Nurses' perceptions of patient safety culture : a mixed-methods study

There are relatively few qualitative studies concerning patient safety culture. We aimed to explore patient safety culture as perceived by the nursing staff in two public hospitals in Catalonia, Spain. A mixed-methods design was employed using a questionnaire, in-depth interviews, and non-participant observations. Sixty-two percent of the nursing staff rated patient safety as "Acceptable" but was not higher because of work pressure and lack of resources as perceived by staff. "Teamwork within units" had the highest rate of positive responses, and "Staffing" had the lowest rate. Emergency units showed more negative results than the other two units. Safety incidents are not always reported due to fear of punishment, reflecting a lack of positive safety culture. It is necessary to design and implement strategies that promote a positive culture to avoid punitive responses and apply and evaluate these changes

Efficiency as a determinant of loyalty among users of a community of clinical practice: a comparative study between the implementation and consolidation phases

A community of clinical practice called the Online Communication Tool between Primary and Hospital Care (ECOPIH) was created to enable primary care and specialist care professionals to communicate with each other in order to resolve real clinical cases, thereby improving communication and coordination between care levels. The present work seeks to analyse whether ECOPIH makes it possible to reduce the number of referrals. To that end, the objectives are: (1) To find out the degree of loyalty among ECOPIH users, by comparing the medical professionals' profiles in the tool's implementation phase to those in its consolidation phase. (2) To evaluate the degree of fulfilment of users' expectations, by establishing the determining factors that had an influence on the physicians' intention to use ECOPIH in the implementation phase and observing whether its use had an effective, direct impact on the number of patient referrals that primary care physicians made to specialist care professionals. Two studies were conducted. Based on a survey of all the physicians in a Primary Care area, Study 1 was a descriptive study in ECOPIH's implementation phase. Study 2 was a randomised intervention study of ECOPIH users in the tool's consolidation phase. The results from both studies were compared. Various bivariate and multivariate statistical techniques (exploratory factor analysis, cluster analysis, logistic regression analysis and ANOVA) were used in both studies, which were conducted on a sample of 111 and 178 physicians, respectively. We confirmed the existence of an ECOPIH user profile stable across both phases: under-50-year-old women. Regarding the second objective, there were two particular findings. First, the discriminant factors that had an influence on greater ECOPIH use were habitual Social media website and app use and Perceived usefulness for reducing costs. Second, PC professionals who were ECOPIH members made fewer referrals to SC professionals in Cardiology, Endocrinology and Gastroenterology than older PC professionals who were not ECOPIH members. The use of a community of clinical practice by primary care and specialist care professionals helps to reduce the number of referrals among medical professionals

Increasing Cervical Cancer Screening Coverage: A Randomised, Community-based Clinical Trial

Background: Opportunistic cervical cancer screening can lead to suboptimal screening coverage. Coverage could be increased after a personalised invitation to the target population. We present a community randomized intervention study with three strategies aiming to increase screening coverage. Methods: The CRICERVA study is a community-based clinical trial to improve coverage of population-based screening in the Cerdanyola SAP area in Barcelona. A total of 32,858 women residing in the study area, aged 30 to 70 years were evaluated. A total of 15,965 women were identified as having no registration of a cervical cytology in the last 3.5 years within the Public Health data base system. Eligible women were assigned to one of four community randomized intervention groups (IGs): (1) (IG1 N = 4197) personalised invitation letter, (2) (IG2 N = 3601) personalised invitation letter + informative leaflet, (3) (IG3 N = 6088) personalised invitation letter + informative leaflet + personalised phone call and (4) (Control N = 2079) based on spontaneous demand of cervical cancer screening as officially recommended. To evaluate screening coverage, we used heterogeneity tests to compare impact of the interventions and mixed logistic regression models to assess the age effect. We refer a "rescue" visit as the screening visit resulting from the study invitation. Results: Among the 13,886 women in the IGs, 2,862 were evaluated as having an adequate screening history after the initial contact; 4,263 were lost to follow-up and 5,341 were identified as having insufficient screening and thus being eligible for a rescue visit. All intervention strategies significantly increased participation to screening compared to the control group. Coverage after the intervention reached 84.1% while the control group reached 64.8%. The final impact of our study was an increase of 20% in the three IGs and of 9% in the control group (p<0.001). Within the intervention arms, age was an important determinant of rescue visits showing a statistical interaction with the coverage attained in the IGs. Within the intervention groups, final screening coverage was significantly higher in IG3 (84.4%) (p< 0.001). However, the differences were more substantial in the age groups 50-59 and those 60+. The highest impact of the IG3 intervention was observed among women 60+ y.o with 32.0% of them being rescued for screening. The lowest impact of the interventions was in younger women. Conclusions: The study confirms that using individual contact methods and assigning a fixed screening date notably increases participation in screening. The response to the invitation is strongly dependent on age

Relationship between Retinal Microvasculature, Cardiovascular Risk and Silent Brain Infarction in Hypertensive Patients

Risc cardiovascular; Hipertensió; Microvasculatura retinianaRiesgo cardiovascular; Hipertensión; Microvasculatura retinianaCardiovascular risk; Hypertension; Retinal microvasculatureObjective: The aims of this study are to analyze the role of artery-vein ratio AVR assessment using VesselMap 2 software (Imedos Systems) and cardiovascular risk evaluation by means of REGICOR in the prediction of silent brain infarction (SBI) in middle-age hypertensive patients from the ISSYS study. Material and Methods: A cross-sectional study with 695 patients with hypertension aged 50 to 70 years who participated in the project Investigating Silent Strokes in HYpertensives: a Magnetic Resonance Imaging Study (ISSYS), was conducted in two Primary Care Centres of Barcelona. Participants agreed to a retinography and an MRI to detect silent brain infarction (SBI). The IMEDOS software was used for the semiautomatic caliber measurement of retinal arteries and veins, and the AVR was considered abnormal when <0.66. The REGICOR score was calculated for all patients. Results: Multivariate logistic regression analysis was used to evaluate the impact of AVR and REGICOR scores on SBI. The OR (odds ratio) for a high REGICOR score and an abnormal AVR were 3.16 and 4.45, respectively. When analysing the interaction of both factors, the OR of an abnormal AVR and moderate REGICOR score was 3.27, whereas with a high REGICOR score it reached 13.07. Conclusions: The measurement of AVR in patients with hypertension and with a high REGICOR score can contribute to the detection of silent brain infarction.This project was co-funded by the Basque Government and the European Regional Development Fund

Perinatal contraceptive counselling: effectiveness of a reinforcement intervention on top of standard clinical practice

Objective: to assess the effectiveness of supplemental perinatal contraceptive counselling in addition to standard Spanish postpartum contraceptive counselling with regard to contraceptive use and use of effective contraception up to 1 year postpartum. Women's satisfaction with counselling and the method chosen was also assessed. Design: community-randomized trial. Setting: 'Reproductive and Sexual Health Care' units of the National Health Care System at twenty public Primary Care facilities in Catalonia. Participants: 1,004 consecutive pregnant women (~week 30) receiving prenatal care between 1st October 2015 and 31st March 2016. Women were considered eligible for analysis if appropriate information was available. Interventions: at half of the centres, midwives provided the standard Spanish postpartum contraceptive counselling (control group, CG). At the other half, supplemental perinatal contraceptive counselling was provided in addition to standard counselling (intervention group, IG) at different time points during pregnancy and postpartum. This consisted of a leaflet and a blog with practical information about all contraceptive options plus a short reminder message in the mobile phone during the third quarter of pregnancy and a face-to-face or a virtual meeting lasting 20 min in the first 15 days postpartum. Midwives used ad hoc questionnaires to collect information at week 30 of pregnancy (recruitment), and week 6, month 6 and month 12 postpartum. Measurements and findings: 975 women were eligible for analysis (482 in the CG and 493 in the IG). ~33% women had resumed sexual intercourse by week 6, and nearly all by months 6 and 12. Use and effectiveness of contraceptives was similar in both groups at week 6 and month 6. At month 12, more women in the IG used more effective contraception and less women used contraceptives considered somewhat effective vs. those of the CG (P = 0.006). When considering the place of origin, this was only true for Spanish women. Women of other origins had a much higher use of very effective contraceptives at month 12 also in the CG, with contraceptive counselling having scarce effect. On multivariate analysis, conducted only in Spanish women, the additional counselling resulted in a higher use of highly effective methods while having a university degree increased 3.6 times the OR for this behaviour. A bias towards fostering use of very effective contraceptives among women with low education was seen in standard clinical practice. Satisfaction with counselling and the type of contraception chosen was higher in the IG. Key conclusions: our study has shown that the supplemental counselling tested has a moderate impact on contraceptive use and use of effective contraception in postpartum women. Results of this effort were seen after 6 months postpartum. A possible bias towards women who were more socially vulnerable was found in standard clinical practice, which reduced the effectiveness of the intervention in women who were otherwise the most needy. Implications for practice: despite the benefits provided by supplemental support in perinatal contraceptive counselling, the existence of a possible bias affecting the effectiveness of these interventions should be investigated and addressed

Factors que influencien l'adopció i l'ús de les comunitats virtuals de pràctica clínica

L'any 2009 es va implementar a diferents centres mèdics de Badalona i Sant Adrià de Besòs ECOPIH, una plataforma de comunicació online entre professionals d'Atenció Primària i Atenció Especialitzada per tal d'establir un sistema de comunicació que permeti agilitzar i optimitzar l'atenció que reben els pacients. Aquest estudi ha analitzat l'ús d'ECOPIH entre els cossos mèdic i d'infermeria. Els resultats mostren que la percepció d'utilitat d'aquesta plataforma web 2.0 ve determinada per factors organitzacionals, tecnològics i socials.En el año 2009 se implementó en diferentes centros médicos de Badalona y Sant Adrià de Besòs ECOPIH, una plataforma de comunicación online entre profesionales de Atención Primaria y Atención Especializada para establecer un sistema de comunicación que permita agilizar y optimizar la atención que reciben los pacientes. Este estudio ha analizado el uso de ECOPIH entre los cuerpos médico y de enfermería. Los resultados muestran que la percepción de utilidad de esta plataforma web 2.0 viene determinada por factores organizacionales, tecnológicos y sociales

Impact of dietary habit, iodine supplementation and smoking habit on urinary iodine concentration during pregnancy in a catalonia population

1) Background: The nutritional status of women during pregnancy can have a considerable effect on maternal and fetal health, and on the perinatal outcome. Aim: to assess the changes occurring in dietary iodine intake, potassium iodide supplementation, and smoking habit, and the impact of these changes on the urinary iodine concentration (UIC) during pregnancy in a population of women in Catalonia (Spain). (2) Methods: Between 2009-2011, an observational study included a cohort of women whose pregnancies were monitored in the public health system in the Central and North Metropolitan areas of Catalonia. Women received individual educational counseling, a dietary questionnaire was completed, and a urine sample was collected for iodine determination at each trimester visit. (3) Results: 633 (67.9%) women answered the questionnaire at all 3 visits. The percentage of women with a desirable UIC (≥150 μg/L) increased from the first to the second trimester and remained stable in the third (57.3%, 68.9%, 68%; p < 0.001). Analysis of the relationship between UIC≥150 μg/L and the women's dietary habits showed that the percentage with UIC ≥150 μg/L increased with greater consumption of milk in the first trimester, and the same was true for iodized salt use in all three trimesters and iodine supplementation in all three. (4) Conclusion: During pregnancy, increased intake of milk, iodized salt, and iodine supplements were associated with an increase in the UIC. Keywords: pregnancy; iodine; dietary habits; iodine supplement; urinary iodine concentratio

Increasing Cervical Cancer Screening Coverage: A randomised, Community-Based Clinical Trial

Altres ajuts: The project received a research grant from the Carlos III Institute of Health, Ministry of Economy and Competitiveness (Spain), awarded on the 2010 call under the Health Strategy Action 2013-16, within the National Research Program oriented to Societal Challenges within the Technical, Scientific and Innovation Research National Plan 2013-16 with reference PI10/01275 co-funded with European Union ERDF funds. Additional support was provided by the European Regional Development Fund (ERDF), public grants from the Carlos III Institute of Health (RTIC RD06/0020/0095 RD12/0036/0056 and CIBERESP) and the Agència de Gestió d'Ajuts Universitaris i de Recerca (grants AGAUR 2014SGR1077 and 2014SGR2016) and the Primary Health Care Unit IDIAP Jordi Gol and the Catalan Institute of Health resolved 07/04/2014.Background. Opportunistic cervical cancer screening can lead to suboptimal screening coverage. Coverage could be increased after a personalised invitation to the target population. We present a community randomized intervention study with three strategies aiming to increase screening coverage.Methods. The CRICERVA study is a community-based clinical trial to improve coverage of population based screening in the Cerdanyola SAP area in Barcelona.A total of 32,858 women residing in the study area, aged 30 to 70 years were evaluated. A total of 15,965 women were identified as having no registration of a cervical cytology in the last 3.5 years within the Public Health data base system. Eligible women were assigned to one of four community randomized intervention groups (IGs): (1) (IG1 N = 4197) personalised invitation letter, (2) (IG2 N =3601) personalised invitation letter + informative leaflet, (3) (IG3 N = 6088) personalised invitation letter + informative leaflet + personalised phone call and (4) (Control N = 2079) based on spontaneous demand of cervical cancer screening as officially recommended. To evaluate screening coverage, we used heterogeneity tests to compare impact of the interventions and mixed logistic regression models to assess the age effect. We refer a ªrescueº visit as the screening visit resulting from the study invitation. Results. Among the 13,886 women in the IGs, 2,862 were evaluated as having an adequate screening history after the initial contact; 4,263 were lost to follow-up and 5,341 were identified as having insufficient screening and thus being eligible for a rescue visit. All intervention strategies significantly increased participation to screening compared to the control group. Coverage after the intervention reached 84.1% while the control group reached 64.8%. The final impact of our study was an increase of 20% in the three IGs and of 9% in the control group (p<0.001). Within the intervention arms, age was an important determinant of rescue visits showing a statistical interaction with the coverage attained in the IGs. Within the intervention groups, final screening coverage was significantly higher in IG3 (84.4%) (p<0.001). However, the differences were more substantial in the age groups 50±59 and those 60+. The highest impact of the IG3 intervention was observed among women 60+ y.o with 32.0% of them being rescued for screening. The lowest impact of the interventions was in younger women.Conclusions. The study confirms that using individual contact methods and assigning a fixed screening date notably increases participation in screening. The response to the invitation is strongly dependent on age

La anticoncepción durante la cuarentena: situación actual y colectivos más vulnerables a embarazos no planificados durante este periodo.

Objetivos: Conocer la prevalencia de reinicio de relaciones sexuales coitales (RSC) en mujeres puérperas, antes de las 6 semanas posparto, cuántas tienen cobertura anticonceptiva inadecuada y sus características. Sujetos, material y método: Estudio transversal de datos recogidos en mujeres participantes en el grupo control del estudio MAYA, llevado a cabo en 20 centros de Cataluña con el fin de analizar la efectividad a largo plazo de un programa de asesoramiento anticonceptivo posparto de refuerzo (grupo intervención, 10 centros) con respecto a la práctica clínica habitual (grupo control, 10 centros). Los datos analizados provienen de la información recogida a las 30 semanas de embarazo y a las 6 semanas posparto. No usar métodos anticonceptivos y el coito interrumpido se consideraron «cobertura anticonceptiva inadecuada». Resultados: Se analizaron 428 mujeres de 32 ± 5,1 años. El 32,9% (n= 141) había reiniciado las RSC antes de las 6 semanas posparto, y el 20% (n= 28) tenía una cobertura anticonceptiva inadecuada. Las mujeres <30 años o usuarias de lactancia artificial frente a mixta/materna reiniciaron las RSC durante la cuarentena con más frecuencia. Las extranjeras frente a las españolas, con un menor nivel educativo o que daban lactancia mixta frente a artificial/materna presentaron más frecuentemente una cobertura anticonceptiva inadecuada. Las que no eran laboralmente activas o no habían planificado la gestación presentaban ambos comportamientos. Conclusiones: Una de cada 3 mujeres inicia las relaciones sexuales antes de las 6 semanas, y de éstas, 1 de cada 5 no tiene una cobertura anticonceptiva adecuada. Este estudio ha identificado las características de mujeres que podrían ser especialmente vulnerables a embarazos no planificados