Legibilidad de los consentimientos informados de España y Flandes

El proceso de consentimiento informado, nace de la necesidad de otorgar a los ciudadanos la autonomía para poder decidir sobre las posibles actuaciones sanitarias propuestas para él mismo o para la persona a la que representa. (Ley 41/2002 de 14 de noviembre, básica reguladora de la autonomía. Ley 2002 de 22 de agosto de derechos de los pacientes). La información es la base de todo el proceso, ya que gracias a ésta, el ciudadano puede conocer la identidad, objetivos y posibles riesgos a los que enfrentarse. La información emana de los profesionales sanitarios y es obligación moral y legal proporcionarla de forma adecuada a cada persona (Simón-Lorda, 2000). De la información adecuada nacerá la comprensión, ésta, será la responsable de una buena toma de decisiones. El documento de consentimiento informado aumenta las posibilidades de afianzamiento de ia información ofrecida de forma verbal (Escudero-Carretero, et al, 2013). En España la Ley 41/2002 de 14 de noviembre estima obligatoria la recogida de un documento de consentimiento informado escrito para "intervenciones quirúrgicas, procedimientos terapéuticos o diagnósticos invasores y, en general, aquellos aplicación de procedimientos que suponen riesgos o inconvenientes de notoria y previsible repercusión negativa sobre la salud del paciente". Sin embargo, en la legalidad belga, solo se estima precisa la recogida por escrito del consentimiento si el paciente lo requiere o el profesional lo estima oportuno asimismo, expresa que debe evitarse el uso prolongado del documento de consentimiento informado ya que puede impedir que ia comunicación entre profesional y paciente sea uniforme y estandarizada. (Ley 2002 de 22 de agosto de derechos de los pacientes) Pero hay que tener en cuenta que el documento de consentimiento informado debe estar elaborado de acuerdo a estándares de legibilidad adaptados a todo tipo de lector. Una sencilla herramienta para analizar el nivel de legibilidad de los consentimientos informados en español es Inflesz, Este software permite conocer por escalas el nivel de legibilidad y representa una manera fácil de evaluar los consentimientos elaborados (Barrio-Cantalejo, et al, 2003 y 2008). A lo largo de los años se han realizado estudios sobre la legibilidad de los documentos de consentimiento informado en España, pero circunscritos a determinados Hospitales o Servicios. (Navarro-Royo, et ai, 2002,, Casajús-Pérez et al 2005, Creu et al, 2005, Calle-Urra et al, 2013) Este hecho nos revela el desconocimiento de la legibilidad de ios consentimientos informados en la totalidad de España. Asimismo, se desconoce tanto ei acceso como la calidad de información sanitaria que reciben los usuarios españoles y flamencos. Nuestro objetivo principal pretende describir esta situación mediante el análisis de la legibilidad de los consentimientos informados de la Red de Hospitales públicos de España y Flandes. Como objetivos específicos, describir el proceso de consentimiento informado de España y Flandes así como realizar un estudio cualitativo de ambos objetivos. Material y métodos. Estudio descriptivo mixto. En España se recogieron un total de 11640 consentimientos informados (DCI) de una población desconocida a través de los portales web de salud, las páginas web de los Hospitales y el contacto tanto email como telefónico con Gerencias, Dirección médica y enfermera, los servicios de Calidad, Documentación clínica, Comité Ético Asistencial y Docencia e Investigación desde marzo de 2012 a febrero de 2013. Se seleccionó una muestra de 372 (DCI) para analizar la legibilidad mediante el instrumento Inflesz. Este instrumento valora los parámetros número de palabras, silabas y frases, promedio sílabas/paiabra y palabras/frase, índice de correlación Word, índice de Flesch-Szigriszt, índice de Fernández-Huerta y grado en ia escala Infíesz, Además se analizaron las variables identidad de los CI como ia CCAA a la que pertenecían y el Hospital, la finalidad del DCI (Diagnóstico, tratamiento, Mixto o Miscelánea), el número de páginas y ia estandarización. En Flandes se recogieron un total de 155 DCI de una población desconocida a través de las páginas web de los Hospitales públicos y se seleccionó una muestra de 75DCI para analizar la legibilidad a través del instrumento Douma que analiza ia legibilidad de los textos basándose en ia largura de las frases, palabras y sílabas. Se añadieron variables como la provincia a la que correspondían los diferentes DCI, el número de páginas, la aparición o no de imágenes, las palabras y las frases. Para ia descripción del objetivo específico de descripción del proceso de consentimiento informado flamenco, se llevaron a cabo tres entrevistas abiertas a tres personas y se contactó con los Ombuds (defensores del pueblo) a través de un cuestionario cerrado autoadministrado al que contestaron 8 de ellos. El proceso de análisis de los objetivos generales corresponde con una metodología cuantitativa mientras que con los objetivos específicos se trabajó con metodología cualitativa. Resultados. La media de legibilidad de los DCI en España es de 48,78 en índice de Flesch. Esta media corresponde con la escala 'Algo Difícil' de Inflesz. El 65,3% de los CI se sitúan en la escala Inflesz 'Algo Difícil', el 20,2% en 'Normal' y el 12,8% en 'Muy Difícil'. La media de legibilidad más alta reside en las CCAA de Andalucía y Valencia y las más bajas en Melilla y Extremadura. En los CI estandarizados, el mayor porcentaje (52,7%) se sitúa en la escala 'Normal' y en los no estandarizados el 66,9% en la escala 'Algo Difícil'. La media de legibilidad de los DCI en Flandes es de 46,4 correspondiente en la escala de Douma a 'Difícil'. La media de legibilidad más alta reside en la provincia de Limburg mientras que WestVIaanderen posee la media de legibilidad más baja. Un 59,2% corresponden a DCI con 4 páginas o más y una media de legibilidad de 47,43 en Douma. Conclusiones. El nivel de legibilidad de los consentimientos informados de España y Flandes debe mejorarse ya que no se encuentra en escalas normales. Asimismo, existe una gran variabilidad de legibilidades entre CCAA y/o Hospitales, tanto españoles como flamencos. Este hecho clarifica la inequidad frente ai acceso a la información de los ciudadanos españoles y flamencos.Background. Regarding the right to health information, both laws Belgian and Spanish agree and guarantee this right due the necessity of providing patients with clear and adequate information at any time. (Article 4 and 5 Spanish law and article 7 of Belgian law). Initially, information should be given orally and this action should be registered in each clinic history (Article 7 in Belgian law and 4 in Spanish one).Belgian and Spanish laws: law 20 august 2002 of the rights of the patient, and Law 41/ 2002 on 14 November, of autonomy, duties and rights of the patients in information and clinical documentation subject. (Ley 41/2002 de 14 de noviembre, básica reguladora de la autonomía del paciente y de derechos y obligaciones en materia de información y documentación clínica)). Information is essential for a real informed consent process. Having access of a truly and comprehensible information from the beginning of the process facilitates a positive confrontation to illness and contributes to decrease anxiety or fear. It also prevents wrong believes. (Simón-Lorda, Júdez-Gutiérrez, 2001 and Escudero- Carretero, et a I, 2013). In addition, it is proved that if professionals provide oral information and then give patients written informed consent, it will work as a tool that guarantees real and truly information whenever a patient needs it. (Escudero- Carretero, et al, 2013). However, written informed consent has to be well done so as to achieve its virtues. The information collected in the informed consent should be based on the best science evidence available. This fact entails a preview researching work and a constant upgrade. (Escudero-Carretero, et al, 2013).In Spain, for instance, there are a lot of articles which prove that written informed consents have low readability, for example, Alvarez-Diaz (2011), Ezeome, et al, (2011), San-Norberto, et al, (2012) and Ramirez-Puerta et al, (2012). In these articles some written informed consents from some services of different Hospitals were analyzed. In Belgium, and although law of the patient's rights is clear about not giving written informed consent to patients if they do not ask for, in quotidian practice, surgeons tend to give written informed consents for large surgeries to their patients (Somville,FJ, Von Stritzky, M. (2008). This fact proves the need of analyzing written informed consents. The found bibliography shows that there are not articles in which all Belgian written informed consents have been analyzed. The same happens in Spain. So there is a hole in this field that has to be researched since it is necessary to know if those documents given to patients currently have good readability levels. And if they do not, we should be able to fix them to guarantee comprehension and improve patient's autonomy in their decisions. Results. The readability mean of the Spanish DCI is 48.78 according to the Flesch index. In the Inflesz index this mean represents the scale 'Some difficult^. The 65.3% of the DCI are included in the scale 'Some difficult', the 20.2% of the DCI are included in the scale 'Normal' and the 12.8% are included in the scale 'Very difficult7. The highest readability means correspond to Andalucía and Valencia. The lowest means correspond to Meiilla and Extremadura. The readability mean of the Flanders DCI is 46.4 according to the Douma index which represents the scale 'Difficult'. The highest readability mean corresponds to Limburg. The lowest mean corresponds to WestVlaanderen. The 59.2% of the DCI have 4 pages or more and readability mean of 47.43 in Douma. Conclusions. The readability's level of DCI in Spain and Flanders should be improved because their readability's levels are not included into 'Normal' scales. Furthermore, there is a huge variability of readability's levels among both Spanish and Flanders provinces and/or Hospitals. This fact clarifies that there is an inequity to the access of information among both Spanish and Flanders' citizens

Metaparadigm and innovative theorization on nursing theories and models

Objetivos: - Crear un metaparadigma compendio de las ideas esenciales y más actuales de las teóricas Orem, Roy, Leininger, Allen, Peplau, Henderson, Orlando, Rogers, Parse, Watson y Johnson. - Crear una teorización con el hilo conductor de Orem y las aportaciones de las autoras Roy, Leininger, Allen y Peplau, para aproximarnos a la práctica. Método: Instrumentos: los fundamentos teóricos enfermeros descritos por las diferentes autoras. Procedimiento: Pensamiento crítico- reflexivo utilizando una estructura de mayor a menor nivel de abstracción y a través de la generación de ideas. Resultados: Un metaparadigma y teorización innovadores y actuales que tienen como base la teoría de Orem (teoría de alto rango), que guió, dio sentido, forma y fiabilidad a nuestro nuevo constructo. Conclusiones: Se observa que es posible la sinergia de las teorías y modelos de Enfermería así como otorgarles un enfoque actual y moderno. Se abren líneas futuras de investigación que fundamenten el autocuidado y el cuidado como objeto propio de nuestra disciplina.Objectives: - To develop a new metaparadigm as a compendium of the essential ideas and the most current theories and models written by Orem, Roy, Leininger, Allen, Peplau, Henderson, Orlando, Rogers, Parse, Watson and Johnson. - To develop a theorization following the leitmotif of Orem´s theory and the contributions of authors such as Roy, Leininger, Allen and Peplau, to approach practice. Method: - Tools: Foundations described in the different theories we previously mentioned. - Procedure: Critical-thoughtful thinking using a structure with a wide level of abstraction and generation of ideas. Results: An innovative metaparadigm following the base of Orem´s theory (high ranking theory), which has led and supported our new development. Conclusions: We find out that it is possible to find synergies between theories and practical models in the Nursing Sector. New future researches focused on selfcare are open as a new discipline

Persistently positive PCR after COVID-19. How to diagnose reinfections?

La persistencia de una prueba de reacción en cadena de la polimerasa (PCR) positiva durante un tiempo prolongado en pacientes que han presentado un síndrome respiratorio grave asociado a coronavirus puede interferir en el diagnóstico de las reinfecciones, ocasionando así falsos positivos de la enfermedad, con las implicaciones que ello tiene para la necesidad de aislamiento y, en consecuencia, para la Salud Pública. Presentamos aquí la experiencia de una paciente con PCR positiva de ocho meses de evolución a la que se le diagnosticó erróneamente una reinfección de COVID-19 por una gastroenteritis aguda, resultando en realidad ser una infección por Campylobacter jejuni.Persistence of a long-term positive polymerase chain reaction (PCR) test in patients with severe coronavirus-associated respiratory syndrome may interfere with the diagnosis of reinfections, causing false positives of the disease, with the potential implications to determine the need for isolation and, consequently, for Public Health. In these field notes we present the experience of a patient with positive PCR of eight months of evolution to which an erroneous diagnosis of COVID-19 reinfection was made due to a gastrointestinal disease, resulting in a Campylobacter jejuni infection

Talent identification and location: A configurational approach to talent pools

Purpose: Talent management (TM) has become a strategic priority for companies seeking to identify employees with outstanding performances and the potential to hold strategic positions in the future. In fact, talent is considered an intangible capital that adds value to the organisation. However, there are only a handful of studies in the literature that address the process of identifying talent in organisations for its subsequent development. Thus, the purpose of this paper is to reach a better understanding of the process of identifying and locating talent, while proposing a configurational approach as a theoretical framework for grouping talented individuals into different configurations or talent pools to initiate talent development in firms. Design/methodology: Case study methodology research based on four companies that have implemented TM programmes in Spain. Findings: The research questions formulated here and the case studies shed light on the process of identifying talent and on the criteria for grouping it in order to facilitate its future development. Our results highlight the following. First, talent means people with certain characteristics. Second, companies focus more on developing the talent identified than on considering the innate nature of that talent. Finally, talent can be found throughout an organisation, in both management and non-management positions. In turn, we conclude with the relevant theoretical contribution of the configurational approach to explain that a company's future competitive advantage is based on the different talent pools existing in its organisation that group talent for its differential management. Practical implications: Our results imply major recommendations for companies on how to identify talent and group it into talent pools in order to implement a process of differentiated management involving a range of temporal pathways. Originality/value: The identification and location of talent, as well as grouping it into talent pools, is an essential prior process for proposing the talent architecture that is so much in demand in the literature

Evolution of a Cohort of COVID-19 Infection Suspects Followed-Up from Primary Health Care

Diagnosis and home follow-up of patients affected by COVID-19 is being approached by primary health care professionals through telephone consultations. This modality of teleconsultation allows one to follow the evolution of patients and attend early to possible complications of the disease. The purpose of the study was to analyze the evolution of a cohort of patients with suspected SARS-CoV-2 disease followed by primary care professionals and to determine the factors that are associated with hospital admission. A prospective cohort study was carried out on 166 patients selected by consecutive sampling that showed symptoms compatible with COVID-19. The follow-up was approached via telephone for 14 days analyzing hospitalization and comorbidities of the patients. There were 75% of the hospitalized patients that were male (p = 0.002), and 70.8% presented comorbidities (p < 0.001). In patients with diabetes, the risk of hospitalization was 4.6-times larger, in hypertension patients it was 3.3-times, those suffering from renal insufficiency 3.8-times, and immunosuppressed patients 4.8-times (IC 95%: 1.9–11.7). In 86.7% of the cases, clinical deterioration was diagnosed in the first seven days of the infection, and 72% of healing was reached from day seven to fourteen. Monitoring from primary care of patients with COVID-19 allows early diagnosis of clinical deterioration and detection of comorbidities associated with the risk of poor evolution and hospital admission

Aplicabilidad de las herramientas de ayuda a la toma de decisiones compartidas en los servicios de urgencias: una revisión exploratoria

Fundamentos: Las herramientas de ayuda en la toma de decisiones (HATD) han sido muy utilizadas en las enfermedades crónicas, pero existen pocos estudios sobre su utilidad en los servicios de urgencias. El objetivo de este estudio fue analizar la utilización de las HATD en los servicios de urgencias. Métodos: Se realizó una revisión exploratoria. Se realizaron búsquedas de ensayos clínicos aleatorizados y controlados, revisiones sistemáticas y otros estudios secundarios donde se utilizaran las HATD para la asistencia a pacientes de cualquier edad en los servicios de urgencias, entre el 1 de enero de 2012 y el 1 de agosto de 2019. Dos revisores examinaron y seleccionaron los estudios. Se utilizaron las siguientes bases de datos: Pubmed, Embase, Web Of Science, Cuiden, Patient Decision Aids Research Group IPDAS Collaboration, Cochrane, Centres for Reviews and Dissemination, National Guideline Clearinghouse, Guidelines International Network. Resultados: Se incluyeron doce estudios, de calidad metodológica moderada-baja. Los pacientes del Grupo de Intervención (GI) tenían mayor conocimiento de la enfermedad (=3,6 frente a 3 preguntas correctas y =4,2 frente a 3,6) y más implicación en las decisiones (puntuación en OPTION: 26,6 contra 7 y 18,3 contra 7). El conflicto se redujo en el GI en las decisiones sobre pruebas de imagen en el traumatismo craneoencefálico (TCE) (=14,8 frente a 19,2). En el GI era menos frecuente el ingreso para realizar una prueba de esfuerzo en casos de dolor torácico de bajo riesgo (58% contra 77%; IC95%=6%-31%, y 37% contra 52%; p<0,001). Cuando se utilizaba una HATD en niños con diarrea o vómitos, en el 80% la decisión era seguir una rehidratación oral frente al 61% en el GC (p=0,001). Conclusiones: Las HATD en los servicios de urgencias mejoran el conocimiento de los pacientes sobre la enfermedad y la participación en los cuidados. Se necesitan más estudios para desarrollar HATD en los servicios de urgenciasBackground: Decision aid tools (DAT) have been widely used in chronic diseases, but there are few studies on their usefulness in emergency departments. The objective of this study was to analyse the applicability of DAT in emergency services. Methods: An exploratory review was conducted. Between January 1, 2012 and August 1, 2019, searches of randomised and controlled clinical trials, systematic reviews and other secondary studies where DAT are used to assist patients of any age in emergency services were conducted. The databases used were: Pubmed, Embase, Web Of Science, Cuiden, Patient Decision Aids Research Group IPDAS Collaboration, Cochrane, Centres for Reviews and Dissemination, National Guideline Clearinghouse, Guidelines International Network. Two reviewers analysed and selected the studies. Results: Twelve studies of moderate-low quality were included. The patients in the intervention group (IG) were more aware of their illness (=3.6 vs 3 correct answers and =4.2 vs 3.6), and more involved in the decisions (score in OPTION: 26.6 vs 7 and 18.3 vs 7). The conflict was reduced in the IG regarding those imaging tests in the TBI (traumatic brain injury; =14.8 vs 19.2). In the IG, admittance to perform effort tests was reduced in low-risk chest pain (58% vs 77%; CI95%=6%-31%, 37% vs 52%; p<0.001). When DAT were used in children with diarrhoea or vomiting, in 80% of the cases the decision was to use oral rehydration against 61% in the control group (CG, p=0.001). Conclusions: DAT in emergency services improve patient’s knowledge about the disease and their participation in care. More studies are needed to develop DAT in emergency service

ZNF330/NOA36 interacts with HSPA1 and HSPA8 and modulates cell cycle and proliferation in response to heat shock in HEK293 cells

Background: The human genome contains nearly 20.000 protein-coding genes, but there are still more than 6,000 proteins poorly characterized. Among them, ZNF330/NOA36 stand out because it is a highly evolutionarily conserved nucleolar zinc-finger protein found in the genome of ancient animal phyla like sponges or cnidarians, up to humans. Firstly described as a human autoantigen, NOA36 is expressed in all tissues and human cell lines, and it has been related to apoptosis in human cells as well as in muscle morphogenesis and hematopoiesis in Drosophila. Nevertheless, further research is required to better understand the roles of this highly conserved protein. Results: Here, we have investigated possible interactors of human ZNF330/NOA36 through affinity-purification mass spectrometry (AP-MS). Among them, NOA36 interaction with HSPA1 and HSPA8 heat shock proteins was disclosed and further validated by co-immunoprecipitation. Also, “Enhancer of Rudimentary Homolog” (ERH), a protein involved in cell cycle regulation, was detected in the AP-MS approach. Furthermore, we developed a NOA36 knockout cell line using CRISPR/Cas9n in HEK293, and we found that the cell cycle profile was modified, and proliferation decreased after heat shock in the knocked-out cells. These differences were not due to a different expression of the HSPs genes detected in the AP-MS after inducing stress. Conclusions: Our results indicate that NOA36 is necessary for proliferation recovery in response to thermal stress to achieve a regular cell cycle profile, likely by interaction with HSPA1 and HSPA8. Further studies would be required to disclose the relevance of NOA36-EHR interaction in this context.14 página

Evaluation of learning outcomes of humanities curricula in medical students. A meta-review of narrative and systematic reviews

ObjectivesTo assess the expected learning outcomes of medical humanities subjects in medical studies curricula. To connect those expected learning outcomes with the types of knowledge to be acquired in medical education.MethodsMeta-review of systematic and narrative reviews. Cochrane Library, MEDLINE (Pubmed), Embase, CINAHL, and ERIC were searched. In addition, references from all the included studies were revised, and the ISI Web of Science and DARE were searched.ResultsA total of 364 articles were identified, of which six were finally included in the review. Learning outcomes describe the acquisition of knowledge and skills to improve the relationship with patients, as well as the incorporation of tools to reduce burnout and promote professionalism. Programs that focus on teaching humanities promote diagnostic observation skills, the ability to cope with uncertainty in clinical practice, and the development of empathetic behaviors.ConclusionThe results of this review show heterogeneity in the teaching of medical humanities, both in terms of content and at the formal level. Humanities learning outcomes are part of the necessary knowledge for good clinical practice. Consequently, the epistemological approach provides a valid argument for including the humanities in medical curricula

Metabolómica de la lágrima

Unidad Docente de Inmunología, Oftalmología y ORLFac. de Óptica y OptometríaTRUEpu