Impact of specialized training for emergency department nurses screening or undetected HIV infection: the "Urgències VIHgila" project experience. / Impacto de una formación específica y generalizada de los profesionales de enfermería en el despistaje en urgencias de infección oculta por VIH: experiencia del proyecto "Urgències VIHgila".

OBJECTIVES: To evaluate the impact of specialized training for nurses on selective screening for undetected HIV infection in the emergency department. MATERIAL AND METHODS: The intervention group was comprised of 6 emergency departments that had been participating in a screening program (the "Urgències VIHgila" project) for at least 3 months. Nurses on all shifts attended training sessions that emphasized understanding the circumstances that should lead to suspicion of unidentified HIV infection and the need to order serology. Two studies were carried out: 1) a quasi-experimental pre-post study to compare the number of orders for HIV serology in each time period and measures of sensitivity, and 2) a case-control study to compare the changes made in the 6 hospitals where specialized training was provided (cases) vs 6 control hospitals in the HIV screening program where no training was given. RESULTS: A total of 280 HIV serologies were ordered for the 81015 patients (0.3%) attended during the period before training; 331 serologies were ordered for the 79620 patients in the period after training (0.4%). The relative increase in serologies was 20.3% (95% CI, 2.9% to 34.5%; P = .022). The relative increase in measures of sensitivity ranged between 19% and 39%, consistent with the main comparison. Serologies in the control group decreased between periods, from 0.9% to 0.8%, indicating a relative decrease of 15.7% (95% CI, -25.1% to -6.2%; P = .001). The absolute number of patients tested in the training group was 0.2% higher in the training hospitals (95% CI, 0.11% to 0.31%; P .001) than in the control hospitals. CONCLUSION: Training nurses to screen for undetected HIV infection in the emergency department increased the number of patients tested, according to the pre-post and case-control comparisons.

OBJETIVO: Evaluar el impacto de una formación específica para enfermería en el servicio urgencias (SU) sobre el despistaje selectivo de infección por VIH oculta. METODO: Participaron 6 SU adheridos al programa "Urgències VIHgila" con un mínimo de 3 meses y se realizaron sesiones formativas para los diferentes turnos. Las sesiones enfatizaban en qué circunstancias debía sospecharse infección oculta VIH y la necesidad de solicitar serología. Se realizaron dos estudios: 1) cuasiexperimental pre/post, que comparó la tasa de solicitudes VIH entre ambos periodos, con diversos análisis de sensibilidad; 2) caso-control, que comparó el cambio entre periodos de los 6 SU con formación (caso) con el cambio en otros 6 SU que no tuvieron formación (control). RESULTADOS: Se realizaron serologías de VIH a 280 de los 81.015 pacientes atendidos durante el periodo preintervención (0,3%) y a 331 de los 79.620 del periodo posintervención (0,4%). El incremento relativo fue del 20,3% (IC 95% de +2,9% a +34,5%; p = 0,022). Los análisis de sensibilidad mostraron incrementos relativos congruentes con el análisis principal (entre 19% y 39%). En el grupo control hubo descenso de solicitudes entre periodos, del 0,9% al 0,8% (descenso relativo del 15,7%, IC 95% de ­25,1% a­6,2%; p = 0,001). El grupo caso, en relación con el grupo control, tuvo un incremento absoluto de 0,2% (IC 95% de +0,11 a +0,31%, p 0,001) de pacientes testados. CONCLUSIONES: La formación de enfermería para despistaje de la infección VIH oculta en urgencias incrementa el número de pacientes investigados, tanto comparado con el periodo previo a la formación como comparado con SU sin formación específica para enfermería.

Impacto de un programa de cribado poblacional basado en detección de sangre oculta en heces sobre el manejo quirúrgico del cáncer colorrectal / Impact of a population screening program based on fecal occult blood detection on the surgical management of colorectal cancer

OBJETIVO PRINCIPAL: comparar los pacientes intervenidos de CCR (Cáncer colorrectal) en el contexto de un programa de cribado poblacional versus aquellos diagnosticados por presentar síntomas. METODOLOGÍA: estudio longitudinal retrospectivo. Se estudiaron dos cohortes de pacientes intervenidos de CCR en el Hospital Clínico de Barcelona (2010-2012) procedentes del Programa de detección precoz de CCR de Barcelona (n = 59), y de Urgencias o de Consultas Externas por presentar sintomatología (n = 118). RESULTADOS PRINCIPALES: Los del grupo cribado presentaron con mayor frecuencia tumores en estadio precoz (estadios I-II) que el grupo síntomas (57,6% vs 23,7%; p < 0,001). La necesidad de uso de ostomía, y la estancia hospitalaria fue superior en el grupo síntomas (36,4% vs 10,2%; p = 0,001; 10,1 días vs 7,1 días; p < 0,001. CONCLUSIÓN PRINCIPAL: los pacientes con CCR diagnosticados en el contexto de programas de cribado presentan un estadio más precoz, menor estancia hospitalaria y menor necesidad de ostomías. El programa de cribado poblacional presenta beneficios para los pacientes y el sistema sanitario

OBJECTIVE: the comparison of patients diagnosed in a screening program versus those diagnosed by symptoms has not been studied in depth. The aim of this study is to compare patients diagnosed with CRC in the context of a population-based screening program and those diagnosed only by symptoms. METHODS: longitudinal retrospective study in which two cohorts of patients with CRC are compared between 2010 and 2012 at Hospital Clinic de Barcelona depending on the method of diagnosis. Fifty-nine patients diagnosed by the cancer screening programme of Barcelona were compared with 118 patients diagnosed only by symptoms at the emergency room or outpatient clinic. RESULTS: Patients in the screened group presented more frequently tumors in the early stage (stages I-II) compared with the symptom group (57.6% vs. 23.7%, p < 0.001). The need for ostomy was higher in the symptom group, (36, 4% vs 10,2%, p = 0.001). Hospital stay was higher in the group diagnosed only by symptoms (10.1 days vs 7.1 days, p < 0.001). CONCLUSIONS: Patients with CRC diagnosed in the context of screening programmes have an earlier stage, shorter hospital stay and less need for ostomy. In conclusion, the population screening program, beyond the reduction of delayed diagnosed and mortality, directly benefits CRC patients and decreases Hospital costs

How sensitive and specific is the visual diagnosis of sarcoptic mange in free-ranging Iberian ibexes?

BACKGROUND: Sarcoptic mange is a broadly distributed parasitic disease caused by Sarcoptes scabiei that affects wild mammals from all over the world, including the Iberian ibex (Capra pyrenaica). Selective culling of the scabietic individuals is the main management measure for disease control in Iberian ibex populations. Although visual identification of mange-compatible lesions is the reference method to decide the target individual, both false negative and positive cases are common in the wild. The aim of this work is to determine the sensitivity (SE), and the specificity (SP) of selective culling after evaluating 403 ibexes hunted in the Sierra Nevada Nature Space for sarcoptic mange control between 2002 and 2015. METHODS: A combination of skin scrapings and potassium hidroxide (KOH) skin digestion was used for sarcoptic mange diagnosis. Generalized linear models (GLM) were used to assess the effects of sex, age (juveniles and adults) and period of the year (wet and dry periods) on the SE and SP of the visual diagnosis method. RESULTS: The SE obtained for the visual determination of scabietic ibexes was 87.14%, whereas the SP was 60.71%. According to our model selection, SE of the visual diagnosis was explained by the additive effects of age and the period of the year. In fact, SE was lower in juveniles (64.76%) than in adults (94.26%) and during the dry period (73.44%) as compared to the wet period (92.09%). On the other hand, SP was best explained by the GLM including the additive effects of sex and the period of the year. The visual diagnosis of sarcoptic mange resulted less specific in females (22.73%) than in males (74.19%) and during the wet (55.22%) than in the dry period (82.35%). CONCLUSIONS: Maximizing SE and SP is essential to achieving a high rate of removal of affected individuals from the environment without eliminating potentially resistant individuals. Selective culling must be conservative during the wet period and with females due to the lower SP. Conversely, visual diagnosis of scabietic juveniles and during the dry period has to be improved, due to the lower SE.

Characterizing the growth of Sarcoptes scabiei infrapopulations.

During the course of parasitic disease infestations, parasite population sizes change at both individual host (infrapopulation) and host population (metapopulation) levels. However, most studies only report epidemiological values for specific locations and times. In this study we analysed the dynamics of several Sarcoptes scabiei infrapopulations from experimentally infested Iberian ibex, Capra pyrenaica. We obtained mite counts by digesting small skin biopsies, which we compared with indices obtained from histopathological analyses performed on adjacent skin biopsies. We obtained the finite growth rate and the daily growth rate for the mite infrapopulations: mean ± SE = 11.53 ± 10.17 and 0.10 ± 0.08 mites/day, respectively. Mite counts derived from skin sample digestion did not correlate with the histological mite indices obtained from adjacent skin biopsies. At a metapopulational level, both indices of mite abundance were modelled using GLMMs and the factors influencing their variation are analysed and discussed. Our results suggest that mites are not distributed uniformly over the whole area of the skin lesion. Therefore, direct diagnoses of mange and mite counts could be inaccurate if only small skin samples are used.

How to provide care for patients suffering from terminal non-oncological diseases: barriers to a palliative care approach.

Despite the seemingly evident pertinence of palliative care for patients suffering from non-oncological long-term life-threatening diseases, everyday clinical practice is far from that assumption. This study aims to explore palliative care service provision for these patients in Spain. Patients, family caregivers and healthcare professionals were interviewed, individually or in a group, aiming at identifying barriers in the provision of care and strategies to overcome them. Ritchie and Spencer's framework was used for data analysis. The barriers identified were as follows: lack of clarity about prognosis, the hegemony of the curative approach, avoiding words and the desire to cheat death. Provision of palliative care services for these patients should be guided by the characteristic trajectory of each type of disease. Even if healthcare systems were capable of providing specialized palliative care services to this large group of patients, other barriers should not be overlooked. It would then seem appropriate to provide therapeutic and palliative care simultaneously, thus facilitating adaptation processes for both patients and relatives.