Andalusian Public Health System Research Articles

Improving healthcare at home for complex chronic patients (CCPs) in Andalusia (JADECARE pilot)

Introduction: A Complex Chronic Disease is a condition involving multiple morbidities that requires the attention of multiple health care providers and, therefore, a holistic approach. 
 The Andalusian Public Health System is responsible for the provision of healthcare and public health services to the Andalusian population (8.5 million inhabitants), where around 200000 complex chronic patients (CCPs), with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) have been identified and prioritized. Healthcare at home for CCPs is considered a key element that facilitates patient follow-up, can avoid emergency episodes, promoting patient empowerment.
 The Andalusian participation in the EU Joint Action JADECARE “joint action on implementation of digitally enabled integrated person-centered care” (GA 951442) focuses on improving healthcare at home for CCPs with CHF and COPD. The development, implementation and testing of a Centralised System for Proactive Follow-up (SCSP) of chronic patients is being monitored, as well as the tele-referral service which is being expanded. The SCSP is supported by National funds as well (Servicio para la implantación de una solución corporativa para el seguimiento proactivode pacientes crónicos en el sistema sanitario público de Andalucía (Expdte. 039/21-SP.).
 The aim of the JADECARE Andalusian pilot is to improve health status and quality of life of CCPs by enhancing home healthcare proactive follow-up and its evaluation.
 Method: The development, implementation and testing of the Centralised System for Proactive Follow-up of chronic patients within Andalusian Public Health System includes several steps, from tendering, SCSP design and development, to training and assessment.
 The SCSP will allow to gather information from home healthcare of CCPs integrated in the corporate IT system and EHR (Diraya). The platform will be a key element for healthcare professionals in the proactive and remote monitoring of chronic patients, allowing early identification of warning signs/signals, adaptation of prescriptions, anticipation of health problems, providing support to caregivers and avoiding unplanned inpatient episodes. This SCSP will be monitored as well as the tele-referral system for CCPs.
 
 Results, Conclusions and Lessons learned: Results of this pilot will be presented during the conference. Process, outcomes, patients’ satisfaction and technology acceptance model indicators will be measured.
 The SCSP is expected to facilitate patients’ follow-up, improving continuity of care by healthcare professionals and patients’ quality of life.
 Discussions: The Andalusian JADECARE pilot is aligned with the Andalusian Comprehensive Healthcare Plan for Patients with Chronic Diseases and the Andalusian Comprehensive Care Plan, and takes into account the experience of the “Digital roadmap towards an integrated health care sector”, from the Region of Southern Denmark.
 An integrated healthcare system linked to a solid corporate IT system allow the development of a Centralised System for Proactive Follow-up of chronic patients that leads to an improvement of patient care and quality of life while public healthcare resources are optimized.
 Limitations: Health outcomes assessment in the timeframe of the project.
 Suggestions for future research: Home healthcare monitoring assessment.

Trans people perceptions of care received from healthcare professionals — A phenomenological study

IntroductionTrans people have unique health needs and turn to the public health system to meet them. Offering them a more inclusive assistance requires health professionals to know these needs and work on cultural competence. Understanding trans people perceptions of service received will improve therapeutic relationships and the assistance provided to them. ObjectiveTo understand trans patients experiences with health care and their perception of care rendered by the Andalusian Public Health System. DesignA qualitative phenomenological study according to Ricoeur's hermeneutic approach. Methodology18 in-depth interviews were conducted between January and April 2022 with trans adult users of the Andalusian Public Health System. These interviews were audio recorded, transcribed and analyzed following the steps proposed by Tan. The Consolidated Criteria for Reporting Qualitative Research was used for writing the study report. ResultsThree themes were generated from trans patients experiences in the Andalusian Public Health System related to the assistance provided to them: 1) Positive and negative feelings during their pass through the public health system, 2) The importance of being able to receive the care they need, and 3) Having the chosen identity in official documents in order to utterly complete their transition. ConclusionCare rendered by healthcare professionals to trans people was received as positive in mostly cases. However, trans people think these professionals need more training in order to avoid some behaviors they perceive as discriminatory and which they believe tends to pathologize gender identity. They also require more information about the treatments in particular they are about to receive and they demand to end drug shortages. Administrative procedures to change identity are also problematic. So the healthcare system must undergo some modifications in order to become more inclusive.

Efectividad de una aplicación de telerrehabilitación para tableta en pacientes con fractura de extremo distal del radio

IntroductionTo assess whether, in patients with distal radius fracture feedback-guided exercises performed on a tablet touchscreen reduce healthcare usage and improve clinical recovery, more than the conventional home exercise program prescribed on paper. Material and methodsA multicentre, parallel, two-group, pragmatic, controlled trial with assessor blinding and intention-to-treat analysis. Forty-six patients with distal radius fracture were recruited in Andalusian Public Health System. Participants in the experimental and control groups received the same in-patient physiotherapy sessions. Experimental group received a home exercise program using the ReHand tablet application and control group received an evidence-based home exercise program on paper. The primary outcome was the number of physiotherapy sessions tallied from hospitals data management system. Secondary outcomes included: the face-to-face rehabilitation consultations with a physiatrist, and clinical outcomes such as functional ability, grip strength, dexterity, pain intensity and range of motion. ResultsThe experimental group required fewer physiotherapy sessions (MD: −16.94; 95%CI: −32.5 to −1.38) and rehabilitation consultations (MD: −1.7; 95%CI: −3.39 to −0.02) compared to the control group. ConclusionsIn patients with distal radius fracture, prescribing feedback-guided exercises performed on a tablet touchscreen provided by ReHand reduced number of physiotherapy sessions and rehabilitation consultations.

The paradoxical position of nurses regarding euthanasia and its legalisation: A descriptive quantitative study.

To learn about the attitudes of nurses working in the Andalusian Public Health System regarding euthanasia and its legalisation. Euthanasia often finds itself in the crosshairs of ethical and political debate on an international scale. Currently, the Spanish Organic Law 3/2021 of 24 March, 2021, recognises euthanasia as a fundamental right in Spain. It is of particular interest to know about the views, attitudes and stances that Andalusian nurses have of euthanasia as they are key players within the framework of euthanasia and administration of life-ending drugs. They play a central role in guiding patients through the euthanasia application process. Observational descriptive study. A study of Andalusian Public Health System nurses was carried out using non-probability convenience sampling. 518 nurses with an average age of 44.75 years answered in a questionnaire that was distributed on an online platform. Socio-demographic and occupational variables were assessed, together with the Death Anxiety Scale and the Euthanasia Attitude Scale. A bivariate analysis and a multivariate linear regression model were performed. The STROBE checklist was used. The mean score obtained on the Euthanasia Attitude Scale was 75.95 (SD = 16.53). The mean score obtained on the Death Anxiety Scale was 7.56 (SD = 3.05). The variables age and work experience were negatively correlated with the total scores of the Euthanasia Attitude Scale and the categories 'Ethical considerations', 'Practical considerations' and 'Treasuring life'. On the other hand, there was a significant positive correlation between age and work experience and 'Spiritual beliefs' category. The current situation shows a worrying paradox. There is a stark difference between positive professional attitudes towards euthanasia and the desire to participate in its application. It is vital that educational and healthcare institutions make the necessary efforts to ensure that nurses develop sound moral judgement, displaying the moral conscience and ethical commitment required of this established profession. No patient or public contribution.

A prospective observational concordance study to evaluate computational model-driven clinical practice guidelines for Type 2 diabetes mellitus

Background: Clinical Practice Guidelines (CPGs) provide healthcare professionals with performance and decision-making support during the treatment of patients. Sometimes, however, they are poorly implemented. The IDE4ICDS platform was developed and validated with CPGs for type 2 diabetes mellitus (T2DM). Objective: The main objective of this paper is to present the results of the clinical validation of the IDE4ICDS platform in a real clinical environment at two health clinics in the Andalusian Public Health System (SSPA) in the southern Spanish region of Andalusia. Methods: National and international knowledge sources on T2DM were selected and reviewed and used to define a diabetes CPG model on the IDE4ICDS platform. Once the diabetes CPG was configured and deployed, it was validated. A total of 506 patients were identified as meeting the inclusion criteria, of whom 130 could be recruited and 89 attended the appointment. Results: A concordance analysis was performed with the kappa value. Overall agreement between the recommendations provided by the system and those recorded in each patient's EHR was good (0.61 - 0.80) with a total kappa index of 0.701, leading to the conclusion that the system provided appropriate recommendations for each patient and was therefore well-functioning. Conclusions: A series of possible improvements were identified based on the limitations for the recovery of variables related to the quality of these recolected variables, the detection of duplicate recommendations based on different input variables for the same patient, and clinical usability, such as the capacity to generate reports based on the recommendations generated. Nevertheless, the project resulted in the IDE4ICDS platform: a Clinical Decision Support System (CDSS) capable of providing appropriate recommendations for improving the management and quality of patient care and optimizing health outcomes. The result of this validation is a safe and effective pathway for developing and adopting digital transformation at the regional scale of the use of biomedical knowledge in real healthcare.

Leadership in a hospital of the Andalusian Public Health System

ObjectiveTo analyse, from a gender perspective, the characteristics and perception of the effects of leadership of nurses in a hospital of the Andalusian Public Health System. MethodologyQualitative study with a phenomenological approach. The participants were nurses in care and intermediate positions with a contract of more than 6 months. A qualitative content analysis was carried out. Four phases were established for data analysis, from which 5 categories resulted. NVivo 11 software was used to analyse the dialogues. ResultsThe participants’ discourses endow the leader with characteristics that define him as a reference person. The contribution of middle management is necessary for the achievement of the objectives of the care units and the cohesion of the group, although this group perceives it only in relation to the management of resources. Access to management positions is not linked to gender. ConclusionsThe participants’ discourses endow the leader with characteristics that define him as a reference person. The contribution of middle management is necessary for the achievement of the objectives of the care units and the cohesion of the group, although this group perceives it only in relation to the management of resources. Access to management positions is not linked to gender.

Percutaneous radiofrequency ablation is an effective treatment option for small renal masses, comparable to partial nephrectomy.

The standard therapy for small renal masses (SRMs) remains partial nephrectomy (PN), which is associated with relatively high morbidity and complication rate. Therefore, percutaneous radiofrequency ablation (PRFA) emerges as an alternative therapy. This study aimed to compare the efficacy, safety, and oncological outcomes of PRFA versus PN. A multicenter non-inferiority study with retrospective analysis of 291 patients with SRMs (N0M0), who underwent PN or PRFA (2:1), recruited prospectively from two hospitals in the Andalusian Public Health System, Spain, between 2014 and 2021. Comparisons of treatment features were evaluated using the t test, Wilcoxon-Mann-Whitney U test, chi-square test, Fisher test, and Cochran-Armitage trend test. Kaplan-Meier curves depicted overall survival (OS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS) rates in the overall study population. A total of 291 consecutive patients were identified; 111 and 180 patients underwent PRFA and PN, respectively. Median follow-up time was 38 and 48months, and mean hospitalization days were 1.04 and 3.57days, respectively. The variables underpinned with high surgical risk were significantly increased in PRFA compared to those in PN (mean age was 64.56 and 57.47years, the solitary kidney presence was 12.6% and 5.6%, ASA score ≥ 3 was 36% and 14.5%, respectively). The rest of oncological outcomes were comparable amongst PRFA and PN. Patients undergoing PRFA did not improve OS, LRFS, and MFS compared to those undergoing PN. Limitations comprise retrospective design and limited statistical power. PRFA for SMRs in high-risk patients is non-inferior in terms of oncological outcomes and safety compared to PN. Our study has a direct clinical application as it proves that radiofrequency ablation is an effective and uncomplicated therapeutic option for patients with small renal masses. •There are non-inferiority results in overall survival, local recurrence-free survival, and metastasis-free survival between PRFA and PN. •Our two-center study showed that PRFA is non-inferior to PN in oncological outcomes. •Contrast-enhanced power ultrasound-guided PRFA provides an effective therapy for T1 renal tumors.

Effectiveness of a telerehabilitation tablet app in combination with face-to-face physiotherapy for people with wrist, hand or finger injuries: A pragmatic multicentre clinical trial.

To evaluate whether, in patients with trauma and soft tissue injuries of the wrist, hand and/or fingers, an exercise program performed on a touchscreen tablet-based app reduces the consumption of face-to-face resources and improves clinical recovery, compared to a conventional home exercise program prescribed on paper. Pragmatic, multicentre, parallel, two-group, controlled clinical trial with blinded assessor. Eighty-one patients with traumatic bone and/or soft tissue injuries of the hand, wrist and/or fingers recruited in four hospitals of the Andalusian Public Health System. The experimental group received a home exercise program using a touchscreen tablet application and the control group received a home exercise program on paper. Both groups received the same treatment of face-to-face physiotherapy. Number of physiotherapy sessions. Secondary outcomes were the duration of physiotherapy and clinical variables such as functional ability, grip strength, pain and manual dexterity. The experimental group required fewer physiotherapy sessions (MD -11,5 sessions; 95% CI -21.4 to -1.4), showed a shorter duration of physiotherapy (MD -3.8 weeks, 95% CI -7 to -1) and had better recovery of grip strength, pain and dexterity compared to the control group. In patients with trauma and soft tissue injuries of the wrist, hand and/or fingers, an exercise program performed on a touchscreen tablet-based app in combination with face-to-face physiotherapy reduces the consumption of face-to-face resources and improves clinical recovery, compared to conventional home exercise program prescribed on paper.

Electronic consultation (e-consultation) between primary care and the neurology department: One-year experience in a healthcare area in Andalusia, Spain

IntroductionThe COVID-19 pandemic has prompted the implementation of telemedicine programmes to facilitate healthcare. In November 2020 we initiated an e-consultation programme between primary care and the neurology department, with asynchronous response, through a platform integrated into the corporate computer system of the Andalusian Public Health System. We present the results of the first year of operation. MethodsWe present a descriptive study of the e-consultations received in 2021 from a health area of approximately 300,000 inhabitants aged ≥14 years. The reasons for consultation were pre-established: “primary headache” (PH), “new-onset cognitive impairment” (CI), “complications of dementia” (DEM), and “epilepsy” (EPI). We defined inclusion criteria and the clinical information/tests that had to be provided. General practitioners could choose between e-consultation or face-to-face referral. ResultsA total of 1,806 e-consultations were received (approximately 6/1,000 population/year). By reasons for consultation: CI 34.3%, PH 32%, DEM 14.4%, EPI 11.7%, unspecified 7.6%. Responses were sent after an average of 2.25 days and were classified as: “refer for in-person consultation” (47.12%), “resolved” (39.98%), “criteria not met” (12.57%), or “follow-up by e-consultation” (0.33%). As expected, a high proportion of face-to-face referrals were required for CI (73.46%); the main value of the system for these patients was to prioritise appointments and select the most appropriate form of care. For the rest of the reasons for consultation, the proportion of “resolved” e-consultations reached 52.61%. ConclusionsAsynchronous e-consultation between primary care and the neurology department is a useful tool in the indicated conditions, offering a rapid, “one-stop” response to a significant proportion of clinical or therapeutic uncertainties, as well as optimising face-to-face appointments.

Study of the Psychometric Properties of the Spanish Version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA).

The early detection of moral distress requires a validated and reliable instrument. The aim of this study was to carry out an advanced analysis of the psychometric properties of the moral distress scale for health professionals (MMD-HP-SPA) by performing a validation of the construct and its internal and external reliability. We performed a multicentre cross-sectional study in health professionals belonging to the Andalusian public health system. Construct validity was performed by exploratory (n = 300) and confirmatory (n = 275) factor analysis (EFA/CFA) in different subgroups; we also analysed the internal consistency and temporal reliability of the scale. 384 doctors and 191 nurses took part in the survey. The overall mean for moral distress was 128.5 (SD = 70.9), 95% CI [122.7-134.3], and it was higher in nurses at 140.5 (SD = 74.9) than in doctors at 122.5 (SD = 68.1), F = 8.37 p < 0.01. The EFA produced a model of five components which accounted for 54.8% of the variance of the model. The CFA achieved a goodness of fit of Chi2 = 972.4; AIC = 1144.3; RMSEA = 0.086; CFI = 0.844; TLI = 0.828; NFI = 0.785. The MMD-HP-SPA scale has solid construct validity, excellent internal consistency, optimal temporal reliability, and underlying dimensions which effectively explore the causes of moral distress in health professionals, thus guaranteeing its use in hospital and community settings.

Design and implementation of an online tool for managing the availability of high-cost perishable medicines.

IntroductionDue to their impact on healthcare systems, the sustainability and optimization of high-cost drugs is an issue of concern for several countries. Different strategies have been implemented such as centralized purchasing to optimize budgetary resources. However, there is still a need for a mechanism to optimize these drugs further.MethodsWe conducted this prospective multicenter intervention study in five hospitals in the Andalusian Public Health System of Cádiz (Spain) between July 2019 and September 2021. We developed an online website (Farmastock) and implemented it to determine the availability of high-cost, low-use, and near-expiry medicines in each hospital. We used a simple analysis using operational variables to assess the project intervention's savings impact on managing these high-cost drugs.ResultsThe implementation of Farmastock in Cádiz resulted in savings of 675,757.52 € for the Andalusian Public Health System, with 238 medicines transferred out of the 373 available. Of these medicines offered, the most considerable percentage were medicines used for pathologies with high clinical instability and accounted for nearly 80% of the medicines optimized by the tool.ConclusionsFarmastock allowed the Andalusian Public Health System to make substantial financial savings by not making new purchases of high-cost drugs available in other centers of this health network that were not being used. Therefore, this tool is a very efficient measure to contribute to the sustainability of the APHS and could be implemented in more hospitals soon.

Consumption of Psychiatric Drugs in Primary Care during the COVID-19 Pandemic.

Background: The main objective of this research was to analyze whether there were changes in the use of antidepressants, anxiolytics, and hypnotic-sedative drugs, in the context of primary health care, during the COVID-19 pandemic compared to the pre-pandemic period. We further sought to study consumption in vulnerable population groups. Methods: A cross-sectional observational study was performed in a primary health district of Spain. The data were obtained from the Andalusian Public Health System database, for the pre-COVID-19 period, from March 2019 to February 2020, and for the COVID-19 period, from March 2020 to February 2021. Univariant and bivariant analyses were performed. The effect size was measured using the Rosenthal test. Results: While the total number of medical prescriptions decreased by 2.5% in the COVID-19 period, the prescriptions of psychiatric drugs increased by 6.1%. The increase in the dose consumption per 1000 inhabitants (DHD) was highest for anxiolytics (7.2%), followed by hypnotic-sedatives (5.6%) and antidepressants (3.7%). The consumption of antidepressants, anxiolytics, and sedative-hypnotic drugs was higher in women, older people, and rural areas and lower in areas with social transformation needs, with these differences being statistically significant. Conclusions: The consumption of psychiatric drugs has increased over the COVID-19 pandemic, especially in women, older people, and rural areas. Thus, we should reflect on the adequate use of these drugs.

Factors associated with prolonged episodes of mechanical restraint in mental health hospitalization units in Andalusia.

WHAT IS KNOWN ON THE SUBJECT?: Risk factors associated with prolonged episodes of mechanical restraint and other coercive measures are understudied. There have been no studies of this phenomenon in the context of the Andalusian public health system. Knowledge about factors associated with prolonged episodes is essential to increase the understanding of this phenomenon and develop strategies to reduce its occurrence. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: In Andalusia, prolonged restraint is still frequent and varies depending on the unit. It is associated with less time since admission, male gender, diagnosis, reason for restraint and the shift on which it was initiated. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Interventions at the level of the units could be necessary to prevent prolonged episodes of mechanical restraint. The results suggest the need for stricter control during the shifts on which restraint starts, especially in the first days after the patient's admission. Preventive risk assessment considering clinical and sociodemographic risk factors could help to reduce prolonged restraint. ABSTRACT: Introduction Factors associated with prolonged episodes of mechanical restraint and other coercive interventions are not clearly established and have been not studied in Andalusia (Spain). Aim To study factors associated with prolonged episodes of mechanical restraint. Method We analysed retrospectively episodes of mechanical restraint (N=6267, prolonged episode >9.5hours) in all public mental health hospitalization units (N=20, 535 beds) that offer health coverage for the autonomous community of Andalusia. The data came from clinical records. A multivariable mixed logistic regression was used. Results In Andalusia, prolonged restraint is still frequent and varies depending on the unit. It is associated with less time since admission, male gender, diagnosis, reason for restraint and the shift on which it was initiated. Discussion The results provide evidence that prolonged episodes largely depend on the unit where they occur and that stricter control and regulation are necessary to prevent prolonged episodes. Implications for practice Interventions at the level of the unit are necessary. Stricter control in the shifts during which there is more risk of prolonged restraint may be necessary, especially in the first days following admission.

P–726 Analysis of the results of conjugal artificial insemination in a third-level public health hospital

Abstract Study question Our objective was to compare the results and costs between conjugal intrauterine insemination (IAC) and in vitro fertilization (IVF) in a third-level public health hospital. Summary answer The direct estimated cost for achieving a clinical pregnancy was € 3808.24 for IAC and € 14,195.88 for IVF. What is known already There is a belief among patients, professionals, and media in favor of the results offered by IVF. Studies on the results, risks, complications and costs are difficult to understand, thus making IVF the most widespread and in demand reproduction technique among fertility clinics. In 2013 the National Institute of Health and Care Excellence conducted a study comparing artificial insemination using 25 mg of clomiphene citrate vs. expectant management of sterility, without finding significant differences. After this, in their guide they recommended the elimination of insemination from the couples’ treatment protocols, proposing to replace it with three cycles of IVF. Study design, size, duration This is a retrospective observational study of a total of 1384 conjugal insemination cycles carried out in our center between 2007–2019 and 646 cycles of in vitro fertilization, intracytoplasmic injection (ICSI) or mixed. Participants/materials, setting, methods All IAC were included. IVF cycles analyzed were those made under the diagnose of tubal factor, to homogenize the samples. The calculation of the direct costs of each technique has been carried out by the collection of the costs of these procedures from the registry of public costs of the Andalusian public health system. The pharmacy spending in an average cycle has been obtained from the public prices of prescriptions made in our service. Main results and the role of chance The direct estimated cost for achieving a clinical pregnancy with the cumulative clinical pregnancy rate found in our sample was € 3808.24 for IAC and € 14,195.88 for IVF. The additional cost of a pregnancy achieved by IVF compared to one achieved by IAC was € 10,387.64. The mean age of the patients was higher in the group undergoing in vitro fertilization treatment (34.41 years) compared to those undergoing artificial insemination treatment (32.18 years), the differences between both being statistically significant ( p &amp;lt; 0.005). We also found statistically significant differences between the clinical pregnancy rate (12.2% in the group that underwent an AI and the 25.8% in which an IVF was performed) and the live newborn rate between both groups (8.7% in the group that underwent AI and 16% in which IVF was performed), both being higher for the group subjected to in vitro fertilization. In the twin pregnancy rate, we also found significant differences (p 0.005) between both groups, being 6.8% in the patients undergoing IVF compared to 0.8% in the inseminations. Limitations, reasons for caution Regarding the costs per cycle, indirect costs of these have not been taken into account, such as values in the cost of pregnancy and delivery of single or multiple pregnancies, or costs of complications derived from the techniques (ovarian hyperstimulation syndrome, fetal reductions, terminations for other reasons, etc.) Wider implications of the findings: The recommendations made by the NICE promote IVF treatment to couples with infertility of unknown origin. In our opinion, this recommendation should be subjected to a more extensive cost-effectiveness analysis of both techniques, given that IVF requires a considerably higher investment of resources, finding results not so different as expected. Trial registration number Not applicable

The Andalusian Registry of Donors for Biomedical Research: Five Years of History.

The mission of the Andalusian Public Health System Biobank is to offer the best options for biological samples of human origin and associated clinical information, protecting the rights of citizens who donate their samples for research. Since the Andalusian Biobank provides high-quality biological samples of all types in a specified format, adapting the preanalytical phase according to the requirements of the research, prospective collection and distribution of samples are being prioritized in order to contribute to the sustainability of the Biobank. The Andalusian Registry of Donors for Biomedical Research is a tool for the recruitment of donors and the prospective collection of samples. Its operation is based on the informed consent of donors for their incorporation into the Registry and contact with possible donors under request from specific projects. An additional advantage of this unique initiative is to ensure that societal actors work together throughout the entire research process, establishing alliances with patient associations and groups to develop joint actions and promote biomedical research. Here, we describe the creation, ethical–legal aspects, management and results of the Andalusian Registry of Donors for Biomedical Research after five years of operation.

Understanding the concept of compassion from the perspectives of nurses.

The high level of satisfaction of users of a health service is largely due to the fact that they receive excellent care from healthcare professionals. Compassionate care is an essential component of excellent care. But what do nurses understand compassion to be? To analyse the concept of compassion from the perspective of nurses in the Andalusian Public Health System, Spain. This is a qualitative study following the grounded theory model. Four focus groups and 25 in-depth interviews were conducted. A total of 68 nursing professionals working in the Andalusian Public Health System (Spain) participated. Theoretical sampling was used, with participants being recruited using the snowball technique. This research was approved by the Research Ethics Committee of the Centro-Almería Health District (CEICA 27/9/17). From the analysis of the data, four themes emerged that helped to understand the concept of compassion according to nurses: 'Negative perception of the term compassion', 'Compassion and empathy as synonyms', 'Beyond empathy', and 'Effects of having a compassionate attitude'. Nurses perceive the concept of compassion differently to each other and even contradictorily. This concept is imbued with cultural elements, which adds confusion to understanding it, and is even perceived as something negative similar to pity. Nurses confuse the concepts of empathy and compassion as if they were synonymous. Before considering training in compassion for healthcare professionals, it is essential to clarify the concept of compassion through educational interventions.

Emotions, Feelings, and Experiences of Social Workers While Attending to Vulnerable Groups: A Qualitative Approach.

Social workers in the community setting are in constant contact with the suffering experienced by the most vulnerable individual. Social interventions are complex and affect social workers’ emotional well-being. The aim of this study was to identify the emotions, feelings, and experiences social workers have while attending to individuals in situations of vulnerability and hardship. A qualitative methodology based on hermeneutic phenomenology was used. Six interviews and two focus group sessions were conducted with social workers from the community social services and health services of the Andalusian Public Health System in the province of Almería (Spain). Atlas.ti 8.0 software was used for discourse analysis. The professionals highlighted the vulnerability of certain groups, such as the elderly and minors, people with serious mental problems, and people with scarce or no economic resources. Daily contact with situations of suffering generates a variety of feelings and emotions (anger, sadness, fear, concern). Therefore, more attention should be paid to working with the emotions of social workers who are exposed to tense and threatening situations. Peer support, talking, and discussions of experiences are pointed out as relevant by all social workers. Receiving training and support (in formal settings) in order to learn how to deal with vulnerable groups could be positive for their work and their professional and personal quality of life.

Pluripotent stem cell regulation in Spain and the Spanish National Stem Cell Bank.

The Spanish National Stem Cell Bank (Banco Nacional de Líneas Celulares, BNLC) was established in 2006 thanks to a change in the legislative framework in Spain. The Law 14/2006 updated the previous Assisted Reproduction Techniques Law (Law 45/2003) allowing the use of the surplus frozen embryos following IVF for research. The BNLC has a network structure with 3 nodes: the Regenerative Medicine Program (IDIBELL), the Principe Felipe Research Center (CIPF) in Valencia and the Andalusian Public Health System Biobank (SSPA Biobank) in Granada. The aim of the BNLC is to guarantee throughout the national territory the availability of human stem cell lines for biomedical research. At present time, there are 40 human embryonic stem cell lines (hESC) and 171 human induced pluripotent stem cell lines (hiPSC) registered in the BNLC. These lines are fully characterized and available in the context of research projects approved by the Technical Committee of the BNLC.

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.

The Age at Which a Woman Becomes a Mother and Her Satisfaction with the Process of Pregnancy, Childbirth and the Puerperium.

This study assessed the effect of maternal age on satisfaction at each stage of pregnancy, childbirth and puerperium, and globally. An observational study was carried out in five hospitals of the Andalusian public health system with older primiparous women, from May 2016 to May 2018. Using a pre-piloted questionnaire, information was collected on pregnancy, childbirth, puerperium, newborn variables and degree of satisfaction with the care received. Crude and adjusted mean differences and the standard error of the mean were calculated. A total of 373 women participated. In total, 43.0% of the sample were very satisfied with the care received during pregnancy, and 74.2% with the care received during childbirth. During the puerperium, the highest percentage (60.4%) was found among the women who reported being quite satisfied, although the results were not significant in any of these stages (p > 0.05). No significant differences were established between women’s different age strata and maternal satisfaction. However, the average given by women regarding their satisfaction with the process, on a scale from 0 to 4, was: 3.5 ± 0.5 in general, 3.2 ± 0.8 regarding pregnancy, 3.7 ± 0.5 in childbirth and 3.1 ± 0.6 in the postpartum period. The woman’s satisfaction with the follow up and health care received during pregnancy, childbirth and puerperium is independent of the mother’s age.