1
|
Cano-Valderrama O, Cerdán-Santacruz C, Fernández Veiga P, Fernández-Miguel T, Viejo E, García-Granero Á, Calderón T, Reyes ML. National observational study about the surgical treatment of anal fistula: Does the kind of hospital modify the results? Cir Esp 2024; 102:150-156. [PMID: 38224771 DOI: 10.1016/j.cireng.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/19/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Performing the surgical procedure in a high-volume center has been seen to be important for some surgical procedures. However, this issue has not been studied for patients with an anal fistula (AF). MATERIAL AND METHODS A retrospective multicentric study was performed including the patients who underwent AF surgery in 2019 in 56 Spanish hospitals. A univariate and multivariate analysis was performed to analyse the relationship between hospital volume and AF cure and fecal incontinence (FI). RESULTS 1809 patients were include. Surgery was performed in a low, middle, and high-volume hospitals in 127 (7.0%), 571 (31.6%) y 1111 (61.4%) patients respectively. After a mean follow-up of 18.9 months 72.3% (1303) patients were cured and 132 (7.6%) developed FI. The percentage of patients cured was 74.8%, 75.8% and 70.3% (p = 0.045) for low, middle, and high-volume hospitals. Regarding FI, no statistically significant differences were observed depending on the hospital volume (4.8%, 8.0% and 7.7% respectively, p = 0.473). Multivariate analysis didńt observe a relationship between AF cure and FI. CONCLUSION Cure and FI in patients who underwent AF surgery were independent from hospital volume.
Collapse
Affiliation(s)
- Oscar Cano-Valderrama
- Departmento de Cirugía, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain
| | | | - Pilar Fernández Veiga
- Departmento de Cirugía, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigaciones Sanitarias Galicia Sur, Vigo, Spain.
| | | | - Elena Viejo
- Departamento de Cirugía, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Teresa Calderón
- Departamento de Cirugía, Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain
| | - María L Reyes
- Departamento de Cirugía, Hospital Virgen del Rocío, Sevilla, Spain
| |
Collapse
|
2
|
López-Cano M, Hernández-Granados P, Morales-Conde S, Ríos A, Pereira-Rodríguez JA. Abdominal wall surgery units accreditation. The Spanish model. Cir Esp 2024:S2173-5077(24)00036-X. [PMID: 38296193 DOI: 10.1016/j.cireng.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 02/10/2024]
Abstract
The Spanish Association of Surgeons (AEC) deems it essential to define and regulate the acquisition of high-specialization competencies within General Surgery and Gastrointestinal Surgery and proposes the Regulation for the accreditation of specialized surgical units. The AEC aims to define specialized surgical units as those functional elements of the health system that meet the defined requirements regarding their provision, solvency, and specialization in care, teaching, and research. In this paper we present the proposed accreditation model for Abdominal Wall Surgery Units, as well as the results of a survey conducted to assess the status of such units in our country. The model presented represents one of the pioneering initiatives worldwide concerning the accreditation of Abdominal Wall Surgery Units.
Collapse
Affiliation(s)
- Manuel López-Cano
- Unidad de Cirugía de Pared Abdominal Hospital Universitario Vall d´Hebrón, Barcelona Universidad Autónoma de Barcelona, Spain.
| | - Pilar Hernández-Granados
- Unidad de Pared Abdominal Hospital Universitario Fundación Alcorcón. Universidad Rey Juan Carlos, Spain
| | - Salvador Morales-Conde
- Serviciode Cirugía General y del Aparato Digestivo Hospital Universitario Virgen Macarena. Sevilla Facultad de Medicina, Universidad de Sevilla, Spain
| | - Antonio Ríos
- Unidad de Pared Abdominal Hospital Clínico Universitario Virgen de la Arrixaca Universidad de Murcia, Spain
| | | |
Collapse
|
3
|
García EI, Martin-Delgado J, Queiro R, Pérez Venegas JJ, Gratacos J, Sanz J, Torrés A, Mira JJ. Quality certification standard proposal "SpACE" for axial spondyloarthritis treatment units. ACTA ACUST UNITED AC 2021; 18:299-303. [PMID: 34736873 DOI: 10.1016/j.reumae.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Axial spondyloarthritis is an immune-mediated disease with a high cost, diagnostic delay and associated complications that makes it a particularly important condition. This work aims to establish a certification standard (SpACE Project) for monographic consultations in its diagnosis and treatment. MATERIALS AND METHODS Qualitative study of consensus, through the technique of the nominal group. First, a pragmatic review of the literature was carried out. Second, professionals involved throughout the care process (rheumatology, ophthalmology, gastroenterology, traumatology, family medicine, physical therapy, and nursing) were included. RESULTS Thirty-seven possible standards were extracted from the pragmatic review of the literature. During the consensus phase only those standards with high feasibility and importance in the care process were prioritized. Finally, the group of 26 experts agreed on the inclusion of 14 standards. DISCUSSION AND CONCLUSIONS SpACE is a consensus-based certification standard that seeks to improve health outcomes and more integrated care.
Collapse
Affiliation(s)
| | - Jimmy Martin-Delgado
- Grupo de Investigación Atenea, Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Sant Joan d'Alacant, Alicante, Spain.
| | - Ruben Queiro
- Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - Jordi Gratacos
- Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - Jesús Sanz
- Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - José Joaquín Mira
- Departamento de Salud Alicante-Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain; Universidad Miguel Hernández, Elche, Alicante, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Alicante, Spain
| | | |
Collapse
|
4
|
Álvarez-Dobaño JM, Atienza G, Zamarrón C, Toubes ME, Ferreiro L, Riveiro V, Casal A, Suárez-Antelo J, Rodríguez-Núñez N, Lama-López A, Rábade-Castedo C, Rodríguez-García C, Lourido-Cebreiro T, Ricoy J, Abelleira R, Golpe A, Pais B, González-Barcala FJ, Valdés L. Health outcomes: Towards the accreditation of respiratory medicine departments. Arch Bronconeumol 2021; 57:637-647. [PMID: 35702904 DOI: 10.1016/j.arbr.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/13/2021] [Indexed: 06/15/2023]
Abstract
National health systems must ensure compliance with conditions such as equity, efficiency, quality, and transparency. Since it is the right of society to know the health outcomes of its healthcare system, our aim was to develop a proposal for the accreditation of respiratory medicine departments in terms of care, teaching, and research, measuring health outcomes using quality of care indicators. The management tools proposed in this article should be implemented to improve outcomes and help us achieve our objectives. Promoting accreditation can serve as a stimulus to improve clinical management and enable professionals to take on greater leadership roles and take action to improve outcomes in patient care.
Collapse
Affiliation(s)
- José Manuel Álvarez-Dobaño
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain; Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Gerardo Atienza
- Unidad de Calidad y Seguridad del Paciente, Subdirección de Calidad, Área Sanitaria de Santiago de Compostela y Barbanza, Santiago de Compostela, Spain
| | - Carlos Zamarrón
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - María Elena Toubes
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Lucía Ferreiro
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain.
| | - Vanessa Riveiro
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Ana Casal
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Nuria Rodríguez-Núñez
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Adriana Lama-López
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Carlos Rábade-Castedo
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Carlota Rodríguez-García
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Tamara Lourido-Cebreiro
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Jorge Ricoy
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Romina Abelleira
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Golpe
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain; Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Beatriz Pais
- Unidad de Calidad y Seguridad del Paciente, Subdirección de Calidad, Área Sanitaria de Santiago de Compostela y Barbanza, Santiago de Compostela, Spain
| | - Francisco Javier González-Barcala
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain; Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Luis Valdés
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain; Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| |
Collapse
|
5
|
García EI, Martin-Delgado J, Queiro R, Pérez Venegas JJ, Gratacos J, Sanz J, Torrés A, Mira JJ. Quality Certification Standard Proposal "SpACE" for Axial Spondyloarthritis Treatment Units. Reumatol Clin (Engl Ed) 2021; 18:S1699-258X(21)00126-1. [PMID: 34148827 DOI: 10.1016/j.reuma.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Axial spondyloarthritis is an immune-mediated disease with a high cost, diagnostic delay and associated complications that makes it a particularly important condition. This work aims to establish a certification standard (SpACE Project) for monographic consultations in its diagnosis and treatment. MATERIALS AND METHODS Qualitative study of consensus, through the technique of the nominal group. First, a pragmatic review of the literature was carried out. Second, professionals involved throughout the care process (rheumatology, ophthalmology, gastroenterology, traumatology, family medicine, physical therapy, and nursing) were included. RESULTS Thirty-seven possible standards were extracted from the pragmatic review of the literature. During the consensus phase only those standards with high feasibility and importance in the care process were prioritized. Finally, the group of 26 experts agreed on the inclusion of 14 standards. DISCUSSION AND CONCLUSIONS SpaCE is a consensus-based certification standard that seeks to improve health outcomes and more integrated care.
Collapse
Affiliation(s)
| | - Jimmy Martin-Delgado
- Grupo de Investigación Atenea, Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Sant Joan d'Alacant, Alicante, España.
| | - Ruben Queiro
- Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | - Jordi Gratacos
- Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - Jesús Sanz
- Hospital Puerta de Hierro, Majadahonda, Madrid, España
| | - Antonio Torrés
- Sociedad Española de Calidad Asistencial, Oviedo, España
| | - José Joaquín Mira
- Departamento de Salud Alicante-Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España; Universidad Miguel Hernández, Elche, Alicante, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Alicante, España
| |
Collapse
|
6
|
Álvarez-Dobaño JM, Atienza G, Zamarrón C, Toubes ME, Ferreiro L, Riveiro V, Casal A, Suárez-Antelo J, Rodríguez-Núñez N, Lama-López A, Rábade-Castedo C, Rodríguez-García C, Lourido-Cebreiro T, Ricoy J, Abelleira R, Golpe A, Pais B, González-Barcala FJ, Valdés L. Health Outcomes: Towards the Accreditation of Respiratory Medicine Departments. Arch Bronconeumol 2021; 57:S0300-2896(21)00029-6. [PMID: 33678474 DOI: 10.1016/j.arbres.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/04/2021] [Accepted: 01/13/2021] [Indexed: 11/22/2022]
Abstract
National health systems must ensure compliance with conditions such as equity, efficiency, quality, and transparency. Since it is the right of society to know the health outcomes of its healthcare system, our aim was to develop a proposal for the accreditation of respiratory medicine departments in terms of care, teaching, and research, measuring health outcomes using quality of care indicators. The management tools proposed in this article should be implemented to improve outcomes and help us achieve our objectives. Promoting accreditation can serve as a stimulus to improve clinical management and enable professionals to take on greater leadership roles and take action to improve outcomes in patient care.
Collapse
Affiliation(s)
- José Manuel Álvarez-Dobaño
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España
| | - Gerardo Atienza
- Unidad de Calidad y Seguridad del Paciente, Subdirección de Calidad, Área Sanitaria de Santiago de Compostela y Barbanza, Santiago de Compostela, España
| | - Carlos Zamarrón
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - María Elena Toubes
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Lucía Ferreiro
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España.
| | - Vanessa Riveiro
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Ana Casal
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Juan Suárez-Antelo
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Nuria Rodríguez-Núñez
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Adriana Lama-López
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Carlos Rábade-Castedo
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Carlota Rodríguez-García
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Tamara Lourido-Cebreiro
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Jorge Ricoy
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Romina Abelleira
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Antonio Golpe
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España
| | - Beatriz Pais
- Unidad de Calidad y Seguridad del Paciente, Subdirección de Calidad, Área Sanitaria de Santiago de Compostela y Barbanza, Santiago de Compostela, España
| | - Francisco Javier González-Barcala
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España
| | - Luis Valdés
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España
| |
Collapse
|
7
|
Carmona García P, Zarragoikoetxea Jauregui I, Mateo E, García Fuster R, Vicente R, Argente Navarro P. Multicentric survey on the use of intraoperative echocardiography in cardiovascular surgery in Spain. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:551-555. [PMID: 33162120 DOI: 10.1016/j.redar.2020.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/04/2020] [Accepted: 07/13/2020] [Indexed: 06/11/2023]
Abstract
Transesophageal echocardiography (TEE) is an essential tool in the intraoperative and postoperative period of cardiac surgery with recently wide diffusion. We aimed to know the current situation of TEE in the field of cardiovascular anesthesiology in Spain through a national survey that explores the availability of equipment, indication and use of this technique as well as the training and accreditation of professionals involved. The findings show that in Spain intraoperative TEE is an integral part of cardiovascular procedures today and in most centers it is performed by anesthesiologists highly involved in this type of surgery. Despite the absence of structured training in the curriculum of our specialty, anesthesiologists acquire the skills through specific short-term rotations and a high percentage of them have obtained official accreditation.
Collapse
Affiliation(s)
- P Carmona García
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Fe, Valencia, miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR, coordinadora del grupo de trabajo en Ecocardiografía transesofágica intraoperatoria de la SEDAR, España.
| | | | - E Mateo
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, España
| | - R García Fuster
- Servicio de Cirugía Cardiaca, Consorcio Hospital General Universitario de Valencia, coordinador del grupo de trabajo en Ecocardiografía transesofágica intraoperatoria de la SECCE, España
| | - R Vicente
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Fe, Valencia, España
| | - P Argente Navarro
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Fe, Valencia, España
| |
Collapse
|
8
|
Yousefinezhadi T, Mosadeghrad AM, Hinchcliff R, Akbari-Sari A. Evaluation results of national hospital accreditation program in Iran: The view of hospital managers. J Healthc Qual Res 2020; 35:12-18. [PMID: 31964614 DOI: 10.1016/j.jhqr.2019.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Accreditation programs have a crucial role in improving the safety and effectiveness of hospital services. Many factors contribute to achieve accreditation goals. This study evaluated the national Iranian hospital accreditation program from the view of hospital managers in Iran. METHODS The study was conducted in 2015 using a validated questionnaire designed to collect feedback concerning accreditation processes and impacts. In total, 547 managers were surveyed using a stratified random sampling method. A 5-degree scale Likert from totally disagree=1 to totally agree=5 has been used for the evaluation. Descriptive and inferential statistics were used to analyze the data. RESULTS Approximately half of hospital managers were satisfied with the accreditation standards and surveying methods. The reason for their dissatisfaction was the high number of measures (2.38). The main challenges to the accreditation method were reported inadequate surveyor training (2.94) their satisfaction with the infrastructure was low because of a lack of hospital resources. Nonetheless, the accreditation program was perceived as being successful in improving patient safety (3.80), patient compliance (3.72), and error reduction (3.53). CONCLUSION An effective accreditation program requires reducing the number of standards and making them clearer as well as the infrastructure for the implementation of accreditation such as sufficient and sustainable funds, enough human resources and equipment should be provided. Appropriate surveyors should be selected and trained professionally to ensure inter-rater reliability among them.
Collapse
Affiliation(s)
- T Yousefinezhadi
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - A M Mosadeghrad
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - R Hinchcliff
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - A Akbari-Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
9
|
Brugueras S, Roldán L, Rodrigo T, García-García JM, Caylà JA, García-Pérez FJ, Orcau À, Mir Viladrich I, Penas-Truque A, Millet JP. Organization of Tuberculosis Control in Spain: Evaluation of a Strategy Aimed at Promoting the Accreditation of Tuberculosis Units. Arch Bronconeumol 2020; 56:90-8. [PMID: 31171411 DOI: 10.1016/j.arbres.2019.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/03/2019] [Accepted: 04/26/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Well-coordinated multidisciplinary teams are essential for better tuberculosis (TB) control. Our objective was to evaluate the impact of Spanish Society of Pneumology (SEPAR) accreditation of TB Units (TBU) and to determine differences between the accredited and non-accredited centers. MATERIAL AND METHODS DESIGN Observational descriptive study based on a self-administered survey from October 2014 to February 2018 completed by 139 heads of respiratory medicine departments collected by SEPAR, before and after TBU accreditation. VARIABLES demographic, epidemiological and contact tracing (CT) variables, among others. ANALYSIS basic descriptive analysis, and calculation of medians for continuous variables and proportions for categorical variables. The variables were compared using the Chi-squared test and logistic regression. RESULTS The response rate was 54.7% and 43.2% in the pre- and post-TBU accreditation period, respectively. No differences were observed in the care and coordination variables between the pre- and post-accreditation survey, nor in the organization when only accredited centers were analyzed. When we compared the accredited and non-accredited centers, significant differences were detected in the collection of the final conclusion, management of resistance, coordination with other departments, contact tracing, and directly observed treatment. CONCLUSIONS The approach of different professionals with regard to TB has been addressed. Positive aspects and areas for improvement have been detected, and better results were observed in the accredited versus non-accredited centers. A closer supervision of TBUs is necessary to improve their effectiveness.
Collapse
|
10
|
Carrasco-Peralta JA, Herrera-Usagre M, Reyes-Alcázar V, Torres-Olivera A. Healthcare accreditation as trigger of organisational change: The view of professionals. J Healthc Qual Res 2019; 34:59-65. [PMID: 30713136 DOI: 10.1016/j.jhqr.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Healthcare accreditation seeks to promote the organisational change in healthcare organisations from an approach that values the level of progress achieved through a validated reference framework. The aim of this paper is to analyse the role played by accreditation through the experience perceived by health professionals during the process of self-assessment and external evaluation, taking into account three dimensions of analysis: focus on the patient, internal organisation and leadership, and impact on the clinical aspects of healthcare. MATERIAL AND METHODS Design: Semi-structured interviews with key informants from clinical management units (CMU) within the Andalusian Health System (Spain). PARTICIPANTS The key informants in each CMU were the clinical leader, the head of nursing and two health professionals (doctors and nurses). A qualitative research protocol was employed to conduct the semi-structured interviews (n=52 interviews) with physicians and nurses, in order to analyse their experience with the accreditation process. RESULTS The analysis identified four main outcomes related to the accreditation process perceived by professionals: (1) A benchmarking conceptualisation of the process; (2) Improvements in patient-centred care, quality of clinical records, and organisational culture of the units; (3) Improvement of patient safety culture; (4) As negative outcomes, a slight perception of bureaucratisation and standardisation of the clinical practice. CONCLUSIONS The described initiative of accreditation process in Andalusia (Spain) is widely perceived as positive by health professionals since it fosters the organisational change, although it also has a slightly negative bureaucratisation effect on clinical practice.
Collapse
Affiliation(s)
- J A Carrasco-Peralta
- Andalusian Agency for Healthcare Quality, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain
| | - M Herrera-Usagre
- Andalusian Agency for Healthcare Quality/Pablo de Olavide University, Department of Sociology, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain.
| | - V Reyes-Alcázar
- Andalusian Agency for Healthcare Quality, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain
| | - A Torres-Olivera
- Andalusian Agency for Healthcare Quality, Parque Científico y Tecnológico Cartuja, Pabellón de Italia, calle Isaac Newton 4, 3ª planta, 41092 Sevilla, Spain
| |
Collapse
|
11
|
de la Portilla F, Builes S, García-Novoa A, Espín E, Kreisler E, Enríquez-Navascues JM, Biondo S, Codina A. Analysis of Quality Indicators for Colorectal Cancer Surgery in Units Accredited by the Spanish Association of Coloproctology. Cir Esp 2018; 96:226-233. [PMID: 29606350 DOI: 10.1016/j.ciresp.2018.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/29/2018] [Accepted: 02/03/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Currently, there is growing interest in analyzing the results from surgical units and the implementation of quality standards in order to identify good healthcare practices. Due to this fact, the Spanish Association of Coloproctology (AECP) has developed a unit accreditation program that contemplates basic standards. The aim of this article is to evaluate and analyze the specific quality indicators for the surgical treatment of colorectal cancer, established by the program. Data were collected from colorectal units during the accreditation process. METHODS We analyzed prospectively collected data from elective colorectal surgeries at 18 Spanish coloproctology units during the period 2013-2017. Three main and four secondary quality indicators were considered. Colon and rectal surgeries were analyzed independently; furthermore, results were compared according to surgical approach. RESULTS A total of 3090 patients were included in the analysis. The global anastomotic leak rate was 7.8% (6.6% colon vs 10.6% rectum), while the surgical site infection rate was 12.6% (11.4% colon vs 14.8% rectum). Overall 30-day mortality was 2.3%, and anastomotic leak-related mortality was 10.2%. There were higher surgical site infection and mortality rates in the patients operated by open approach, however there was no difference in the anastomotic leak rate when compared with minimally invasive approaches. CONCLUSIONS The evaluation of these results has determined optimal quality indices for the units accredited in the treatment of colorectal cancer. Furthermore, it allows us to establish realistic references in our country, thereby providing a better understanding and comparison of outcomes.
Collapse
Affiliation(s)
- Fernando de la Portilla
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Virgen del Rocío/IBiS/CSIC/Universidad de Sevilla, Sevilla, España.
| | - Sergio Builes
- Servicio de Cirugía General y Aparato Digestivo, Hospital Juaneda Miramar, Palma de Mallorca, España
| | - Alejandra García-Novoa
- Servicio de Cirugía General y Aparato Digestivo, Hospital Do Salnés, Villagarcía, Pontevedra, España
| | - Eloy Espín
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Coloproctología, Hospital Vall d'Hebron, Barcelona, España
| | - Esther Kreisler
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Coloproctología, Hospital Bellvitge, Barcelona, España
| | - José María Enríquez-Navascues
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Coloproctología, Hospital Donostia, San Sebastián, España
| | - Sebastiano Biondo
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Coloproctología, Hospital Bellvitge, Barcelona, España
| | - Antonio Codina
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Coloproctología, Hospital Josep Trueta, Girona, España
| |
Collapse
|
12
|
Angulo J, Dávila H, Vela R, Abad J, Arley A, Arriaga HR, Beckford C, Borgen JL, Bueso G, Cano LF, Castillo O, Castillo P, Cornejo F, Corrales JG, Costa M, Cózar JM, de la Concepción OM, Figueirido A, Lafos N, Lobo LA, López-Secchi G, Martínez OG, Nardozza A, X AP, Pazos AJ, Plata M, Portillo CR, Salvador D, Serrano EA, Suero F, Torres J, Torrico M. Survey on graduate education in the Confederación Americana de Urología: Opinions and reality. Actas Urol Esp 2017; 41:316-323. [PMID: 28094072 DOI: 10.1016/j.acuro.2016.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Quality graduate medical training is a concern of Confederación Americana de Urología (CAU), the third largest urological society worldwide. It is important to analyse the diversity in the state training programmes and the feasibility and implications of conducting a common CAU programme. MATERIAL AND METHODS A 20-item questionnaire was distributed to the directors of national societies who are members of the CAU concerning the graduate urological training in their institutions. RESULTS A total of 28 presidents and expresidents representing 21 countries responded, the total number of independent states that constitute the confederation. In this setting, 664 residents start their training programme every year, in an area that treats 645.4 million inhabitants, with an active professional force of 16,752 specialists. We present data on the realities of the training (length of the programme, core curriculum) and occupation (job access, possible flow between countries) and on how accreditation and re-certification of specialists in these countries are conducted. We also present the opinions on the feasibility of a joint CAU degree, as well as a number of its implications. CONCLUSIONS The actual graduate training in the CAU setting is heterogeneous in its programmes and in its accreditation and re-certification methods. There is a strong desire to achieve joint degrees, except in Spain and Portugal. To enable joint certification, there will need to be intervention on numerous aspects and levels, redefining the desire for healthcare coverage in each country and considering the possible flow of specialists.
Collapse
|
13
|
Ramiro Avilés MA. [Accreditation of Independent Ethics Committees]. Gac Sanit 2016; 31:53-56. [PMID: 28029466 DOI: 10.1016/j.gaceta.2016.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/31/2016] [Accepted: 08/24/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE According to Law 14/2007 and Royal Decree 1090/2015, biomedical research must be assessed by an Research Ethics Committee (REC), which must be accredited as an Research ethics committee for clinical trials involving medicinal products (RECm) if the opinion is issued for a clinical trial involving medicinal products or clinical research with medical devices. The aim of this study is to ascertain how IEC and IECm accreditation is regulated. METHODS National and regional legislation governing biomedical research was analysed. RESULTS No clearly-defined IEC or IECm accreditation procedures exist in the national or regional legislation. DISCUSSION Independent Ethics Committees are vital for the development of basic or clinical biomedical research, and they must be accredited by an external body in order to safeguard their independence, multidisciplinary composition and review procedures.
Collapse
Affiliation(s)
- Miguel A Ramiro Avilés
- Comité de Ética de la Investigación, Cátedra 'Discapacidad, Enfermedad Crónica y Accesibilidad a los Derecho', Facultad de Derecho, Universidad de Alcalá, Alcalá de Henares, Madrid, España.
| |
Collapse
|
14
|
Padilla-Garrido N, Aguado-Correa F, Huelva-López L, Ortega-Moreno M. [Comparative analysis of quality labels of health websites]. Rev Calid Asist 2016; 31:212-9. [PMID: 26778793 DOI: 10.1016/j.cali.2015.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The search for health related information on the Internet is a growing phenomenon, buts its main drawback is the lack of reliability of information consulted. The aim of this study was to analyse and compare existing quality labels of health websites. MATERIAL AND METHODS A cross-sectional study was performed by searching Medline, IBECS, Google, and Yahoo, in both English and Spanish, between 8 and 9 March, 2015. Different keywords were used depending on whether the search was conducted in medical databases or generic search engines. The quality labels were classified according to their origin, analysing their character, year of implementation, the existence of the accreditation process, number of categories, criteria and standards, possibility of self-assessment, number of levels of certification, certification scope, validity, analytical quality of content, fee, results of the accreditation process, application and number of websites granted the seal, and quality labels obtained by the accrediting organisation. RESULTS Seven quality labels, five of Spanish origin (WMA, PAWS, WIS, SEAFORMEC and M21) and two international ones (HONcode and Health Web Site Accreditation), were analysed. There was disparity in carrying out the accreditation process, with some not detailing key aspects of the process, or providing incomplete, outdated, or even inaccurate information. The most rigorous guaranteed the level of confidence that the websites had in relation to the content of information, but none checked the quality of them. CONCLUSIONS Although rigorous quality labels may become useful, the deficiencies in some of them cast doubt on their current usefulness.
Collapse
|
15
|
Alsius-Serra A, Ballbé-Anglada M, López-Yeste ML, Buxeda-Figuerola M, Guillén-Campuzano E, Juan-Pereira L, Colomé-Mallolas C, Caballé-Martín I. [Comparability study of analytical results between a group of clinical laboratories]. ACTA ACUST UNITED AC 2015; 30:281-8. [PMID: 26546167 DOI: 10.1016/j.cali.2015.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the study of the comparability of the measurements levels of biological tests processed in biochemistry in Catlab's 4 laboratories. MATERIAL AND METHODS Quality requirements, coefficients of variation and total error (CV% and TE %) were established. Controls were verified with the precision requirements (CV%) in each test and each individual laboratory analyser. Fresh serum samples were used for the comparability study. The differences were analysed using a Microsoft Access® application that produces modified Bland-Altman plots. RESULTS The comparison of 32 biological parameters that are performed in more than one laboratory and/or analyser generated 306 Bland-Altman graphs. Of these, 101 (33.1%) fell within the accepted range of values based on biological variability, and 205 (66.9%) required revision. Data were re-analysed based on consensus minimum specifications for analytical quality (consensus of the Asociación Española de Farmacéuticos Analistas (AEFA), the Sociedad Española de Bioquímica Clínica y Patología Molecular (SEQC), the Asociación Española de Biopatología Médica (AEBM) and the Sociedad Española de Hematología y Hemoterapia (SEHH), October 2013). With the new specifications, 170 comparisons (56%) fitted the requirements and 136 (44%) required additional review. Taking into account the number of points that exceeded the requirement, random errors, range of results in which discrepancies were detected, and range of clinical decision, it was shown that the 44% that required review were acceptable, and the 32 tests were comparable in all laboratories and analysers. CONCLUSIONS The analysis of the results showed that the consensus requirements of the 4 scientific societies were met. However, each laboratory should aim to meet stricter criteria for total error.
Collapse
|
16
|
Llorente Ballesteros MT, Navarro Serrano I, López Colón JL. [Validation of an in-house method for the determination of zinc in serum: Meeting the requirements of ISO 17025]. Rev Calid Asist 2015; 30:319-326. [PMID: 26546168 DOI: 10.1016/j.cali.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/02/2015] [Accepted: 08/04/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this report is to propose a scheme for validation of an analytical technique according to ISO 17025. MATERIAL AND METHODS According to ISO 17025, the fundamental parameters tested were: selectivity, calibration model, precision, accuracy, uncertainty of measurement, and analytical interference. RESULTS A protocol has been developed that has been applied successfully to quantify zinc in serum by atomic absorption spectrometry. CONCLUSION It is demonstrated that our method is selective, linear, accurate, and precise, making it suitable for use in routine diagnostics.
Collapse
|
17
|
Barba-Meseguer N, Martínez-Ollé X, Alsius-Serra A, López-Yeste ML, Caballé-Martín I. [UNE-EN ISO 15189 accreditation of the preanalytical phase of a clinical laboratory]. Rev Calid Asist 2015; 30:273-280. [PMID: 26547107 DOI: 10.1016/j.cali.2015.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Description of the procedures followed in Catlab's pre-analytical area for UNE-EN ISO 15189 accreditation, and implementation of quality indicators to evaluate the standard requirements in the pre-analytical phase processes. MATERIAL AND METHODS Description of Catlab's 2 self-developed computer applications: Catlab Program Incidents (CPI) and Refrigerator Management Program (RMP). Both of them, among other applications, documentation and quality indicators, had enabled us to achieve UNE-EN ISO 15189 accreditation and have traceability in the pre-analytical phase. RESULTS Results of 4 quality indicators are shown. In the customers satisfaction measurement indicator, 97.3% clinicians value positively (quite/lot) different aspects of the laboratory. The indicator of pre-analytical incidents went from 7.2% in 2011 down to 4.4% in 2014. In the prompt transport of late arrival samples, 3 of the routes (33%) did not reach the acceptable target. And finally, the indicator of default opening time of sample coolers, 100% of the routes reached the desired objective in the second quarter of 2014. CONCLUSIONS The use of those applications, allowed us to design quality control indicators of the processes in the pre-analytical phase; from sample extraction to its analytical process in the laboratory, enhancing the collaboration with extraction sites, and allowing improvement actions to be established.
Collapse
|
18
|
Abstract
There are few experiences of accreditation models validated by primary care teams (EAP). The aim of this study was to detail the process of design, development, and subsequent validation of the consensus EAP accreditation model of Catalonia. An Operating Committee of the Health Department of Catalonia revised models proposed by the European Foundation for Quality Management, the Joint Commission International and the Institut Català de la Salut and proposed 628 essential standards to the technical group (25 experts in primary care and quality of care), to establish consensus standards. The consensus document was piloted in 30 EAP for the purpose of validating the contents, testing standards and identifying evidence. Finally, we did a survey to assess acceptance and validation of the document. The Technical Group agreed on a total of 414 essential standards. The pilot selected a total of 379. Mean compliance with the standards of the final document in the 30 EAP was 70.4%. The standards results were the worst fulfilment percentage. The survey target that 83% of the EAP found it useful and 78% found the content of the accreditation manual suitable as a tool to assess the quality of the EAP, and identify opportunities for improvement. On the downside they highlighted its complexity and laboriousness. We have a model that fits the reality of the EAP, and covers all relevant issues for the functioning of an excellent EAP. The model developed in Catalonia is a model for easy understanding.
Collapse
Affiliation(s)
- Josep Davins
- Departament de Salut, Generalitat de Catalunya, Barcelona, España.
| | - Montserrat Gens
- Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España
| | - Clara Pareja
- Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España
| | - Ramón Guzmán
- Departament de Salut, Generalitat de Catalunya, Barcelona, España
| | - Roser Marquet
- Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España
| | - Roser Vallès
- Departament de Salut, Generalitat de Catalunya, Barcelona, España
| |
Collapse
|
19
|
Parés-Pollán L, Gonzalez-Quintana A, Docampo-Cordeiro J, Vargas-Gallego C, García-Álvarez G, Ramos-Rodríguez V, Diaz Rubio-García MP. [Modal failure analysis and effects in the detection of errors in the transport of samples to the clinical laboratory]. ACTA ACUST UNITED AC 2014; 29:197-203. [PMID: 24725518 DOI: 10.1016/j.cali.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Owing to the decrease in values of biochemical glucose parameter in some samples from external extraction centres, and the risk this implies to patient safety; it was decided to apply an adaptation of the «Health Services Failure Mode and Effects Analysis» (HFMEA) to manage risk during the pre-analytical phase of sample transportation from external centres to clinical laboratories. MATERIALS AND METHODS A retrospective study of glucose parameter was conducted during two consecutive months. The analysis was performed in its different phases: to define the HFMEA topic, assemble the team, graphically describe the process, conduct a hazard analysis, design the intervention and indicators, and identify a person to be responsible for ensuring completion of each action. RESULTS The results of glucose parameter in one of the transport routes, were significantly lower (P=.006). The errors and potential causes of this problem were analysed, and criteria of criticality and detectability were applied (score≥8) in the decision tree. It was decided to: develop a document management system; reorganise extractions and transport routes in some centres; quality control of the sample container ice-packs, and the time and temperature during transportation. CONCLUSIONS This work proposes quality indicators for controlling time and temperature of transported samples in the pre-analytical phase. Periodic review of certain laboratory parameters can help to detect problems in transporting samples. The HFMEA technique is useful for the clinical laboratory.
Collapse
Affiliation(s)
- L Parés-Pollán
- Servicio de Análisis Clínicos/Bioquímica, Hospital universitario 12 de Octubre, Madrid, España.
| | - A Gonzalez-Quintana
- Servicio de Análisis Clínicos/Bioquímica, Hospital universitario 12 de Octubre, Madrid, España
| | - J Docampo-Cordeiro
- Servicio de Análisis Clínicos/Bioquímica, Hospital universitario 12 de Octubre, Madrid, España
| | - C Vargas-Gallego
- Servicio de Análisis Clínicos/Bioquímica, Hospital universitario 12 de Octubre, Madrid, España
| | - G García-Álvarez
- Dirección Médica de Continuidad Asistencial, Hospital universitario 12 de Octubre, Madrid, España
| | - V Ramos-Rodríguez
- Subdirección Médica de Servicios Centrales, Hospital universitario 12 de Octubre, Madrid, España
| | - M P Diaz Rubio-García
- Servicio de Análisis Clínicos/Bioquímica, Hospital universitario 12 de Octubre, Madrid, España
| |
Collapse
|