RESUMEN
INTRODUCTION: Integrated care is a top priority for most of the National Health Services. In this study, an evaluation is made on the professional's beliefs and expectations regarding integration. MATERIAL AND METHODS: Between March and June 2017, Health Professionals from El Bierzo, León, Spain, were invited to complete 2 questionnaires on health integration process, including an online questionnaire on patient care integration (405 and 211 participants, respectively out of the total 1854 professionals). RESULTS: Three out of four professionals pointed at communication as the most important factor to achieve integration. Medical records, Health Care Education and medication reconciliation were the other prioritised factors. Care pathways (98%), nurse navigator (93%) or shared care protocols (92%) were highly recommended. The entire Hospital Service (55%) was the preferred link, with Primary Care versus a single consultant for every Primary Care Centre (29%), or for all the whole area (16%).There were no differences between primary and hospital services in most of the tools assessed. CONCLUSIONS: Communication tools are the cornerstone to achieve a successful integration of the care services according to Health Professionals.
Asunto(s)
Actitud del Personal de Salud , Prestación Integrada de Atención de Salud/organización & administración , Personal de Salud/organización & administración , Atención al Paciente/métodos , Adulto , Comunicación , Femenino , Encuestas de Atención de la Salud , Personal de Salud/psicología , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/organización & administración , EspañaRESUMEN
Pneumococcal parapneumonic empyema is an increasingly common complication in children. Conventional microbiological cultures indicate bacterial causes in as few as 8% of cases; therefore, there is a vital need for new molecular methods of detection and diagnosis. The development and clinical evaluation of real-time PCR-based assays to detect the pneumococcal capsular wzg gene of all serotypes tested are reported here, and 24 of them have been identified in clinical specimens. Using real-time PCR assays with highly specific TaqMan MGB probes that target DNA sequences within the capsular polysaccharide gene cluster, it was possible to differentiate serotypes 1, 3, 5, 4, 6A, 6B, 7F/A, 8, 9V/A/N/L, 14, 15B/C, 18C/B, 19A, 19F/B/C, 23F and 23A. These assays showed high sensitivity (five to ten pneumococcal DNA equivalents) and they were validated with 175 clinical isolates of known serotypes. The clinical value of this approach was demonstrated by analysis of 88 culture-negative pleural fluids from children diagnosed with parapneumonic empyema in three Spanish hospitals. Pneumococcal DNA was detected in 87.5% of pleural fluids, and serotypes 1, 7F and 3 were responsible for 34.3%, 16.4% and 11.9%, respectively, of cases of parapneumonic empyema in children. Such molecular methods are critical for the diagnosis of invasive pneumococcal disease and continued epidemiological surveillance in order to monitor serotype vaccine effectiveness.
Asunto(s)
Empiema/microbiología , Infecciones Neumocócicas/diagnóstico , Reacción en Cadena de la Polimerasa/métodos , Streptococcus pneumoniae/clasificación , Streptococcus pneumoniae/genética , Cápsulas Bacterianas/genética , Proteínas Bacterianas/genética , Niño , ADN Bacteriano/genética , Humanos , Sondas de Oligonucleótidos/genética , Derrame Pleural/microbiología , Sensibilidad y Especificidad , Serotipificación/métodos , España , Streptococcus pneumoniae/aislamiento & purificaciónRESUMEN
Nasopharyngeal pneumococci were collected from 635 Spanish children aged 6 months to 6 years attending four primary healthcare centres (n = 276) or two hospital emergency rooms (n = 359); 36% of the children had received >/=1 dose of pneumococcal conjugate vaccine (PCV7). Overall, the carriage rate of Streptococcus pneumoniae was 31%, with no significant differences in carriage rates according to setting. Colonization with vaccine serotypes was significantly associated with the absence of PCV7 immunization (29.4% vs. 5.9%, p <0.001). Forty-seven per cent of all isolates were penicillin- and/or erythromycin-non-susceptible; 13 international antibiotic-resistant clones were represented among non-susceptible pneumococci and were similarly distributed among vaccine and non-vaccine serotypes.
Asunto(s)
Antibacterianos/farmacología , Portador Sano/epidemiología , Nasofaringe/microbiología , Infecciones Neumocócicas/epidemiología , Streptococcus pneumoniae/efectos de los fármacos , Portador Sano/microbiología , Niño , Preescolar , Farmacorresistencia Bacteriana , Eritromicina/farmacología , Vacuna Neumocócica Conjugada Heptavalente , Humanos , Lactante , Vacunas Meningococicas/administración & dosificación , Pruebas de Sensibilidad Microbiana , Epidemiología Molecular , Penicilinas/farmacología , Infecciones Neumocócicas/microbiología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/administración & dosificación , España/epidemiología , Streptococcus pneumoniae/clasificación , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/aislamiento & purificación , VacunaciónRESUMEN
We compared the E-test to the broth microdilution method for testing the susceptibility of 115 clinical isolates of Acinetobacter baumannii to colistin. Twenty-two (19.1%) strains were resistant to colistin and 93 (80.8%) strains were susceptible according to the reference broth microdilution method. A categorical agreement of 98.2% was found, with only two (1.7%) very major errors. Agreement within 1 twofold dilution between the E-test and the broth microdilution was 16.5%. Complete agreement was found for the strains for which MICs fell within the range of 0.25 to 1 microg of colistin/ml. However, there was poor concordance, particularly in extreme dilutions with higher MICs by the E-test method.