[Impact of the COVID-19 pandemic on patient safety incident and medication error reporting systems]. / Impacto de la pandemia COVID-19 en los sistemas de notificación de incidentes de seguridad del paciente y errores de medicación.

BACKGROUND AND AIM: To determine the impact of the COVID-19 pandemic on the epidemiology of safety incidents (SI) and medication errors (ME) reported to the CISEMadrid notification system in the hospital and primary care settings of the Madrid Health Service (SERMAS). MATERIALS AND METHODS: Observational and descriptive study with a retrospective analysis of data including all CISEMadrid notifications from 01-Jan-2018 to 31-Dec-2020, from 33 hospitals and 262 health care centres of the SERMAS. The two periods in 2020 with the greatest increase in COVID-19 cases were identified to compare incidents reported in the pre-pandemic and pandemic periods. RESULTS: 36,494 incidents were reported. Comparing both periods, an overall decrease in pandemic notifications of 60.7% was observed, being higher in primary care, falling to 33% of previous levels. The reduction in notifications was similar in the peaks and valleys of the waves. The three most frequent SIs in both periods and care settings were: diagnostic tests, medical devices/equipment/clinical furniture and organisational management/citations. In ME, dose failure and inappropriate selection were the most frequent in both settings and periods. There were no relevant differences in patient consequences in both periods. CONCLUSIONS: During the pandemic, patient safety notifications decreased although the most frequent types remained the same, as did their impact on the patient, both in hospitals and in primary care. The safety culture of organisations is a critical aspect for the maintenance of reporting systems.

[EFQM Model in the hospitals of Madrid Regional Health Service: full self-assessment cycle]. / Modelo EFQM en los hospitales del Servicio Madrileño de Salud: ciclo completo de autoevaluación.

AIM: To analyse a complete cycle of self-assessment using the European Foundation for Quality Management (EFQM) Model in the hospitals of the Madrid Health Service as regards the fundamental concepts of excellence (FCE). METHOD: Descriptive study of the EFQM self-assessments of the entire public hospital sector identifying the methodology and the information on strengths, weaknesses, evidence, RADAR matrix (Results, Approach, Deployment, Assessment and Review), and the related FCEs in the enabling criteria and in the prioritised action plans. RESULTS: The self-assessment was carried out in 85% of the hospitals (29/34), 86% of them required specific training (25/29), with a total of 329 teaching hours and 833 people in training. Multidisciplinary working groups were required in 83% of the hospitals (24/29), with 123 groups and 857 people involved. There were 3,686 strengths and 3,197 weaknesses identified: strengths and weaknesses were 78% (2,869) and 74% (2,355), respectively, for the enabling criteria and 22% (817) and 26% (842), respectively, for the results criteria. The mean score was 404 points with a median of 399. The main FCEs were managing with agility, developing organisational capability, sustaining outstanding results, creating a sustainable future, succeeding through the talent of people, and adding value for customers, with harnessing creativity/innovation and leading with vision, inspiration and integrity being placed in lower positions. A total of 113 action plans were identified for all the hospitals. CONCLUSION: A complete EFQM self-assessment cycle of the entire public hospital sector of a Regional Health Service is provided, linking the analysis and action plans with the FCE of the EFQM Model.

Assessing the competences associated with a nursing Bachelor thesis by means of rubrics.

BACKGROUND: Writing a Bachelor thesis is the last step in obtaining a university degree. The thesis may be job- or research-orientated, but it must demonstrate certain degree-level competences. Rubrics are a useful way of unifying the assessment criteria. OBJECTIVES: To design a system of rubrics for assessing the competences associated with the Bachelor thesis of a nursing degree, to examine the system's reliability and validity and to analyse results in relation to the final thesis mark. DESIGN: Cross-sectional and psychometric study conducted between 2012 and 2014. SETTINGS: Nursing degree at a Spanish university. PARTICIPANTS: Twelve tutors who designed the system of rubrics. Students (n = 76) who wrote their Bachelor thesis during the 2013-2014 academic year. METHODS: After deciding which aspects would be assessed, who would assess them and when, the tutors developed seven rubrics (drafting process, assessment of the written thesis by the supervisor and by a panel, student self-assessment, peer assessment, tutor evaluation of the peer assessment and panel assessment of the viva). We analysed the reliability (inter-rater and internal consistency) and validity (convergent and discriminant) of the rubrics, and also the relationship between the competences assessed and the final thesis mark. RESULTS: All the rubrics had internal consistency coefficients >0.80. The rubric for oral communication skills (viva) yielded inter-rater reliability of 0.95. Factor analysis indicated a unidimensional structure for all but one of the rubrics, the exception being the rubric for peer assessment, which had a two-factor structure. The main competences associated with a good quality Bachelor thesis were written communication skills and the ability to work independently. CONCLUSION: The assessment system based on seven rubrics is shown to be valid and reliable. Writing a Bachelor thesis requires a range of degree-level competences and it offers nursing students the opportunity to develop their evidence-based practice skills.

Integrating genomic alterations in diffuse large B-cell lymphoma identifies new relevant pathways and potential therapeutic targets.

Genome studies of diffuse large B-cell lymphoma (DLBCL) have revealed a large number of somatic mutations and structural alterations. However, the clinical significance of these alterations is still not well defined. In this study, we have integrated the analysis of targeted next-generation sequencing of 106 genes and genomic copy number alterations (CNA) in 150 DLBCL. The clinically significant findings were validated in an independent cohort of 111 patients. Germinal center B-cell and activated B-cell DLBCL had a differential profile of mutations, altered pathogenic pathways and CNA. Mutations in genes of the NOTCH pathway and tumor suppressor genes (TP53/CDKN2A), but not individual genes, conferred an unfavorable prognosis, confirmed in the independent validation cohort. A gene expression profiling analysis showed that tumors with NOTCH pathway mutations had a significant modulation of downstream target genes, emphasizing the relevance of this pathway in DLBCL. An in silico drug discovery analysis recognized 69 (46%) cases carrying at least one genomic alteration considered a potential target of drug response according to early clinical trials or preclinical assays in DLBCL or other lymphomas. In conclusion, this study identifies relevant pathways and mutated genes in DLBCL and recognizes potential targets for new intervention strategies.

Análisis comparativo de 2 registros de infarto agudo de miocardio tras una década de cambios. Estudio IBERICA (1996-1998) y Código Infarto-Illes Balears (2008-2010) / Comparative analysis between 2 periods of acute myocardial infarction after a decade in Mallorca. IBERIA Study (996-1998) and Infarction-Code (2008-2010)

OBJETIVO: Investigar las diferencias en la mortalidad a 28 días y otras variables pronósticas en 2 periodos: IBERICA-Mallorca (1996-1998) y Código Infarto-Illes Balears (CI-IB) (2008-2010). DISEÑO: Dos cohortes prospectivas observacionales. Ámbito: Hospital Universitario Son Dureta, 1996-1998 y 2008-2010. PACIENTES: Síndrome coronario agudo con elevación de ST de≤24h, de localización anterior e inferior. Variables principales de interés: Edad, sexo, factores de riesgo cardiovascular, localización, tiempos de actuación, tratamiento de reperfusión con fibrinólisis y angioplastia primaria, administración de ácido acetilsalicílico, betabloqueantes e inhibidores de la enzima conversora de la angiotensina. Se incluyeron el grado de Killip, las arritmias malignas, las complicaciones mecánicas y el fallecimiento a los 28 días. RESULTADOS: Se analizaron 442 pacientes de los 889 incluidos en el IBERICA-Mallorca y 498 de los 847 registrados en el CI-IB. La localización y el Killip fueron similares en ambas cohortes. Las principales diferencias significativas entre el grupo IBERICA y el CI-IB fueron: edad (64 vs. 58 años), infarto previo (17,9 vs. 8,1%), tiempo síntomas-primer ECG (120 vs. 90min), tiempo primer ECG-fibrinólisis (60 vs. 35min), tratamiento fibrinolítico (54,8 vs. 18,7%), pacientes sin reperfusión (45,9 vs. 9,2%), angioplastia primaria (1,0 vs. 92,0%). La mortalidad a los 28 días fue inferior en el CI-IB (12,2 vs. 7,2%; hazard ratio 0,560; IC 95% 0,360-0,872; p = 0,010). CONCLUSIÓN: La mortalidad a los 28 días en el síndrome coronario agudo con elevación de ST en Mallorca ha disminuido en la última década, probablemente debido a un mayor tratamiento de reperfusión con angioplastia primaria y a una reducción de los tiempos de reperfusión

OBJECTIVE: To investigate the differences in mortality at 28 days and other prognostic variables in 2 periods: IBERICA-Mallorca (1996-1998) and Infarction Code of the Balearic Islands (IC-IB) (2008-2010). DESIGN: Two observational prospective cohorts. SETTING: Hospital Universitario Son Dureta, 1996-1998 and 2008-2010. PATIENTS: Acute coronary syndrome with ST elevation of≤24h of anterior and inferior site. Main variables of interest: Age, sex, cardiovascular risk factors, site of AMI, time delays, reperfusion therapy with fibrinolysis and primary angioplasty, administration of acetylsalicylic acid, beta blockers and angiotensin converting enzyme inhibitors. Killip class, malignant arrhythmias, mechanical complications and death at 28 days were included. RESULTS: Four hundred and forty-two of the 889 patients included in the IBERICA-Mallorca and 498 of 847 in the IC-IB were analyzed. The site and Killip class on admission were similar in both cohorts. The main significant difference between IBERICA and IC-IB group were age (64 vs. 58 years), prior myocardial infarction (17.9 vs. 8.1%), the median symtoms to first ECG time (120 vs. 90min), median first ECG to fibrinolysis time (60 vs. 35min), fibrinolytic therapy (54.8 vs. 18.7%), patients without revascularization treatment (45.9 vs. 9.2%), primary angioplasty (1.0% vs. 92.0%). The mortality at 28 days was lower in the IC-IB (12.2 vs. 7.2%; hazard ratio 0.560; 95% CI 0.360-0.872; P=.010). CONCLUSION: The 28-day mortality in acute coronary syndrome with ST elevation in Mallorca has declined in the last decade, basically due to increased reperfusion therapy with primary angioplasty and reducing delays time to reperfusion

Comparative analysis between 2 periods of acute myocardial infarction after a decade in Mallorca. IBERIA Study (996-1998) and Infarction-Code (2008-2010). / Análisis comparativo de 2 registros de infarto agudo de miocardio tras una década de cambios. Estudio IBERICA (1996-1998) y Código Infarto-Illes Balears (2008-2010).

OBJECTIVE: To investigate the differences in mortality at 28 days and other prognostic variables in 2 periods: IBERICA-Mallorca (1996-1998) and Infarction Code of the Balearic Islands (IC-IB) (2008-2010). DESIGN: Two observational prospective cohorts. SETTING: Hospital Universitario Son Dureta, 1996-1998 and 2008-2010. PATIENTS: Acute coronary syndrome with ST elevation of≤24h of anterior and inferior site. MAIN VARIABLES OF INTEREST: Age, sex, cardiovascular risk factors, site of AMI, time delays, reperfusion therapy with fibrinolysis and primary angioplasty, administration of acetylsalicylic acid, beta blockers and angiotensin converting enzyme inhibitors. Killip class, malignant arrhythmias, mechanical complications and death at 28 days were included. RESULTS: Four hundred and forty-two of the 889 patients included in the IBERICA-Mallorca and 498 of 847 in the IC-IB were analyzed. The site and Killip class on admission were similar in both cohorts. The main significant difference between IBERICA and IC-IB group were age (64 vs. 58 years), prior myocardial infarction (17.9 vs. 8.1%), the median symtoms to first ECG time (120 vs. 90min), median first ECG to fibrinolysis time (60 vs. 35min), fibrinolytic therapy (54.8 vs. 18.7%), patients without revascularization treatment (45.9 vs. 9.2%), primary angioplasty (1.0% vs. 92.0%). The mortality at 28 days was lower in the IC-IB (12.2 vs. 7.2%; hazard ratio 0.560; 95% CI 0.360-0.872; P=.010). CONCLUSION: The 28-day mortality in acute coronary syndrome with ST elevation in Mallorca has declined in the last decade, basically due to increased reperfusion therapy with primary angioplasty and reducing delays time to reperfusion.

Bioassessment of trace element contamination of Mediterranean coastal waters using the seagrass Posidonia oceanica.

A large scale survey of the trace element (TE) contamination of Mediterranean coastal waters was performed from the analysis of Ag, As, Cd, Cu, Hg, Ni and Pb in the bioindicator Posidonia oceanica, sampled at 110 sites differing by their levels of exposure to contaminants. The holistic approach developed in this study, based on the combined utilization of several complementary monitoring tools, i.e. water quality scale, pollution index and spatial analysis, accurately assessed the TE contamination rate of Mediterranean coastal waters. In particular, the mapping of the TE contamination according to a new proposed 5-level water quality scale precisely outlined the contamination severity along Mediterranean coasts and facilitated interregional comparisons. Finally, the reliability of the use of P. oceanica as bioindicator species was again demonstrated through several global, regional and local detailed case studies. NB: The designations employed and the presentation of the information in this document do not imply the expression of any opinion whatsoever on the part of the authors concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

A B-cell epigenetic signature defines three biologic subgroups of chronic lymphocytic leukemia with clinical impact.

Prospective identification of patients with chronic lymphocytic leukemia (CLL) destined to progress would greatly facilitate their clinical management. Recently, whole-genome DNA methylation analyses identified three clinicobiologic CLL subgroups with an epigenetic signature related to different normal B-cell counterparts. Here, we developed a clinically applicable method to identify these subgroups and to study their clinical relevance. Using a support vector machine approach, we built a prediction model using five epigenetic biomarkers that was able to classify CLL patients accurately into the three subgroups, namely naive B-cell-like, intermediate and memory B-cell-like CLL. DNA methylation was quantified by highly reproducible bisulfite pyrosequencing assays in two independent CLL series. In the initial series (n=211), the three subgroups showed differential levels of IGHV (immunoglobulin heavy-chain locus) mutation (P<0.001) and VH usage (P<0.03), as well as different clinical features and outcome in terms of time to first treatment (TTT) and overall survival (P<0.001). A multivariate Cox model showed that epigenetic classification was the strongest predictor of TTT (P<0.001) along with Binet stage (P<0.001). These findings were corroborated in a validation series (n=97). In this study, we developed a simple and robust method using epigenetic biomarkers to categorize CLLs into three subgroups with different clinicobiologic features and outcome.

Multiorgan failure in the serious trauma patient.

Multiorgan failure remains one of the leading causes of late morbidity and mortality after severe trauma. In the early phase, it is related with an uncontrolled hyper-inflammation state, whereas in the late phase (>72 h), septic complications play a major role. We review the underlying pathophysiology, the evaluation with different scales and the clinical factors associated with multiorgan failure, as well as potential treatment options.

Variability in glutenin subunit composition of Mediterranean durum wheat germplasm and its relationship with gluten strength.

The allelic composition at five glutenin loci was assessed by one-dimensional sodium dodecyl sulphate polyacrylamide gel electrophoresis (1D SDS-PAGE) on a set of 155 landraces (from 21 Mediterranean countries) and 18 representative modern varieties. Gluten strength was determined by SDS-sedimentation on samples grown under rainfed conditions during 3 years in north-eastern Spain. One hundred and fourteen alleles/banding patterns were identified (25 at Glu-1 and 89 at Glu-2/Glu-3 loci); 0·85 of them were in landraces at very low frequency and 0·72 were unreported. Genetic diversity index was 0·71 for landraces and 0·38 for modern varieties. All modern varieties exhibited medium to strong gluten type with none of their 13 banding patterns having a significant effect on gluten-strength type. Ten banding patterns significantly affected gluten strength in landraces. Alleles Glu-B1e (band 20), Glu-A3a (band 6), Glu-A3d (bands 6 + 11), Glu-B3a (bands 2 + 4+15 + 19) and Glu-B2a (band 12) significantly increased the SDS-value, and their effects were associated with their frequency. Two alleles, Glu-A3b (band 5) and Glu-B2b (null), significantly reduced gluten strength, but only the effect of the latter locus could be associated with its frequency. Only three rare banding patterns affected gluten strength significantly: Glu-B1a (band 7), found in six landraces, had a negative effect, whereas banding patterns 2 + 4+14 + 15 + 18 and 2 + 4+15 + 18 + 19 at Glu-B3 had a positive effect. Landraces with outstanding gluten strength were more frequent in eastern than in western Mediterranean countries. The geographical pattern displayed from the frequencies of Glu-A1c is discussed.

Barreras y retos de las unidades funcionales de gestión de riesgos sanitarios en los hospitales del Servicio Madrileño de Salud / Barriers and challenges of the functional healthcare risk management units in hospitals of Madrid health service

Objetivo. Identificar las barreras y los retos para el desarrollo efectivo de las unidades de gestión de riesgos sanitarios en los hospitales del Servicio Madrileño de Salud. Material y métodos. Estudio descriptivo transversal dirigido a los equipos directivos y a los miembros de las unidades funcionales de 31 hospitales del Servicio Madrileño de Salud. Se solicitó en forma de texto libre, dentro de un cuestionario autoadministrado, la identificación de un máximo de 5 barreras y retos y su priorización a través de la adjudicación de uno a 5 puntos de acuerdo con su importancia. Posteriormente se realizó un análisis del discurso agrupando los temas comunes y ordenándolos de acuerdo con la puntuación recibida. Resultados. La tasa de respuesta global fue del 94%. Las barreras más frecuentemente identificadas fueron: falta de tiempo (21%), insuficiente cultura de seguridad (13%), escasa difusión de sus actividades (10%) y falta de formación (10%). El reto más importante fue potenciar la formación (18%), seguido de mejorar la cultura (17%), difundir las actividades de seguridad (11%) y lograr el liderazgo de los responsables de los servicios (11%). Conclusiones. En las condiciones del estudio, la barrera fundamental identificada fue la falta de tiempo y el reto principal la necesidad de formación. Por ello parece necesario mejorar el apoyo organizativo a la seguridad clínica en el ámbito objeto de estudio (AU)

Objective. To identify the barriers and challenges for the effective development of risk management units in hospitals of the Madrid Health Service Material and methods. Descriptive cross-sectional study aimed at the management teams and members of the functional units of 31 hospitals in the Madrid Health Service. A self-administered questionnaire requesting answers in free text was used, identifying up to five barriers and challenges, and their prioritization by awarding from 1-5 points according to their importance. A discourse analysis was then conducted, grouping common themes and sorting them according to their score. Results. The overall response rate was 94%. The most frequently identified barriers were lack of time (21%), inadequate safety culture (13%), lack of publication of their activities (10%), and lack of training (10%). The most important challenge was developing the training (18%), followed by improving the culture (17%), communication of safety activities (11%), and achieve leadership from the managers of the services (11%). Conclusions. According to the study conditions, the main identified barrier identified was the lack of available time, and the principal challenge found was promoting a proactive learning culture (AU)

[Barriers and challenges of the functional healthcare risk management units in hospitals of Madrid health service]. / Barreras y retos de las unidades funcionales de gestión de riesgos sanitarios en los hospitales del Servicio Madrileño de Salud.

OBJECTIVE: To identify the barriers and challenges for the effective development of risk management units in hospitals of the Madrid Health Service. MATERIAL AND METHODS: Descriptive cross-sectional study aimed at the management teams and members of the functional units of 31 hospitals in the Madrid Health Service. A self-administered questionnaire requesting answers in free text was used, identifying up to five barriers and challenges, and their prioritization by awarding from 1-5 points according to their importance. A discourse analysis was then conducted, grouping common themes and sorting them according to their score. RESULTS: The overall response rate was 94%. The most frequently identified barriers were lack of time (21%), inadequate safety culture (13%), lack of publication of their activities (10%), and lack of training (10%). The most important challenge was developing the training (18%), followed by improving the culture (17%), communication of safety activities (11%), and achieve leadership from the managers of the services (11%). CONCLUSIONS: According to the study conditions, the main identified barrier identified was the lack of available time, and the principal challenge found was promoting a proactive learning culture.

Genetic improvement of bread wheat yield and associated traits in Spain during the 20th century.

A collection of 26 wheat genotypes widely grown in Spain during the 20th century was evaluated in eight contrasting environments in order to quantify breeding achievements in yield and associated traits. From 1930 to 2000, yield increased at a rate of 35·1 kg/ha/yr or 0·88%/yr, but estimations of relative genetic gain (RGG) were environment-dependent. RGG estimated for yield were positively associated with the average minimum daily temperatures from sowing to heading in the testing environments (R(2) = 0·81; P < 0·01). The number of grains/spike and the number of spikes/m(2) increased at a rate of 0·60%/yr and 0·30%/yr, respectively, while grain weight remained unchanged. The present study detected two main episodes of yield improvement during the century. The first one coincided with the introduction, during the 1950s, of the first improved cultivars derived from intra-specific crosses, which increased the yield of landraces by 30% due to an increase of c. 58% in the number of grains/spike, accompanied by a 16% reduction in grain weight. These initial cultivars (termed 'old-bred' in a previous study by Sanchez-Garcia et al. 2012) exhibited a higher harvest index (HI), increased from 0·25 to 0·40, but maintained the same aboveground biomass at maturity as the landraces (despite reducing both plant height and the number of tillers/plant) due to increases in the proportion of tillers bearing spikes. The second yield gain occurred after the introduction, in the early 1970s, of semi-dwarf germplasm from CIMMYT (International Maize and Wheat Improvement Centre) and some French cultivars. This new germplasm further reduced plant height, improved HI up to 0·45 and increased the number of tillers/plant while maintaining their rate of fertility, thus resulting in a yield gain of c. 37%. The cultivars released during the last decade of the century did not contribute to significant yield improvements.

Evaluación del sistema de información de seguridad del paciente de los centros sanitarios del Servicio Madrileño de Salud (Atención Primaria y Hospitales) / Assessment of Patient Safety reporting system in Madrid Health Services (Primary Care and Hospitals)

Objetivos. Mejorar el sistema de información de seguridad del paciente de las unidades funcionales de gestión de riesgos sanitarios (UFGRS) de los centros del Servicio Madrileño de Salud; analizando la opinión de las UFGRS sobre el contenido, cumplimentación y utilidad, detectando las dificultades e identificando las áreas de mejora. Método. Se ha realizado un estudio descriptivo mediante cuestionarios dirigidos a las 45 UFGRS de los centros sanitarios del Servicio Madrileño de Salud. Resultados. El cuestionario, en una escala de 1 a 5, obtuvo respuestas en promedios superiores a 3,70 en: los contenidos (3,77), la forma de cumplimentar (3,72) el formulario; la claridad en la exposición de los datos del informe (3,94) y en la utilidad global de la información (3,77). Las dificultades detectadas más significativas estaban relacionadas con el exceso y reiteración de información solicitada. En las áreas de mejora destacan la demanda de mayor depuración y análisis de información sobre prácticas seguras, la realización de dos formatos de informe de resultados para facilitar la difusión en los centros y la revisión de la clasificación de incidentes de seguridad. Conocer la opinión de las unidades funcionales sobre el sistema de información permite mejorar la utilidad del mismo en cuanto a la accesibilidad, presentación e intercambio de la información en materia de seguridad del paciente(AU)

Objectives. Improve the patient safety reporting system of the Functional Units of Health Risk Management (UFGRS) in Madrid health services, analysing the opinion of the UFGRS about its content, completion and usefulness, detecting the difficulties and identifying the areas for improvement. Method. A descriptive study was conducted using a questionnaire addressed to the 45 UFGRS of the Madrid Health Services. Results. The questionnaire, with a scale of 1 to 5, received responses with an average higher than 3.70: contents (3.77); how to complete the form (3.72); clarity of data shown in the report (3.94) and the overall usefulness of the information (3.77). The most significant difficulties found were related to the excess and reiteration of the information requested. As regards areas for improvement, the most notable was the demand for more refining and analysis of the information about safe practices, the execution of two types of format for reporting results in order to facilitate dissemination among the centres and the review of the classification of safety incidents. Knowing the opinion of the Functional Units of the information system may improve the usefulness of the report as far as accessibility, presentation and exchange of information on patient safety is concerned(AU)

[Assessment of patient safety reporting system in Madrid health services (primary care and hospitals)]. / Evaluación del sistema de información de seguridad del paciente de los centros sanitarios del Servicio Madrileño de Salud (Atención Primaria y Hospitales).

OBJECTIVES: Improve the patient safety reporting system of the Functional Units of Health Risk Management (UFGRS) in Madrid health services, analysing the opinion of the UFGRS about its content, completion and usefulness, detecting the difficulties and identifying the areas for improvement. METHOD: A descriptive study was conducted using a questionnaire addressed to the 45 UFGRS of the Madrid Health Services. RESULTS: The questionnaire, with a scale of 1 to 5, received responses with an average higher than 3.70: contents (3.77); how to complete the form (3.72); clarity of data shown in the report (3.94) and the overall usefulness of the information (3.77). The most significant difficulties found were related to the excess and reiteration of the information requested. As regards areas for improvement, the most notable was the demand for more refining and analysis of the information about safe practices, the execution of two types of format for reporting results in order to facilitate dissemination among the centres and the review of the classification of safety incidents. Knowing the opinion of the Functional Units of the information system may improve the usefulness of the report as far as accessibility, presentation and exchange of information on patient safety is concerned.

A single primer pair gives a specific ortholog amplicon in a wide range of Cyanobacteria and plastid-bearing organisms: applicability in inventory of reference material from collections and phylogenetic analysis.

The scarcity of universally applied molecular markers for algae has resulted in the development of multiple, independent and not easily comparable systems. The goal of this work is to increase the number of available molecular markers and to generate easily comparable systems. Thereby, we have designed a primer pair capable of amplifying a broad range of organisms: Cyanobacteria, Chlorophyta, Chlorarachniophyta, Cryptophyta, Euglenida, Glaucophyta, Rhodophyta, Stramenopiles and Streptophyta including plants. This primer pair can amplify a portion of the 23S rRNA gene with sufficient variability to identify reference material form collections across a broad range of taxa and perform phylogenetic studies alongside other available markers.

Utilización de los ejes transversales del modelo EFQM en el ámbito sanitario público / Use of the EFQM Red Threads in the Health Public Health System

Objetivo: Analizar la utilización de los ejes transversales (EETT) del modelo EFQM en la autoevaluación de las organizaciones de servicios en una comunidad autónoma, y describir el resultado de la autoevaluación para el conjunto del sistema sanitario público (SSP). Material y métodos: Estudio descriptivo en dos etapas: 1) evaluación del uso del modelo EFQM en el SSP, y 2) análisis de la metodología de trabajo mediante EETT. En la primera fase se analizó el 100% de los informes de autoevaluación (37 gerencias) de Atención Primaria (AP) y Especializada (AE) (2007). Se realizó un análisis cuantitativo de la distribución de puntos fuertes (PF) y áreas de mejora (AM), según nivel asistencial, centro sanitario y su agrupación en criterios y EETT del Modelo. Resultados: La utilización del modelo EFQM en el conjunto del SSP alcanza el 84% de las gerencias (32/37) y el 94% despliegan planes de mejora (30/32). Se describen 3.543 PF y 3.573 AM, para el SSP. Del total de PF, los criterios agentes suponen un 67,6%.ResultadosLos resultados por EETT resaltan la dominancia de los ejes de gestión de la organización, personas, clientes, proceso y comunicación. Resultados: Las dificultades para su aplicación derivan del liderazgo de la organización en gestión de la calidad, de las estrategias formativas para su despliegue, del carácter novedoso que supone la herramienta en determinados entornos, y de la potencial carga de trabajo generada. Conclusiones: Los EETT se perciben como un método de trabajo factible para la agrupación y síntesis de las AM, precisando una formación adecuada para optimizar su utilización (AU)

Objective: To analyse the use of transversal axes (TA) of the EFQM Model in the self- assessment of the service organisations in an Autonomous Community and to describe the self assessment results for the health care system (HCS) as a whole. Material and methods: Descriptive study divided in two phases: 1) evaluation of the use of the EFQM model in the HCS, and 2) analysis of the methodology using TA. All (37) of the self-assessment reports corresponding to Primary Care and Hospitals in 2007 were analysed. A quantitative analysis was performed on the strengths (S) and areas of improvement (AI) identified, stratifying them according to level of care, centre and EFQM criteria and TA. Results: The use of the EFQM in the HCS reaches 84% of the organizations (32/37), and 94% deploy improvement plans (30/32). A total of 3543 S and 3573 AI were described for the HCS as a whole. From the total identified S, enablers reach 67.66%. Results: Results according to TA the organization management axes are the dominant ones: people, clients, process and communication. Results: Application difficulties derive from the organizations’ leadership in quality management, the training strategies for deployment, the innovation character of the model in certain settings and the potential workload generated. Conclusions: TA are perceived as a feasible work method to gather and synthesize AI. However it requires appropriate training to optimize its use (AU)

[Use of the EFQM red threads in the health public health system]. / Utilización de los ejes transversales del modelo EFQM en el ámbito sanitario público.

OBJECTIVE: To analyse the use of transversal axes (TA) of the EFQM Model in the self- assessment of the service organisations in an Autonomous Community and to describe the self assessment results for the health care system (HCS) as a whole. MATERIAL AND METHODS: Descriptive study divided in two phases: 1) evaluation of the use of the EFQM model in the HCS, and 2) analysis of the methodology using TA. All (37) of the self-assessment reports corresponding to Primary Care and Hospitals in 2007 were analysed. A quantitative analysis was performed on the strengths (S) and areas of improvement (AI) identified, stratifying them according to level of care, centre and EFQM criteria and TA. RESULTS: The use of the EFQM in the HCS reaches 84% of the organizations (32/37), and 94% deploy improvement plans (30/32). A total of 3543 S and 3573 AI were described for the HCS as a whole. From the total identified S, enablers reach 67.66%. Results according to TA the organization management axes are the dominant ones: people, clients, process and communication. Application difficulties derive from the organizations' leadership in quality management, the training strategies for deployment, the innovation character of the model in certain settings and the potential workload generated. CONCLUSIONS: TA are perceived as a feasible work method to gather and synthesize AI. However it requires appropriate training to optimize its use.