Needs and Expectations of Long-Term Cancer Survivors: Multi-Centre Study Protocol.

Cancer is a social issue as its outreach affects not only mortality (it is the second cause of death in our environment) but also the costs due to morbidity and the distress it causes, as well as the losses and consequences in personal, family, work, and even social areas. This study is trying to find out the health needs of long-term cancer survivors and their perceptions and expectations of the care they received during their survival stage. For this, a joint, cross-sectional descriptive study with a qualitative and quantitative approach has been designed. For the qualitative approach, we have used different focus groups representing different geographical areas of the Spanish territory. For the qualitative approach, we have used a validated questionnaire. This study will provide a better knowledge of the quality of life of these patients, as well as their level of unmet and even unexpressed needs, in order to develop effective strategies and interventions that allow for the implementation of adapted care plans that include such unexpressed needs. This study will also allow for the creation and development of assessment methods for health results from the patient's perspective and experience. These issues require a multidisciplinary, complex approach. These survivors may require not well-known health services, as the number of these patients has grown recently, and their survival time is also longer. This research explores a wider and more thorough perspective of long-term cancer survivors' needs, experiences, and expectations to be achieved.

La formación técnica y tecnológica como apuesta de desarrollo local. el programa universidad al barrio en barranquilla

Este artículo tiene como finalidad entender la contribución de la educación técnica y tecnológica en la generación de empleo y emprendimiento, como elementos importantes en el desarrollo local, al evaluar la eficacia del programa Universidad al Barrio en el distrito de Barranquilla. Esto se logra bajo un enfoque mixto tanto de análisis documental como de consulta a algunos de los actores principales, para valorar su eficacia a partir del alcance, la calidad, empleabilidad y emprendimiento del programa. Los resultados muestran que el programa logra altos niveles de cobertura y empleabilidad en jóvenes de estratos socioeconómicos bajos, sin embargo, tiene grandes desafíos en términos de calidad.

This article aims to understand the contribution of technical and technological education in the generation of employment and entrepreneurship, as important elements in local development, by evaluating the effectiveness of the program Universidad al Barrio in the District of Barranquilla. This is achieved under a mixed approach of both documentary analysis and interviews with some of the main actors, to assess the effectiveness of the program from its coverage, quality, employability, and entrepreneurship. Results show that the program achieves high levels of coverage and employability in young people from low socio-economic levels, however, it has great challenges in terms of quality.

Compliance with the clinical laboratory quality protocol in public primary healthcare centres.

The clinical and economic relevance of the clinical laboratories procedures in Andalusia (Spain) have led the Regional Department of Health to focus attention on their improvement. A unified laboratory protocol was implemented that consisted of the unification of criteria in the handling and processing of samples, and report of results. The objective of this study is to describe the degree of compliance with the clinical laboratory protocol in the preanalytical phase, which includes the analytical request and up to the delivery in the laboratory, as well as the influencing factors. Cross-sectional descriptive study with a sample of 214 healthcare professionals involved in the preanalytical phase of laboratory procedures in primary care. A self-reported questionnaire with 11 items was used for data collection. Each item was assessed separately with a scale from 0 to 10. A 5 points score was considered as the cutoff point. Descriptive analysis was conducted and Mann-Whitney U test was used to determine differences between subgroups. Internal consistency of the questionnaire was considered. The best rated item was verifying the correspondence between the request form and identity of the patient. Each item scored from 3 to 10, and the mean for each item ranged from 6.40 (standard deviation = 3.06) to 8.57 (standard deviation = 2.00). Values above or equal to 8 were obtained, for 63.6% of them. Statistically significant differences between accredited and nonaccredited centres were found. Differences were not noteworthy regarding centres with a teaching activity or those without it. All the items were measured separately. The compliance with the protocol was adequate among primary healthcare professionals, who have a strategic position in the sample collection and its transport during the preanalytical phase. Being so, standardisation should be a priority to reduce errors and improve clinical safety and results.

Knowledge of COVID-19 among Brazilian health care professionals and associated factors.

ABSTRACT: Health care professional's knowledge is essential to contain epidemics. This research aimed to evaluate the knowledge of Brazilian health care professionals regarding COVID-19 to analyze whether there is a difference in knowledge between professionals in Primary Health Care and those in other levels of care or not; and to identify factors associated with knowledge. This is a cross-sectional study, including 716 participants who answered an online questionnaire between April and May 2020. Descriptive statistics, difference tests between groups, and logistic regression models were used to analyze the data. The average knowledge score was 12.42 points (out of a possible total of 15). There was no significant difference between professionals in Primary Health Care and those in other levels of care. Knowledge was associated with age, profession, perception regarding media's information quality, and hours exposed to information on COVID-19. Participants showed adequate knowledge, despite some specific gaps. Continuing education actions should prioritize younger nonmedical professionals.

Aloe Vera (L. ) como floculante para remoción de turbidez de aguas superficiales / Aloe Vera (L. ) as a flocculant to remove turbidity from surface water

El acceso al agua potable por red pública es un problema de la población rural en el departamento de Huánuco, por ende, se suele realizar el consumo de este recurso sin previo tratamiento, produciéndose así enfermedades estomacales. El uso de agentes naturales como el Aloe vera (L.) (Sábila) viene a ser una alternativa como floculante para el tratamiento convencional del agua, por tal motivo, en esta investigación se visualizaron experimentalmente las características y reacciones del gel de A. vera como floculante en la remoción de la turbidez. La turbidez del agua se simuló con el caolín, y se determinó la concentración óptima de alúmina y sábila (1%) a valores diferentes de pH y turbidez iniciales, con los datos resultantes se optimizó las dosis mediante el modelo matemático de superficie de respuesta, para después realizar su respectiva validación mediante métodos gráficos e índices matemáticos; los resultados reflejaron que la turbidez inicial, pH inicial y la dosis del coagulante influyen significativamente en la remoción de la turbidez de agua, de forma individual, concluyendo según el modelo de superficie de respuesta que el volumen óptimo de sábila al 1% alcanza su mayor eficiencia a 0,1 mL y 0,4 mL por cada 500 mL, dosis que varía de acuerdo a su pH y turbidez inicial, este modelo matemático se ajusta para aguas superficiales de la ciudad de Tingo María(AU)

Access to drinking water through the public network is a problem for the rural population in the department of Huánuco, therefore, this resource is usually consumed without prior treatment, thus producing stomach illnesses. The use of natural agents such as Aloe vera (L.) becomes an alternative as a flocculant for conventional water treatment, for this reason, in this investigation the characteristics and reactions of the A. vera gel were visualized experimentally as a flocculant in the removal of turbidity. The turbidity of the water was simulated with kaolin, and the optimum concentration of alumina and aloe vera (1%) was determined at different values of initial pH and turbidity. With the resulting data, the doses were optimized using the mathematical model of the response surface. to later carry out their respective validation through graphic methods and mathematical indices; The results showed that the initial turbidity, initial pH and the dose of the coagulant significantly influence the removal of the turbidity of the water, individually, concluding according to the response surface model that the optimal volume of aloe at 1% reaches its highest level. efficiency at 0.1 mL and 0.4 mL per 500 mL, a dose that varies according to its pH and initial turbidity, this mathematical model is adjusted for surface waters of the city of Tingo María(AU)

Implications of Lifestyle and Occupational Factors on the Risk of Breast Cancer in Shiftwork Nurses.

Shift work that involves circadian disruption has been highlighted as a likely carcinogenic factor for breast cancer in humans. Also, unhealthy lifestyle habits observed in night work nurses could be causally related to an increase in the incidence of estrogen-positive breast tumours in this population. Assessing baseline risk of breast cancer in nurses is essential. The objective of this study was to analyze the risk of breast cancer that nurses had in relation to their lifestyle and labour factors related to shift work. A cross-sectional descriptive study through a questionnaire about sociodemographic variables, self-perception of health, and working life was designed. The sample consisted of 966 nurses. The relationship between variables was tested. A binary logistic regression and a classification and regression tree were performed. The most significant labour variables in relation to the risk of breast cancer were the number of years worked (more than 16 years; p < 0.01; OR = 8.733, 95% CI = 2.811, 27.134) and the total years performing more than 3 nights per month (10 or more years; p < 0.05; OR = 2.294, 95% CI = 1.008, 5.220). Also, the nights worked throughout life (over 500; OR = 4.190, 95% CI = 2.118, 8.287) were significant in the analysis. Nurses who had or ever had breast cancer valued their self-perceived health more negatively (p < 0.001) and referred a lower quality of sleep (p < 0.001) than the non-cases nurses. The occupational factors derived from night work could have several impacts on nurses' health and their family-work balance. Promoting healthy lifestyles, informing about shift work risks, and adjusting shift work schedules are critical methods to decrease the possible effects of circadian disruption in nurses.

Work engagement and psychological distress of health professionals during the COVID-19 pandemic.

AIMS: To describe the level of work engagement of active health care professionals during the COVID-19 pandemic, and its relationship with psychological distress according to the professional category. BACKGROUND: Health care professionals working on the front line of the COVID-19 pandemic are at risk of psychological distress, and work engagement could be a positive attitude that could serve as a protective factor. METHODS: Cross-sectional observational study of 1,459 health care professionals. Psychological distress was measured with the General Health Questionnaire and work engagement with the Utrecht Work Engagement Scale. Data were analysed with bivariate analyses and correlations. RESULTS: Psychological distress was reported by 80.6% of health care professionals. Work engagement as high with a total mean score of 5.04 (SD = 1.14). The results showed that distressed professionals showed significantly lower levels of work engagement. CONCLUSIONS: The present study identified psychological distress and work engagement experienced by health care professionals during the COVID-19 pandemic. Most of the variables included in the study revealed a significant relationship with psychological distress and work engagement. IMPLICATIONS FOR NURSING MANAGEMENT: The relationship between the working conditions with psychological distress and work engagement suggests that improvements in the workplace are needed to promote protective measure for the mental health of health care professionals.

Preanalytical errors in emergency department samples: Investigating error sources.

BACKGROUND: The presence of preanalytical errors is a recurring fact in all areas of healthcare that send samples to laboratories. Increasing the knowledge of possible sources of error in the preanalytical phase has been the objective of this group during the last 10 years. METHODS: In this study, descriptive research has been carried out using professionals' opinions obtained by means of the Strengths, Weaknesses, Opportunities, and Threats method in a focus group. RESULTS: The opinions expressed within the focus group have emphasised the importance of patients' safety and willingness for the introduction of a computerized analytical module. The most commented weakness in both hospitals was the transport of samples through the pneumatic tube. Improving the duration of workers' contracts, especially in the laboratory, and creating a circuit for professional's localization during the work shift to facilitate potential error solving are some opportunities for the future. CONCLUSIONS: Different approaches have been developed depending on the healthcare scenario. For this, establishing a flow of information between the different professionals allows identifying identical aspects through a priori, different points of view. The line to follow is to improve the safety of the patient and also to give professionals an opportunity to express themselves.

Relationship between chemotherapy-induced adverse reactions and health-related quality of life in patients with breast cancer.

BACKGROUND AND OBJECTIVES: Chemotherapy does not only affect cancer cells; it also affects, to a greater or lesser degree, all other cells in the body. This toxicity should be assessed according to its severity, frequency, and duration, taking into account objective and subjective dimensions in its assessment. This assessment is a highly relevant aspect when providing care to chemotherapy patients, mainly due to the impact of the treatment on the patient's quality of life, as well as the vital risk it may imply under certain circumstances. For all this, the objective of this study was to assess the relationship between chemotherapy-associated adverse reactions and health-related quality of life in breast cancer patients. MATERIALS AND METHODS: With this purpose, a descriptive cross-sectional study was developed on 110 breast cancer patients who were treated with docetaxel, epirubicin, and cyclophosphamide. RESULTS: It is worth highlighting the negative effect of nausea, dysgeusia, peripheral neuropathy, loss of appetite, myalgia, and peripheral edema on the quality of life. Likewise, it is worth mentioning peripheral neuropathy as the toxicity that affects a greater number of quality-of-life indicators. CONCLUSIONS: To sum up, it would be necessary to make health professionals aware of the importance of chemotherapy-associated adverse reactions.

Costs analysis of a training intervention for the reduction of preanalytical errors in primary care samples.

BACKGROUND: To perform a cost-error analysis based on a quasi-experimental pre-post study of the preanalytical errors in 2 hospital laboratories. The real cost and theoretical cost are defined as the cost resulting from errors with or without the training intervention. The real impact associated to the training program was estimated, calculated as the total associated to the preanalytical errors cost difference. The costs were measured using Andalusian Public Health Service fees. Cost analysis of an educational intervention presented in a previous study from 2017. Preanalytical errors were detected in the laboratories of the University Hospital Virgen de la Victoria (Málaga, Spain) and in the University Hospital Juan Ramón Jiménez (Huelva, Spain). METHODS: The founded errors were divided into blood and urine samples. Univariate sensitivity analysis was used to assess how parameter uncertainty impacted on overall results. Variations of parameters between 0% and 5% were substituted into the base case. RESULTS: The real impact associated with educational intervention in LAB1 was an increase of &OV0556;16,961.378, and the expected impact was an increase &OV0556;78,745.27 (difference of &OV0556;61,783.9). In LAB2, the real impact in the same period amounted to &OV0556;260,195.37, and the expected impact was &OV0556;193,905.83 (difference of -&OV0556;66,289.54). The results were different in the 2 laboratories, proving the intervention in only one of them to be more effective. CONCLUSIONS: Costs analysis determined that this training intervention can provide saves in the costs, as the effectiveness of the educational sessions in reducing preanalytical errors currently results in a significant decrease of the costs associated with these errors.

Transcultural Adaptation and Piloting of the "Regarding Blood-Sampling Practices at Primary Health Care Centres" Questionnaire.

Preanalytical errors account for up to 70% of the total potentially detectable errors in the laboratory. The main problems detected are related with procedures associated with Primary Care nursing practices that are directly involved in the preanalytical phase. The objective of this study is to carry out a transcultural adaptation and piloting of the "Regarding Blood-Sampling Practices at Primary Health Care Centres" questionnaire as regards blood sampling in Primary Care. For this, a cross-sectional descriptive study has been developed within the Primary Care area of the Andalusian Public Health System. The venous blood sampling questionnaire was translated into and adapted to Spanish by qualified professionals and expert translators. The questionnaires were then delivered to all staff nurses from the health districts involved. The total sample consisted of 224 primary care nursing professionals. The factors that showed statistically significant relationships were identification and sample collection, management with information search, storage and labelling of samples, and reporting of errors. A lack of global relationship between factors makes it impossible to find a global quality factor in the sampling process. The process of translation, adaptation, and piloting of the questionnaire from its original version to the Spanish one has proven to be understandable by professionals in its entirety and to offer data similar to the original version.

Utilization of a healthcare failure mode and effects analysis to identify error sources in the preanalytical phase in two tertiary hospital laboratories.

INTRODUCTION: The presence of errors in the preanalytical phase is a thoroughly studied problem. A strategy to increase their source detection might be the use of the Healthcare Failure Mode and Effects Analysis (HFMEA). The aim of this study is improving the capacity of identifying sources of error during the preanalytical period in samples provided by primary care clinics (PCC) with the use of the HFMEA as a tool in the laboratories of two tertiary hospitals. MATERIALS AND METHODS: A HFMEA was carried out in each laboratory, by means of the creation of groups of experts with similar characteristics (doctors and nurses from PCC and laboratory, support staff, and laboratory technicians). The Risk Priority Number (RPN) was calculated. RESULTS: Items with elevated RPN were presented in both centers. The highest RPN were in LAB1: "two request notes for a patient" and "the segregation of oncology urgent samples" (both with 384), while in LAB2 was "the lack of information in patients with oral glucose overload test" (RPN 576). Considering the different steps in the preanalytical phase, LAB1 paid attention in sampling, samples reception and the programming in the Laboratory Information System, while LAB2 paid attention in the request form, the appointment system, sampling procedures, transport and reception. CONCLUSION: The laboratories prioritized the problems differently. However, both centers offer solutions to these possible sources of error. We proposed improvement actions that can be resolved easily, with a low cost for the system, mainly to schedule a specific formative programme and a deep revision of the existing protocols.

Integrating Research Techniques to Improve Quality and Safety in the Preanalytical Phase.

BACKGROUND: Reducing errors in the preanalytical phase is difficult, which suggests the issue may be multidimensional. As such, qualitative research may be truly innovative in this context. METHOD: We carried out a descriptive study using a qualitative method incorporating 4 focus groups. Data analysis followed the principles of Grounded Theory. RESULTS: We queried in each of the 4 focus groups collectively to identify weaknesses in the system. Those weaknesses that were most cited were logistics, coupled with uneven compliance with regulations. CONCLUSION: All 4 focus groups mapped out directives for future work, so that regulatory aspects, process management, communication and resources could be identified as key areas where error reduction is critical.

Multidisciplinary training activities for decreasing preanalytical mistakes in samples from primary care.

BACKGROUND: The presence of preanalytical mistakes (PM) in samples from primary care centres (PCC) is a widely studied topic. Different correcting strategies have been proposed, with variable success. We planned a series of multidisciplinary sessions for clinical update, with the aim to decrease PM rates in samples from PCC. METHODS: The incidence of PM in samples from PCC processed at the laboratories of University Hospital Virgen de la Victoria (LAB1) and University Hospital Juan Ramon Jimenez (LAB2) was assessed during two time periods (October to November 2013 and January to May 2014). Clinical update sessions were conducted between periods (2014). Differences in PM rates between observation periods were evaluated. RESULTS: With respect to 2014, we observed a significant reduction of PM rates in blood samples processed at LAB1 during 2015, whereas those in LAB2 were slightly increased. The most common PMs were haemolysed sample at LAB1 and missed sample at LAB2. CONCLUSIONS: Although the presence of PM remains slightly high, there was a significant reduction after the clinical update sessions in LAB1, where the most frequent PM was haemolysed sample. In contrast, the PM rates were slightly increased at LAB2, and the main source was missed sample. This might be explained, at least in part, by different problems associated with sample transportation, and by the delay in transferring acquired knowledge into clinical practice. Implementation of regular programme of update sessions and improvements in sample transportation might help to reduce the PM presence in our area.

Preanalytical errors: a preliminary approach to the point of view of primary health care givers.

BACKGROUND: The presence of errors in the preanalytical phase is a widely studied topic. However, information regarding the perspective of those professionals involved is rather scant. METHODS: Two focus groups of professionals from Primary Care involved in the preanalytical phase (general practitioners [GP], community nurses [CN], and other auxiliary health workers, including administrative personnel [AHW]) were convened. A qualitative analysis with a phenomenological approach was performed by using the structure of SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis as a guide, and results were categorized by grouping the resultant dimensions according to this structure. RESULTS: Overall, 12 professionals (3 GP, 6 CN, and 3 AHW) were distributed in two groups. Age and gender distribution were similar between groups. The most commented strengths were organizational capability and teamwork. The main weakness was the workload increase (compared to the short time spent on sample collection). Opportunities were related to workload optimization through on-line analytical requests. Threats were related to the long time elapsed between sample drawing at Primary Care and delivery to the Central Laboratory. CONCLUSIONS: The phenomenological approach allows revealing those aspects that cannot be entirely elucidated by objective data measurement. Attitudes considered as positive can be exploited by the institution, whereas those considered as negative alert us to possible future problems. Primary Care professionals offered a different point of view to laboratory staff, but both recognized high workload as the main threat and on-line analytical request as the best opportunity. These perspectives may help to improve detection and decrease the number of errors.

Experiencia de un nuevo modelo organizativo en un hospital de día oncohematológico / Experience with a new organizational model in an oncology and hematology day hospital

La mayoría de los pacientes con cáncer reciben tratamiento de quimioterapia. Las especiales características de esta terapia requieren que sean atendidos en instalaciones ad hoc, comúnmente denominadas Hospitales de Día (HD) oncológicos u oncohematológicos, aunque su organización no es uniforme en el territorio nacional. Conseguir una adecuada gestión de estos servicios proporciona no solo una mejor atención clínica, sino un mejor aprovechamiento de los recursos existentes y mayor satisfacción de los profesionales y pacientes. El propósito de este trabajo es presentar el cambio organizativo realizado en un HD, en el que se ha empleado la filosofía de centrar la atención sanitaria en el paciente, para proporcionar un entorno mucho más amigable, una organización más empática y una mejor gestión de los recursos, junto con una mayor implicación de las enfermeras en la gestión de los cuidados. Se describen las características de la situación de partida y los cambios introducidos, consistentes en la creación de una Consulta de Acogida Enfermera(CAE) para recibir a los pacientes que acuden al HD por primera vez; una Mesa de Coordinación Enfermera (MCE) que gestiona los cuidados y recursos del HD; agrupamiento de las camas y sillones en cuatro áreas de Consultad e Administración de Tratamientos (CAT) atendidas por una enfermera y creación de un Informe de Cuidados al Alta (ICA) para las enfermeras comunitarias. Todo ello ha permitido pasar de una atención a demanda a una atención programada y ha supuesto una mayor implicación de los profesionales en la organización y gestión del servicio que presta el HD (AU)

The majority of patients with cancer receive chemotherapy. The special characteristics of this therapy requires that these patients be attended in ad hoc facilities, commonly referred to as day hospitals (oncology DH or oncology and hematology DH), although their organization is not unified across the country. Achieve effective management of these services provides not only better clinical care, but a better use of existing resources and increased satisfaction of professionals and patients. The purpose of this paper is to present the organizational change made in a DH, which has used the philosophy of focusing on patient-centered care, to provide a much friendlier environment, a more empathetic and better management of resources, together with greater involvement of nurses in the management of care. We describe the characteristics of the on-entry patient status and the changes introduced, consisting in the creation of a Nursing Admission Consultation(NAC) to receive DH patients coming for the first time, a Nursing Coordination Station (NCS) that manages care and resources at the DH; grouping of the beds and armchairs/chairs in the four areas of Treatment Administration Consultation (TAC) attended by a nurse and finally the creation of a Discharge Care Instructions Report (DCIR) for subsequent use by community nurses . These measures have enabled to go from care on demand to programmed care, which has implied greater involvement on the part of health professionals in the organization and management of the services provided by the DH (AU)

Role of training activities for the reduction of pre-analytical errors in laboratory samples from primary care.

BACKGROUND: The presence of pre-analytical errors (PE) is a usual contingency in laboratories. The incidence may increase where it is difficult to control that period, as it is the case with samples sent from primary care (PC) to clinical reference laboratory. Detection of a large number of PE in PC samples in our Institution led to the development and implementation of preventive strategies. The first of these has been the realization of a cycle of educational sessions for PC nurses, followed by the evaluation of their impact on PE number. METHODS: The incidence of PE was assessed in two periods, before (October-November 2007) and after (October-November, 2009) the implementation of educational sessions. Eleven PC centers in the urban area and 17 in the rural area participated. In the urban area, samples were withdrawn by any PC nurse; in the rural area, samples were obtained by the patient's reference nurse. The types of analyzed PE included missed sample (MS), hemolyzed sample (HS), coagulated sample (CS), incorrect sample (ISV) and others (OPE), such as lipemic or icteric serum or plasma. RESULTS: In the former period, we received 52,669 blood samples and 18,852 urine samples, detecting 3885 (7.5%) and 1567 (8.3%) PEs, respectively. After the educational intervention, there were 52,659 and 19,048 samples with 5057 (9.6%) and 1.256 (6.5%) PEs, respectively (p<0.001). According to the type of PE, the incidents compared before and after compared incidences were: MS, 4.8% vs. 3.8%, p<0.001; HS, 1.97% vs. 3.9%, p<0.001; CS, 0.54% vs. 0.25%, p<0.001; ISV, 0.15% vs. 0.19% p=0.08; and OPE, 0.3% vs. 0.42%, p<0.001. CONCLUSIONS: Surprisingly the PE incidence increased after the educational intervention, although it should be noted that it was primarily due to the increase of HS, as the other EP incidence decreased (MS and CS) or remained unchanged (ISV). This seems to indicate the need for a comprehensive approach to reduce the incidence of errors in the pre-analytical period, as one stage interventions do not seem to be effective enough.

Preanalytical mistakes in samples from primary care patients.

BACKGROUND: Preanalytical mistakes (PAMs) in samples usually led to rejection upon arrival to the clinical laboratory. However, PAMs might not always be detected and result in clinical problems. Thus, PAMs should be minimized. We detected PAMs in samples from Primary Health Care Centres (PHCC) served by our central laboratory. Thus, the goal of this study was to describe the number and types of PAMs, and to suggest some strategies for improvement. METHODS: The presence of PAMs, as sample rejection criteria, in samples submitted from PHCC to our laboratory during October and November 2007 was retrospectively analysed. RESULTS: Overall, 3885 PAMs (7.4%) were detected from 52,669 samples for blood analyses. This included missed samples (n=1763; 45.4% of all PAMs, 3.3% of all samples), haemolysed samples (n=1408; 36.2% and 2.7%, respectively), coagulated samples (n=391; 10% and 0.7%, respectively), incorrect sample volume (n=110; 2.8% and 0.2%, respectively), and others (n=213; 5.5% and 0.4%, respectively). For urine samples (n=18,852), 1567 of the samples were missing (8.3%). CONCLUSIONS: We found the proportion of PAMs in blood and urine samples to be 3-fold higher than that reported in the literature. Therefore, strategies for improvement directed towards the staff involved, as well as an exhaustive audit of preanalytical process are needed. To attain this goal, we first implemented a continued education programme, financed by our Regional Health Service and focused in Primary Care Nurses.