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In 2008, the World Health Organization launched the Surgical Safety Checklist (SSC) to reduce the number of adverse events occurring at operating suites. The objective of this study was to explore middle managers' experiences of patient safety culture, the meanings they attach to this culture, and their perceptions of one of its best-known strategies, the SSC. This study used a qualitative design involving structured interviews with the head of department, quality managers, and nursing supervisors at an operating suite. Eleven middle managers acknowledged that the SSC supports memory and instils accountability. Work overload was highlighted as the main barrier in SSC implementation, while feedback was identified as the main facilitator. We found significant differences in levels of understanding of patient safety culture among different types of middle managers and professions. Key aspects for promoting an effective, long-lasting patient safety culture were also identified. [ABSTRACT FROM AUTHOR]

Objective:  It is important to determine whether the use of different quality improvement tools in neonatal resuscitation is well-received by health care teams and improves coordination and perceived quality of the stabilization of the newborn at birth. This study aimed to explore the satisfaction of personnel involved in resuscitation for infants under 32 weeks of gestational age (<32 wGA) at birth with the use of an assistance toolkit: Random Real-time Safety Audits (RRSA) of neonatal stabilization stations, the use of pre-resuscitation checklists, and the implementation of briefings and debriefings., Study Design:  A quasi-experimental, prospective, multicenter intervention study was conducted in five level III-A neonatal intensive care units in Madrid (Spain). The intervention involved conducting weekly RRSA of neonatal resuscitation stations and the systematic use of checklists, briefings, and debriefings during stabilization at birth for infants <32 wGA. The satisfaction with their use was analyzed through surveys conducted with the personnel responsible for resuscitating these newborns. These surveys were conducted both before and after the intervention phase (each lasting 1 year) and used a Likert scale response model to assess various aspects of the utility of the introduced assistance tools, team coordination, and perceived quality of the resuscitation., Results:  Comparison of data from 200 preintervention surveys and 155 postintervention surveys revealed statistically significant differences ( p  < 0.001) between the two phases. The postintervention phase scored higher in all aspects related to the effective utilization of these tools. Improvements were observed in team coordination and the perceived quality of neonatal resuscitation. These improved scores were consistent across personnel roles and years of experience., Conclusion:  Personnel attending to infants <32 wGA in the delivery room are satisfied with the application of RRSA, checklists, briefings, and debriefings in the neonatal resuscitation and perceive a higher level of quality in the stabilization of these newborns following the introduction of these tools., Key Points: · RRSA, checklists, briefings, and debriefings improve the quality of neonatal resuscitation at birth.. · These tools, when used together, are well-received and enhance perceived resuscitation quality.. · Perception of utility and quality improvement is consistent across roles and experience.., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Here we report the reliability and test/re-test validity of a Castillan version of the PCL-5 (PCL5-C) in mental health nurses., Methods: A sample of 52 consecutive nurses was recruited from two psychiatric hospitals and four psychiatrists units of general hospitals in Madrid, Spain., Results: We detected high internal consistency for the study questionnaire at the test assessment (n = 52) and at retest 0.929 and 0.935, respectively, by total Cronbach's α. All of the items at test and re-test correlated with the total score., Conclusions: Reproducibility analysis showed excellent test/re-test reliability for the total score and each item. Based on our findings, we conclude that the PCL5-C is a valid and reliable questionnaire when applied among Spanish mental health nurses population., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Patient safety constitutes a priority in health care, being the surgical safety checklist one of the strategies implemented by the WHO. The objective was to determine the level of compliance in the application of the surgical safety checklist in surgical room personnel of a public institution. Materials and Methods: Cross-sectional study in 45 members of the surgical team in a hospital, in which compliance to the WHO checklist was evaluated during July and August 2018. Results: Overall compliance was 13.3% (n=6), with the pre-anesthesia phase reaching the highest level (55.6%, n=25). The highest compliance was recorded by the surgical instrumentation staff (100%, n=8), while the lowest by the nursing staff (25%, n=3), with statistically significant differences (p=0.005). Additionally, a correlation was observed between years of work in the service and compliance in the transfer phase (rho= -0.30, p=0.048). Discussion: Overall compliance was low, which corroborates the stated hypothesis and is similar to other studies described in the literature. Conclusions: The overall compliance to the checklist was very low, with differential behaviors as the surgical instrument technicians showed the highest compliance and the nursing staff the lowest. The antibiotic prophylaxis item was the least compliant, while the pre-anesthesia phase was the most compliant. [ABSTRACT FROM AUTHOR]

Introduction: The expansion of new tobacco consumption formats and electronic vapor products threatens to reverse the trend of declining smoking rates that had been observed among younger people in recent decades. Early detection in the health sector requires screening tools that have been adapted and validated in our context. This study aims to translate, culturally adapt, pilot and empirically validate the Hooked on Nicotine Checklist (HONC) with Spanish adolescents., Methods: The process of translation and cultural adaptation included the following stages: direct translation, synthesis of translations, back translation, consolidation with a committee of experts and pre-test, along with a cognitive interview, which served as pilot testing. Empirical validation was conducted with a sample of 1027 adolescents aged between 12 and 18 (M=15.40; SD=1.638)., Results: The results obtained confirm that the HONC is a brief, clear and easy-to-understand tool, with appropriate psychometric properties. A Cronbach's alpha value of 0.90 was obtained. Sensitivity, specificity, PPV and NPV indices reached values of 0.56, 0.94, 0.79 and 0.83, respectively. Cut-off point 1 is the one reaching the best balance between the two values. CFA showed a model good overall fit., Conclusion: This study makes the Spanish version of the HONC available to researchers and clinicians, so that it can be used with sufficient psychometric guarantees., (Copyright © 2024 The Authors. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To verify the validity of a checklist of risk factors (RFs) proposed by the Spanish "Zero Resistance" project (ZR) in the detection of multidrug-resistant bacteria (MRB), and to identify other possible RFs for colonization and infection by MRB on admission to the Intensive Care Unit (ICU)., Design: A prospective cohort study, conducted in 2016., Setting: Multicenter study, patients requiring admission to adult ICUs that applied the ZR protocol and accepted the invitation for participating in the study., Patients or Participants: Consecutive sample of patients admitted to the ICU and who underwent surveillance (nasal, pharyngeal, axillary and rectal) or clinical cultures., Interventions: Analysis of the RFs of the ZR project, in addition to other comorbidities, included in the ENVIN registry. A univariate and multivariate analysis was performed, with binary logistic regression methodology (significance considered for p < 0.05). Sensitivity and specificity analyses were performed for each of the selected factors., Main Variables of Interest: Carrier of MRB on admission to the ICU, RFs (previous MRB colonization/infection, hospital admission in the previous 3 months, antibiotic use in the past month, institutionalization, dialysis, and other chronic conditions) and comorbidities., Results: A total of 2270 patients from 9 Spanish ICUs were included. We identified MRB in 288 (12.6% of the total patients admitted). In turn, 193 (68.2%) had some RF (OR 4.6, 95%CI: 3.5-6.0). All 6 RFs from the checklist reached statistical significance in the univariate analysis (sensitivity 66%, specificity 79%). Immunosuppression, antibiotic use on admission to the ICU and the male gender were additional RFs for MRB. MRB were isolated in 87 patients without RF (31.8%)., Conclusions: Patients with at least one RF had an increased risk of being carriers of MRB. However, almost 32% of the MRB were isolated in patients without RFs. Other comorbidities such as immunosuppression, antibiotic use on admission to the ICU and the male gender could be considered as additional RFs., (Copyright © 2023 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.)

An updated checklist of the cited simuliid species in Spain is presented, together with maps, which show the provincial distribution of each of the known species. [ABSTRACT FROM AUTHOR]

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem 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.)

Copyright of SHILAP Revista de Lepidopterologia is the property of Sociedad Hispano-Luso-Americana de Lepidopterologia 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.)

Copyright of Nova Acta Científica Compostelana is the property of Universidad de Santiago de Compostela, Servicio de Publicaciones 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.)

Objective: The complexity of consultations for child and adolescent sexual abuse (CSA), added to the high service pressure in Emergency Department (ED), makes legal proceedings to be prioritized over medical action, and security incidents may appear. Our objective was to evaluate the impact of a checklist for the management of acute CSA in ED, assessing the number and type of security incidents., Methods: A single-centre, descriptive-observational study was conducted between 2018 in ED. Clinical, epidemiological and follow-up data were collected in those patients younger than 18 that were reported as acute CSA suspicions. Incidents about clinical history, procedures and medication were analyzed. The sample were divided in two groups in relation the use of checklist (Group1: January-May and Group 2: June-December)., Results: Thirty-two patients were included: 13 Group 1, 19 Group 2. In 25 (78.1%) incidents were detected from the clinical history, in 20 (56.3%) from procedures and in 5 (15.5%) from medication. One-hundred by one-hundred clinical history incidents and 100% procedural incidents were observed in Group 1 vs 63.2% and 36.8% in Group 2 (p=0.025 y p=0.007) and 30.8% of medication incidents in Group 1 vs 5.3% in Group 2 (p=0.051)., Conclusions: The implementation of the checklist has led to an improvement in the medical care of patients with acute CSA with a decrease in security incident.

Depression constitutes a major public health problem due to its high prevalence and difficulty in diagnosis. The Hopkins Symptom Checklist-25 (HSCL-25) scale has been identified as valid, reproducible, effective, and easy to use in primary care (PC). The purpose of the study was to assess the psychometric properties of the HSCL-25 and validate its Spanish version. A multicenter cross-sectional study was carried out at six PC centers in Spain. Validity and reliability were assessed against the structured Composite International Diagnostic Interview (CIDI). Out of the 790 patients, 769 completed the HSCL-25; 738 answered all the items. Global Cronbach's alpha was 0.92 (0.88 as calculated for the depression dimension and 0.83 for the anxiety one). Confirmatory factor analysis (CFA) showed one global factor and two correlated factors with a correlation of 0.84. Area under the curve (AUC) was 0.89 (CI 95%, 0.86-0.93%). For a 1.75 cutoff point, sensibility was 88.1% (CI 95%, 77.1-95.1%) and specificity was 76.7% (CI 95%, 73.3-79.8%). The Spanish version of the HSCL-25 has a high response percentage, validity, and reliability and is well-accepted by PC patients.

An important element of vector control and surveillance of mosquito-borne diseases is updated information on vector species distribution. The aim of this study was to collect available information about mosquito species reported in Extremadura between 1920 and 2020 and create a catalog that would combine both published data and our recent field identifications. An exhaustive list is hereby presented, including species status and detailed distribution maps at a municipal level as well as their importance for public health. A total of 33 species, classified into five genera: Anopheles (five species), Aedes (14), Culex (nine), Culiseta (four), and Orthopodomyia (one) has been recorded, including 31 autochthonous, one invasive, Aedes ( Stegomyia ) albopictus , and one disappeared since 1953, Aedes ( Stegomyia ) aegypti . For the first time in Extremadura, we report the presence of important vectors such as Aedes ( Aedimorphus ) vexans vexans and Culex ( Culex ) perexiguus , and the new record of six species in the province of Badajoz, namely: Aedes ( Dahliana ) echinus, Aedes ( Fredwardsius ) vittatus, Aedes ( Ochlerotatus ) berlandi , Aedes ( Ochlerotatus ) pulcritarsis , Culex ( Culex ) mimeticus , and Culiseta ( Culiseta) subochrea . Nineteen of these species are potential vectors of medical and veterinary relevance.

Providing a complete data set with species and trait information for a given area is essential for assessing plant conservation, management, and ecological restoration, for both local and global applications. Also, these data sets provide additional information for surveys or data collections, establishing the starting point for more detailed studies on plant evolution, vegetation dynamics, and vegetation responses to disturbance and management. This data base covers Sierra Nevada mountains (southeastern Spain), a recognized plant biodiversity hotspot within the Mediterranean context. According to previous available data (before this augmented compilation), these mountains host 7% of the 24,000 Mediterranean vascular plants, despite covering just 0.01% of its area. Another characteristic of the Sierra Nevada is the great singularity of its flora, with 95 taxa being endemic to the high‐mountain area of Sierra Nevada and surroundings. From these endemic taxa, 70% are endangered by different threats, global warming being a leading cause. We seek to provide a complete and updated database of the flora of the Sierra Nevada mountains (southeast Spain). The goal of the present data set is to compile the names of all the vascular plant taxa inhabiting Sierra Nevada, together with relevant features including taxonomical, morphological–ecological traits, distribution, habitats, abundance, and conservation status. The data were compiled according to all the available information sources on taxonomy, ecology, and plant‐species distribution. The resulting data set includes 2,348 taxa belonging to 1,937 species, 377 subspecies, and 34 hybrids, from a total of 756 genera and 146 families represented in the collection. For each taxa, together with taxonomical information (Phylum, Class, Family, Genus, Taxa), we compiled plant traits (life form, spinescence, flower symmetry, flower sexuality, plant gender, androecium:ginoecium ratio, flower color, perianth type, pollinator type, flowering, seed dispersal, and vegetative reproduction), and their environmental association (origin, endemic character, general distribution, substrate, elevation, habitat, local abundance, hygrophilous behavior, and conservation status). All these traits were compiled from all the available information sources, resulting in a complete and updated database for Sierra Nevada vascular flora. This data set provides valuable information on plant traits in an outstanding micro hotspot within the Mediterranean hotspot. This data set can be freely used for noncommercial purposes. This data set is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). When you use this data set, we request that you cite the data and this data paper. [ABSTRACT FROM AUTHOR]

Soft-tissue sarcomas constitute an uncommon and heterogeneous group of tumors of mesenchymal origin. Diagnosis, treatment, and management should be performed by an expert multidisciplinary team. MRI/CT of the primary tumor and biopsy is mandatory before any treatment. Wide surgical resection with tumor-free tissue margin is the mainstay for localized disease. Radiotherapy is indicated in large, deep, high-grade tumors, or after marginal resection not suitable for re-excision. Perioperative chemotherapy should be discussed for high-risk sarcomas of the extremities and trunk-wall. In the case of oligometastatic disease, patients should be considered for local therapies. First-line treatment with anthracyclines (or in combination with ifosfamide) is the treatment of choice. Other drugs have shown activity in second-line therapy and in specific histological subtypes but options are limited and thus, a clinical trial should always be discussed.

Background: The interruption of surgical care in Spain caused by the pandemic must end. Recovery from this activity must be carried out on an elective basis and in conjunction with possible cases of COVID-19. The objective of this review was to incorporate good practice criteria related to COVID-19 into the context of safe surgery, which would make it possible to develop a proposed surgical safety checklist adapted to patients with this disease., Methods: Narrative literature review, following the PRISMA protocol, in the Medline and Cochrane directories, using the MeSH terms (coronavirus, infections, safety, surgical procedures, operative, checklist) and the Boolean operator AND. In addition, recommendations from scientific bodies and societies were reviewed (grey literature)., Results: Thirty-three final studies were included with recommendations for safe surgery and surgical safety checklist adapted for COVID-19, the most frequent being aspects related to treatment (41.3%) and prevention and control measures (27.6%)., Conclusions: The existence of a broad consensus on good practices recommended for COVID surgical patients makes it possible to make a proposal for surgical safety checklist to these patients., (Copyright © 2021 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Torture methods have traditionally been quantified using checklists. However, checklists fail to capture accurately both the almost infinite range of available methods of torture and the victims' subjective experience. The Torturing Environment Scale (TES) was designed as a multidimensional alternative that groups torture methods according to the specific human function under attack. This study aims to do an exploratory assessment of the internal consistency reliability and discriminatory validity of the TES as part of a construct validity assessment in a sample of Basque torture survivors., Methods: We applied the TES to a sample of 201 torture survivors from the Istanbul Protocol Project in the Basque Country Study (IPP-BC) to profile torturing environments in detention. To estimate the internal consistency reliability of the scale, categorical omega values were obtained for each subscale of the TES. To assess its discriminatory validity, the "known groups" method was used comparing mean scorings by gender, state security forces involved in the detention, and decade (the 1980s to the present) when the events took place., Results: Men reported more physical pain, while women reported more attacks on self-identity and sexual integrity. The TES also showed significant differences as regards the security forces involved in the detention: Civil Guard (a militarised police) used more manipulation of the environment, threats, fear, pain and extreme pain, as compared to national and regional corps. Finally, although patterns of torture remained mostly unchanged across decades, more recent detentions included more emphasis on psychological attacks: context manipulation, humiliation linked to sexual identity, and attacks to meaning and identity. For all subscales of the TES, categorical omega values ranged from 0.44 to 0.72., Conclusion: The TES may be a useful tool in profiling torturing environments. Its sensitivity to key contextual variables supports the discriminatory validity of the scale. While some of the subscales showed an acceptable degree of internal consistency, others require further analysis to improve reliability. The scale provides unique insights into the profile of contemporary torture. It will allow for future quantitative research on the relationship between different torturing environments and the medical and psychological consequences thereof.

At the international level, the enormous demand to manage the COVID-19 pandemic has posed a challenge both in the provision of personnel and in supplies and sanitary material. There is no precedent or publication related to the management and leadership of nursing services in Spain within the emergency plan for the COVID-19 pandemic. This article describes the experience of the Hospital Clinico de Barcelona in the current extraordinary circumstances that undoubtedly constitute a nursing management of enormous magnitude and unprecedented due to the high number of people affected and the extraordinary risk of healthcare personnel. Following national and international guidelines to alleviate the pandemic, protect health and prevent the spread of the outbreak. The ability to work as a team, emotional management and respect for organizational decisions have made it possible to face the challenges that the pandemic has put in place and that the Nursing Department can lead in a calm and orderly manner the different actions to perform. Lastly, it will be necessary to continue with an in-depth analysis of the situation and of the actions carried out in order to identify the areas for improvement as well as to evaluate the overall nature of the process., (© 2020 Elsevier España, S.L.U. All rights reserved.)

Teledermatology has facilitated specialist care during the crisis caused by the coronavirus disease 2019 pandemic, eliminating unnecessary office visits and the possible exposure of patients or dermatologists. However, teledermatology brings forward certain ethical and medicolegal questions. A medical consultation in which the patient is not physically present is still a medical act, to which all the usual ethical and medicolegal considerations and consequences apply. The patient's right to autonomy and privacy, confidentiality, and data protection must be guaranteed. The patient must agree to remote consultation by giving informed consent, for which a safeguard clause should be included. Well-defined practice guidelines and uniform legislation are required to preserve the highest level of safety for transferred data. Adequate training is also needed to prevent circumstances involving what might be termed «telemalpractice»., (Copyright © 2020 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: In recent years, the way CPR instructions are given has changed because of the development of new technology that allows bystanders who witness a cardiac arrest to be guided in performing CPR. This study aimed to compare the effectiveness of using a mobile phone application (app) versus telephone operator assistance in performing cardiopulmonary resuscitation (CPR) techniques in simulated settings., Methods: A comparative study was performed with 2 intervention groups: (1) mobile phone app and (2) telephone assistance. A total of 128 students participated and were distributed randomly into each intervention group. A CPR observation checklist and standard CPR quality parameter measurements were used for data collection., Results: The group that used the app obtained better results than the group that had telephone assistance on 5 items during CPR observation: checking if the area is secure (X 2 (1) = 26.81; P < 0.05), asking for help (X 2 (1) = 66.07; P < 0.05), opening of airways (X 2 (1) = 12.03; P < 0.05), checking for breathing (X 2 (1) = 6.10; P < 0.05), and contacting emergency services (X 2 (1) = 12.41; P < 0.05). Regarding the skill level of CPR, no statistically significant differences were found when comparing the 2 intervention groups (X 2 (1) = 0.91; P = 0.33). As for the parameters measured, there were only statistically significant differences found in the item compression fraction (U = 1,593.00; Z = -2.16; P < 0.05), with the group that used the app obtaining better results., Discussion: Better outcomes were observed in recognizing if the area was safe, asking for help, opening up the airways, checking for breathing, and calling emergency services in the mobile phone app group. However, the results indicated that there were no differences in the CPR parameters, except compression fraction, when the app was used as opposed to being guided by telephone., (Copyright © 2020 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Objective: Decision making in hospitals, and especially in their own healthcare services, is hardly referenced in the literature. During the pandemic period, healthcare services have put in place contingency plans to minimize the consequences of the coronavirus on professionals and patients. However, the deployment of contingency plans and results are hardly shared, depriving other services of references to refute, compare or emulate the aforementioned plans. The objective of this work was the description of the implementation and evaluation of Contingency Plans in the Covid-19 pandemic in a unit of inflammatory bowel disease of a Digestive Service in the Sanitary Area of Pontevedra and O Salnés., Methods: A team of managers and professionals adapted the 10 measures recommended by Deloitte to face a pandemic to the healthcare environment. The measures were then formulated as a checklist. From the Plan-Do-Check-Act improvement cycle, they were grouped into categories: risk management, organizational management and decision-making. Finally, an external team carried out a qualitative evaluation of the implementation of the contingency plan carried out., Results: The Intestinal Inflammatory Disease Unit of the Digestive Service has obtained an assessment of compliance with the 10 recommended measures to confidently face a pandemic., Conclusions: Sharing the deployment of the contingency plan and its results is useful to identify good practices. This article shows a method to evaluate decision-making in pandemic situations. The outcomes faces the The Intestinal Inflammatory Disease Unit in an excelent position.

Background: Since autism detection protocols rely primarily on parental accounts of early symptoms, the use by Spanish-speaking populations of screening tools developed in a different language and socio-cultural context (usually English) might hamper the success of early detection programs., Method: A systematic search in four databases was completed, identifying 59 tools used for ASD detection. Of these, only nine tools had been applied in Spanish-speaking populations, and of those, only five can be considered specific tools for the early detection of autism., Results: Sensitivity detecting autism was generally lower in the Spanish versions of the reviewed instruments, while specificity tended to be equal to or higher than that reported in the original screeners., Conclusions: Heterogeneity and poor methodological rigor of the studies conducted to date emphasize an urgent need for a concerted effort to develop reliable and valid instruments for the early detection of autism in Spanish-speaking populations worldwide.

Objective: The objective of this study was to describe the current provision of basic resources for asthma management in Primary Health Care (PHC)., Design: Cross-sectional study, with an ad hoc quantitative survey., Location and Participants: A total of 380 primary healthcare physicians in Spain., Interventions and Main Measurements: Analysis of perceptions of management and use of basic human, organisational and material resources to ensure appropriate care provision to asthma patients., Results: Survey respondents stated that their centre did not have a consultant doctor (64%) or nurse (62%) in respiratory disease. Almost all (92%) of the centres have spirometers, of which 70% have peak flow meters, and 93% have placebo inhalers. In the last year, respondents have received specific theoretical/practical training from the centre (46%), and by third parties (83%). More than three-quarters (78%) of the centres has educational material available for patients. There is no specific healthcare protocol in 36% of the centres, and 43% had no referral protocol. A clinical interview is conducted to monitor the patient (90%), but there are no validated questionnaires to measure therapeutic adherence (85%), or a checklist to check inhalation technique (83%). Differences are observed in the relevant variables in the analysis of each Spanish Autonomous Community., Conclusions: Access to certain resources in the care of patients with asthma is limited in aspects of coordination between levels, varied according to Spanish Autonomous Community, and improved in most health resources in Asthma., (Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To evaluate the validity, acceptability, and impact on the level of knowledge and skills of Primary Care health professionals of a training model aimed at improving the care of critical patients., Design: A quasi-experimental interventional, multicentre study., Location: Eight health care teams in Barcelona., Participants: A total of 272 professionals., Interventions: A training program consisting of 48 simulations of acute myocardial infarction and stroke., Main Measurements: A checklist was used to evaluate critical patient skills, effect of training on the knowledge of the participants, and a satisfaction survey. The training was carried out after 2 series of simulations (AMI+Stroke). In the second series, 3evaluations were made: in situ, one week after, and at 3weeks. Concordance and reliability were measured. The differences in means were analysed using the Student t test for paired data., Results: A total of 449 knowledge tests were answered, with a higher score being obtained at the end of each simulation (3.89 -SD 1.01 vs. 3.21 -SD 1.09). Doctors obtained better medical scores than nurses (3.81 - SD 0.87 vs. 3.32 - SD 1.15), and professionals with a specialty completed scored more than those in training (MIR) (3.6 - SD 1.08 vs. 3.4 - SD 1.18). The mean score was 7.7 points (SD 1.56) in the first evaluation, and improved to 9.1 points (SD 0.78). The kappa index was greater than 0.40 in all cases., Conclusions: A training methodology in the management of emergencies in Primary Care based on simulations is valid, reliable and well accepted, achieving an improvement in the level of knowledge and skills of the participating professionals., (Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

In the field of psychopathy, there is an ongoing debate about the core traits that define the disorder, and that therefore must be present to some extent in all psychopaths. The main controversy of this debate concerns criminal behaviour, as some researchers consider it a defining trait, while others disagree. Using a representative sample of 204 Spanish convicted inmates incarcerated at the Pereiro de Aguiar Penitentiary in Ourense, Spain, we tested two competing models, the Psychopathy Checklist-Revised (PCL-R), which includes criminal behaviour items, versus the Comprehensive Assessment of Psychopathic Personality (CAPP), which does not. We used two different PCL-R models, one that includes criminal items and another that does not. PCL-R factors, facets, and testlets from both models and CAPP dimensions were correlated and compared. Two different PCL-R cut-off scores, 25 or more and 30 or more, were used for the analysis. Overall, a strong correlation was found between PCL-R and CAPP scores in the whole sample, but as scores increased and inmates became more psychopathic, the correlations weakened. All these data indicate that psychopathy, understood to mean having high scores on the PCL-R and CAPP, is a multidimensional entity, and inmates can develop the disorder and then receive the diagnosis through different dimensions. The CAPP domains showed better correlations when compared with the PCL-R factors from both models, showing that an instrument for the assessment of psychopathy without a criminal dimension is valuable for clinical assessment and research purposes., Competing Interests: The authors have declared that no competing interests exist.

The consensus paper for the implementation and development of the sepsis code, finished in April 2017 is presented here. It was adopted by the Regional Office of Health as a working document for the implementation of the sepsis code in the Community of Madrid, both in the hospital setting (acute, middle and long-stay hospitals) and in Primary Care and Out-of-Hospital Emergency Services. It is now published without changes with respect to the original version, having only added the most significant bibliographical references. The document is divided into four parts: introduction, initial detection and assessment, early therapy and organizational recommendations. In the second to fourth sections, 25 statements or proposals have been included, agreed upon by the authors after several face-to-face meetings and an extensive "online" discussion. The annex includes nine tables that are intended as a practical guide to the activation of the sepsis code. Both the content of the recommendations and their formal writing have been made taking into account their applicability in all areas to which they are directed, which may have very different structural and functional characteristics and features, so that we have deliberately avoided a greater degree of concretion: the objective is not that the sepsis code is organized and applied identically in all of them, but that the health resources work in a coordinated manner aligned in the same direction., (©The Author 2019. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

Introduction: Pre-exposure prophylaxis is defined as the use of antiretroviral drugs to prevent HIV acquisition in uninfected individuals. Recognizing the increasing use of informal pre-exposure prophylaxis in Portugal, CheckpointLX, a community clinic targeted to men who have sex with men in Lisbon, Portugal, began offering counselling and follow-up services prior to formal introduction. This study aims to characterize pre-exposure prophylaxis users attending CheckpointLX before formal pre-exposure prophylaxis introduction in Portugal, and those who were referred to pre-exposure prophylaxis in the National Health Service following formal approval of pre-exposure prophylaxis., Material and Methods: Data was collected by peer counsellors between May 2015 and September 2018 and inserted in a database. Medical care followed the European AIDS Clinical Society recommendations for pre-exposure prophylaxis eligibility, initiation and follow-up. For formal pre-exposure prophylaxis, the General-Directorate for Health's Pre-exposure Prophylaxis guidelines checklist was used., Results: Until the end of May 2018, CheckpointLX had a total of 90 appointments for wild pre-exposure prophylaxis, of which 64 (71%) were first time visits. As for the 380 service users referred to the National Health Service, most were Portuguese (n = 318, 84%), and the mean age was 31 (8.9) years old. Condomless sex in the last six months with partners of unknown HIV status was the most common eligibility criteria (n = 59, 83%)., Discussion: Pre-exposure prophylaxis delivery should be complemented with effective information on the importance of immunization and education on safer practices of drug administration, in the scope of broader preventive sexual health care., Conclusion: Much remains to be done in Portugal to ensure that pre-exposure prophylaxis is available to those who need it the most. Offering pre-exposure prophylaxis at community clinics could be a first step.

Objective: To assess the effectiveness, on people with chronic pain, of an intervention (Time In) designed to reduce pain and to improve psychological symptoms., Design: A randomized clinical trial with a control group, taking three measurements over three months., Setting: Granada, Spain., Participants: A sample of 40 women aged 18 or older with a history (over 6 months) of chronic pain. The recruitment was in the Fibromyalgia Association of Granada, Spain (AGRAFIM)., Interventions: Time In is a sensorimotor intervention that combines biomechanical physiotherapeutic procedures and psychological strategies. A weekly session of 3h was planned and the total of the program was developed during five weeks., Main Measurements: Independent variables: sociodemographic information, clinical history and Time In intervention. Dependent variables: Brief Pain Inventory (BPI-S), Short-Form Health Survey (SF-12), Symptom Check List-90-R (SCL-90-R) and Clinical Outcome in Routine Evaluation (CORE-OM)., Results: Significant differences were observed between control group and intervention group of most of the scales used in postintervention and follow up measurements. Thus, significantly lower mean scores were obtained in intensity, interference and areas of pain, quality of life, psychological symptoms and behavioural change. Similar results were observed on d Cohen scores. They were 'very important' on intensity of pain (d=-1.01, d=-0.97) and interference of pain (d=-0.85, d=-0.74), with an improvement percentage from 21% to 30%., Conclusions: Time In intervention reduces pain and improves psychological symptoms in patients with fibromyalgia; this results in a better quality of life., (Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

ABSTRACTObjectives:To estimate the prevalence of Mild Behavioral Impairment (MBI) in people with Subjective Cognitive Decline (SCD), and validate the Mild Behavioral Impairment Checklist (MBI-C) with respect to score distribution, sensitivity, specificity, and utility for MBI diagnosis, as well as correlation with other neuropsychological tests., Design: Correlational study with a convenience sampling. Descriptive, logistic regression, ROC curve, and bivariate correlations analyses were performed., Setting: Primary care health centers., Participants: 127 patients with SCD., Measurements: An extensive evaluation, including Questionnaire for Subjective Memory Complaints, Mini-Mental State Examination, Cambridge Cognitive Assessment-Revised, Neuropsychiatric Inventory-Questionnaire (NPI-Q), the Geriatric Depression Scale-15 items (GDS-15), the Lawton and Brody Index and the MBI-C, which was administered by phone to participants' informants., Results: MBI prevalence was 5.8% in those with SCD. The total MBI-C scoring was low and differentiated people with MBI at a cut-off point of 8.5 (optimizing sensitivity and specificity). MBI-C total scoring correlated positively with NPI-Q, Questionnaire for Subjective Cognitive Complaints (QSCC) from the informant and GDS-15., Conclusions: The phone administration of the MBI-C is useful for detecting MBI in people with SCD. The prevalence of MBI in SCD was low. The MBI-C detected subtle Neuropsychiatric symptoms (NPS) that were correlated with scores on the NPI-Q, depressive symptomatology (GDS-15), and memory performance perceived by their relatives (QSCC). Next steps are to determine the predictive utility of MBI in SCD, and its relation to incident cognitive decline over time.

Objectives: To identify priorities among comorbidities in axial spondyloarthritis (AxSpA) and recommend how to follow them from an eminently practical perspective., Methods: A multidisciplinary group was selected (10 rheumatologists-six of them experts in AxSpA-, 2 general practitioners, an internist, a cardiologist, a gastroenterologist and a psychologist). In a first discussion meeting, the scope and users were established and a list of comorbidities was voted based on frequency and impact. The panelists had to defend the inclusion of each comorbidity/item in the document with consistent arguments. Four panelists and two methodologists developed systematic reviews on controversial topics. In a second meeting, the results of the reviews and the arguments concerning the items to be included were presented. After the meeting, the final document was drafted., Results: The final document includes two checklists, one for health professionals and another for patients; they incorporate cardiovascular risk, renal comorbidities, gastrointestinal risk, lifestyle, risk of infections and vaccinations, pulmonary involvement, concomitant medication, psycho-affective disorders, osteoporosis, and risk of fracture. In addition, the document reflects the arguments favoring the inclusion of each item and how to record the items for subsequent collection. The panel considered it also appropriate to likewise establish «practices to avoid» applicable to comorbidity in AxSpA., Conclusions: Two checklists and a list of situations to avoid were generated to facilitate the management of comorbidities in AxSpA. In a future step, their utility and acceptance will be tested by a broad group of users that includes doctors, patients and nurses., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Background and Objective: To assess the effect of home based telehealth or structured telephone support interventions with respect to usual care on quality of life, mortality and healthcare utilization in elderly high-risk multiple chronic condition patients., Patients and Methods: 472 elderly high-risk patients with plurimorbidity in the region of Valencia (Spain) were recruited between June 2012 and May 2013, and followed for 12 months from recruitment. Patients were allocated to either: (a) a structured telephone intervention, a nurse-led case management program with telephone follow up every 15 days; (b) telehealth, which adds technology for remote self-management and the exchange of clinical data; or (c) usual care. Main outcome measures was quality of life measured by the EuroQol (EQ-5D) instrument, cognitive impairment, functional status, mortality and healthcare resource use. Inadequate randomization process led us to used propensity scores for adjusted analyses to control for imbalances between groups at baseline., Results: EQ-5D score was significantly higher in the telehealth group compared to usual care (diff: 0.19, 0.08-0.30), but was not different to telephone support (diff: 0.04, -0.05 to 0.14). In adjusted analyses, inclusion in the telehealth group was associated with an additional 0.18 points in the EQ-5D score compared to usual care at 12 months (p<0.001), and with a gain of 0.13 points for the telephone support group (p<0.001). No differences in mortality or utilization were found, except for a borderline significant increase in General Practitioner visits., Conclusions: Telehealth was associated with better quality of life. Important limitations of the study and similarity of effects to telephone intervention call for careful endorsement of telemedicine. Clinicaltrials.gov (identifier: NCT02447562)., (Copyright © 2018 Elsevier España, S.L.U. All rights reserved.)

Objective: To standardize clinical evaluation of patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA) using a checklist., Methods: Qualitative study that included: 1) nominal group (18 experts); 2) literature reviews of measures used in the assessment of patients with axial SpA or PsA; and 3) focus groups, one with rheumatologists and another with patients, organized to become familiar with their opinion on medical assistance. Taking this into account, the experts selected the measures to be included in the checklist based on their relevance, feasibility, and the outcome type., Results: The checklist includes measures for the evaluation of personal history, physical examination, activity and function, laboratory tests, imaging studies and treatments. It also defines risk factors of radiographic progression, predictors of the response to biological therapies, and comprises measures of excellence., Conclusions: This checklist for patients with axial SpA and PsA could help standardize daily clinical practice and improve clinical management and patient prognosis., (Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Handover is a frequent and complex task that also implies the transfer of the responsibility of the care. The deficiencies in this process are associated with important gaps in clinical safety and also in patient and professional dissatisfaction, as well as increasing health cost. Efforts to standardize this process have increased in recent years, appearing numerous mnemonic tools. Despite this, local are heterogeneous and the level of training in this area is low. The purpose of this review is to highlight the importance of IT while providing a methodological structure that favors effective IT in ICU, reducing the risk associated with this process. Specifically, this document refers to the handover that is established during shift changes or nursing shifts, during the transfer of patients to other diagnostic and therapeutic areas, and to discharge from the ICU. Emergency situations and the potential participation of patients and relatives are also considered. Formulas for measuring quality are finally proposed and potential improvements are mentioned especially in the field of training., (Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.)

Objective: To describe the results of applying the European Quality Instrument for Health Promotion (EQUIHP) tool in the MIHsalud programme and to discuss its perceived utility by the programme's team members., Method: Evaluation study applying EQUIHP to a health promotion programme. A total of ten MIHsalud staff (eight women and two men) completed the EQUIHP and participated in two group interviews to discuss its perceived utility., Results: The programme obtained a total score of 6.5 points out of 10 in quality. The use of EQUIHP enabled the programme's weaknesses to be identified, such as lack of a communication plan, evaluability and sustainability; as well as its strengths, such as the inclusion of health promotion principles. The MIHsalud team believes that the EQUIHP is a useful tool which can facilitate a comprehensive evaluation of the programme in terms of a health promotion initiative., Conclusion: The use of the EQUIHP has made it possible to evaluate the quality of the programme and to make recommendations for its improvement, and it could be applied to other programmes and activities., (Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The right to educational inclusion for students with intellectual disability (SWID) requires the development of good assessment and intervention practices from holistic perspectives not exclusively focused on the academic limitations that SWID may present. These practices are settled in Spain, via regulations drawn up by each Autonomous Community (AC). The variety of existing regulations demands a critical review of the decisions taken to promote the inclusion of those students., Method: current regulations-in-force in each AC that regulate attention to diversity (AD) have been were analyzed by using a checklist that includes the variables that defining each stage of the AD process and the ways of providing supports that favor the development, learning and participation of SWID., Results: attention to diversity measures in each AC emphasize organizational and curricular issues, with no AC following holistic approaches in both assessment and intervention, but rather neglecting self-determination and the promotion of quality of life for SWID., Conclusions: guidelines for the development of new legal frameworks and professional practices based on the latest evidence-based models of attention to SWID and on the results are discussed.

Purpose: To assess the performance of the Brief Sexual Symptom Checklist for men (BSSC-M) questionnaire in General Practitioner's (GP) consults in Spain., Methods: Multicenter, cross-sectional study conducted in Spain among men ≥50 years, visiting a GP for any reason, and being able to answer self-administered questionnaires. Patients receiving medicines for erectile dysfunction (ED) and those with poor functional status were excluded. Sexual satisfaction was assessed by the BSSC-M, ED by the Sexual Health Inventory for Men (SHIM), and quality of life (QoL) using a 5-point Likert scale., Results: In all, 770 men met all the selection criteria and 556 patients (72.2%) reported sexually related problems, ED being the most frequent (n = 427; 55.5%). The SHIM score decreased progressively with the number of causes of sexual dissatisfaction. Prevalence of ED (SHIM ≤21) was greater in patients who referred problems with erection in the BSSC-M questionnaire (76 vs. 14%; p < 0.001). Multivariate analysis for ED prediction revealed that sexual dissatisfaction, QoL (average or low/very low), and the presence of 3 or more comorbidities significantly influenced the chances of having ED., Conclusions: Our results encourage the use of the BSSC-M for identifying suspicion of ED and other sexual problems in patients > 50 who visit their GP for a routine follow-up., (© 2018 S. Karger AG, Basel.)

A literature-based taxonomic catalogue of nemerteans (phylum Nemertea) from Spain and Portugal is provided, listing 75 species (12 Palaeonemertea, 24 Pilidiophora, and 39 Hoplonemertea) belonging to 34 genera. This is a low species number compared with the approximately 400 species listed in Europe. This lack of knowledge is mainly due to the low number of researchers interested in the phylum and the well-known taxonomic difficulties of its study. Geographic records are indicated for each species, and for some, comments are included on certain biological and taxonomic aspects.

Background: Behavioral and psychological symptoms of Dementia (BPSD) are a cause of significant stress in caregivers. The revised memory and behavior problems checklist (RMBPC) (Teri et al., 1992) is an instrument used for the assessment of BPSD. The psychometric properties of the RMBPC-Spanish version were analyzed., Method: 361 family caregivers of people with dementia were interviewed individually. The RMBPC is a 24-item questionnaire that assesses both the frequency of the BPSD and the reaction they cause in the caregiver. It has three factors: memory problems, disruptive behaviors, and depressive behaviors. Caregivers' depressive symptomatology, anxiety and burden, and the functional capacity of the person with dementia were also measured., Results: The results of a confirmatory factor analysis (CFA) show that the original three-factor model with 24 items, with error covariances, had a marginally acceptable adjustment for the frequency and reaction scales. The deletion of items with low factor loadings results in a better adjustment of the data to the model, for both the frequency and reaction scales. We found adequate internal consistency for all subscales, and significant associations between the subscales, burden, anxiety, and depression., Conclusions: The results suggest that the Spanish version of the RMBPC shows adequate adjustment for the three-factor model with 24-items, but that removing some of the items improves the adjustment. The results support the use of this instrument for the assessment of BPSD in Spanish people with dementia.

Background: Fragile X syndrome (FXS) is an inherited neurodevelopmental condition characterised by behavioural, learning disabilities, physical and neurological symptoms. In addition, an important degree of comorbidity with autism is also present. Considered a rare disorder affecting both genders, it first becomes apparent during childhood with displays of language delay and behavioural symptoms.Main aim: To show whether the combination of 10 mg/kg/day of ascorbic acid (vitamin C) and 10 mg/kg/day of α-tocopherol (vitamin E) reduces FXS symptoms among male patients ages 6 to 18 years compared to placebo treatment, as measured on the standardized rating scales at baseline, and after 12 and 24 weeks of treatment.Secondary aims: To assess the safety of the treatment. To describe behavioural and cognitive changes revealed by the Developmental Behaviour Checklist Short Form (DBC-P24) and the Wechsler Intelligence Scale for Children-Revised. To describe metabolic changes revealed by blood analysis. To measure treatment impact at home and in an academic environment., Methods/design: A phase II randomized, double-blind pilot clinical trial., Scope: male children and adolescents diagnosed with FXS, in accordance with a standardized molecular biology test, who met all the inclusion criteria and none of the exclusion criteria., Instrumentation: clinical data, blood analysis, Wechsler Intelligence Scale for Children-Revised, Conners parent and teacher rating scale scores and the DBC-P24 results will be obtained at the baseline (t0). Follow up examinations will take place at 12 weeks (t1) and 24 weeks (t2) of treatment., Discussion: A limited number of clinical trials have been carried out on children with FXS, but more are necessary as current treatment possibilities are insufficient and often provoke side effects. In the present study, we sought to overcome possible methodological problems by conducting a phase II pilot study in order to calculate the relevant statistical parameters and determine the safety of the proposed treatment. The results will provide evidence to improve hyperactivity control and reduce behavioural and learning problems using ascorbic acid (vitamin C) and α-tocopherol (vitamin E). The study protocol was approved by the Regional Government Committee for Clinical Trials in Andalusia and the Spanish agency for drugs and health products., Trial Registration: ClinicalTrials.gov Identifier: NCT01329770 (29 March 2011).

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.)

Objective: To determine the effectiveness of adding psychoeducational treatment implemented in general practice to usual care for patients with fibromyalgia (FM), and to analyze the cost-utility of the intervention from health care and societal perspectives., Methods: Twelve-month randomized controlled trial. A total of 216 primary care patients meeting the American College of Rheumatology criteria for FM participated in the study. The intervention included 9, 2-hour sessions of psychoeducation (5 sessions of education about the illness+4 sessions of autogenic relaxation) added to usual care provided by a multidisciplinary group in general practice was compared to usual care in the public health system., Results: At 12-month follow-up, patients who received psychoeducation showed greater improvement in global functional status (Cohen d=0.36; -2.49 to 3.81), physical functioning (Cohen d=0.56; 0.08 to 1.00), days feeling well (Cohen d=0.40; -0.16 to 1.02), pain (Cohen d= 0.35; -0.04 to 0.80), morning fatigue (Cohen d=0.24; -0.20 to 0.76), stiffness (Cohen d=0.34; -0.10 to 0.87), and depression (Cohen d=0.30; -0.26 to 0.93). Mean incremental cost per person receiving the intervention was &OV0556;-215.49 (-615.13 to 287.81) from the health care perspective, and &OV0556;-197.32 (-785.12 to 395.74) from the societal perspective. The incremental gain in quality-adjusted life-years per person was 0.12 (0.06 to 0.19), yielding a "dominant" intervention from both perspectives. The sensitivity analysis suggested that the intervention was cost-effective even imputing all missing data., Discussion: Our findings demonstrate the long-term clinical effectiveness of a psychoeducational treatment program for FM implemented at primary care level and the cost-utility from a health care and societal perspective., Trial Registration: NCT00550966.

Background: Some domains of the questionnaires used to measure symptoms and quality of life (QOL) in patients with advanced cancer seem to measure similar dimensions or constructs, so it would be useful for clinicians to demonstrate the interchangeability of equivalent domains of the questionnaires in measuring the same constructs., Objective: This study investigated the reliability and concurrent validity of the Palliative Outcome Scale (POS), the Rotterdam Symptom Checklist (RSCL), and the Brief Pain Inventory (BPI), used to measure symptom control in patients with advanced cancer., Design: This was an evaluative study., Setting/subjects: Subjects were patients with advanced cancer attended by Spanish primary care physicians., Measurements: Secondary analysis was performed of 117 outpatients who completed the POS, BPI, and RSCL at two different times, with an interval of 7 to 10 days. Bland and Altman analyses and plot, repeatability coefficient, as well as Spearman correlations were carried out., Results: There were 117 included patients. Mean age was 69.4 (11.5) years, gender was 60% male, 37.6% completed only elementary school, diagnoses were mainly digestive and lung cancer, with a low functional rate and presence of oncologic pain. First and second questionnaire rounds showed significant correlations and agreement. Agreement was shown between pain intensity of BPI and pain and physical scales of RSCL, and between physical symptoms of RSCL and of POS, with significant correlations in equivalent dimensions., Conclusion: BPI, POS, and RSCL have shown adequate reliability and moderate concurrent validity among them.

This paper identifies problems and analyzes those conflicts posed by the evaluation of research projects involving the collection and use of human induced pluripotent stem cells (iPS) in Spain. Current legislation is causing problems of interpretation, circular and unnecessary referrals, legal uncertainty and undue delays. Actually, this situation may cause a lack of control and monitoring, and even some paralysis in regenerative medicine and cell therapy research, that is a priority nowadays. The analysis of the current legislation and its bioethical implications, led us to conclude that the review of iPS research projects cannot be assimilated to the evaluation of research projects that involve human embryonic stem cell (hESC). In this context, our proposal is based on the review by the Research Ethics Committees and the checkout by the Spanish Comission of Guarantees for Donation and Use of Human Cells and Tissues (CGDUCTH) of human iPS cells research projects. Moreover, this article claims for a more transparent research system, by effectively articulating the Registry on Research Projects. Finally, a model of verification protocol (checklist) for checking out biomedical research projects involving human iPS cells is suggested.

Unlabelled: One of the biggest challenges for the public health sector is to ensure the clinical safety of the patient, which is affected by mistakes made in pre-hospital emergency care. A culture of safety is encouraged and health professionals have tools at their disposal to help them maintain that safety., Objective: [corrected] We propose as a hypothesis that compliance with safety standards in for the care of patients using extra-hospital emergency systems improves care and minimize risks. Our goal is to build a tool that enables us to measure the safety quality for patients in need of non-hospital emergency services., Method: To create this tool we have taken the SENECA study as a basis, and using the European Quality Model of the European Foundation of Quality Management (EFQM). The indicators were created using the Delphi Method., Results: A total of 74 indicators were proposed, 9 of which were proposed by the panelists, and 44% being accepted. A definitive tool of 41 indicators was created. The most notable indicators were; "The expiry dates of consumable material and drugs that are stored in the units are controlled" grouped in "Alliances and resources", and "Patients who do not adhere to treatment due to unresolved doubts" grouped in "Key results"., Conclusions: The use of the EFQM model to build the assessment tool allows information to be appropriately structured and to organize safety standards and indicators of security in a consistent manner. This methodology helped to propose a suitable tool for measuring patient safety in an extra-hospital situation. The application of this tool will identify areas for improvement related to the patient safety., (Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.)

Objective: [corrected] To analyse the evolution of continuing education activities in the main areas of the Strategy for Patient Safety of the Andalusian Accreditation Model., Material and Methods: An observational study was carried out on continuing education activities related to patient safety according to the Andalusian Accreditation Model, during 2003-2010. Results were evaluated (Fisher's exact test) by SPSS v.16 program., Results: A total of 12,975 health professional activities were accredited, of which 1,002 (7.7%) activities and 13,413 meetings were related to one or more of safety lines. The main target groups of this training were Nursing with 4,763 meetings (35.5%), Medicine with 4,090 meetings (30.5%), and Medical Technicians with 1,963 meetings (14.6%)., Conclusions: The implementation and consolidation of the Strategy for Patient Safety, has encouraged the development of accredited continuing education activities related to safety, as well as an improvement in the qualitative value of this activities., (Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.)

We present this document as a guide to preparing a specific institutional pre-anaesthesia checklist, as recommended in the Helsinki declaration on patient safety in anaesthesiology. Also, the recently recommended WHO "safe surgery check-list" includes a check-list for anaesthesia. A working group was established in accordance with the charter of the Spanish Society of Anaesthesiology and Resuscitation (Sociedad Española de Anestesiología y Reanimación [SEDAR]). The new patient safety culture introduced into medicine, and the recommendations of European anaesthesia societies has led us to design and update protocols in order to improve results in this important part of our speciality. We have prepared these recommendations or guidelines using, as examples, updates of pre-anaesthesia check-lists by other American (ASA), British, or Canadian societies of anaesthesia. With that aim, we enlisted the help of anaesthesia ventilator experts and the participation and advice of experienced anaesthesiologists from all parts of Spain. After various corrections and modifications, the document was available at www.sedar.es, so that any anaesthesiologist could propose any correction, or give their opinion. Finally, these guidelines have been approved by the SEDAR Board of Directors, before it was sent for publication in this journal. The aims of this document are to provide: a guideline applicable to all anaesthesia machines, a descriptive pre-anaesthesia check-list that include everything necessary for the anaesthesia procedure, and a resumed check-list to be available in all the anaesthesia machines or other equivalent, but prepared for each institution, which should include anaesthetic equipment and drugs. So, in order to ensure the aims and requirements of the European Board of Anaesthesiology, the European Society of Anaesthesiology, and the WHO are met, each institution should have a protocol for checking equipment and drugs. These guidelines are applicable to any anaesthesia equipment, enabling every institution to develop their own checking protocols, adapted to their anaesthesia machines and their procedures. With the consent of the SEDAR, this group will collaborate with anaesthesia machines providers in order to develop specific checklists for each of their models that will be available at www.sedar.es., (Copyright © 2011 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.)

This paper examines from a practical perspective, the content of the information sheet to the participant in a clinical trial in which pharmacogenetic studies are conducted and/or pharmacogenomics, and scope of informed consent. The text is accompanied by a guide of questions to assess the fit of a participant information sheet on the regulation of clinical trials, biological samples and protection of personal data.

Background: Since 1986, the study of disability in Spain has been mainly addressed by National Disability Surveys (NDSs). While international attempts to frame NDS designs within the International Classification of Functioning, Disability and Health (ICF) have progressed, in general, the ICF has hardly been used in either the NDS or epidemiological studies. This study sought to identify ICF Activity- and Participation-related content in the most recent Spanish NDS, the 2008 Survey on Disabilities, Independence and Dependency Situations (Encuesta sobre discapacidades, autonomía personal y situaciones de Dependencia - EDAD 2008), and estimate the prevalence of such ICF-framed disability., Methods: EDAD 2008 methods and questions were perused. Of the 51 EDAD items analysed, 29 were backcoded to specific d2-d7 domains of the ICF Checklist and, by rating the recorded difficulty to perform specific tasks with or without help, these were then taken as performance and capacity respectively. A global ICF score was also derived, albeit lacking data for d1, "Learning and applying knowledge", d8, "Major Life Areas" and d9, "Community, Social and Civic Life". Data were grouped by sex, age, residence and initial positive screening, and prevalence figures were calculated by disability level both for the general population, using the originally designed weights, and for the population that had screened positive to disability. Data for institutionalised persons were processed separately., Results: Crude prevalence of ICF severe/complete and moderate disability among the community-dwelling population aged ≥6 years was 0.9%-2.2% respectively, and that of severe/complete disability among persons living in sheltered accommodation was 0.3%.Prevalence of severe/complete disability was: higher in women than in men, 0.8% vs. 0.4%; increased with age; and was particularly high in domains such as "Domestic Life", 3.4%, "Mobility", 1.8%, and "Self-care", 1.9%, in which prevalence decreased when measured by reference to performance. Moreover, global scores indicated that severe/complete disability in these same domains was frequent among the moderately disabled group., Conclusions: The EDAD 2008 affords an insufficient data set to be ICF-framed when it comes to the Activity and Participation domains. Notwithstanding their unknown validity, ratings for available ICF domains may, however, be suitable for consideration under the ADL model of functional dependency, suggesting that there are approximately 500,000 persons suffering from severe/complete disability and 1,000,000 suffering from moderate disability, with half the latter being severely disabled in domains capable of benefiting from technical or personal aid. Application of EDAD data to the planning of services for regions and other subpopulations means that need for personal help must be assessed, unmet needs ascertained, and knowledge of social participation and support, particularly for the mentally ill, improved. International, WHO-supported co-operation in ICF planning and use of NDSs in Spain and other countries is needed.