A comparative evaluation of internal medicine wards in spain

Objective – This analysis investigates the functional and environmental quality of several internal medicine wards in Spain. Background – Despite the economic recession, the Spanish healthcare system has proven to be resilient. In the near future, Spain will be faced with the demographic challenge of an ever-ageing population. Further efforts should be made to ensure a sustainable and affordable healthcare system. The elderly population is the group that requires the highest rates of healthcare resources, especially in acute-care hospitals, with the maximum hospital attendances and the longest average length of stay. Since there is scientific evidence that links healthcare outcomes with design (evidence-based-design), one way of improving the efficiency of healthcare delivery is by enhancing the quality of existing internal medicine wards as it is usually the place where the elderly inpatients are cared for. Post-Occupancy- Evaluation (POE) tools have been used globally to assess the performance of existing buildings but little has been applied in the Spanish context. Research question – How well do existing internal medicine wards perform in relation to guidelines and research on functional and environmental quality? Methods – Both quantitative and qualitative methods have been used in this case study for the triangulation of data. Four internal medicine wards have been evaluated with the following methods: architectural layout analysis, photo analysis and a POE tool designed for the Spanish context (CURARQ-H). Results – Not surprisingly, the oldest ward scores lower than the most recent buildings. The analysis reveals that the patients’ area is the one that gets better grades while the access area scores the lowest marks. Further details on improvement measures are given for each ward area. Conclusion – Compared to Scandinavia, USA or Canada, healthcare architecture in Spain is being slow to embark on EBD. This evaluation method together with CURARQ-H tool could be an enabler for generating synergies between healthcare staff and architects in Spain and work as an accelerator in the use of EBD at a national level.publishedVersio

Evaluación de la arquitectura hospitalaria: unidad de neonatología

The pursuit of efficiency and quality is particularly relevant in healthcare architecture because its design has a direct impact on clinical outcomes. Within a hospital, the neonatal unit is the place where patients are most vulnerable to their surrounding environment. This study evaluates the design of two Spanish neonatal units using architectural layout analysis, photo analysis and the post-occupancy-evaluation tool CURARQ-UNeo, and compares these against national guidelines and principles based on the evidence-based design process. The results from these studies are used to identify areas for improvement in each unit. This kind of evaluation might enhance the progress of the evidence-based design process in Spain, with the aim of guiding project decisions that contribute towards improving the quality of life of neonates, their relatives and the staff in the neonatal unit.La búsqueda de la eficiencia y la calidad es especialmente relevante en la arquitectura sanitaria ya que su diseño tiene una repercusión directa en los resultados clínicos obtenidos. Dentro del hospital, la unidad de neonatología es el lugar donde se atiende a los pacientes más vulnerables al entorno que les rodea. Este estudio evalúa el diseño de dos unidades españolas en relación con las guías de diseño nacionales y las recomendaciones del proceso de diseño basado en evidencias a partir del análisis de sus plantas, fotografías y la herramienta de evaluación post-ocupacional CURARQ-UNeo. Los resultados identifican las posibles actuaciones de mejora para cada unidad. Este tipo de evaluación puede impulsar el avance del proceso de diseño basado en evidencias en España con la finalidad de que las decisiones del proyecto contribuyan a mejorar la calidad de vida de los neonatos, sus familiares y el personal de una unidad de neonatología

ENE-COVID nationwide serosurvey served to characterize asymptomatic infections and to develop a symptom-based risk score to predict COVID-19

Objectives: To characterize asymptomatic SARS-CoV-2 infections and develop a symptom-based risk score useful in primary healthcare. Study design and setting: Sixty-one thousand ninty-two community-dwelling participants in a nationwide population-based serosurvey completed a questionnaire on COVID-19 symptoms and received an immunoassay for SARS-CoV-2 IgG antibodies between April 27 and June 22, 2020. Standardized prevalence ratios for asymptomatic infection were estimated across participant characteristics. We constructed a symptom-based risk score and evaluated its ability to predict SARS-CoV-2 infection. Results: Of all, 28.7% of infections were asymptomatic (95% CI 26.1-31.4%). Standardized asymptomatic prevalence ratios were 1.19 (1.02-1.40) for men vs. women, 1.82 (1.33-2.50) and 1.45 (0.96-2.18) for individuals <20 and ≥80 years vs. those aged 40-59, 1.27 (1.03-1.55) for smokers vs. nonsmokers, and 1.91 (1.59-2.29) for individuals without vs. with case contact. In symptomatic population, a symptom-based score (weights: severe tiredness = 1; absence of sore throat = 1; fever = 2; anosmia/ageusia = 5) reached standardized seroprevalence ratio of 8.71 (7.37-10.3), discrimination index of 0.79 (0.77-0.81), and sensitivity and specificity of 71.4% (68.1-74.4%) and 74.2% (73.1-75.2%) for a score ≥3. Conclusion: The presence of anosmia/ageusia, fever with severe tiredness, or fever without sore throat should serve to suspect COVID-19 in areas with active viral circulation. The proportion of asymptomatics in children and adolescents challenges infection control.The ENE-COVID study was supported by the Spanish Ministry of Health, the Institute of Health Carlos III, and the Spanish National Health System. The funders were in- volved in the study logistics, but they had no role in study design or in the collection, analysis, interpretation of data, or the decision to submit the article for publicationS

A comparative evaluation of internal medicine wards in spain

Objective – This analysis investigates the functional and environmental quality of several internal medicine wards in Spain. Background – Despite the economic recession, the Spanish healthcare system has proven to be resilient. In the near future, Spain will be faced with the demographic challenge of an ever-ageing population. Further efforts should be made to ensure a sustainable and affordable healthcare system. The elderly population is the group that requires the highest rates of healthcare resources, especially in acute-care hospitals, with the maximum hospital attendances and the longest average length of stay. Since there is scientific evidence that links healthcare outcomes with design (evidence-based-design), one way of improving the efficiency of healthcare delivery is by enhancing the quality of existing internal medicine wards as it is usually the place where the elderly inpatients are cared for. Post-Occupancy- Evaluation (POE) tools have been used globally to assess the performance of existing buildings but little has been applied in the Spanish context. Research question – How well do existing internal medicine wards perform in relation to guidelines and research on functional and environmental quality? Methods – Both quantitative and qualitative methods have been used in this case study for the triangulation of data. Four internal medicine wards have been evaluated with the following methods: architectural layout analysis, photo analysis and a POE tool designed for the Spanish context (CURARQ-H). Results – Not surprisingly, the oldest ward scores lower than the most recent buildings. The analysis reveals that the patients’ area is the one that gets better grades while the access area scores the lowest marks. Further details on improvement measures are given for each ward area. Conclusion – Compared to Scandinavia, USA or Canada, healthcare architecture in Spain is being slow to embark on EBD. This evaluation method together with CURARQ-H tool could be an enabler for generating synergies between healthcare staff and architects in Spain and work as an accelerator in the use of EBD at a national level

Evidence-based design accreditation and certification program for healthcare architecture reaches Spain

EDAC stands for Evidence-based Design Accreditation and Certification and identifies individuals able to apply the evidence-based design process for healthcare buildings. This process consists of basing design decisions on credible research to achieve the best possible outcomes. What differentiates this design process from others is its emphasis on using research both to inform a priori and to evaluate a posteriori design decision. The evidence-based design term appeared printed for the first time in 2000 but its origins date back to three key factors that happened years before: i) the evidence-based medicine movement, ii) the patientcentred care movement and, iii) a published paper that related a design strategy (the windows of the hospitalisation patient bedroom) with the recovery process of the patients. This scientific link between design and clinical outcomes not only evidenced the potential of architectural design on influencing patients' recovery but also the financial impact for the healthcare institutions. While in other countries evaluation mechanisms are already in place to improve the efficiency and performance of healthcare buildings, in Spain only one person has obtained the EDAC program. To what extent can this knowledge be incorporated into the Spanish design process for healthcare buildings and will this influence architects to confront their social responsibility with the healthcare system?S

La acreditación y certificación del diseño basado en evidencias para la arquitectura sanitaria llega a España

EDAC stands for Evidence-based Design Accreditation and Certification and identifies individuals able to apply the evidence-based design process for healthcare buildings. This process consists of basing design decisions on credible research to achieve the best possible outcomes. What differentiates this design process from others is its emphasis on using research both to inform a priori and to evaluate a posteriori design decision. The evidence-based design term appeared printed for the first time in 2000 but its origins date back to three key factors that happened years before: i) the evidence-based medicine movement, ii) the patientcentred care movement and, iii) a published paper that related a design strategy (the windows of the hospitalisation patient bedroom) with the recovery process of the patients. This scientific link between design and clinical outcomes not only evidenced the potential of architectural design on influencing patients’ recovery but also the financial impact for the healthcare institutions. While in other countries evaluation mechanisms are already in place to improve the efficiency and performance of healthcare buildings, in Spain only one person has obtained the EDAC program. To what extent can this knowledge be incorporated into the Spanish design process for healthcare buildings and will this influence architects to confront their social responsibility with the healthcare system?El acrónimo EDAC corresponde a las siglas inglesas Evidence-based Design Accreditation and Certification e identifica a las personas capaces de aplicar el proceso de diseño basado en evidencias en la arquitectura sanitaria. Este proceso consiste en fundamentar las decisiones de diseño en investigaciones creíbles con el fin de conseguir los mejores resultados posibles. Su principal característica reside en el énfasis del uso de la investigación, tanto para informar a priori como para evaluar a posteriori las decisiones de diseño. El término Evidence-Based Design apareció impreso por primera vez en 2000, aunque sus orígenes se remontan a tres factores clave que sucedieron años atrás: i) el movimiento de la medicina basada en evidencias; ii) el movimiento de los cuidados centrados en los/las pacientes; iii) la publicación de un estudio científico que relacionaba una estrategia de diseño (las ventanas de la habitación de hospitalización) con el proceso de recuperación de los pacientes. Este vínculo empírico entre el diseño y los resultados médicos puso en evidencia no solo el potencial que tiene el diseño arquitectónico en la recuperación de pacientes, sino la repercusión económica que supone para las instituciones sanitarias. Mientras que en otros países ya se utilizan mecanismos de evaluación de la arquitectura sanitaria para mejorar la efectividad de sus infraestructuras, en España tan solo una persona cuenta con la certificación EDAC. ¿Hasta dónde se podría llegar si se incorporara este conocimiento al proceso de diseño y los/las arquitectos/ as afrontaran su responsabilidad social para con el sistema sanitario

Hospital Architecture in Spain and Italy: Gaps Between Education and Practice

Aim The research sheds light on the challenges and limitations of Spanish and Italian hospital design by looking at the gaps between education and practice. Background Hospital design plays an important role in providing high-quality and cost-effective facilities for any healthcare system. Spain and Italy face contemporary challenges (i.e., elderly population, staff retention, and obsolete healthcare facilities) and have similar issues of life expectancy, health expenditure, hospital beds provision, and decentralized tax-financed healthcare systems. Method A cross-sectional, mixed-method study was used. This involved two different data collection strategies and analysis for each area of investigation: (i) education and (ii) practice. For the former, educational programs were reviewed via a web search; for the latter, an online survey of 53 architectural/engineering offices involved in hospital design was conducted. Results Hospital design education is limited to 0/58 in Spanish and 2/60 courses in Italian universities, although each country offers three postgraduate courses. The practitioners’ survey shows that even though their offices have a long history of healthcare design, only 48% in Spain and 60% in Italy have received specific university training. Office staff lack employees with medical backgrounds, which hinders any partnership between health and design fields either for design practice or the education fields. Laws, national regulations, technical guidelines, and previous experience are the most useful information sources, while international scientific publications appear underused by practitioners. Conclusions Italian and Spanish healthcare architecture could be improved by promoting multidisciplinary teams (in practice and education) and improving the education offer by tailoring it to national needs

Tras el estallido de la burbuja inmobiliaria ¿es posible una política social de vivienda en España?

Mesa redonda celebrada el 27 de noviembre de 2013 dentro de las jornadas "Conversaciones-Solasaldiak", organizadas por el Parlamento de Navarra y la Universidad Pública de NavarraEn el ámbito de la vivienda se produce una paradoja dramática en España, la convivencia de un gran número de viviendas vacías con un amplio sector de la población con dificultades de acceso o mantenimiento de la vivienda. El escaso desarrollo de un sector de política social de vivienda en España, a diferencia de otros países europeos, sólo puede ser explicado por la colisión del objetivo público de cobertura de las necesidades de la población con los intereses económicos de diversos sectores de nuestra economía. El estallido de la burbuja quizás constituye un momento en el que replantear una apuesta por un nuevo modelo de política de vivienda que la haga más accesible al conjunto de la población