Quality indicators in the rational management of severe asthma: A Spanish multidisciplinary consensus.

AIM: Severe asthma is a complex, heterogeneous condition that can be difficult to control despite currently available treatments. Multidisciplinary severe asthma units (SAU) improve control in these patients and are cost-effective in our setting; however, their implementation and development can represent an organizational challenge. The aim of this study was to validate a set of quality care indicators in severe asthma for SAU in Spain. METHODS: The Carabela initiative, sponsored by SEPAR, SEAIC, SECA and SEDISA and implemented by leading specialists, analyzed the care processes followed in 6 pilot centers in Spain to describe the ideal care pathway for severe asthma. This analysis, together with clinical guidelines and SEPAR and SEAIC accreditation criteria for asthma units, were used to draw up a set of 11 quality of care indicators, which were validated by a panel of 60 experts (pulmonologists, allergologists, and health-policy decision-makers) using a modified Delphi method. RESULTS: All 11 indicators achieved a high level of consensus after just one Delphi round. CONCLUSIONS: Experts in severe asthma agree on a series of minimum requirements for the future optimization, standardization, and excellence of current SAUs in Spain. This proposal is well grounded on evidence and professional experience, but the validity of these consensus indicators must be evaluated in clinical practice.

Validation of genetic classifiers derived from mouse and human tumors to identify molecular subtypes of colorectal cancer.

Colorectal cancer (CRC) is a leading cause of cancer death in the United States. Standard treatment for advanced-stage CRC for decades has included 5-fluorouracil-based chemotherapy. More recently, targeted therapies for metastatic CRC are being used based on the individual cancer's molecular profile. In the past few years, several different molecular subtype schemes for human CRC have been developed. The molecular subtypes can be distinguished by gene expression signatures and have the potential to be used to guide treatment decisions. However, many subtyping classification methods were developed using mRNA expression levels of hundreds to thousands of genes, making them impractical for clinical use. In this study, we assessed whether an immunohistochemical approach could be used for molecular subtyping of CRCs. We validated two previously published, independent sets of immunohistochemistry classifiers and modified the published methods to improve the accuracy of the scoring methods. In addition, we evaluated whether protein and genetic signatures identified originally in the mouse were linked to clinical outcomes of patients with CRC. We found that low DDAH1 or low GAL3ST2 protein levels in human CRCs correlate with poor patient outcomes. The results of this study have the potential to impact methods for determining the prognosis and therapy selection for patients with CRC.

Tumor aggressiveness is independent of radiation quality in murine hepatocellular carcinoma and mammary tumor models.

PURPOSE: Estimating cancer risk associated with interplanetary space travel is complicated. Human exposure data to high atomic number, high-energy (HZE) radiation is lacking, so data from low linear energy transfer (low-LET) γ-ray radiation is used in risk models, with the assumption that HZE and γ-ray radiation have comparable biological effects. This assumption has been challenged by reports indicating that HZE radiation might produce more aggressive tumors. The goal of this research is to test whether high-LET HZE radiation induced tumors are more aggressive. MATERIALS AND METHODS: Murine models of mammary and liver cancer were used to compare the impact of exposure to 0.2Gy of 300MeV/n silicon ions, 3 Gy of γ-rays or no radiation. Numerous measures of tumor aggressiveness were assessed. RESULTS: For the mammary cancer models, there was no significant change in the tumor latency or metastasis in silicon-irradiated mice compared to controls. For the liver cancer models, we observed an increase in tumor incidence but not tumor aggressiveness in irradiated mice. CONCLUSION: Tumors in the HZE-irradiated mice were not more aggressive than those arising from exposure to low-LET γ-rays or spontaneously. Thus, enhanced aggressiveness does not appear to be a uniform characteristic of all tumors in HZE-irradiated animals.

Butt Why? Exploring factors associated with cigarette scavenging behaviors among adult smokers enrolling in a clinical trial for smoking cessation.

INTRODUCTION: Cigarette smoking is associated with many adverse health effects and is an important public health concern. Increased understanding of smokers' behavior is central to developing effective interventions. Cigarette scavenging, a behavior that involves smoking shared or previously used cigarettes has thus far only been shown to be prevalent among homeless or incarcerated populations. The current study examines whether cigarette scavenging is prevalent in a more general population of adult smokers enrolling in a smoking cessation clinical trial, and whether engagement in this behavior is associated with demographic or smoking-related psychosocial factors. METHODS: Baseline data was obtained from adult smokers (N=227) enrolling in a randomized clinical trial for smoking cessation. Cigarette scavenging was assessed using three items: a) sharing a cigarette with a stranger; b) smoking a "found" cigarette and c) smoking a previously used cigarette "butt". Participants who endorsed engaging in at least one of these three behaviors were categorized as a scavenger. RESULTS: Approximately 32% of participants endorsed at least one cigarette scavenging behavior. A multiple logistic regression analysis found that scavengers were more likely to be: men (p<0.001), of younger age at smoking onset (p=0.012), unemployed (p=0.003), more likely to have used marijuana in the past 30days (p=0.005), single or living alone (p=0.003), and to have experienced higher withdrawal symptoms during previous quit attempts (p=0.044) as compared to non-scavengers. CONCLUSIONS: Scavenging is common among adult smokers. Interventions that address cigarette scavenging behaviors may better meet the needs of this unique smoking subgroup.

SERPINB3 expression on B-cell surface in autoimmune diseases and hepatitis C virus-related chronic liver infection.

SERPINB3 is a serine protease inhibitor with pleiotropic functions. It is involved in several physiological and pathological processes, where it appears to exert antiapoptotic effects. Little is known about its expression on immune system cells, the major players in mechanisms of viral defense and autoimmune disorders. The aim of this study was to characterize the expression of SERPINB3 on the surface of peripheral blood mononuclear cell subsets in both normal subjects and in patients with chronic viral infections and autoimmune diseases. Sixty-two patients were analyzed by flow cytometric analysis, including 45 with hepatitis C virus (HCV)-related chronic liver disease and 17 with systemic lupus erythematosus (SLE). SERPINB3 was expressed on B lymphocytes in 79% of the controls, in 32% of the HCV-infected patients and in none of the SLE patients. Surface localization of SERPINB3 was confirmed by confocal microscopy. SERPINB3 positivity was associated with CD27 reactivity (r = 0.98), but not to other activation molecules (CD69, CD71, CD86 and CXCR3). SERPINB3 is physiologically expressed on the surface of CD27(+) B lymphocytes, but its expression is reduced in HCV viral infection and not detectable in SLE patients. These results may suggest a role for SERPINB3 in B-cell defects typically found in viral infections and autoimmune disorders.

Resultados y reflexiones del Comité Científico del XXVIII Congreso de la Sociedad Española de Calidad Asistencial / Results and reflections of the Scientific Committee of the XXVIII Conference of the Spanish Society of Quality in Healthcare

Objetivos. Valorar el cumplimiento de los objetivos encomendados al comité científico (CC) y conocer si los resultados obtenidos han variado respecto a anteriores congresos de la Sociedad Española de Calidad Asistencial (SECA). Métodos. Descripción cronológica del trabajo del CC y comparación con los resultados de los dos últimos congresos de la SECA. Resultados. Ochocientos sesenta y nueve trabajos presentados, de los cuales el 32,6% correspondían al área temática de seguridad de pacientes. Galicia fue la comunidad que más comunicaciones presentó (28,0%), seguida de Cataluña (12,9%) y Murcia (10,9%). Conclusiones. La metodología seguida por el CC facilitó el cumplimiento de los plazos previstos en el manual de congresos de la SECA y ayudó a alcanzar los objetivos del mismo, estructurando las presentaciones de los trabajos según su nivel de calidad. Se constata un año más las características de congreso multidisciplinar, abierto a los países del área latinoamericana, por el número de comunicaciones presentadas y su distribución por estamentos, comunidades autónomas y países que las presentan(AU)

Objectives. To determine whether the objectives entrusted to the Scientific Committee (SC) of the 28th National Conference have been met, and to determine whether the results differed from those of previous conferences. Methods. A chronological description of the work of the SC and a comparison with the results of the previous two Conferences of the Spanish Society for Quality in health care (SSQHC). Results. A total of 869 papers were submitted, of which 32.6% corresponded to the area of patient safety. Galicia was the community that presented more communications (28%), followed by Catalonia (12.9%) and Murcia (10.9%). Conclusions. The methodology used by the SC helped in the compliance with the deadlines in the SSQHC Conference manual and contributed to achieve its objectives. Abstract presentations were classified accordingly to their quality. The Conference has been consolidated as a multidisciplinary meeting with participation by doctors, nurses, managers and open to the Latin-American community(AU)

[Results and reflections of the Scientific Committee of the XXVIII Conference of the Spanish Society of Quality in Healthcare]. / Resultados y reflexiones del Comité Científico del XXVIII Congreso de la Sociedad Española de Calidad Asistencial.

OBJECTIVES: To determine whether the objectives entrusted to the Scientific Committee (SC) of the 28th National Conference have been met, and to determine whether the results differed from those of previous conferences. METHODS: A chronological description of the work of the SC and a comparison with the results of the previous two Conferences of the Spanish Society for Quality in health care (SSQHC). RESULTS: A total of 869 papers were submitted, of which 32.6% corresponded to the area of patient safety. Galicia was the community that presented more communications (28%), followed by Catalonia (12.9%) and Murcia (10.9%). CONCLUSIONS: The methodology used by the SC helped in the compliance with the deadlines in the SSQHC Conference manual and contributed to achieve its objectives. Abstract presentations were classified accordingly to their quality. The Conference has been consolidated as a multidisciplinary meeting with participation by doctors, nurses, managers and open to the Latin-American community.

Evaluación de la efectividad de un programa de lucha contra el tabaquismo en un hospital universitario / Assessment of effectiveness of a plan against tobacco in a universitary hospital

Objetivos. Evaluar la efectividad del proyecto titulado «Hospital libre de humo», en cuanto a disminución del número de trabajadores fumadores y aumento del número de espacios libres de humo de tabaco. Métodos. Estudio de intervención poblacional no controlado. En el año 2004 se realizó un estudio basal de la situación, con el fin de conocer la prevalencia de fumadores y el apoyo de los trabajadores a los planteamientos del proyecto Hospital libre de humo. Para ello se pasó el cuestionario validado por la red europea de hospitales libres de humo (ENSH) a una muestra de 483 trabajadores, seleccionados al azar y estratificados por sexo, edad y estamento. En 2007, se repitió el estudio, con la misma metodología, para conocer la evolución del proyecto, en este caso se recogió una muestra de 425 trabajadores. Resultados. La prevalencia de trabajadores fumadores había pasado del 35,2 al 27,4% (p < 0,05). Esta reducción se había manifestado en prácticamente todos los estamentos, pero era poco acusada en el personal de enfermería. En el año 2007 se había conseguido que prácticamente sólo se fumase en los sitios para fumadores (p < 0,0001). El proyecto era apoyado por fumadores y no fumadores. Conclusiones. El proyecto «Hospital libre de humo» ha conseguido los objetivos propuestos. Las acciones favorecedoras de que se cumpla la ley y se respete que en los espacios de un hospital no se debe fumar, junto con un apoyo decidido a ayudar a los trabajadores que quieren dejar de fumar se manifiestan como efectivas(AU)

Aims. Assessment of effectiveness of a plan entitled «Smoke-free hospitals», specifically the reduction in the number of smoking staff and an increase in smoke-free areas. Method. Interventional, non-controlled, populational study. A baseline study was conducted in 2004 to find out the situation as regards the prevalence of smokers in our hospital and the support of health workers for the smoke-free hospital plan. We used the questionnaire validated for the European smoke free hospital network in a sample of 483 workers randomly selected and stratified by gender, age and establishment. In 2007 we repeated the study with the same methodology to ascertain the progress of the project, in this case a sample of 425 workers was collected. Results. The number of smoking workers had decreased from 35.2% to 27.4 (P<.05). This reduction was seen in virtually all sectors, but was less so in nursing staff. In 2007 we had achieved that people only smoke in smoking areas (P<.0001). The plan was supported by smokers and non-smokers. Conclusions. The «Smoke-free hospital» plan has achieved the objectives proposed. The actions carried out helped to enforce the law and respect that hospital areas should not be for smoking, together with strong support to help workers who want to quit smoking are shown to be effective(AU)

[Assessment of effectiveness of a plan against tobacco in a universitary hospital]. / Evaluación de la efectividad de un programa de lucha contra el tabaquismo en un hospital universitario.

AIMS: Assessment of effectiveness of a plan entitled «Smoke-free hospitals¼, specifically the reduction in the number of smoking staff and an increase in smoke-free areas. METHOD: Interventional, non-controlled, populational study. A baseline study was conducted in 2004 to find out the situation as regards the prevalence of smokers in our hospital and the support of health workers for the smoke-free hospital plan. We used the questionnaire validated for the European smoke free hospital network in a sample of 483 workers randomly selected and stratified by gender, age and establishment. In 2007 we repeated the study with the same methodology to ascertain the progress of the project, in this case a sample of 425 workers was collected. RESULTS: The number of smoking workers had decreased from 35.2% to 27.4 (P<.05). This reduction was seen in virtually all sectors, but was less so in nursing staff. In 2007 we had achieved that people only smoke in smoking areas (P<.0001). The plan was supported by smokers and non-smokers. CONCLUSIONS: The «Smoke-free hospital¼ plan has achieved the objectives proposed. The actions carried out helped to enforce the law and respect that hospital areas should not be for smoking, together with strong support to help workers who want to quit smoking are shown to be effective.

Estándares de calidad de actividades educativas dirigidas a pacientes y familiares en un hospital universitario / Quality standards of educational activities for patients and families in a university hospital

Objetivo. Identificar grupos de pacientes que reciben atención educativa en el hospital, diferenciando actividades puntuales de programas estructurados; así como analizar información sobre estructura, proceso y resultados de los programas. Material y métodos. Estudio transversal mediante lista de verificación, generada por traducción y adaptación de los National Standards for Diabetes Self-Management Education. Se recogió información sobre estructura (recursos, disponibilidad del programa escrito y formación de profesionales), proceso que sigue el paciente (evaluación inicial, metodología, cursos, material de soporte y registro de actividad) y resultados en el paciente (evaluación post-intervención, instrumentos, registro de evaluación y resultados) y del programa (número de pacientes/familiares incluidos, evaluación periódica). Resultados. Los grupos de pacientes tributarios de educación identificados fueron: enfermos crónicos, susceptibles de tratamiento psiquiátrico y enfermos onco-hematológicos. Mayoritariamente consistían en actividades informativas y entrenamiento de habilidades técnicas, a demanda e integradas en la actividad asistencial. Los programas de educación terapéutica estructurados iban dirigidos a pacientes/familiares con: diabetes, obesidad, enfermedades del aparato locomotor, sida, esplenectomizados, enfermedad pulmonar obstructiva crónica, hipertensión e incontinencia urinaria. No todos disponían de programa escrito ni tenían definidos parámetros sobre estructura, proceso y resultados. Conclusiones. La aplicación de estándares de calidad a los programas educativos es útil en la identificación de: pacientes tributarios de educación, calidad y tipo de intervenciones realizadas, así como puntos débiles. El desarrollo de software basado en estos estándares permitiría conocer tendencias de la educación al paciente e identificar oportunidades de mejora, así como la evaluación del impacto de la actividad educativa sobre los indicadores de calidad relacionados con cada programa(AU)

Objective. To identify groups of patients receiving hospital-based educational programs, to determine whether the education was structured or ad hoc, and to analyse information on the structure, process and results of the programs. Material and methods. We performed a cross-sectional study using a translated and adapted version of the National Standards for Diabetes Self-Management Education. Information was collected on structure (resources, availability of a written program and professional training), the process followed by the patient (baseline assessment, methodology, training courses, support materials and record of activities), patient outcomes (post-intervention assessment, tools, record of evaluation and results) and program results (number of patients/relatives included, regular assessment). Results. Patient groups receiving education were: patients with chronic diseases, patients with treatable psychiatric disorders and patients with oncological and haematological processes. Most educational activities involved informative activities and technical skills training, both on-demand and integrated in care activity. Structured therapeutic education programs were aimed at patients/relatives with: diabetes, obesity, musculoskeletal diseases, AIDS, splenectomy, chronic obstructive pulmonary disease, hypertension and urinary incontinence. Not all programs had written guidelines or defined parameters with respect to structure, process and results. Conclusions. The application of quality standards to hospital educational programs is useful in detecting: patients receiving education and the quality, type and weaknesses of the programs studied. Software based on these standards may provide information on trends in patient education, identify opportunities for improvement and aid the evaluation of the impact of each educational activity on the quality indicators associated with each program(AU)

[Quality standards of educational activities for patients and families in a university hospital]. / Estándares de calidad de actividades educativas dirigidas a pacientes y familiares en un hospital universitario.

OBJECTIVE: To identify groups of patients receiving hospital-based educational programs, to determine whether the education was structured or ad hoc, and to analyse information on the structure, process and results of the programs. MATERIAL AND METHODS: We performed a cross-sectional study using a translated and adapted version of the National Standards for Diabetes Self-Management Education. Information was collected on structure (resources, availability of a written program and professional training), the process followed by the patient (baseline assessment, methodology, training courses, support materials and record of activities), patient outcomes (post-intervention assessment, tools, record of evaluation and results) and program results (number of patients/relatives included, regular assessment). RESULTS: Patient groups receiving education were: patients with chronic diseases, patients with treatable psychiatric disorders and patients with oncological and haematological processes. Most educational activities involved informative activities and technical skills training, both on-demand and integrated in care activity. Structured therapeutic education programs were aimed at patients/relatives with: diabetes, obesity, musculoskeletal diseases, AIDS, splenectomy, chronic obstructive pulmonary disease, hypertension and urinary incontinence. Not all programs had written guidelines or defined parameters with respect to structure, process and results. CONCLUSIONS: The application of quality standards to hospital educational programs is useful in detecting: patients receiving education and the quality, type and weaknesses of the programs studied. Software based on these standards may provide information on trends in patient education, identify opportunities for improvement and aid the evaluation of the impact of each educational activity on the quality indicators associated with each program.

Desarrollo y aportaciones del Comité Científico del XXV Congreso de la Sociedad Española de Calidad Asistencial en Barcelona, 2007 / Development and opportunities from de scientific committee of 25 SECA congress held in Barcelona, 2007

Objetivo: Realizar la autoevaluación de la labor del Comité Científico (CC) del XXV Congreso de la Sociedad Española de Calidad Asistencial (SECA), celebrado en Barcelona en octubre de 2007 para aportar líneas de mejora en el desarrollo de la actividad más importante del SECA: el congreso anual. Material y métodos: Diseño: aplicar la metodología de evaluación PDCA (plan, do, check, act ‘planificar, hacer, verificar, actuar’) a las tareas desarrolladas por el CC del XXV Congreso. Plan: descripción de la preparación del congreso según el procedimiento de gestión de comunicaciones del CC del manual de congresos de la SECA. Do: descripción de la implementación de éste. Check: proceso de evaluación de las actividades realizadas. Act: propuestas de mejora para los siguientes congresos. Resultados: El CC (22 personas) desarrolló las labores de gestión de comunicaciones, la edición del libro y la gestión de las actividades científicas en el congreso. La gestión de comunicaciones se organizó en 11 parejas de revisores que evaluaron de forma ciega las comunicaciones recibidas: 348 orales y 457 pósteres, de las que se rechazó el 10,09%. Las comunicaciones se presentaron en 36 mesas orales y 24 sesiones de pósteres. El libro se ha editado con los resúmenes de comunicaciones, las ponencias de las mesas y las conferencias inaugural y de clausura. Premios: las comunicaciones con puntuación por encima de 7,5 optaron a premio y se evaluaron in situ por parte del CC. El congreso en línea también tuvo buena acogida. Conclusiones: La satisfacción de los congresistas con la parte científica del congreso fue buena y se han identificado áreas de mejora (AU)

Objective: To perform a self-assessment of the Scientific Committee of the 25th Conference of the Spanish Society for Quality in Healthcare held in Barcelona on October 2007 in order to identify improvement areas for future Conferences. Material and methods: Design: Applying PDCA methodology to the tasks undertaken by the Scientific Committee (SC) of the Conference. Plan: A description of the preparation of the conference based on the abstract management of the Scientific Committee. Do: description of the implementation. Check: evaluation of activities. A: improvement proposals for the coming conferences. Results: The SC (22 people) worked in the abstracts management, book publishing and development of the scientific aspects of the Conference. Abstracts evaluation was conducted by 11 pairs of blind evaluators who analysed 348 oral communications and 457 posters, and 10.09% were rejected. Oral communications were performed in a total of 36 oral presentations sessions and 24 poster sessions. The book was published with the abstracts, addresses and the Conference opening and closing sessions. Awards: communications graded over 7.5 applied for an award and were reassessed by the SC. The on-line conference was also well received. Conclusions The satisfaction with the Conference regarding the scientific activities was good; however, several areas of improvement were identified (AU)