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Background Metastatic breast cancer, has a heterogeneous presentation and management, therefore its overall survival ranges from 2 to 3 years. Despite advances in breast cancer screening, diagnosis, and treatment, nearly 12-30% of early stage breast cancer patients eventually develop metastatic disease. In Ecuador, breast cancer is the most common malignancy among women, and the leading cause of newly diagnose cancer in the general population (Globocan 2020). This study aims to determine the frequency of metastatic sites and its impact in overall survival. Methods: An observational, retrospective, descriptive, single-center study was carried out. All patients with Metastatic breast cancer who had been treated at the National Oncology Institute SOLCA Guayaquil, in the period from 2016 to 2020 were included in the analysis. All statistical analyses were performed using SPSS for Windows (version 25.0;SPSS). The Kolmogorov-Smirnov test was used to test for the normality of distribution. Correlations were determined with Spearman correlation coefficients. The number of metastatic sites were recorded and their impact on overall survival was calculated by the Kaplan-Meier method and compared by the long-rank test, multivariable adjusted hazard ratios (HR) were estimated by Cox regression models. Results: A total of 1113 patients were included in the analysis, of which 84 patients (7.5%) were metastatic disease. The distribution of metastatic sites at diagnosis were: bone 64% (n=53), lung 51% (n=42), liver 30% (n=25), soft tissues 23% (n=19), and the least frequent were metastases to the central nervous system 17% (n=14), mediastinal lymph node 5% (n=4), peritoneal lymph node 1% (n=1). Regarding metastatic sites, 41% (N: 35) had only 1 metastatic site, 33,7% (N: 28) had 2 metastatic sites, and 25.3% (N:21) has 3 or more sites. A multivariable analysis was performed which takes into account all the metastases in the analysis. All have a higher risk of mortality vs not having any metastasis (all are greater than 1). But the only significant one is CNS with a RR 1,31 (1,08 - 1,61) P=0,005. Three or more sites of metastasis have RR 1,22 (0.95-1.57) p: 0.11. Relative Risk (RR) according to the different sites of metastasis are shown in the table#1. The association between 3 or more sites of metastasis showed a negative impact on overall survival (15 months +/-2.3 SD vs 36 months +/- 3.7 SD) compared to 1 site of metastasis. Conclusions: Approximately half of the women (N:49) with metastatic breast cancer in our population presented 2 or more sites of metastasis, which significantly decreases overall survival. The central nervous system is the site of metastasis with the highest relative risk of mortality, generating functional deterioration, adding morbidity, and only 64% (9 out of 14) of the patients access to radiotherapy as palliative treatment. Thus, better strategies for early diagnosis and adequate treatment of metastatic disease should be developed. Citation Format: Lissette Yagual Bohorquez, Evelyn Valencia-Espinoza, Emiliano Pulla-Cadmilema, Lissette P. Velez Avila, Maria del Mar Sanchez Salazar, Patricia Tamayo Aguilar, Jimmy Martin-Delgado, Glenda Ramos Martinez, Katherine Garcia Matamoros, Felipe Campoverde Merchan, Ruth Engracia Vivanco, Mayra Santacruz Maridueña, Roberto Escala Cornejo, Isabel Delgado Guerrero, Veronica Torres Floril, Diego Garcia Gamboa, Elina A. Rodriguez-Melendez. Impact on overall survival according to sites of metastasis: Real-world data [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-07.

Background: Breast cancer immunohistochemistry subtype classification by hormone receptor has become the standard practice for therapeutic decision making. The subtype is one of the crucial factors affecting breast cancer prognostic. Despite the progress in understanding of complex mechanisms in progression of breast cancer, the treatment is a global challenge health around the world, the 5-year survival rate is 26%. Currently in develop countries, in the metastatic stage, a gain in survival in the HR+/HER2+ subtype has been evidenced, likely attributable to major advances in HER2-targeted treatment (1). However, although in developed countries there is access to targeted therapy, in the Ecuadorian health system, difficulties complicate patients access to health care and treatment. Methods: We conducted a retrospective study about survival data in breast cancer metastatic according immunohistochemistry subtype. We analyzed all primary invasive breast cancer cases in the period from 2016 to 2020 in an oncology institute of Ecuador, the final study sample consisted for 83 patients. The overall survival was calculated by the Kaplan-Meier method and compared by the long-rank test. Multivariable adjusted hazard ratios (HR) were estimated by Cox regression models. Results: There were 31 patients (37.1%) with a HR(+)/HER2(-) breast cancer subtype, 15 patients HR(+)/HER2(+), 5 patients HER2 (+),18 patients HR(-)/HER2(-) and 14 patients without breast cancer subtype identified. Most patients were treated with different chemotherapy protocols; additional, in the group of women with HR(+)/HER2(+) subtype and HER2 (+) subtype only 15.87% were treated with HER2-targeted treatment, the vast majority in the last year. The best survival pattern was observed among women with HR(+)/HER2(-) breast cancer subtype with 35 months (IC 95% = 14,9 – 55), followed by HR(+)/HER2(+) with 27 months (IC 95% = 13,21 – 40,79), HER2 with 24 months (IC 95% = 4.4 – 32), and 14 months (IC 95% = 0 – 29.7) for HR(-)/HER2(-), however the difference wasn’t significant (p = 0.08). Hazard ratio of HR(+)/HER2(-) breast cancer subtype for breast cancer specific mortality risk was 1.61 (IC 95% = 0.64 – 4.19 p = 0.29). Conclusions: Hormone receptor subtype wasn’t s a significant independent prognostic factor in female metastatic breast cancer patients in a single center of Ecuador. However, there is a trend that subtype HR(+)/HER2(-) breast cancer subtype, has a better survival than the rest of the subtypes. These results differ from those of the rest of the world, probably access to target medicine and difficulties in access to health care system are the cause. Thus, better strategies for early access to adequate chemotherapy protocols should be developed Citation Format: Evelyn Valencia-Espinoza, Emiliano Pulla-Cadmilema, Lissette P. Velez Avila, Lissette Yagual Bohorquez, Maria del Mar Sanchez Salazar, Patricia Tamayo Aguilar, Jimmy Martin-Delgado, Glenda Ramos Martinez, Katherine Garcia Matamoros, Roberto Escala Cornejo, Felipe Campoverde Merchan, Ruth Engracia Vivanco, Mayra Santacruz Maridueña, Isabel Delgado Guerrero, Veronica Torres Floril, Diego Garcia Gamboa, Elina A. Rodriguez-Melendez. IMPACT ON OVERALL SURVIVAL ACCORDING TO BREAST CANCER IMMUNOPHENOTYPES: REAL-WORLD DATA IN METASTATIC BREAST CANCER IN ECUADOR [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-08.

Background: Breast cancer is the most common type of neoplasm in women. According to statistics from Globocan 2020, the incidence of breast cancer in Ecuador, as well as worldwide is 47.8 per 100,000 people/year, with a mortality rate of 13.6 per 100,000 people/year. Our health system provides coverage to approximately 60% of the population by the Ministry of Public Health (MSP), 30% by The Ecuadorian social security Institute (IESS), 5% by other entities (ISSFA, ISSPOL, MUNICIPIOS), and < 3% of the population have private medical coverage. Medical care attentions for breast cancer, covered by the MSP was 7,134 consults in 2013, with an increase to 8,767 in 2018. SOLCA Guayaquil, as a national reference Center, provides 24.425 oncologic consults per year, with 38% corresponding to breast cancer. The presentation of breast cancer, at diagnosis, corresponds approximately to 63% in localized stage, 29% as locally advanced, 6% as metastatic disease, with a 5-year overall survival of 99%, 85% and 29% respectively. The proportion of clinical stage IV breast cancer diagnoses varies from 5-10%, with an average of 6% in urban areas, reaching up to 50% in rural areas, so metastatic breast cancer is a public health challenge, especially for countries with emerging economies like ours. Methods: An observational, retrospective, descriptive, single-center study was carried out. All patients with metastatic breast cancer who had been treated at the National Oncology Institute SOLCA Guayaquil, in the period from 2016 to 2020 were included in the analysis. The clinical and pathological characteristics were recorded and their impact on overall survival was calculated by the Kaplan-Meier method and compared by the long-rank test, multivariable adjusted hazard ratios (HR) were estimated by Cox regression models. Results: 3700 patients were identified between January 2016-December 2020. A total of 2587 patients were excluded. Of a total of 1113 remaining patients, 84 debuted as metastatic disease. No male patients where reported with metastatic breast cancer in the past 5 years. Median age at diagnosis was 53,31 years (28-88 years). The most frequent metastatic sites, were: bone 63.86% (N:53), lungs 50.6% (N:42), liver 30,12% (N:25), soft tissue 22.89% (N:19), CNS 16.87% (N:14); A multivariable analysis was performed, all metastatic sites have a higher risk of mortality vs not having any metastasis, but the only significant one is CNS metastases RR 1.31 (1.08-1.61), p< 0.005. A total of 28 patients (33.73%) had 2 metastatic sites at presentation; 21 patients (25.30%) had 3 o more metastatic sites at presentation with a RR 1,22 (0.95-1,57) p:0,011, with overall survival -OS- (36 months vs 15 months) (long Rank 0,001). ECOG 1 was reported in 59 patients (71.08%), ECOG 2 in 18 (21.69%) and ECOG 3 in 5 (6,02%). A multivariable analysis was perform with ECOG 2-3, RR 1.03 (0,43-2-44), p:0,94. Principal reported comorbidities where: hypertension in 28 patients (33,73%), dyslipidemia in 16 (19,28%), obesity 14 (16,87%), Diabetes 8 (9,64%). By grouping 2 or more comorbidities, the RR 1,04 (0,83-1.30), p:0,71. Surgery was classified as done or not, where 33 patients (39,77%) underwent rescue mastectomy. Multivariable analysis shows Not Surgery with a RR 1,88 (1.07-3,3) p:0.02. Median OS was estimated for surgery 44,48 months +/-4,7SD; Not surgery 20,72 months +/-2,8 SD. Conclusions: In our population, metastatic breast cancer occurs in 7.6% (84 patients out of 1113 total), similar to that reported worldwide. Being a neoplasm with multiple immunophenotypes, and therefore, different treatment options, OS depends on multiple clinicopathological variables. This study showed that CNS metastases have a negative impact on OS, it is an independent variable for RR of mortality. ECOG and comorbidities did not show an impact on OS. Ultimately, mastectomy was offered to patients with good clinical response to systemic chemotherapy, and shows positive impact in OS. Citation Format: Elina A. Rodriguez-Melendez, Emiliano Pulla-Cadmilema, Lissette P. Velez Avila, Maria del Mar Sanchez Salazar, Patricia Tamayo Aguilar, Lissette Yagual Bohorquez, Jimmy Martin-Delgado, Glenda Ramos Martinez, Katherine Garcia Matamoros, Mayra Santacruz Maridueña, Ruth Engracia Vivanco, Roberto Escala Cornejo, Felipe Campoverde Merchan, Isabel Delgado Guerrero, Veronica Torres Floril, Diego Garcia Gamboa, Luis Pendola Gomez, Elizabeth Gamarra Cabezas, Juan Carlos Garces Santos, Evelyn Valencia-Espinoza. Impact of baseline ECOG, comorbidities, and surgery treatment election on overall survival [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-64.

Introducción: la espondiloartrtis axial (Esp-Ax) es una enfermedad inflamatoria crónica del esqueleto axial. Su inicio insidioso y baja prevalencia dificultan un diagnóstico temprano. Por eso cada vez más el involucramiento de la Atención Primaria y el médico de familia gana más relevancia para una adecuada coordinación para el control de la enfermedad y la detección oportuna de comorbilidades. El objetivo de este estudio fue identificar estándares de calidad para la atención de pacientes con Esp-Ax con especial énfasis en la Atención Primaria. Métodos: se hizo una revisión de la literatura en las siguientes bases de datos: MEDLINE, EMBASE y Cochrane Library para la identificación de publicaciones y literatura gris que validen o reporten estándares de calidad para la atención de pacientes con Esp-Ax, con especial énfasis en la Atención Primaria. No se aplicaron restricciones de idioma, fecha ni de tipología de documentos para obtener una búsqueda más amplia. Resultados: fueron identificados 161 documentos, de los cuales 3 cumplieron con los criterios de inclusión. Los estándares fueron agrupados siguiendo el modelo de Donabedian, 7 estándares de estructura, 3 estándares de proceso y 10 estándares de resultado. Conclusiones. La mejora de la práctica clínica depende de la identificación de oportunidades de mejora. Los estándares de calidad persiguen este objetivo, para disminuir la variabilidad clínica, mejorar los resultados y aumentar la satisfacción de las personas con la atención prestada. Palabras clave: espondiloartritis, Atención Primaria, calidad asistencial.

Background and objective Axial spondyloarthritis is an immune-mediated disease with a high cost, diagnostic delay and associated complications that makes it a particularly important condition. This work aims to establish a certification standard (SpACE Project) for monographic consultations in its diagnosis and treatment. Materials and methods Qualitative study of consensus, through the technique of the nominal group. First, a pragmatic review of the literature was carried out. Second, professionals involved throughout the care process (rheumatology, ophthalmology, gastroenterology, traumatology, family medicine, physical therapy, and nursing) were included. Results Thirty-seven possible standards were extracted from the pragmatic review of the literature. During the consensus phase only those standards with high feasibility and importance in the care process were prioritized. Finally, the group of 26 experts agreed on the inclusion of 14 standards. Discussion and conclusions SpACE is a consensus-based certification standard that seeks to improve health outcomes and more integrated care.

Resumen Antecedentes y objetivo La espondiloartritis axial es una enfermedad inmunomediada con un elevado coste, retraso diagnostico y complicaciones asociadas, lo que la convierte en una enfermedad con especial importancia. Este trabajo busca por consenso establecer un modelo de certificacion (Proyecto SpACE) para consultas monograficas en su diagnostico y tratamiento. Materiales y metodos Estudio cualitativo de consenso, a traves de la tecnica del grupo nominal. Primero, fue realizada una revision pragmatica de la literatura. Segundo, fueron incluidos profesionales involucrados a lo largo del proceso asistencial (reumatologia, oftalmologia, gastroenterologia, traumatologia, medicina de familia, fisioterapia y enfermeria). Resultados Producto de la revision pragmatica de la literatura fueron extraidos 37 posibles estandares. Durante la fase de consenso solo aquellos estandares con una elevada factibilidad e importancia en el proceso asistencial fueron priorizados. Finalmente, el grupo de 26 expertos acordo la inclusion de 14 estandares. Discusion y conclusiones SpaCE es una norma de certificacion, fruto del consenso, que busca mejorar los resultados en salud y una atencion mas integrada.

Resumen Antecedentes y objetivos Entre las principales causas de ceguera y de perdida severa de la vision se encuentran la degeneracion macular asociada a la edad, el edema macular diabetico y la oclusion venosa de la retina. Las recomendaciones «no hacer» son estrategias para mejorar la calidad asistencial y optimizar los costes sanitarios. Este estudio tuvo por objetivo definir por consenso practicas de escaso valor en las enfermedades mencionadas, ademas de estimar su ocurrencia. Materiales y metodos Estudio de metodos mixtos. En una primera fase se busco el consenso de un panel multidisciplinar de expertos a traves de la tecnica del grupo nominal. En una segunda fase, se realizo un estudio observacional retrospectivo, mediante el cual se revisaron los registros de historias clinicas. Resultados Fueron establecidas 7 recomendaciones para degeneracion macular asociada a la edad, 4 para edema macular diabetico y 5 para oclusion venosa de la retina. En total, 1.012 registros de pacientes fueron revisados por los 4 hospitales participantes. La revision de historias clinicas revelo que los «no hacer» consensuados ocurrian en un rango entre 0,6 y 31,4% de los casos incluidos en el estudio. Conclusion Este estudio identifico recomendaciones «no hacer» en estas enfermedades que ocurren con relativa frecuencia en la practica clinica. Es necesario revisar el proceso asistencial para erradicar estas practicas y mejorar la calidad asistencial.

Background: As of 7 January 2022, it is estimated that 5.5 million people worldwide have died from COVID-19. Although the full impact of SARS-CoV-2 (COVID-19) on healthcare systems worldwide is still unknown, we must consider the socio-economic impact. For instance, it has resulted in an 11% decrease in the GDP (Gross Domestic Product) in the European Union. We aim to provide valuable information for policymakers by analysing widely available epidemiological and socioeconomic indicators using Spanish data. Methods: Secondary analysis of routinely available data from various official data sources covering the period from 1 March 2020 to 31 March 2021. To measure the impact of COVID-19 in the population, a set of epidemiological and socioeconomic indicators were used. The interrelationships between these socioeconomic and epidemiological indicators were analysed using Pearson’s correlation. Their behaviour was grouped according to their greater capacity to measure the impact of the pandemic and was compared to identify those that are more appropriate to monitor future health crises (primary outcome) using multivariate analysis of canonical correlation for estimating the correlation between indicators using different units of analysis. Results: Data from different time points were analysed. The excess of mortality was negatively correlated with the number of new companies created during the pandemic. The increase in COVID-19 cases was associated with the rise of unemployed workers. Neither GDP nor per capita debt was related to any epidemiological indicators considered in the annual analysis. The canonical models of socioeconomic and epidemiological indicators of each of the time periods analysed were statistically significant (0.80–0.91 p < 0.05). Conclusions: In conclusion, during the COVID-19 pandemic in Spain, excess mortality, incidence, lethality, and unemployment constituted the best group of indicators to measure the impact of the pandemic. These indicators, widely available, could provide valuable information to policymakers and higher management in future outbreaks.

Chronic esophageal conditions (CEC) are associated with significant disease-related burden, disability, and costs. Health-related quality of life (HRQOL) constructs are intended to capture the physical, mental, social, and emotional aspects of a patient's life and how health status impacts these domains. The Northwestern Esophageal Quality of Life (NEQOL) can be used among esophageal diseases while maintaining sensitivity to specific conditions. We aimed to translate, cross-cultural adapt, and validate the NEQOL into Spanish.After language and cross-cultural adaptation, the NEQOL was applied to an outpatient clinic-based population in a single tertiary center. We analyzed the internal consistency, construct, criterion validity, and test-retest reliability of the questionnaire. The criterion validity was tested against the SF-12 questionnaire.After completing the translation process, no item was considered problematic. A total of 385 patients were included in the validation study. The internal consistency (Cronbach's alpha) for the total NEQOL-S score was 0.89. The NEQOL-S questionnaire showed moderate test-retest reliability (ICC = 0.828; 95% CI 0.755-0.881; p 0.001). Criterion validity showed good coherence when correlated with the SF-12 survey (RThe translated and cross-culturally adapted NEQOL-S showed good psychometric properties that allow its use in Spanish-speaking patients suffering from CEC.

INTRODUCTION The global prevalence of diabetes in 2019 in adults was estimated to be 9.3%. This study developed in Ecuador, for the first time, instruments to assess patient-reported outcomes and experiences. METHODS The Experiences of the Person with Diabetes (EPD) Questionnaire is a diabetes-specific instrument. A mixed-methods study was conducted. First, a qualitative item development phase that included four focus groups and six semi-structured interviews with patients was conducted in different rural and urban areas of Ecuador to obtain information on culture, beliefs, demographics, diet and social perspectives. A second quantitative phase for psychometric validation was carried out in primary care settings of rural and urban areas of Ecuador. RESULTS Forty-two and four hundred and eighty-nine participants were included in each phase, respectively. The item development phase resulted in a questionnaire of 44 items (23 for perceived outcomes and 21 for experiences). In the validation study, most participants were women (58%) and from urban areas (57%). Exploratory factor analysis revealed three dimensions for each instrument. Outcomes instrument dimensions were symptoms and burnout, worries and fears and social limitations. Experiences instrument dimensions were information, patient-centred care and care delivery. Cronbach's α values of the total score and dimensions were high, ranging between .81 and .93 in both instruments. Confirmatory factor analysis showed an acceptable fit of the data. CONCLUSION The EPD Questionnaire is probably the first instrument developed to assess patient-reported experiences and perceived outcomes in a middle-income country that included patients to capture all dimensions relevant for the intended population. Its psychometric properties are robust and could provide valuable information for clinicians and policymakers in the region. PATIENT OR PUBLIC CONTRIBUTION The development of these instruments has taken into consideration patients and the public since their conception. A qualitative approach gathered relevant information related to the cultural, social and economic burden of different populations in Ecuador. Before validation, a pilot test was carried out with users of the National Health Services to obtain their perspectives and insights of the developed instrument. Finally, during the data analysis, we have given special consideration to social variables such as rural and urban populations.

Background A Study related to Safety in Hospitals in the Region of Madrid (ESHMAD) was carried out in order to determine the prevalence, magnitude and characteristics of adverse events in public hospitals. This work aims to define a useful methodology for the multicenter study of adverse events in the Region of Madrid, to set out the preliminary results of the hospital enrollment and to establish a model of a strategy of training of trainers for its implementation. Methods ESHMAD was a multicenter, double phase study for the estimation of adverse events and incidents prevalence across the Region of Madrid. First phase comprehended a 1-day cross-sectional prevalence study, in which it was collected, through a screening guide, information about admission, patient characteristics, intrinsic and extrinsic risk factors, and the possibility of an adverse event or incident had happened during the hospitalization. Second phase was a retrospective nested cohort study, in which it was used a Modular Review Form for reviewing the positive screenings of the first phase, identifying in each possible adverse event or incident the classification of the patient safety event, clinical onset, root, and associated causes and factors, impact, and preventability. A pilot study was performed in an Internal Medicine Unit of a tertiary hospital. Results 34 public hospitals participated, belonging to 6 healthcare categories and with more than 10,000 hospitalisations aggregate capacity. 72 coordinators were enrolled in the strategy of training of trainers, which was performed through five on-site training workshops. In the pilot study, 45.2% patients were identified with at least one positive event of the screening. Of them, 48.1% (25 positive events) were identified as truly AE, with a result of 0.29 EA per analyzed patient. Conclusions The ESHMAD protocol allows to estimate the prevalence of adverse events, and the strategy of training of trainers facilitated the spread of the research methodology among the participants.

Resumen Objetivo Analizar la frecuencia con que los pacientes presentan una reclamacion escrita por la negativa de los medicos de atencion primaria a indicar una prueba diagnostica, tratamiento o derivacion solicitada por un paciente. Metodo Estudio observacional, retrospectivo, en el que se analizaron las reclamaciones de los anos 2016 a 2018 de un area de salud. Resultados Se analizaron 378 reclamaciones escritas. De estas, 30 (8%) se justificaron en la negativa de los medicos a una peticion del paciente (28 dirigidas a medicos de familia y 2 a pediatras), siendo las mas frecuentes las relacionadas con la solicitud de un tratamiento (18 [60%]), seguidas de la peticion de pruebas diagnosticas (9 [30%]). Mientras el numero total de reclamaciones se incremento en un 151%, el peso relativo de las reclamaciones por no atender una peticion del paciente se redujo (2016: 8/70, 11,4%; 2017: 11/132, 8,3%; 2018: 11/176, 6,3%). No se presento ninguna reclamacion patrimonial. Conclusion Las reclamaciones estan creciendo, pero las motivadas por rechazar peticiones de pacientes tienen un menor peso relativo en el volumen de quejas escritas. Sin embargo, su impacto en los profesionales puede derivar en practicas de medicina defensiva.

Objectives: To describe lessons learned during the first COVID-19 outbreak in developing urgent interventions to strengthen healthcare workers’ capacity to cope with acute stress caused by health care pressure, concern about becoming infected, despair of witnessing patients’ suffering, and critical decision-making requirements of the SARS-CoV-2 pandemic during the first outbreak in Spain. Methods: A task force integrated by healthcare professionals and academics was activated following the first observations of acute stress reactions starting to compromise the professionals’ capacity for caring COVID-19 patients. Literature review and qualitative approach (consensus techniques) were applied. The target population included health professionals in primary care, hospitals, emergencies, and nursing homes. Interventions designed for addressing acute stress were agreed and disseminated. Findings: There are similarities in stressors to previous outbreaks, and the solutions devised then may work now. A set of issues, interventions to cope with, and their levels of evidence were defined. Issues and interventions were classified as: adequate communication initiative to strengthen work morale (avoiding information blackouts, uniformity of criteria, access to updated information, mentoring new professionals), resilience and recovery from physical and mental fatigue (briefings, protecting the family, regulated recovery time during the day, psychological first aid, humanizing care), reinforce leadership of intermediate commands (informative leadership, transparency, realism, and positive messages, the current state of emergency has not allowed for an empirical analysis of the effectiveness of proposed interventions. Sharing information to gauge expectations, listening to what professionals need, feeling protected from threats, organizational flexibility, encouraging teamwork, and leadership that promotes psychological safety have led to more positive responses. Attention to the needs of individuals must be combined with caring for the teams responsible for patient care. Conclusions: Although the COVID-19 pandemic has a more devastating effect than other recent outbreaks, there are common stressors and lessons learned in all of them that we must draw on to increase our capacity to respond to future healthcare crises.

Background The COVID-19 pandemic has affected the response capacity of the health care workforce, and health care professionals have been experiencing acute stress reactions since the beginning of the pandemic. In Spain, the first wave was particularly severe among the population and health care professionals, many of whom were infected. These professionals required initial psychological supports that were gradual and in line with their conditions. Objective In the early days of the pandemic in Spain (March 2020), this study aimed to design and validate a scale to measure acute stress experienced by the health care workforce during the care of patients with COVID-19: the Self-applied Acute Stress Scale (EASE). Methods Item development, scale development, and scale evaluation were considered. Qualitative research was conducted to produce the initial pool of items, assure their legibility, and assess the validity of the content. Internal consistency was calculated using Cronbach α and McDonald ω. Confirmatory factor analysis and the Mann-Whitney-Wilcoxon test were used to assess construct validity. Linear regression was applied to assess criterion validity. Back-translation methodology was used to translate the scale into Portuguese and English. Results A total of 228 health professionals from the Spanish public health system responded to the 10 items of the EASE scale. Internal consistency was .87 (McDonald ω). Goodness-of-fit indices confirmed a two-factor structure, explaining 55% of the variance. As expected, the highest level of stress was found among professionals working in health services where a higher number of deaths from COVID-19 occurred (P Conclusions The EASE scale was shown to have adequate metric properties regarding consistency and construct validity. The EASE scale could be used to determine the levels of acute stress among the health care workforce in order to give them proportional support according to their needs during emergency conditions, such as the COVID-19 pandemic.

Up to 50% of cancer patients and up to 90% of those in terminal stages experience pain associated with disease progression, poor quality of life, and social impact on caregivers. This study aimed to establish standards for the accreditation of oncological pain management in healthcare organizations. A mixed methods approach was used. First, a pragmatic literature review was conducted. Second, consensus between professionals and patients was reached using the Nominal Group and Delphi technique in a step that involved anesthesiologists, oncologists, family physicians, nurses, psychologists, patient representatives, and caregivers. Third, eight hospitals participated in a pilot assessment of the level of fulfillment of each standard. A total of 37 standards were extracted. The Nominal Group produced additional standards, of which 60 were included in Questionnaire 0 that was used in the Delphi Technique. Two Delphi voting rounds were performed to reach a high level of consensus, and involved 64 and 62 participants with response rates of 90% and 87%, respectively. Finally, 39 standards for the management of cancer pain were agreed upon. In the self-evaluation, the average range of compliance was between 56.4% and 100%. The consensus standards of the ACDON Project might improve the monitoring of cancer pain management. These standards satisfied the demands of professionals and patients and could be used for the accreditation of approaches in cancer pain management.

Objetivo: el objetivo de este estudio fue describir los casos de pacientes con dolor abdominal y diagnóstico confirmado de COVID-19. En países de La-tinoamérica la pandemia ha tenido un gran impacto por el alto índice de mortalidad. Ecuador es el quinto país más afectado en la región en número de casos confirmados con una tasa de 223 fallecidos por cada millón de habitantes, ubicándose en el primer lugar de letalidad. En la población pediátrica el comportamiento del COVID-19 sigue siendo inespecífico. Materiales y métodos: se realizó un estudio observacional, descriptivo y retrospectivo en el cual se incluyó a todos los pacientes menores de 18 años exceptuando neonatos, que ingresaron por dolor abdominal a un hospital pediátrico de la ciudad de Guayaquil entre los meses de abril y mayo de 2020 y obtuvieron diagnóstico confirmado COVID-19. Resultados: fueron incluidos 30 pacientes con diagnóstico confirmado de CO-VID-19 y dolor abdominal. La edad promedio fue 8,46 años a predomino del sexo masculino (70%). En la valoración del dolor 19 (63%) tuvieron un EVA moderado-severo y 11 (37%) EVA leve. 7 pacientes (23.33%) requirieron intervención qui-rúrgica, 21 (70%) necesitaron de unidad de cuidados críticos, y 1 (3.33%) falleció. Conclusiones: el dolor abdominal constituye un desafío diagnóstico en este tiempo de pandemia y debería ser considerado dentro de las posibles manifesta-ciones clínicas de COVID-19 en la población pediátrica.

ObjectivesTo determine the volume of health professionals who suffered distress due to their care of patients with COVID-19 and to analyse the direction in which the response capacity of the professionals to face future waves of COVID-19 is evolving.DesignA cross-sectional study.SettingPrimary care and hospitals in Spain.ParticipantsA non-randomised sample of 685 professionals (physicians, nurses and other health staff).Primary and secondary outcome measuresFrequency and intensity of stress responses measured by the Acute Stress of Health Professionals Caring COVID-19 Scale (EASE). Variation of stress responses according to the number of deaths per day per territory and the evolutionary stage of the COVID-19 outbreak measured by the Kruskal-Wallis and the Mann-Whitney U tests.ResultsThe average score on the EASE Scale was 11.1 (SD 6.7) out of 30. Among the participants, 44.2% presented a good emotional adjustment, 27.4% a tolerable level of distress, 23.9% medium–high emotional load and 4.5% extreme acute stress. The stress responses were more intense in the most affected territories (12.1 vs 9.3, p=0.003) and during the disillusionment phase (12.7 vs 8.5 impact, 10.2 heroic and 9.8 honeymoon, p=0.000).ConclusionsThe pandemic has affected the mental health of a significant proportion of health professionals which may reduce their resilience in the face of future waves of COVID-19. The institutional approaches to support the psychological needs of health professionals are essential to ensure optimal care considering these results.

Digital, Many affected counties have had experienced a shortage of personal protective equipment (PPE) during the coronavirus disease (COVID-19) pandemic. We aimed to investigate the needs of healthcare professionals and the technical difficulties faced by them during the initial outbreak. A cross-sectional web-based survey was conducted among the healthcare workforce in the most populous cities from three Latin American countries in April 2020. In total, 1,082 participants were included. Of these, 534 (49.4%), 263 (24.3%), and 114 (10.5%) were physicians, nurses, and other professionals, respectively. At least 70% of participants reported a lack of PPE. The most common shortages were shortages in gown coverall suits (643, 59.4%), N95 masks (600, 55.5%), and face shields (569, 52.6%). Professionals who performed procedures that generated aerosols reported shortages more frequently (p, Ciencias Médicas y de la Salud

Background COVID-19 became a major public health concern in March 2020. Due to the high rate of hospitalizations for COVID-19 in a short time, health care workers and other involved staff are subjected to a large workload and high emotional distress. Objective The objective of this study is to develop a digital tool to provide support resources that might prevent and consider acute stress reactions in health care workers and other support staff due to the COVID-19 pandemic. Methods The contents of the digital platform were created through an evidence-based review and consensus conference. The website was built using the Google Blogger tool. The Android version of the app was developed in the Java and XML languages using Android Studio version 3.6, and the iOS version was developed in the Swift language using Xcode version 11.5. The app was evaluated externally by the Andalusian Agency for Healthcare Quality. Results We detected the needs and pressing situations of frontline health care workers, and then, we proposed a serial of recommendations and support resources to address them. These resources were redesigned using the feedback received. A website in three different languages (Spanish, English, and Portuguese) and a mobile app were developed with these contents, and the AppSaludable Quality Seal was granted to the app. A specific self-report scale to measure acute stress and additional tools were included to support the health care workforce. This instrument has been used in several Latin American countries and has been adapted considering cultural differences. The resources section of the website was the most visited with 18,516 out of 68,913 (26.9%) visits, and the “Self-Report Acute Stress Scale” was the most visited resource with 6468 out of 18,516 (34.9%) visits. Conclusions The Be + against COVID platform (website and app) was developed and launched to offer a pool of recommendations and support resources, which were specifically designed to protect the psychological well-being and the work morale of health care workers. This is an original initiative different from the usual psychological assistance hotlines.

Backgroud: This study designed and validated a scale to measure acute stress experienced during the care of patients with COVID-19 (EASE scale). Methods: The COSMIN recommendations were followed in the design and validation of the EASE scale. Internal consistency was calculated using Cronbach's Alpha and McDonald's Omega. Qualitative research was conducted to assess content validity. Exploratory and Confirmatory Factorial Analysis were used to assess construct validity. Mann-Whitney-Wilcoxon test and Lineal Regression were applied to assess criterion validity. Responsiveness and interpretability were also assessed.Results: A total of 228 health professionals from the Spanish public health system responded to the ten items, of the EASE scale. Internal consistency was 0.87 (McDonald’s Omega). Two factors explaining 55% of the variance were isolated. Goodness-of-fit indices confirmed this factor structure. The highest level of stress was found among professionals working in health services who accumulated a higher number of deaths from COVID-19 (P

BACKGROUND COVID-19 became a major public health concern in March 2020. Due to the high rate of hospitalizations for COVID-19 in a short time, health care workers and other involved staff are subjected to a large workload and high emotional distress. OBJECTIVE The objective of this study is to develop a digital tool to provide support resources that might prevent and consider acute stress reactions in health care workers and other support staff due to the COVID-19 pandemic. METHODS The contents of the digital platform were created through an evidence-based review and consensus conference. The website was built using the Google Blogger tool. The Android version of the app was developed in the Java and XML languages using Android Studio version 3.6, and the iOS version was developed in the Swift language using Xcode version 11.5. The app was evaluated externally by the Andalusian Agency for Healthcare Quality. RESULTS We detected the needs and pressing situations of frontline health care workers, and then, we proposed a serial of recommendations and support resources to address them. These resources were redesigned using the feedback received. A website in three different languages (Spanish, English, and Portuguese) and a mobile app were developed with these contents, and the AppSaludable Quality Seal was granted to the app. A specific self-report scale to measure acute stress and additional tools were included to support the health care workforce. This instrument has been used in several Latin American countries and has been adapted considering cultural differences. The resources section of the website was the most visited with 18,516 out of 68,913 (26.9%) visits, and the “Self-Report Acute Stress Scale” was the most visited resource with 6468 out of 18,516 (34.9%) visits. CONCLUSIONS The Be + against COVID platform (website and app) was developed and launched to offer a pool of recommendations and support resources, which were specifically designed to protect the psychological well-being and the work morale of health care workers. This is an original initiative different from the usual psychological assistance hotlines.

Objectives: The aim of this systematic review was to consolidate studies to determine whether root cause analysis (RCA) is an adequate method to decrease recurrence of avoidable adverse events (AAEs). Methods: A systematic search of databases from creation until December 2018 was performed using PubMed, Scopus and EMBASE. We included articles published in scientific journals describing the practical usefulness in and impact of RCA on the reduction of AAEs and whether professionals consider it feasible. The Mixed Methods Appraisal Tool was used to assess the quality of studies. Results: Twenty-one articles met the inclusion criteria. Samples included in these studies ranged from 20 to 1,707 analyses of RCAs, AAEs, recommendations, audits or interviews with professionals. The most common setting was hospitals (86%; n = 18), and the type of incident most analysed was AAEs, in 71% (n = 15) of the cases; 47% (n = 10) of the studies stated that the main weakness of RCA is its recommendations. The most common causes involved in the occurrence of AEs were communication problems among professionals, human error and faults in the organisation of the health care process. Despite the widespread implementation of RCA in the past decades, only 2 studies could to some extent establish an improvement in patient safety due to RCAs. Conclusions: RCA is a useful tool for the identification of the remote and immediate causes of safety incidents, but not for implementing effective measures to prevent their recurrence.

Background: Shortage of Personal Protective Equipment and preparedness to fight back the pandemic have been a common issue in most of the affected countries. The aim was to establish what were the needs of the healthcare professionals, and the technical difficulties they must face, during the first impact of the outbreak. Methods:A cross-sectional web-based survey was conducted involving healthcare workforce in most populous cities from three Latin American countries in April 2020. Findings: 1082 participants were included, of these physicians accounted for 534 (49·4%) and nurses 263 (24·3%). At least 70% reported lack of PPE availability. Most common perceived deficiencies were closed special protection suits 643 (59·4%), N95 masks 600 (55·5%) and face shields 569 (52·6%). Professionals who performed procedures that generated aerosols reported more deficiencies (p

Introduction Risk management and patient safety are closely related, following this premise some industries have adopted measures to omit number 13. Healthcare is not left behind, in some hospital the day of surgery's or bed numbering avoid number 13. The objective was to assess whether it is necessary to redesign the safety policies implemented in hospitals based on avoiding 13 in the numbering of rooms/beds. Methods A retrospective cohort study was conducted. Mortality and the number of adverse events suffered by patients admitted to rooms/beds numbering 13 (bad chance) or 7 (fair chance) over a two-year period to Intensive Care Unit, Medicine, Gastroenterology, Surgery, and Paediatric service were registered and compared. Results A total of 8553 admissions were included. They had similar length-of-stay and Charlson Index scores (p-value = 0.435). Mortality of bed 13 was 268 (6.2%, 95% CI 5.5–6.9) and 282 in bed 7 (6.7%, 95% CI 5.9–7.5) (p-value = 0.3). A total of 422 adverse events from 4342 admissions (9.7%, 95% CI 8.9–10.6) occurred in bed 13, while in bed 7 the count of adverse events was 398 in 4211 admissions (9.4%, 95% CI 8.6–10.4) (p-value = 0.6). Odds Ratio for mortality was equal to 0.9 (95% CI 0.8–1.1) and suffering adverse events when admitted to bed 13 versus bed 7 was 1.03 (95% CI 0.9–1.2). Conclusions Bed 13 is not a risk factor for patient safety. Hospitals should pay attention to causes and interventions to avoid adverse events based on evidence rather than beliefs or myths.

Introduccion. Las consultas por cefalea son el motivo mas frecuente de demanda de atencion de causa neurologica en la atencion primaria y en los servicios de neurologia. Las unidades de cefalea mejoran la calidad asistencial, reducen las listas de espera, facilitan el acceso a nuevos tratamientos de eficacia contrastada y optimizan el gasto sanitario. No obstante, la implantacion de estas unidades no esta extendida en Espana debido a la relativa importancia atribuida a la patologia y a la suposicion de que su coste es elevado. Objetivo. Definir la estructura y los requerimientos minimos de una unidad de cefalea con la intencion de contribuir a su extension en los hospitales de Espana. Sujetos y metodos. Estudio de consenso entre profesionales tras la revision de la bibliografia sobre la estructura, las funciones y los recursos de una unidad de cefalea para un area de 350.000 habitantes. Resultados. Se tomaron como referencia ocho publicaciones para la identificacion de recursos minimos necesarios de una unidad de cefalea. El panel de expertos estuvo integrado por 12 profesionales de diferentes especialidades. El principal recurso para la implementacion de estas unidades son profesionales (superiores y tecnicos), lo que puede suponer un coste adicional para el primer ano de alrededor de 107.287,19 euros. Conclusiones. Si consideramos los costes directos e indirectos debidos a las perdidas por productividad laboral por paciente y los comparamos con los costes estimados de implantacion de estas unidades y su expectativa de resultados, todo apunta a que es necesaria la generalizacion de unidades de cefalea en Espana.