Search

In the healthcare field, the effective implementation of clinical protocols is crucial to ensuring patient safety and well-being. In this context, this study evaluates nurses' adherence to the maintenance and replacement protocol of peripheral venous catheters (PVCs) in a university hospital in Spain, examining the impact of compliance with the protocol on the loss of PVCs and on patient safety in addition to analyzing the related costs. A retrospective observational study was conducted with 590 patients who were admitted in 2018 and 2019. The chi-square test or Fisher's exact test, as appropriate, was used to see the association between the study variables; with the dependent variable being the loss of PVCs (including, as a dependent variable, the loss of PVCs before 48 h). The patients' electronic and physical medical records were reviewed to analyze nursing interventions related to the management of PVCs. A total of 24% of patients experienced PVC loss within the first 24 h after insertion. Failure to comply with the protocol resulted in 80% more catheter loss and increased the cost of cannulation by 46.84%. Low compliance with PVC care protocols significantly increases the risk of catheter loss, suggesting the need for increased training and strict protocol implementation. The findings emphasize the critical role of nursing in ensuring patient safety through adherence to evidence-based protocols. Continuing education and diligent protocol implementation are essential to reducing healthcare costs and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Estudios de Historia de España is the property of Pontificia Universidad Catolica Argentina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To evaluate the impact of a psychoeducational, mobile health intervention based on cognitive behavioural therapy and mindfulness‐based approaches on the mental health of healthcare workers at the frontline against COVID‐19 in Spain. Design: We will carry out a two‐week, individually randomized, parallel group, controlled trial. Participants will be individually randomized to receive the PsyCovidApp intervention or control App intervention. Methods: The PsyCovidApp intervention will include five modules: emotional skills, lifestyle behaviour, work stress and burnout, social support, and practical tools. Healthcare workers having attended patients with COVID‐19 will be randomized to receive the PsyCovidApp intervention (intervention group) or a control App intervention (control group). A total of 440 healthcare workers will be necessary to assure statistical power. Measures will be collected telephonically by a team of psychologists at baseline and immediately after the 2 weeks intervention period. Measures will include stress, depression and anxiety (DASS‐21 questionnaire—primary endpoint), insomnia (ISI), burnout (MBI‐HSS), post‐traumatic stress disorder (DTS), and self‐efficacy (GSE). The study was funded in May 2020, and was ethically approved in June 2020. Trial participants, outcome assessors and data analysts will be blinded to group allocation. Discussion: Despite the increasing use of mobile health interventions to deliver mental health care, this area of research is still on its infancy. This study will help increase the scientific evidence about the effectiveness of this type of intervention on this specific population and context. Impact: Despite the lack of solid evidence about their effectiveness, mobile‐based health interventions are already being widely implemented because of their low cost and high scalability. The findings from this study will help health services and organizations to make informed decisions in relation to the development and implementation of this type of interventions, allowing them pondering not only their attractive implementability features, but also empirical data about its benefits. Clinical trial registration: NCT04393818 (ClinicalTrials.gov identifier). Approved funding: May 2020. [ABSTRACT FROM AUTHOR]

The main objective of this work is to analyse how the representation in the public sphere of the Crown and the Head of the Spanish State is managed towards public opinion through public, official, and unofficial institutional acts, as reported by the House of H. M. the King. To answer the research questions contained in this objective, a quantitative methodological design based on content analysis is carried out (Krippendorff, 2002). This is applied to a corpus of the 996 public, official, and unofficial acts, contained in the web institution of the House of H. M. the King, between 2015 and 2019, for its subsequent computer processing with SPSS statistical software. Through the concept of intramethod triangulation, a qualitative analysis is applied in an auxiliary way to answer RQ3. The results show not only that the presence of the Royal Family, in the acts observed, contributes towards the public staging of its constitutional functions, but also that there is a map of specific audiences on which the Royal House projects pertinent legitimising messages (regarding the Crown and the Head of State) based on perceived social demands. This confirms the existence of a dialogical communication system, supported by a strategic conception of Crown-society relations, which is resolved mainly through ceremonial acts. [ABSTRACT FROM AUTHOR]

Introduction: Mechanical restraints are widely used in health care practice, despite the numerous ethical conflicts they raise. The aim of this study is to evaluate the ethical considerations contemplated in the current protocols on mechanical restraint in Spain., Method: Systematic review in PubMed, WOS and Scopus, Google and Google Scholar. An ad hoc list of 30 items was used to evaluate the ethical content of the protocols. The quality of guidelines was assessed with AGREE II., Results: The need for informed consent (IC) is reflected in 72% of the documents, the IC model sheet is included in only 41% of them, the rest of the analyzed characteristics on IC are fulfilled in percentages between 6% (the document includes the need to reevaluate the indication for IC) and 31% (the document contemplates to whom it should be requested). More than 20 ethical contents are reflected in 31% of them and less than 10 in 19% of the guidelines. The quality of the guides, according to AGREE II, ranged from 27 to 116 points (maximum possible 161), with a mean score of 68.7. Only 9% of the documents were classified as high quality. Finally, the correlation between ethical content and quality measured with AGREE II was 0.75., Conclusions: The variability of ethical contents in guidelines on mechanical restraints is very high. The ethical requirements to be included in protocols, consensus or Clinical Practice Guidelines should be defined., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)

Aim: To describe and explain nurses' protocol‐based care decision‐making. Background: Protocol‐based care is a strategy to reduce variability in clinical practice. There are no studies looking at protocol‐based care decision‐making. Understand this process is key to successful implementation. Method: A multiple embedded case study was carried out. Nurses' protocol‐based care decision‐making was studied in three inpatient wards (medical, surgical and medical‐surgical) of a university hospital in northern Spain. Data collection was performed between 2015 and 2016 including documentary analysis, non‐participant observations, participant observations and interviews. Analysis of quantitative data involved descriptive statistics and qualitative data was submitted to Burnard's method of content analysis (1996). The data integration comprised the integration of the data set of each case separately and the integration of the findings resulting from the comparison of the cases. The following the thread method of data integration was used for this purpose. The SRQR guideline was used for reporting. Results: The multiple embedded case study revealed protocol‐based care decision‐making as a linear and variable process that depends on the context and consists of multiple interrelated elements, among which the risk perception is foremost. Conclusion: This study has allowed progress in protocol‐based care decision‐making characterisation. This knowledge is crucial to support the design of educational and management strategies aimed at implementing protocol‐based care. Relevance to clinical practice: Strategies to promote protocol‐based care should address the contexts of practice and the ability of professionals' to accurately assess the degree of risk of clinical activity. Hence, it will promote quality of care, patient safety and efficiency in healthcare cost. [ABSTRACT FROM AUTHOR]

Copyright of Migraciones is the property of Universidad Pontificia Comillas, Instituto Universitario de Estudios sobre Migraciones and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: SARS-CoV-2 infection presents a high transmission in the group of health professionals in Spain (12-15% infected). Currently there is no accepted chemoprophylaxis but hydroxychloroquine (HDQ) is known to inhibit the coronavirus in vitro. Our hypothesis is that oral administration of hydroxychloroquine to healthcare professionals can reduce the incidence and prevalence of infection as well as its severity in this group.Methods: Design: Prospective, single center, double blind, randomised, controlled trial (RCT).Participants: Adult health-care professionals (18-65 years) working in areas of high exposure and high risk of transmission of SARS-COV-2 (COVID areas, Intensive Care Unit -ICUs-, Emergency, Anesthesia and all those performing aerosol-generating procedures) will be included. Exclusion criteria include previous infection with SARS CoV2 (positive SARS-CoV-2 PCR or IgG serology), pregnancy or lactation, any contraindication to hydroxychloroquine or evidence of unstable or clinically significant systemic disease.Interventions: Patients will be randomized (1:1) to receive once-daily oral Hydroxychloroquine 200mg for two months (HC group) or placebo (P group) in addition to the protective measures appropriate to the level of exposure established by the hospital. A serological evaluation will be carried out every 15 days with PCR in case of seroconversion, symptoms or risk exposure. Primary outcome is the percentage of subjects presenting infection (seroconversion and/or PCR +ve) by the SARS-Cov-2 virus during the observation period. Additionally, both the percentage of subjects in each group presenting Pneumonia with severity criteria (Curb 65 ≥2) and that of subjects requiring admission to ICU will be determined.Discussion: While awaiting a vaccine, hygiene measures, social distancing and personal protective equipment are the only primary prophylaxis measures against SARS-CoV-2, but they have not been sufficient to protect our healthcare professionals. Some evidence of the in vitro efficacy of hydroxychloroquine against this virus is known, along with some clinical data that would support the study of this drug in the chemoprophylaxis of infection. However, there are still no data from controlled clinical trials in this regard. If our hypothesis is confirmed, hydroxychloroquine can help professionals fight this infection with more guarantees.Participants: This is a single-center study that will be carried out at the Marqués de Valdecilla University Hospital. 450 health professionals working at the Hospital Universitario Marqués de Valdecilla in areas of high exposure and high risk of transmission of SARS COV2 (COVID hospital areas, Intensive Care Unit, Emergency, Anesthesia and all those performing aerosol-generating procedures) will be included.Inclusion Criteria: 1) Health professionals aged between 18 and 65 years (inclusive) at the time of the first screening visit; 2) They must provide signed written informed consent and agree to comply with the study protocol; 3) Active work in high exposure areas during the last two weeks and during the following weeks.Exclusion Criteria: 1) Previous infection with SARS CoV2 (positive coronavirus PCR or positive serology with SARS Cov2 negative PCR and absence of symptoms); 2) Current treatment with hydroxychloroquine or chloroquine; 3) Hypersensitivity, allergy or any contraindication for taking hydroxychloroquine, in the technical sheet; 4) Previous or current treatment with tamoxifen or raloxifene; 5) Previous eye disease, especially maculopathy; 6) Known heart failure (Grade III to IV of the New York Heart Association classification) or prolonged QTc; 7) Any type of cancer (except basal cell) in the last 5 years; 6) Refusal to give informed consent; 8) Evidence of any other unstable or clinically significant untreated immune, endocrine, hematological, gastrointestinal, neurological, neoplastic or psychiatric illness; 9) Antibodies positive for the human immunodeficiency virus; 10) Significant kidney or liver disease; 11) Pregnancy or lactation.Intervention and Comparator: Two groups will be analyzed with a 1: 1 randomization rate. 1)Intervention: (n = 225): One 200 mg hydroxychloroquine sulfate coated tablet once daily for two months.2)Comparator (control group) (n = 225): One hydroxychloroquine placebo tablet (identical to that of the drug) once daily for two months MAIN OUTCOMES: The primary outcome of this study will be to evaluate: number and percentage of healthcare personnel presenting symptomatic and asymptomatic infection (see "Diagnosis of SARS CoV2 infection" below) by the SARS-Cov2 virus during the study observation period (8 weeks) in both treatment arms;number and percentage of healthcare personnel in each group presenting with Pneumonia with severity criteria (Curb 65 ≥2) and number and percentage of healthcare personnel requiring admission to the Intensive Care Unit (ICU) in both treatment arms. DIAGNOSIS OF SARS COV2 INFECTION: Determination of IgA, IgM and IgG type antibodies against SARS-CoV-2 using the Anti-SARS-CoV-2 ELISA kit (EUROIMMUN Medizinische Labordiagnostika AG, Germany) every two weeks. In cases of seroconversion, a SARS-CoV-2 PCR will be performed to rule out / confirm an active infection (RT-PCR in One Step: RT performed with mastermix (Takara) and IDT probes, following protocol published and validated by the CDC Evaluation of COVID-19 in case of SARS-CoV-2 infection RANDOMISATION: Participants will be allocated to intervention and comparator groups according to a balanced randomization scheme (1: 1). The assignment will be made through a computer-generated numeric sequence for all participants BLINDING (MASKING): Both participants and investigators responsible for recruiting and monitoring participants will be blind to the assigned arm.Numbers To Be Randomised (sample Size): Taking into account the current high prevalence of infection in healthcare personnel in Spain (up to 15%), to detect a difference equal to or greater than 8% in the percentage estimates through a two-tailed 95% CI, with a statistical power of 80% and a dropout rate of 5%, a total of 450 participants will need to be included (250 in each arm).Trial Status: The protocol approved by the health authorities in Spain (Spanish Agency for Medicines and Health Products "AEMPS") and the Ethics and Research Committee of Cantabria (CEIm Cantabria) corresponds to version 1.1 of April 2, 2020. Currently, recruitment has not yet started, with the start scheduled for the second week of May 2020.Trial Registration: Eudra CT number: 2020-001704-42 (Registered on 29 March 2020) FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2). [ABSTRACT FROM AUTHOR]

Background: This paper describes a participatory methodology that supports investigation of the synergistic collaboration between communities affected by infectious disease outbreak events and relevant official institutions. The core principle underlying the methodology is the recognition that synergistic relationships, characterised by mutual trust and respect, between affected communities and official institutions provide the most effective means of addressing outbreak situations.Methods: The methodological approach and lessons learned were derived from four qualitative case studies including (i) two tick-borne disease events (Crimean-Congo haemorrhagic fever in Spain, 2016, and tick-borne encephalitis in the Netherlands, 2016); and (ii) two outbreaks of acute gastroenteritis (norovirus in Iceland, 2017, and verocytotoxin-producing Escherichia coli [VTEC] in Ireland, 2018). An after-event qualitative case study approach was taken using mixed methods. The studies were conducted in collaboration with the respective national public health authorities in the affected countries by the European Centre for Disease Prevention and Control (ECDC). The analysis focused on the specific actions undertaken by the participating countries' public health and other authorities in relation to community engagement, as well as the view from the perspective of affected communities.Results: Lessons highlight the critical importance of collaborating with ECDC National Focal Points during preparation and planning and with anthropological experts. Field work for each case study was conducted over one working week, which although limiting the number of individuals and institutions involved, still allowed for rich data collection due to the close collaboration with local authorities. The methodology enabled efficient extraction of synergies between authorities and communities. Implementing the methodology required a reflexivity among fieldworkers that ackowledges that different versions of reality can co-exist in the social domain. The method allowed for potential generalisability across studies. Issues of extra attention included insider-outsider perspectives, politically sensitivity of findings, and how to deal with ethical and language issues.Conclusions: The overall objective of the assessment is to identify synergies between institutional decision-making bodies and community actors and networks before, during and after an outbreak response to a given public health emergency. The methodology is generic and could be applied to a range of public health emergencies, zoonotic or otherwise. [ABSTRACT FROM AUTHOR]

Copyright of Doxa Comunicación is the property of Fundacion Universitaria San Pablo - CEU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The essence of Enhanced Recovery After Surgery (ERAS) programs is the multimodal approach, and many authors have demonstrated safety and feasibility in fast track bariatric surgery. According to this concept, a multidisciplinary ERAS program for bariatric surgery has been developed by the Spanish Fast Track Group (ERAS Spain). The aim of this study was to analyze the initial implementation of this Spanish National ERAS protocol in bariatric surgery, comparing it with a historical cohort receiving standard care. Material and methods: A multi-centric prospective study was performed, including 233 consecutive patients undergoing bariatric surgery during 2015 and following ERAS protocol. It was compared with a historical cohort of 286 patients, who underwent bariatric surgery at the same institutions between 2013 and 2014 and following standard care. Compliance with the protocol, morbidity, mortality, hospital stay and readmission were evaluated. Results: Bariatric techniques performed were Roux-en-Y gastric bypass and sleeve gastrectomy. There were no significant differences in complications, mortality and readmission. Postoperative pain and hospital stay were significantly lower in the ERAS group. The total compliance to protocol was 80%. Conclusion: The Spanish National ERAS protocol is a safe issue, obtaining similar results to standard care in terms of complications, reoperations, mortality and readmissions. It is associated with less postoperative pain and earlier hospital discharge. [ABSTRACT FROM AUTHOR]

Objectives: Primary Objective: The primary objective is to reduce initiation of mechanical ventilator dependency in patients with moderate to severe CoViD- 19. This will be measured as the difference between the control group and active group for subjects admitted to the hospital for CoViD-19. Secondary Objectives: • To evaluate cytokine trends / Prevent cytokine storms • To evaluate supplemental oxygen requirements • To decrease mortality of CoViD-19 patients • Delay onset of ventilation TRIAL DESIGN: The study is a single centre, 2-arm, prospective, randomized (ratio 1:1), controlled trial with parallel groups design to compare the reduction of respiratory distress in a CoViD-19 population, using the intervention of the gammaCore®-Sapphire device plus standard of care (active) vs. standard of care alone (SoC) - the control group. The gammaCore® treatments will be used acutely and prophylactically. The active and control groups will be matched for disease and severity.Participants: i. Inclusion Criteria The subjects have to meet all of the following criteria to be eligible to enter the trial: 1.Patient older than 18 years2.Been tested positive or suspected/presumed positive for CoViD-19 Has a cough, shortness of breath or respiratory O2 Saturation less than or equal to 92% without need for mechanical ventilation or acute respiratory failure 3.Agree to use the gammaCore®-Sapphire device as intended and to follow all of the requirements of the study including recording required study data4.Patient is able to provide signed and witnessed Informed Consent ii. Exclusion Criteria Subjects meeting any of the following criteria cannot be included in this research study: 1.Pregnant women2.On home/therapy oxygen (i.e. for patients with Chronic Obstructive Pulmonary Disease) at baseline prior to development of CoViD-193.Patient already enrolled in a clinical trial using immunotherapeutic regimen for CoViD-194.History of aneurysm, intracranial hemorrhage, brain tumors, or significant head trauma5.Known or suspected severe atherosclerotic cardiovascular disease, severe carotid artery disease (eg, bruits or history of transient ischemic attack or cerebrovascular accident), congestive heart failure, known severe coronary artery disease, or recent myocardial infarction6.Uncontrolled high blood pressure (>140/90)7.Current implantation of an electrical and/or neurostimulator device, including but not limited to a cardiac pacemaker or defibrillator, vagal neurostimulator, deep brain stimulator, spinal stimulator, bone growth stimulator, or cochlear implant8.Current implantation of metal cervical spine hardware or a metallic implant near the gammaCore stimulation site9.Belongs to a vulnerable population or has any condition such that his or her ability to provide informed consent, comply with the follow-up requirements, or provide self-assessments is compromised (e.g. homeless, developmentally disabled and prisoner) Participants will be recruited from Hospital Clínico Universitario de Valencia in Spain.Intervention and Comparator: Intervention: Prophylactic: Administer 2 doses (at 2 minutes each) of gammaCore®-Sapphire, one dose on each side of the neck scheduled three times a day (morning, mid-day and 1 hour before bed at night).Acute respiratory failure or shortness of breath: Administer 2 doses (at 2 minutes each) of gammaCore®-Sapphire, one on each side of the neck. If shortness of breath (SOB) persists 20 minutes after the start of the first treatment, a second dose will be administered. Max doses per day is 9 or 18 stimulations.Plus standard of care Control: Standard of care: oxygen therapy, antibiotics and ventilatory support if necessary depending on the clinic MAIN OUTCOMES: Primary Endpoint: Initiation of mechanical ventilation, from randomization until ICU admission or hospital discharge, whatever occurs first Secondary Endpoints: Safety; ascertainment of Adverse Effects/Serious Adverse Events, from randomisation to ICU admission or hospital discharge, whatever occurs firstCytokine Storm measured by: Tumor necrosis factor α, Interleukin 6, Interleukin 1β. Days 1,3,5,10,15 and/or at hospital dischargeMortality and/or need for Critical Care admission, from randomisation until ICU admission or hospital discharge, whatever occurs first,O2 saturation levels , from randomization until ICU admission or hospital discharge, whatever occurs firstNeed for supplemental oxygen, from randomisation until ICU admission or hospital discharge, whatever occurs first RANDOMISATION: The patients are classified according to their oxygen levels as mild, moderate and severe and randomized according to their classification to the intervention and control in a ratio of 1:1. The randomization will be stratified for gender and age.Blinding (masking): This is an open label study, it is not possible to blind the participants and healthcare providers to the intervention.Numbers To Be Randomised (sample Size): The total number of patients to be included in the study is 90, with 45 in each study group TRIAL STATUS: The protocol version is 8.0 from 07th April 2020. The recruitment began 20th April 2020 and is expected to be complete 31st July 2020.Trial Registration: The study is registered in clinicaltrials.gov on 29th April 2020 with the identification number: NCT04368156 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. [ABSTRACT FROM AUTHOR]

Aim To analyse the efficacy of a 12-month multifactorial intervention by primary care nurses in increasing adherence to physical activity prescription (150 min/week) in patients with two or more cardiovascular risk factors and with cardiovascular risk up to 15% determined by the REGICOR equation. Background In Spain, cardiovascular diseases are responsible for 30.5% of deaths. Regular physical activity decreases mortality risk due to cardiovascular diseases but the effectiveness of physical activity prescription in routine in primary care settings has been shown to be low. Design Multicentre, single-blind, parallel randomized (in two different branches) clinical trial. Methods At least 368 participants will be recruited (184 control and 184 intervention), to show an 8% increase in adherence to the physical activity prescription (1.2% control group and 9.2% intervention group). Participants will be patients aged 35-75 years with at least two cardiovascular risk factors and with a cardiovascular risk of up to 15% measured using the Framingham- REGICOR equation. Intervention will be performed throughout baseline and three follow-up visits. A motivational interview, the trans-theoretical stages of changes of Prochaska and DiClemente and an individualized prescription of physical exercise using physical activity assets will be used in the intervention. Data will be collected at baseline and after the 1-year intervention. Discussion The present study will allow us to find out whether this brief multifactorial intervention induces greater adherence to physical activity prescription than usual practice, improving the quality of patient care. Trial Registration International Standard Randomized Controlled Trial Number ( ISRCTN): ISRCTN76069254. Protocol version 1.1, 6 July 2015. [ABSTRACT FROM AUTHOR]

What is known and objective The correct management of high-alert medications is a priority issue in expert recommendations for improving the clinical safety of patients. Objectives were to assess the impact of the implementation of vasoactive drug ( VAD) protocols on safety and efficacy in the treatment of critically ill patients. Methods A prospective before-and-after study on the implementation of different VAD protocols, comparing medication errors ( MEs) rates, mean intensive care unit ( ICU) stay, mean blood pressure ( MAP), heart rate ( HR) and oxygen saturation. Results and discussion The study included 432 patients. There was a statistically significant decrease in prescribing errors (55·9%), validation errors (68·1%) and medication administration records ( MAR) errors (78·8%). No differences were found between the two phases in ICU stay, MAP, HR and oxygen saturation. What is new and conclusion Implementation of protocols decreases variability in clinical practice, reduces the incidence of MEs and maintains the effectiveness of VAD therapy in critically ill patients. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assure the application, in our primary care health district, of the World Health Organisation and Spanish Ebola virus disease (EVD) guidelines, and to identify and resolve gaps, in order to protect professionals from the risks associated with attending to patients with Ebola. Materials and Methods: A checklist was drawn up and an audit procedure of the structural, functional and operational conditions was designed for managing a self-presenting patient suspected with EVD in general practice. This audit was applied twice (before and after assessment) in 9 health centres of a health district in Spain. The checklist was structured according to 9 categories (51 elements in total). This tool was designed to avoid errors in the management of EVD patients that are considered very serious in view of their potential consequences. Results: Of the 51 elements on the checklist, 7-26 (14-51%) required direct intervention to rectify deficits in the first audit. The following elements requiring improvement were identified: the incorporation of memory aids to ensure the correct application of the EVD protocol, defining what information should be provided to the patient and (where applicable) anyone accompanying them as well as incorporating advice on how to deal with any individuals with whom they might have come into contact. A second audit assured the adequacy of the proposed solutions. Conclusion: In this study, the tool achieved the successful application of EVD protocol, assuring that primary care centres were able to handle an Ebola suspect patient safely. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Critical limb ischemia (CLI) is defined by ischemic rest pain, tissue loss, or both, secondary to arterial insufficiency, and its prevalence is increasing mainly as a result of the worldwide high prevalence of diabetes. Currently, there are no available conclusive data on the efficacy of any coadjuvant therapy after revascularization procedure benefiting amputation and patency rates. Macitentan is an orally active dual endothelin (ET) receptor antagonist that may contribute to reduce the amputation rate and improve revascularization patency in CLI. METHODS/DESIGN: REVASC is a proposed pilot, open-label, controlled, randomized, single-center clinical double-blind trial to be conducted in Spain on a study population of European patients with CLI, which will compare the clinical outcomes and cost-effectiveness of macitentan coadjuvant treatment after limb revascularization with the standard antiplatelet treatment strategy for severe limb ischemia. Patients are randomized 1:1 to receive macitentan or placebo for 12 weeks. The primary clinical end point will be amputation-free survival rate at 12 months, defined as the time to major (above the ankle) amputation for the index (trial) limb or death from any cause, whichever comes first. Secondary outcomes include overall survival, quality of life, in-hospital mortality and morbidity, repeat interventions, healing of tissue loss, and hemodynamic changes following revascularization. Sample size is estimated as 120 patients. The economic analysis will consist of two components: a "within-study" analysis, which will be based on study end points; and a "model-based" analysis, which will extrapolate and compare costs and effects likely to accrue beyond the study follow-up period. DISCUSSION: The REVASC trial is designed to be pragmatic and represents current practice of the real-world population management after limb revascularization for CLI due to atherosclerosis. Current evidence does not support any coadjuvant treatment. A new pathway of treatment may be opened with the use of ET receptor antagonists in these patients. [ABSTRACT FROM AUTHOR]

Many existing studies relating to protocol and ceremonial Spanish university. All of them are based on the study of traditional ceremonial universities in an attempt to unite the common protocol for all under the term "university protocol", but there is no study to analyze comparatively the regulations of each in order to generate a ideal that can conform to the protocol of any university in Spain, unifying the existing dispersion to form a general framework, useful for practical purposes, to serve as a model for this particular type of specialized public relations applied to a specific area. [ABSTRACT FROM AUTHOR]

Copyright of Agora de Enfermeria is the property of Agora de Enfermeria SRL and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context: Severe sepsis is associated with high mortality and increased costs. The 'Surviving Sepsis Campaign' (SSC) protocol was developed as an international initiative to reduce mortality. However, its cost-effectiveness is unknown. Objective: To determine the cost-effectiveness of the SSC protocol for the treatment of severe sepsis in Spain after the implementation of an educational program compared with the conventional care of severe sepsis. Design: Observational prospective before-and-after study. Setting: 59 medical-surgical intensive care units located throughout Spain. Patients: A total of 854 patients were enrolled in the pre-educational program cohort (usual or standard care of severe sepsis) and 1,465 patients in the post-educational program cohort (SSC protocol care of severe sepsis). Interventions: The educational program aimed to increase adherence to the SSC protocol. The SSC protocol included pharmacological and medical interventions. Main outcome measures: Clinical (hospital mortality) and economic (health-care resource and treatment costs) outcomes were recorded. A health-care system perspective was used for costs. The primary outcome was incremental cost-effectiveness ratio (ICER). Results: Patients in the SSC protocol care cohort had a lower risk of hospital mortality (44.0% vs. 39.7%, P = 0.04). However, mean costs per patient were 1,736 euros higher in the SSC protocol care cohort (95% CI 114-3,358 euros), largely as a result of increased length of stay. Mean life years gained (LYG) were higher in the SSC protocol care cohort: 0.54 years (95% CI 0.02-1.05 years). The adjusted ICER of the SSC protocol was 4,435 euros per LYG. Nearly all (96.5%) the bootstrap replications were below the threshold of 30,000 euros per LYG. Conclusion: The SSC protocol seems to be a cost-effective option for treating severe sepsis in Spain. [ABSTRACT FROM AUTHOR]

fter the signing of the ICZM Protocol in the Mediterranean (Madrid, 21 January 2008) its implementation became the main focus of interest for the future. Several obstacles on the way to implementation are briefly analysed, starting with the ratification process, the competence for the implementation and the availability of financial resources to put the Protocol requirements in place. A list of mitigation actions is proposed in order to overcome these obstacles. The ways in which the Centre responsible for assisting the countries can implement this legal instrument (i.e. PAP/RAC) is elaborated in the second part of the paper. This includes the preparation of a stocktaking report to allow for defining the starting point for ICZM in the Mediterranean, elaboration of an explanatory guide of the text of the Protocol, as well as guidelines for the definition of a coastal setback. Equally important is awareness-raising and training for the implementation of the Protocol. [ABSTRACT FROM AUTHOR]

This article focuses on the visit by two Fātimid dā'īs (missionaries or propagandists) to 'Umar ibn Hafsūn, a controversial figure in the history of Muslim Spain. Emphasising the significance of the gifts they brought to Bobastro, Ibn Hafsūn's headquarters, this article analyses the diplomatic relations between North Africa and Islamic Spain in the 10th century and the earliest introduction of Shī'ism in Western Europe. [ABSTRACT FROM AUTHOR]

There is increasing interest amongst researchers for understanding how quality can be established and maintained in early childhood education, how it can be evaluated and how the results obtained should be interpreted. Specifically, Spanish legislation recognizes the educational and social nature of the stage comprised of the first six years for which there are numerous pedagogical proposals. Trying to face up to the lack of instruments to help evaluate the quality of these educational programs, we offer the results of the design and application of a protocol to evaluate the quality of a tri-lingual, early childhood educational program (Spanish, Basque and English) developed in a city in the North of Spain through two school years. [ABSTRACT FROM AUTHOR]

The Protocol is a subject that has suffered big changes in the last years in Spain. His presence in the university formation has happened of being a mere anecdote to one more subject to teach in courses of postgraduate courses endorsed by a big social and professional demand. With the purpose of announcing the Protocol subject to the spanish academic field, the present article realizes a study of the theoretical situation of this subject and profession in Spain. This investigation considers to know the scientific character of the Protocol, at the same time that it tries to found such professional side in the current offer of courses and of formation. For this reason, the investigation could be interesting for the spanish academic field to help to explain the reality of the Protocol in Spain and to impel his theoretical development in our country. [ABSTRACT FROM AUTHOR]

Objective: To assess the degree of compliance of the Comprehensive Health and Judicial Care Protocol for Victims of Sexual Assaults attended in Emergencies, and to compare the quality indicators of care with those obtained for the 2 years prior to its implementation., Methods: Retrospective, comparative, cohort study of the 128 victims (124 women and 4 men), aged 4 to 62 years, treated in the Hospital Emergency Department, before and after the publication of the Protocol through the CIE-10 diagnostic code T74.2 Sexual assault and CIE-10 T76.2 Suspected sexual assault, between January 2018 and December 2020. The sample was divided into two groups, before (n=80) and after (n=48) the implementation of the protocol. A sub-analysis of 109 women older than 16 years attended in the Gynecological Emergencies has been performed., Results: The implementation of the Protocol has led to a significant increase in the compliance with the main indicators, more evident in Gynecological Emergencies: HIV prophylaxis (43.4% vs 83.7%, respectively in the Pre and Post-protocol Groups), pregnancy prophylaxis (54.5% vs 81.4%), police intervention (48.5% vs 74.4%) and SIVIO form compliance (16.7% vs 46.5%). Attention time has not shown significant changes. The referral for psychological support has been increased by a very low percentage (0% vs 12.5%)., Conclusions: The implementation of the Protocol has led to an evident improvement in the quality of care in Emergencies, with a significant increase in key indicators. Care time in Emergencies should be reduced, and the SIVIO form compliance, as well as the referral for psychological support should be increased., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Pharmaceutical companies fund most clinical trials on drugs. However, there are clinical issues that might not be a priority from a commercial point of view, but that should certainly be addressed, given their importance for patients and society in general. Independent clinical research represents a fundamental pillar here and its basic element is investigator-initiated studies/trials. In these studies, it is the researcher who conceives the idea, develops the project and also acts as the sponsor. Most researchers are familiar with participating as collaborators in studies sponsored by pharmaceutical companies. In these studies, the company is in charge of all the scientific, legal and financial aspects, leaving the responsibility of the researcher mainly limited to the inclusion of patients and compliance with the protocol. On the contrary, the start-up and development of an independent research study requires considerable resources - of knowledge, money and time - and careful planning on the part of the researcher. In this manuscript, we will review the main characteristics of the studies initiated by the researcher and their fundamental differences with those sponsored by the pharmaceutical industry. We will also outline what its strengths and limitations are. Finally, we will propose some solutions to the main challenges they pose. Our ultimate goal is to stimulate potential researchers to undertake the challenge of conducting an independent clinical research project., (Copyright © 2020 Elsevier España, S.L.U. All rights reserved.)

During the state of alert declared in the national territory in March 2020 due to the health crisis caused by SARS-CoV-2, the free movement of the population was restricted in order to prevent the spread of the virus. In the Balearic Islands, access by air and sea was limited and, in addition, health controls were established at the entry points of the islands aimed to detect people with COVID-19. The health check is understood as a Public Health surveillance procedure through which all persons authorised to travel at that time were tested. This procedure, together with the security measures to prevent the spread of the virus, had never before been implemented in the Balearic Islands and required the collaboration of various organizations in order to organise and execute it. This paper shares the experience and analysis of the health control measures implemented in these circumstances. To do so, it describes the procedure carried out, the devices that were developed, the main results and the assessment of the project as a whole. Finally, the positive aspects and possible improvements are considered. The most of people screened upon arrival in Balearics Islands did not register or show clinical symptoms of COVID-19.

Copyright of Doxa Comunicación is the property of Fundacion Universitaria San Pablo - CEU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Type 1 diabetes mellitus (T1DM) is one of the most frequent chronic endocrine diseases in the paediatric population. As a result, this disease has a strong impact on psychological well-being. In line with this, emotional factors play an important role in adaptation. The aim of the present study protocol is to design an emotional abilities programme to improve metabolic control assessed by haemoglobin A1c (HbA1c) samples. Specifically, this intervention will be focused on adaptive coping strategies to deal with unpleasant emotions associated with T1DM. The primary aim of this project is to assess whether the employment of this new psychological intervention improves the emotional abilities of adolescents with T1DM., Methods and Analysis: Two focus groups will be carried out for the design and evaluation of the programme following the APEASE criteria (affordability, practicability, effectiveness, acceptability, side effects/safety and equity). Behavioural change will be based on the Behaviour Change Wheel. Sixty-two participants from 12 to 18 years of age will be recruited at a public hospital and randomised to either an intervention or a control group. The intervention group will receive an emotional abilities training programme. The control group will receive usual educational intervention. The primary outcomes are metabolic control and emotional abilities. The secondary outcomes include emotional distress control, positive and negative affect, healthy habits, and quality of life. Data will be collected at baseline, immediately postintervention, and at follow-up visits at 6 and 12 months. A feasibility analysis will be conducted., Ethics and Dissemination: The study has been approved by the Ethics Committee of Universidad Loyola Andalucía. Results will be submitted for publication in peer-reviewed journals and disseminated across the scientific community., Trial Registration Number: NCT03734367., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

We herein describe an inter-specialists unit for the monitoring and management of biological therapies and analyze the utilization of biological agents across specialties and diseases. Protocols and therapeutic objectives, as well as outcomes and protocol deviations, are shared and discussed periodically between specialists. All patients treated at one centre with any biological treatment from January 2000 by rheumatology, gastroenterology, dermatology, or neurology, regardless diagnosis, are identified by Clinical Pharmacy and included in an ongoing database that detects use and outcome. The drugs, survival, and reasons for discontinuation differ significantly across specialties. This approach has helped us recognizing the challenges and size of the problem of sharing expensive medications across specialties, and has served as a starting point to contribute to the better use of these compounds., (Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Objectives: Malnutrition is frequent in patients with cancer and is associated with a higher rate of morbidity and mortality. However, a significant number of patients at nutritional risk remain undetected due to the lack of a routine screening procedure during diagnosis. Costa del Sol Hospital in Marbella (Málaga), Spain has implemented a protocol for outpatients with cancer aimed at identifying and treating malnutrition at an early stage. The aim of this study was to determine the prevalence of nutritional risk and the rate of malnutrition when cancer is diagnosed., Methods: We conducted a complete assessment of the nutritional status of patients with cancer of the upper digestive tract (esophagus, stomach, pancreas, or biliary tract) or head and neck cancer. Using the Nutriscore tool at the first oncology consultation, a screening for nutritional risk was performed for patients with other solid tumors. When nutritional risk was detected, a complete nutritional assessment was conducted., Results: Of 295 consecutive patients, 21.4% were found to be at nutritional risk (Nutriscore ≥5). After complete assessment, a moderate degree of malnutrition was observed in 76% and severe malnutrition in 12%. Among patients with colorectal cancer or tumors of gynecologic origin, only 7.5% presented nutritional risk, but 52.8% presented cachexia., Conclusion: The high rate of malnutrition observed and the identification of cachexia at an early stage highlight the importance of obtaining early identification of patients at risk to improve the efficacy of nutritional interventions., (Published by Elsevier Inc.)

Background: The PROFRUVE study is a controlled intervention based on the Theory of Planned Behavior (TPB), which follows those behavioral theories that have proved to be the most effective at changing infant fruit and vegetable (FV) intake pattern. The main purpose of the study is to evaluate the effectiveness of an intervention program in increasing FV consumption in schoolchildren aged 8 to 10 and based on TPB., Methods: Eligible classrooms within schools from Vitoria-Gasteiz (Basque Country, Spain) will be randomly assigned to the intervention (classrooms n = 4; children n = 86) or control (classrooms n = 4; children n = 86) group. The intervention group will receive 14 sessions of 60 min during an academic year (October to June). These sessions, designed by a multidisciplinary team, are based on TPB and are directed at modifying determinants of behavior (attitudes, subjective norms, perceived behavioral control and intention of consumption), and intake of FV itself. Both the process and the evolution of consumption and determinants of behavior will be evaluated (before, during, shortly after and a year after) using validated surveys, 7 day food records, 24 h reminders and questionnaires., Discussion: This study will provide a valid and useful tool to achieve changes in the consumption of FV at school level. A negative result will be helpful in redefining new strategies in the framework of changing habits in the consumption of FV., Trial Registration: This study has been retrospectively registered at ClinicalTrials.gov. Identifier: NCT03400891 . Data registered: 17/01/2018.

Objectives: Competing requirements for organ perfusion may call for antagonistic strategies such as fluid replacement or high positive end-expiratory pressure. We recently proposed an intensive lung donor treatment protocol that nearly tripled lung procurement rates and validated it in a multicentre study. The next step was to evaluate the impact of our proposal on the other organ grafts recovered from lung donors and on the recipients' outcome after transplantation of those grafts., Methods: A quasi-experimental study was conducted in six Spanish hospitals during 2013 (2010-12 was historical control). Organ donor management was led by a trained and experienced intensive care staff., Results: A total of 618 actual donors after brain death (DBDs) were included, 453 DBDs in the control period (annual average 151) and 165 in the protocol period. No baseline differences were found between the periods. Heart, liver, kidney and pancreas retrieval rates were similar in both periods, and heart, liver, kidney and pancreas recipients' survival at 3 months showed no differences between both periods., Conclusions: Our lung donor treatment protocol is safe for other grafts obtained from donors undergoing these procedures with the aim of increasing lungs available for transplantation. It has no negative impact on the recovery rates of other grafts or on early survival of heart, liver, pancreas or kidney recipients., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background: The shortage of lung donors for transplantation is the main limitation among patients awaiting this type of surgery. We previously demonstrated that an intensive lung donor-treatment protocol succeeded in increasing the lung procurement rate. We aimed to validate our protocol for centers with or without lung transplant programs., Methods: A quasi-experimental study was performed to compare lung donor rate before (historical group, 2010 to 2012) and after (prospective group, 2013) the application of a lung management protocol for donors after brain death (DBDs) in six Spanish hospitals. Lung donor selection criteria remained unchanged in both periods. Outcome measures for lung recipients were early survival and primary graft dysfunction (PGD) rates., Results: A total of 618 DBDs were included: 453 in the control period and 165 in the protocol period. Donor baseline characteristics were similar in both periods. Lung donation rate in the prospective group was 27.3%, more than twice that of the historical group (13%; p < 0.001). The number of lungs retrieved, grafts transplanted, and transplants performed more than doubled over the study period. No differences in early recipients' survival between groups were observed (87.6% vs. 84.5%; p = 0.733) nor in the rate of PGD., Conclusion: Implementing our intensive lung donor-treatment protocol increases lung procurement rates. This allows more lung transplants to be performed without detriment to either early survival or PGD rate., (Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

Surgical patient safety is a priority in the national and international quality healthcare improvement strategies. The objective of the study was to implement a collaborative intervention with multiple components and to evaluate the impact of the patient surgical safety checklist (SSC) application. This is a prospective, longitudinal multicenter study with a 7-month follow-up period in 2009 based on a collaborative intervention for the implementation of a 24 item-SSC distributed in 3 different stages (sign in, time out, sign out) for its application to the surgical patient. A total number of 27 hospitals participated in the strategy. The global implementation rate was 48% (95%CI, 47.6%-48.4%) during the evaluation period. The overall compliance with all the items of the SSC included in each stage (sign in, time out, sign out) was 75,1% (95%CI, 73.5%-76.7%) for the sign in, 77.1% (95%CI, 75.5%-78.6%) for the time out and 88.3% (95%CI, 87.2%-89.5%) for the sign out respectively. The individual compliance with each item of the SSC has remained above 85%, except for the surgical site marking with an adherence of 67.4% (95%CI, 65.7%-69.1%)] and 71.2% (95%CI, 69.6%-72.9%)] in the sign in and time out respectively. The SSC was successfully implemented to 48% of the surgeries performed to the participating hospitals. The global compliance with the SSC was elevated and the intervention trend was stable during the evaluation period. Strategies were identified to allow of a higher number of surgeries with application of the SSC and more professional involvement in measures compliance such as surgical site marking., (Copyright © 2014. Published by Elsevier Espana.)