A Latin American, Portuguese and Spanish consensus on a core communication curriculum for undergraduate medical education.

BACKGROUND: To present learning outcomes in clinical communication for a Core Curriculum for medical undergraduate students in Latin America, Portugal and Spain (LAPS-CCC) and to establish an expert network to support a transnational implementation. METHODS: Through an iterative process, an international group of 15 experts developed an initial set of learning outcomes following a review and discussion of relevant international and local literature. A two-round Delphi survey involving 46 experts from 8 countries was performed. Quantative and qualitative analisis permited the definition of the final consensus. RESULTS: The initial proposal included 157 learning outcomes. The Delphi process generated 734 comments and involved the modification, deletion and addition of some outcomes. At the end of the process, a consensus was reached on 136 learning outcomes grouped under 6 competency domains with a high overall acceptance (95.1 %). CONCLUSIONS: The learning outcomes of this proposal provide a guide to introduce, support and develop communication curriculae for undergraduate medical studies in the countries involved or in other Spanish- or Portuguese-speaking countries.

El itinerario de la incertidumbre / The pathway of uncertainty

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Standardizing admission and discharge processes to improve patient flow: a cross sectional study.

BACKGROUND: The aim of this study was to evaluate how hospital capacity was managed focusing on standardizing the admission and discharge processes. METHODS: This study was set in a 900-bed university affiliated hospital of the National Health Service, near Barcelona (Spain). This is a cross-sectional study of a set of interventions which were gradually implemented between April and December 2008. Mainly, they were focused on standardizing the admission and discharge processes to improve patient flow. Primary administrative data was obtained from the 2007 and 2009 Hospital Database. Main outcome measures were median length of stay, percentage of planned discharges, number of surgery cancellations and median number of delayed emergency admissions at 8:00 am. For statistical bivariate analysis, we used a Chi-squared for linear trend for qualitative variables and a Wilcoxon signed ranks test and a Mann-Whitney test for non-normal continuous variables. RESULTS: The median patients' global length of stay was 8.56 days in 2007 and 7.93 days in 2009 (p < 0.051). The percentage of patients admitted the same day as surgery increased from 64.87% in 2007 to 86.01% in 2009 (p < 0.05). The number of cancelled interventions due to lack of beds was 216 patients in 2007 and 42 patients in 2009. The median number of planned discharges went from 43.05% in 2007 to 86.01% in 2009 (p < 0.01). The median number of emergency patients waiting for an in-hospital bed at 8:00 am was 5 patients in 2007 and 3 patients in 2009 (p < 0.01). CONCLUSIONS: In conclusion, standardization of admission and discharge processes are largely in our control. There is a significant opportunity to create important benefits for increasing bed capacity and hospital throughput.

Health-related quality of life assessment in people with multiple sclerosis and their family caregivers. A multicenter study in Catalonia (Southern Europe).

OBJECTIVES: To measure the health-related quality of life (HRQoL) of multiple sclerosis (MS) patients and their caregivers, and to assess which factors can best describe HRQoL. METHODS: A cross-sectional multicenter study of nine hospitals enrolled MS patients and their caregivers who attended outpatient clinics consecutively. The instruments used were the SF-36 for patients and the SF-12 and GHQ-12 for caregivers. Classification and regression tree analysis was used to analyze the explanatory factors of HRQoL. RESULTS: A total of 705 patients (mean age 40.4 years, median Expanded Disability Status Scale 2.5, 77.8% with relapsing-remitting MS) and 551 caregivers (mean age 45.4 years) participated in the study. MS patients had significantly lower HRQoL than in the general population (physical SF-36: 39.9; 95% confidence interval [CI]: 39.1-40.6; mental SF-36: 44.4; 95% CI: 43.5-45.3). Caregivers also presented lower HRQoL than general population, especially in its mental domain (mental SF-12: 46.4; 95% CI: 45.5-47.3). Moreover, according to GHQ-12, 27% of caregivers presented probable psychological distress. Disability and co-morbidity in patients, and co-morbidity and employment status in caregivers, were the most important explanatory factors of their HRQoL. CONCLUSIONS: Not only the HRQoL of patients with MS, but also that of their caregivers, is indeed notably affected. Caregivers' HRQoL is close to population of chronic illness even that the patients sample has a mild clinical severity and that caregiving role is a usual task in the study context.

[Listening to the voice of the patient: an imperative. 2008 SESPAS Report]. / La voz de los pacientes ha de ser escuchada. Informe SESPAS 2008.

To democratize health services, citizen participation should be free, informed and involve choice. To achieve this, a formal and public system of health services' evaluation is required. The present article aims to argue the need to promote the participation of patients and persons affected by disease to achieve greater democratization of health services and improve the effectiveness of healthcare. Qualitative studies and population surveys can be used to assess the extent to which greater participation is being achieved. To this end, the present article uses information extracted from distinct qualitative studies performed in Spanish patients by the team of the Josep Laporte Foundation Library since 2000. The "paradoxes" found in diagnosis allow some recommendations to be made on health policy. There is a substantial chasm between the working of the health system and citizens' perceptions, indicating the need for a communication strategy that would help the majority of citizens - and especially patients as direct users - to identify basic elements of the system. Despite state and regional legislation on patients' rights, a large proportion of patients remain unaware of these rights. This situation reveals the possible discrepancy between legislative and executive settings. The laws shaping health policy should be evaluated to consolidate democratic processes. Providing credibility and publicizing patient rights could legitimize the introduction of the need for dialogue on patients' responsibilities.

Emulando a la publicación científica / No disponible

No disponible

La voz de los pacientes ha de ser escuchada. Informe SESPAS 2008 / Listening to the voice of the patient: an imperative. 2008 SESPAS Report

La participación ciudadana, para la democratización de los servicios de salud, debe ser libre, informada y con capacidad de elección. Para ello se requiere un sistema formal y público de «rendición de cuentas», o evaluación de los servicios de salud. El objetivo de este artículo es defender la necesidad de promover la participación de los pacientes y de las personas afectadas por la enfermedad para conseguir una mayor democratización de la sanidad e intentar mejorar la efectividad de la atención sanitaria. Algo que puede avalarse mediante la observación de un cambio de tendencias hacia un nuevo modelo de paciente con estudios cualitativos y con encuestas a la población. Para ello, se utiliza la información extraída de diferentes estudios cualitativos realizados en pacientes españoles por el equipo de profesionales de la Fundació Biblioteca Josep Laporte desde el año 2000. Las «paradojas» encontradas en el diagnóstico permiten realizar algunas recomendaciones de política sanitaria. Hay una desconexión importante entre el funcionamiento del sistema sanitario y la percepción de los ciudadanos, lo que permite identificar la necesidad de realizar una estrategia de comunicación que ayude a conocer elementos básicos del sistema a la mayor parte de los ciudadanos, y especialmente a los pacientes como usuarios directos. También destacamos el elevado desconocimiento que tienen los ciudadanos de sus derechos formales como pacientes, a pesar de la existencia de legislación estatal y autonómica sobre dichos derechos. Esta situación refleja la posible discrepancia entre los ámbitos legislativo y ejecutivo. Las leyes que conforman la política sanitaria deberían evaluarse con el propósito de consolidar los procesos democráticos. Este hecho es importante, ya que dar credibilidad y publicidad a los derechos de los pacientes puede legitimar la necesaria introducción del necesario diálogo sobre sus obligaciones

To democratize health services, citizen participation should be free, informed and involve choice. To achieve this, a formal and public system of health services¿ evaluation is required. The present article aims to argue the need to promote the participation of patients and persons affected by disease to achieve greater democratization of health services and improve the effectiveness of healthcare. Qualitative studies and population surveys can be used to assess the extent to which greater participation is being achieved. To this end, the present article uses information extracted from distinct qualitative studies performed in Spanish patients by the team of the Josep Laporte Foundation Library since 2000. The ¿paradoxes¿ found in diagnosis allow some recommendations to be made on health policy. There is a substantial chasm between the working of the health system and citizens¿ perceptions, indicating the need for a communication strategy that would help the majority of citizens ¿ and especially patients as direct users ¿ to identify basic elements of the system. Despite state and regional legislation on patients¿ rights, a large proportion of patients remain unaware of these rights. This situation reveals the possible discrepancy between legislative and executive settings. The laws shaping health policy should be evaluated to consolidate democratic processes. Providing credibility and publicizing patient rights could legitimize the introduction of the need for dialogue on patients' responsibilities (AU)

La voz de los pacientes ha de ser escuchada. Informe SESPAS 2008 / Listening to the voice of the patient: an imperative. 2008 SESPAS Report

La participación ciudadana, para la democratización de losservicios de salud, debe ser libre, informada y con capacidadde elección. Para ello se requiere un sistema formal y públicode ®rendición de cuentas», o evaluación de los servicios de salud.El objetivo de este artículo es defender la necesidad de promoverla participación de los pacientes y de las personas afectadaspor la enfermedad para conseguir una mayor democratizaciónde la sanidad e intentar mejorar la efectividad de laatención sanitaria. Algo que puede avalarse mediante la observaciónde un cambio de tendencias hacia un nuevo modelode paciente con estudios cualitativos y con encuestas a lapoblación. Para ello, se utiliza la información extraída de diferentesestudios cualitativos realizados en pacientes españolespor el equipo de profesionales de la Fundació Biblioteca JosepLaporte desde el año 2000.Las ®paradojas» encontradas en el diagnóstico permiten realizaralgunas recomendaciones de política sanitaria. Hay una desconexiónimportante entre el funcionamiento del sistema sanitarioy la percepción de los ciudadanos, lo que permiteidentificar la necesidad de realizar una estrategia de comunicaciónque ayude a conocer elementos básicos del sistema ala mayor parte de los ciudadanos, y especialmente a los pacientescomo usuarios directos. También destacamos el elevado desconocimientoque tienen los ciudadanos de sus derechos formalescomo pacientes, a pesar de la existencia de legislaciónestatal y autonómica sobre dichos derechos. Esta situación reflejala posible discrepancia entre los ámbitos legislativo y ejecutivo.Las leyes que conforman la política sanitaria deberíanevaluarse con el propósito de consolidar los procesos democráticos.Este hecho es importante, ya que dar credibilidad y publicidada los derechos de los pacientes puede legitimar la necesariaintroducción del necesario diálogo sobre sus obligaciones(AU)

To democratize health services, citizen participation shouldbe free, informed and involve choice. To achieve this, a formaland public system of health services’ evaluation is required.The present article aims to argue the need to promotethe participation of patients and persons affected bydisease to achieve greater democratization of health servicesand improve the effectiveness of healthcare. Qualitativestudies and population surveys can be used to assessthe extent to which greater participation is being achieved.To this end, the present article uses information extractedfrom distinct qualitative studies performed in Spanish patientsby the team of the Josep Laporte Foundation Librarysince 2000.The “paradoxes” found in diagnosis allow some recommendationsto be made on health policy. There is a substantialchasm between the working of the health system andcitizens’ perceptions, indicating the need for a communicationstrategy that would help the majority of citizens – andespecially patients as direct users – to identify basic elementsof the system. Despite state and regional legislation on patients’rights, a large proportion of patients remain unawareof these rights. This situation reveals the possible discrepancybetween legislative and executive settings. The laws shapinghealth policy should be evaluated to consolidate democraticprocesses. Providing credibility and publicizing patient rightscould legitimize the introduction of the need for dialogue onpatients’ responsibilities(AU)

Public trust in the Spanish health-care system.

BACKGROUND: Fifteen years ago, public opinion surveys in Spain showed substantial dissatisfaction with the health-care system. Since that time, health-care in Spain has undergone significant changes, including a decentralization of the system, an increase in spending and a change in the way the system is financed. OBJECTIVE: This study examines how Spanish citizens rate the performance of their health system today, both as compared with other sectors of society and as compared with earlier time periods. METHODS: Data are drawn from nationally representative telephone surveys of the non-institutionalized adult Spanish population (age 18 years and over). The study was carried out in two phases: October-November 2005 (n = 3,010) and January 2006 (n = 2,101). RESULTS: The majority of the Spanish population thinks the health system needs to be changed. The problems cited relate mostly to long wait times to get health-care. Nevertheless, over the last 15 years, the proportion of people who have very negative views about the health system has decreased by half. The majority believes that not enough money is spent on health-care, but few people would support an increase in taxes to provide additional funding. The survey finds the National Health System's institutions and health professionals to be more highly trusted than other institutions and professional groups in the country. CONCLUSIONS: Government policy-makers in Spain face a dilemma: the public wants more health spending to decrease wait times, but there is substantial resistance to increasing taxes as a means to finance improvements in the system's capacity.

Innovación, patentes, globalización y derechos humanos / Innovation, patents, globalization and human rights

No disponible

[Nursing based on affectivity]. / Enfermería basada en la afectividad.

Besides the organic disease, there is another emotional disease and also another latent social disease in an ill person and in his/her environment. This emotional disease is determined by the psychological stress caused in the persons suffering a disease and in his/her relatives. To that disease, often a social disease is added. This last disease is driven by one becoming stigmatized, and at times a self-stigmatic process in the patient himself/herself, which tends to isolate a patient in his/her closest surroundings and to make him/her a recluse inside his/her house which leads to a suspension of social relationships.

Enfermería basada en la afectividad / Nursing based on affectivity

Además de la enfermedad orgánica existen una enfermedad emocional y otra social latentes en la persona enferma y en su entorno. La emocional viene determinada por el estrés psicológico causado en las personas que la padecen y en sus familiares. A ello se añade, en muchos casos, la enfermedad social. Esta última está promovida por la estigmatización y, a veces, autoestigmatización de los propios pacientes, que tienden a aislarse de su entorno más cercano y a recluirse en su domicilio suspendiendo las relaciones sociales(AU)

Besides the organic disease, there is another emotional disease and also another latent social disease in an ill person and in his/her environment. This emotional disease is determined by the psychological stress caused in the persons suffering a disease and in his/her relatives. To that disease, often a social disease is added. This last disease is driven by one becoming stigmatized, and at times a self-stigmatic process in the patient himself/herself, which tends to isolate a patient in his/her closest surroundings and to make him/her a recluse inside his/her house which leads to a suspension of social relationships(AU)