII de enero a marzo de 2023. El estudio se centra en seis ámbitos: 1) Ordenación de personal, 2) Plantillas de recursos humanos en VSP en número y funciones, 3) Retribuciones y desarrollo profesional 4) Formación, 5) Ofertas de empleo público y convocatorias públicas de plazas (OEP) y 6) Mecanismos de refuerzo de plantillas de VSP ante situaciones de alerta. Resultados: Han respondido a la encuesta 16 CC. AA., el MS y el CNE (ISCIII). Los resultados definitivos del estudio estarán disponibles en junio de 2023. Se presentarán resultados sobre los perfiles de los profesionales que trabajan en VSP: número de profesionales (plazas cubiertas dotadas y ocupadas, cubiertas sin dotar, vacantes y cedidas), género, edad, régimen profesional, distribución territorial (local, provincial, autonómico), tipos de plazas que ocupan en el SNS, evolución de estas plazas en los últimos 5 años y formación. Además, se presentarán resultados relativos a las condiciones laborales: carrera profesional, retribuciones y guardias, así como a los distintos mecanismos de ordenación de personal que existen en las administraciones públicas para realizar las funciones de VSP. Conclusiones/Recomendaciones: Como se ha demostrado durante la pandemia de COVID-19, para llevar a cabo una vigilancia de calidad, una prioridad es contar con los recursos humanos adecuados. Para ello, es necesario adecuar las plantillas actuales a los nuevos requerimientos de la VSP, tanto en número de efectivos y capacitación para asumir nuevos retos, como en la incorporación de nuevos perfiles profesionales. Es preciso impulsar una política de recursos humanos en todo el SNS para dar solución a estos déficits y fortalecer la VSP y el desarrollo coordinado en todo el SNS de estructuras de salud pública dotadas de los recursos humanos, tecnológicos y presupuestarios necesarios para el desempeño eficaz de sus funciones.Financiación: estudio financiado con fondos del PRTR.N

Incidence, clinical characteristics and management of inflammatory bowel disease in Spain: large-scale epidemiological study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD—Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)—during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100, 000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31–56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Recovery of dialysis patients with COVID-19 : health outcomes 3 months after diagnosis in ERACODA

Background. Coronavirus disease 2019 (COVID-19)-related short-term mortality is high in dialysis patients, but longer-term outcomes are largely unknown. We therefore assessed patient recovery in a large cohort of dialysis patients 3 months after their COVID-19 diagnosis. Methods. We analyzed data on dialysis patients diagnosed with COVID-19 from 1 February 2020 to 31 March 2021 from the European Renal Association COVID-19 Database (ERACODA). The outcomes studied were patient survival, residence and functional and mental health status (estimated by their treating physician) 3 months after COVID-19 diagnosis. Complete follow-up data were available for 854 surviving patients. Patient characteristics associated with recovery were analyzed using logistic regression. Results. In 2449 hemodialysis patients (mean ± SD age 67.5 ± 14.4 years, 62% male), survival probabilities at 3 months after COVID-19 diagnosis were 90% for nonhospitalized patients (n = 1087), 73% for patients admitted to the hospital but not to an intensive care unit (ICU) (n = 1165) and 40% for those admitted to an ICU (n = 197). Patient survival hardly decreased between 28 days and 3 months after COVID-19 diagnosis. At 3 months, 87% functioned at their pre-existent functional and 94% at their pre-existent mental level. Only few of the surviving patients were still admitted to the hospital (0.8-6.3%) or a nursing home (∼5%). A higher age and frailty score at presentation and ICU admission were associated with worse functional outcome. Conclusions. Mortality between 28 days and 3 months after COVID-19 diagnosis was low and the majority of patients who survived COVID-19 recovered to their pre-existent functional and mental health level at 3 months after diagnosis

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research