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Significance: Frequent and effective patient-practitioner communication is essential to ensure instructions regarding contact lens use, care and maintenance are understood and followed. Given the relevance of good patient compliance, the responsibility of practitioners to provide adequate information may not be neglected. Purpose: To determine the content and type of information Licensed Optometrists in Spain provide their patients during the first contact lens fitting and at follow-up visits. Methods: A self-reported ad hoc survey was distributed to Licensed Optometrists in Spain to investigate, amongst other factors, whether practitioners provided information on several aspects of contact lens use and maintenance, how was this information provided and whether in-office practical demonstrations were conducted at all contact lens appointments. Results: Respondents of 321 surveys had a median of 20 years of contact lens fitting experience and worked on independent practices (67.6%), national (29.0%) and regional chains (3.4%). Type of practice influenced continuous education habits (P = .03). Overall, 28.0% of participants did not always instruct patients on the need to rub contact lenses, 34.3% did not always address contact lens replacement and 6.8% did not always explain storage case hygiene and replacement. At the follow-up visit, only 8.4% of respondents asked their patients to demonstrate their care routines. Information was mostly oral (48.6%) or oral and written (43.0%). Contact lens-related complications were reported more frequently by participants with less continuous education training (P = .01), by those not always recommending rubbing (P = .002) and by those not providing written information about storage case hygiene and replacement (P = .002). Conclusion: Patient-practitioner communication was good, albeit several areas were identified were information was insufficient or not provided in a correct and timely format. Precise, written information on rubbing and storage case hygiene and replacement may improve compliance and assist in avoiding complications and drop-out.

ObjectivesMultidisciplinary teams in cancer care are increasingly using information and communication technology (ICT), hospital health information system (HIS) functionalities and ICT-driven care components. We aimed to explore the use of these tools in multidisciplinary team meetings (MTMs) and to identify the critical challenges posed by their adoption based on the perspective of professionals representatives from European scientific societies.DesignThis qualitative study used discussion of cases and focus group technique to generate data. Thematic analysis was applied.SettingHealthcare professionals working in a multidisciplinary cancer care environment.ParticipantsSelection of informants was carried out by European scientific societies in accordance with professionals’ degree of experience in adopting the implementation of ICT and from different health systems.ResultsProfessionals representatives of 9 European scientific societies were involved. Up to 10 ICTs, HIS functionalities and care components are embedded in the informational and decision-making processes along three stages of MTMs. ICTs play a key role in opening MTMs to other institutions (eg, by means of molecular tumour boards) and information types (eg, patient-reported outcome measures), and in contributing to the internal efficiency of teams. While ICTs and care components have their own challenges, the information technology context is characterised by the massive generation of unstructured data, the lack of interoperability between systems from different hospitals and HIS that are conceived to store and classify information rather than to work with it.ConclusionsThe emergence of an MTM model that is better integrated in the wider health system context and incorporates inputs from patients and support systems make traditional meetings more dynamic and interconnected. Although these changes signal a second transition in the development process of multidisciplinary teams, they occur in a context marked by clear gaps between the information and management needs of MTMs and the adequacy of current HIS.

This study explores how health institutions (i.e. hospitals) communicate through their corporate websites to convey reliability and credibil-ity in order to establish relationships with users in the field of medical travel. The 10 world's leading medical tourism hospitals have been selected based on the International Medical Travel Quality Alliance (2019) ranking and their strategic online communication analyzed by applying framing theory. Methodologically, a content analysis was conducted of both web-sites and subsites which aimed specially at medical tourists. We conclude that hospitals are in an embryonic phase in their communicative management model with their public in the field of medical tourism since they disregard the potential role of public relations. This article provides valuable and helpful information for both tourism and communication practitioners in medical tourism Este estudio explora cómo las instituciones de salud (es decir, los hospitales) se comunican a través de sus sitios web corporativos para transmitir confiabilidad y credibilidad a fin de establecer relaciones con los usuarios en el campo de los viajes médicos. Los 10 hospitales de turismo médico líderes en el mundo han sido seleccionados en base a la clasificación del International Medical Travel Quality Alliance (2019) y su comunicación estratégica en línea analizada mediante la aplicación de la teoría del encuadre. Metodológicamente, se realizó un análisis de contenido tanto de los sitios web como de los subsitios que estaban dirigidos específicamente a turistas médicos. Concluimos que los hospitales se encuentran en una fase embrionaria en su modelo de gestión comunicativa con su público en el ámbito del turismo médico ya que desconocen el papel potencial de las relaciones públicas. El artículo proporciona información valiosa y útil para los profesionales del turismo y la comunicación en el área del turismo médico Este estudo explora como as instituições de saúde (ou seja, hospitais) se comunicam por meio de seus sites corporativos para transmitir confiabilidade e credibilidade a fim de estabelecer relacionamentos com usuários no campo de viagens médicas. Os 10 principais hospitais de turismo médico do mundo foram selecionados com base no ranking da International Medical Travel Quality Alliance (2019) e sua comunicação estratégica online analisada pela aplicação da teoria dos quadros. Metodologicamente, foi realizada uma análise de conteúdo de sites e subsites voltados especificamente para turistas médicos. Concluímos que os hospitais estão em fase embrionária em seu modelo de gestão comunicativa com seu público no campo do turismo médico, uma vez que desconsideram o papel potencial das relações públicas. O artigo fornece informações valiosas e úteis para profissionais de turismo e comunicação na área de turismo médico

This study examines the use of metaphors of war and journey in a million-word corpus of Spanish-language blogs written by patients with severe mental disorders and by mental health professionals. Quantitative results indicate that both metaphors are more prevalent among patients than professionals, supporting the idea that they are mostly used in this context for communicating complex and emotionally intense experiences. From a qualitative perspective, our results show that patients use both metaphors to deal with exactly the same ontological elements of the situation (the disorder, symptoms, negative emotions, everyday problems, social prejudice, medical activity, people close to the patients and the patients themselves) but framing them differently. Further analysis shows that both metaphors have positive and negative uses in terms of emotions conveyed, empowerment and suitability for coping with the situation. In light of this, we conclude with a discussion of proposals promoting the positive uses of these metaphors.

Malgrat considerar-se una pràctica clínica de menor rellevància, la comunicació de males notícies en context sanitari és una de les tasques més difícil si amb major impacte emocional tant per a la persona atesa i els familiars propers com per al mateix metge. Si bé el pacient és, en aquest cas, l'eix central de la situació, tots els interlocutors experimenten dificultats pròpies que poden impedir una comunicació eficient, comportar conseqüències emocionals negatives i, en última instància, deteriorar la relació sanitària. En aquest sentit, és important reconèixer les veus de tots els protagonistes d'aquesta interacció i identificar quins són els reptes que cal afrontar a cada cas per poder atendre les seves necessitats i aconseguir una comunicació satisfactòria., A pesar de considerarse una práctica clínica de menor relevancia, la comunicación de malas noticias en contexto sanitario es una de las tareas más difíciles y con mayor impacto emocional tanto para la persona atendida y sus allegados como para el propio médico. Si bien el paciente es, en este caso, el eje central de la situación, los dos interlocutores experimentan dificultades propias que pueden impedir una comunicación eficiente, acarrear consecuencias emocionales negativas y, en última instancia, dañar la relación sanitaria. En este sentido, es importante reconocer las voces de todos los protagonistas de esta interacción e identificar cuáles son los desafíos que afrontan en cada caso para poder atender a sus necesidades y conseguir una comunicación satisfactoria., Despite being considered a less-relevant clinical practice, the communication of bad news is one of the tasks that is the most difficult and has the greatest emotional impact on the person being treated and their relatives, and the doctor themselves. Although the patient plays the most important role in this situation, the two interlocutors Comunicació de males notícies en context sanitari Marta Consuegra-Fernández, Alejandra Fernández-Trujillo (2021) Llengua, Societat i Comunicació, núm. 19 http://revistes.ub/index.php/LSC/ lsc@ub.edu http://creativecommons.org/licenses/by-nc-nd/4.0 doi:10.1344/LSC-2021.19.8 67each experience their own challenges, which can impede efficient communication. Eventually, this may have negative emotional consequences and ultimately damage the patient-provider relationship. In this sense, it is important to recognise the voices of all actors in this interaction and to identify the challenges they face. Achieving satisfactory communication means first recognising that the needs of each speaker have to be met.

INTRODUCTION NlmCategory: BACKGROUND content: In the current mobility and globalization context, there is a growing need to identify potential changes on the pattern of diseases in the European Union (EU)/European Economic Area (EEA) and provide accurate diagnosis and treatment for the population. The pattern of rare communicable diseases that can affect people returning to EU/EEA from travel abroad, visiting EU/EEA or establishing in the EU/EEA is of special relevance. The objective of this manuscript is to give an overview about the EURaDMoG study and discuss the feasibility of establishing a European network on rare communicable diseases and other rare conditions linked to mobility and globalization. - Label: METHODS NlmCategory: METHODS content: We undertook a three-steps process where we first conducted a narrative review to estimate the prevalence and incidence and to list rare communicable and non-communicable diseases linked to mobility and globalization in the EU/EEA; second, we organized an international consultation workshop with experts in the diseases previously selected; and finally, the feasibility study analysed how successful a European expert network on rare diseases linked to mobility and globalization focused on health care provision would be, accounting for different operational and also sustainability criteria. - Label: RESULTS NlmCategory: RESULTS content: "First, considering the areas or topics that the network should cover, it was concluded that communicable and non-communicable rare diseases linked to mobility and globalization should be differentiated. Second, since all non-communicable rare diseases linked to mobility and globalization identified are already covered by different European Reference Networks (ERNs), there is no need for them to be included in a new European network. Three scenarios were considered for establishing a potential European network for rare communicable diseases linked to Mobility and Globalisation with a focus on Health Care provision: 1) To maintain the current situation \"Status Quo\" scenario; 2) to create a specific European expert network (EEN) on rare communicable diseases linked to mobility and globalisation; 3) to develop a new ERN on communicable rare diseases linked to mobility and globalisation." - Label: CONCLUSIONS NlmCategory: CONCLUSIONS content: Since the focus is the provision of health care, an ERN could have the potential to better boost the quality of care being facilitated by technological tools and online platforms that permit the safe and ethically acceptable exchange of data. However, this potential new network should not eclipse current existing networks and they should be complementary.

Background: There is no consensus in the literature about what analytes or values should be informed as critical results and how they should be communicated. The main aim of this project is to establish consensual standards of critical results for the laboratories participating in the study. Among the project’s secondary objectives, establishing consensual procedures for communication can be highlighted. Methods: Consensus was reached among all participating laboratories establishing the basis for the construction of the initial model put forward for consensus in conjunction with the clinicians. A real-time Delphi, methodology “health consensus” (HC), with motivating and participative questions was applied. The physician was expected to choose a numeric value within a scale designed for each analyte. Results: The medians of critical results obtained represent the consensus on critical results for outpatient and inpatient care. Both in primary care and in hospital care a high degree of consensus was observed for critical values proposed in the analysis of creatinine, digoxin, phosphorus, glucose, international normalized ratio (INR), leukocytes, magnesium, neutrophils, chloride, sodium, calcium and lithium. For the rest of critical results the degree of consensus obtained was “medium high”. The results obtained showed that in 72% of cases the consensual critical value coincided with the medians initially proposed by the laboratories. Conclusions: The real-time Delphi has allowed obtaining consensual standards for communication of critical results among the laboratories participating in the study, which can serve as a basis for other organizations.

One of the important developments in assisted reproductive technology is the technique of oocyte preservation, which enables women to preserve their eggs when there is a threat of becoming infertile in the future. In spite of the still experimental status of this procedure, fertility clinics widely recommend it to healthy women who wish to postpone childbearing for social reasons. Since in fertility clinic’s websites appear extensive recommendations and promotion about this technology, it seems important to analyze their online persuasive communication. Our analysis applies a mixed methodology of content and discourse analysis from a framing theory perspective. It provides an in-depth analysis of the content of fertility clinics’ websites in Spain, describing their communication/information strategies regarding fertility preservation for social reasons. The present article confirms the inconsistency that exists in terms of the clarity of the information given by these websites, since the information is framed intending to attract more women to the egg freezing services.

The European Union (EU) initiative on the Digital Transformation of Health and Care (Digicare) aims to provide the conditions necessary for building a secure, flexible, and decentralized digital health infrastructure. Creating a European Health Research and Innovation Cloud (HRIC) within this environment should enable data sharing and analysis for health research across the EU, in compliance with data protection legislation while preserving the full trust of the participants. Such a HRIC should learn from and build on existing data infrastructures, integrate best practices, and focus on the concrete needs of the community in terms of technologies, governance, management, regulation, and ethics requirements. Here, we describe the vision and expected benefits of digital data sharing in health research activities and present a roadmap that fosters the opportunities while answering the challenges of implementing a HRIC. For this, we put forward five specific recommendations and action points to ensure that a European HRIC: i) is built on established standards and guidelines, providing cloud technologies through an open and decentralized infrastructure; ii) is developed and certified to the highest standards of interoperability and data security that can be trusted by all stakeholders; iii) is supported by a robust ethical and legal framework that is compliant with the EU General Data Protection Regulation (GDPR); iv) establishes a proper environment for the training of new generations of data and medical scientists; and v) stimulates research and innovation in transnational collaborations through public and private initiatives and partnerships funded by the EU through Horizon 2020 and Horizon Europe. The workshop participants received funding from the European Union Seventh Program for Research, Technological Development and Demonstration (FP7) and Horizon Research and Innovation Program (H2020) and other European Union programs under the following grant agreements: AETIONOMY (Developing an Aetiology-based Taxonomy of Human Disease—Approaches to Develop a New Taxonomy for Neurological Disorders, IMI-no115568), ANTI-SUPERBUG PCP (ANTISUPERBUG Precommercial Procurement, H2020-no688878), B-CAST (Breast CAncer Stratification understanding the determinants of risk and prognosis of molecular sub-types, H2020-no633784), BRIDGE Health (Bridging information and data generation for evidence-based health policy and research, H2020-no664691), CASyM (Coordinating Action Systems Medicine—Implementation of Systems Medicine across Europe, FP7-n°305033), CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI, FP7-no602150), CECM (Centre for New Methods in Computational Diagnostics and Personalized Therapy, H2020-no763734), COLOSSUS (Advancing a Precision Medicine Paradigm in Metastatic Colorectal Cancer: Systems based patient stratification solutions, H2020-no754923), COMPARE (COllaborative Management Platform for detection and Analyses of (Re-)emerging and foodborne outbreaks in Europe, H2020-no643476), CONNECARE (Personalized Connected Care for Complex Chronic Patients, H2020-no689802), CREATIVE (Collaborative REsearch on ACute Traumatic brain Injury in intensiVe care medicine in Europe, FP7-no602714), DEFORM (Define the global and financial impact of research misconduct H2020-no710246), ECCTR (European Cornea and Cell Transplant Registry, FP7-n°709723), E-COMPARED (European COMPARative Effectiveness Research on online Depression, FP7-no603098), ECRIN-IA (European Clinical Research Infrastructures Network- Integrating Activity, FP7-no284395), EHR4CR (Electronic Health Records Systems for Clinical Research, IMI-no115189) eInfraCentral (European E-infrastructures Services Gateway, H2020-no731049), ELIXIR (European Life-science Infrastructure for Biological Information, FP7-n°211601), ELIXIR-EXCELERATE (Fast track ELIXIR implementation and drive early user exploitation across the life sciences, H2020-no676559), eMEN (e-mental health innovation and transnational implementation platform North West Europe, H2020), EMIF (European Medical Information Framework, IMI-no115372), ERA PerMed (ERA-net Cofund in Personalized Medicine, H2020-no779282), eTRIKS (Delivering European Translational Information and Knowledge Management Services, IMI-1-no115446), EuroPOND (Data-driven models for progression of neurological diseases, H2020-n°666992), EurValve (Personalized Decision Support for Heart Valve disease, H2020-no689617), HBP SGA1/SGA2 (Human Brain Project specific grant agreements, H2020-n°720270/785907), ICT4DEPRESSION (User-friendly ICT tools to enhance self-management and effective treatment of depression in the EU, FP7-n°248778), ImpleMentAll (Towards evidence-based tailored implementation strategies for eHealth, H2020-no733025), INSTRUCT-ULTRA (Releasing the full potential of instruct to expand and consolidate infrastructure services for integrated structural life sciences research, H2020-no731005), MASTERMIND (Management of Mental Disorders through Advanced Technologies, CIP-no621000), MeDALL (Mechanisms of the Development of ALLergy, FP7-n°261357), MedBioinformatics (Creating medically-driven integrative bioinformatics applications focused on oncology, CNS disorders and their comorbidities, H2020-n°634143), MIDAS (Meaningful Integration of Data, Analytics and Services, H2020-no727721), MultipleMS (Multiple manifestations of genetic and non-genetic factors in Multiple Sclerosis disentangled with a multi-omics approach to accelerate personalized medicine, H2020-no733161), myPEBS (Randomized Comparison Of Risk-Stratified versus Standard Breast Cancer Screening European Women Aged 40–74, H2020-no755394), OpenAIRE-Advance (Advancing Open Scholarship, H2020-no777541), OpenMedicine (OpenMedicine, H2020-n°643796), PanCareSurFup (PanCare Childhood and Adolescent Cancer Survival Care and Follow-up Studies, FP7-n°257505), PIONEER (Prostate Cancer DIagnOsis and TreatmeNt Enhancement through the Power of Big Data in EuRope, H2020-IMI-2-n°777492), PREPARE (Platform for European Preparedness Against (Re-)emerging Epidemics, FP7-n°602525), Regions4PerMed (Interregional coordination for a deep and fast uptake of personalized health, H2020-no825812), RD-CONNECT (An integrated platform connecting registries, biobanks and clinical bioinformatics for rare disease research, FP7-no305344), Solve-RD (Solving the unsolved Rare Diseases, H2020-no779257), SPIDIA4P (SPIDIA for Personalized Medicine-Standardization of generic Pre-analytical procedures for In-vitro DIAgnostics for Personalized Medicine, H2020-no733112), SYSCID (A Systems medicine approach to chronic inflammatory disease, H2020-no733100), SysCLAD (Systems prediction of Chronic Allograft Dysfunction, FP7-n°305457), SYSCOL (Systems Biology of Colorectal Cancer, FP7-no258236), SysMedPD (Systems Medicine of Mitochondrial Parkinson’s Disease, H2020-n°668738), U-BIOPRED (Unbiased BIOmarkers for the PREDiction of respiratory disease outcomes, IMI-n°115010), VPH-share (Virtual Physiological Human: Sharing for Healthcare—A Research Environment, FP7-n°269978).

BackgroundDespite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the overall adoption levels of mHealth tools by health professionals remain relatively low. ObjectiveThis study aimed (1) to investigate attitudes of health care providers and mHealth experts toward mHealth tools in the health context in general, and this study aimed (2) to test the acceptability and feasibility of a specific mHealth tool for patients with an eating disorder (ED), called TCApp, among patients and ED specialists. MethodsTo this purpose, we conducted an explorative qualitative study with 4 in-depth group discussions with several groups of stakeholders: our first focus group was conducted with 11 experts on mHealth from the Catalan Association of Health Entities; the second focus group included 10 health care professionals from the Spanish College of Doctors of Barcelona; the third focus group involved 9 patients with an ED who had used the TCApp over a 12-week period, and the fourth and last focus group involved 8 ED specialists who had monitored such ED patients on the Web. ResultsThe focus groups showed that health care providers and mHealth experts reported barriers for mHealth adoption more often than facilitators, indicating that mHealth techniques are difficult to obtain and use. Most barriers were attributed to external factors relating to the human or organizational environment (ie, lack of time because of workload, lack of direct interest on a legislative or political level) rather than being attributed to internal factors relating to individual obstacles. The results of the mHealth intervention study indicate that the TCApp was considered as easy to use and useful, although patients and the ED specialists monitoring them on the Web reported different adoption problems, such as the inability to personalize the app, a lack of motivational and interactive components, or difficulties in adhering to the study protocol. ConclusionsIn general, this paper indicates that both health professionals and patients foresee difficulties that need to be addressed before comprehensive adoption and usage of mHealth techniques can be effectively implemented. Such findings are in line with previous studies, suggesting that although they acknowledge their possible benefits and cost-effectiveness, health care providers are quite resistant and conservative about integrating mHealth technologies in their daily practice.

Programa de Doctorat : Ciències Experimentals i Tecnologies "Tesi per compendi d'articles" Compendi d’estudis publicats entre el 2017 i el 2019, que demostren, entre d’altres coses, que els professionals sanitaris d’atenció primària de la salut (APS) utilitzen habitualment les aplicacions per a telèfons intel·ligents (apps) de plataformes socials, com WhatsApp, en un context professional; que les apps de plataforma social vertical (WhatsICS) poden ser una bona eina per millorar la comunicació efectiva entre els components d’un equip de treball multidisciplinar d’APS; i que l’ús d’un joc seriós, combinat en una mateixa app, amb eines de xarxa social (Tobbstop) , és efectiu per modificar conductes de risc, com l’abandonament de l’hàbit tabàquic durant la gestació. L’ús adequat de les xarxes social i les noves eines de gamificació són alguns camps de la mHealth que caldrà provar i estudiar en els propers anys, donat que aprendre a utilitzar-les pot ajudar-nos a millorar l’assistència, a l’hora que s’optimitzen uns recursos cada cop més escassos. Compendio de estudios publicados entre el 2017 y el 2019, que demuestran, entre otras cosas, que los profesionales sanitarios de atención primaria de la salud (APS) utilizan habitualmente las aplicaciones para teléfonos inteligentes (apps) de plataformas sociales, como WhatsApp, en un contexto profesional; que las apps de plataforma social vertical (WhatsICS) pueden ser una buena herramienta para mejorar la comunicación efectiva entre los componentes de un equipo de trabajo multidisciplinar de APS; y que el uso de un juego serio, combinado en una misma app, con herramientas de red social (Tobbstop), es efectivo para modificar conductas de riesgo, como el abandono del hábito tabáquico durante la gestación. El uso adecuado de las redes social y las nuevas herramientas de gamificación son algunos campos de la mHealth que habrá que probar y estudiar en los próximos años, dado que aprender a utilizarlas puede ayudar a mejorar la asistencia, a la hora que se optimizan unos recursos cada vez más escasos Compendium of studies published between 2017 and 2019, which show, among other things, that health professionals in primary health care (PHC) routinely use social media smartphones applications (apps), such as WhatsApp, in a professional context; that vertical social media apps (WhatsICS) can be a good tool to improve effective communication between the components of a PHC multidisciplinary work team; and that the use of a serious game, combined in the same app, with social network tools (Tobbstop), is effective in modifying risk behaviors, such as smoking cessation during pregnancy. The proper use of social networks and the new gamification tools are some fields of mHealth that will have to be tested and studied in the coming years, since learning to use them can help improve assistance, while optimizing resources increasingly scarce

Background: Communication skills are not learnt innately. It is therefore necessary to both train and evaluate medical students in this area. Aim: To evaluate communication skills of fourth-year medical students with the use of a simulated patient (SP). Material and Methods: Four clinical scenarios (CS) for clinical interviews with simulated patients were designed: chronic and acute diseases, difficult and functional patients. Each student performed the four CS, and his communication skills were evaluated using our own questionnaire as agreed with the SP. The questionnaire included items on verbal and nonverbal communication, warmth, respect, specificity, assertiveness and empathy (rated from 0 to 10). The response variable was the arithmetic mean of the scores on each item. All students received a detailed evaluation report. Results: Sixty one students (32 men) performing 244 interviews, were evaluated. The overall mean score was 7.87 (4.62 to 9.03). The highest scores were for respect and specificity (7.57 and 7.15 respectively). The lowest were for empathy and nonverbal communication (6.44 and 6.84 respectively). The CS evaluations were 7.87 (chronic disease), 7.02 (difficult patient), 6.46 (acute disease) and 6.14 (functional pathology). Women had higher overall scores compared to men (7.26 and 6.51 respectively; p < 0.01) and a significantly higher score in all communication variables (p < 0.01). Conclusions: The overall assessment in clinical communication with SP is satisfactory although there is room for improvement, especially in empathy and nonverbal communication. Women had significantly higher scores than men. info:eu-repo/semantics/acceptedVersion

Access to reliable and quality health information and appropriate medical advice can contribute to a dramatic reduction in the mortality figures of countries. The governments of the Americas are faced with the opportunity to continue working on this challenge, and their institutional presence on their websites should play a key role in this task. In a setting where the access to information is essential to both health professionals and citizens, it is relevant to analyze the role of national health authorities. Given that search engines play such a key role in the access to health information, it is important to specifically know - in connection to national health authorities - whether health information offered is easily available to the population, and whether this information is well-ranked in search engines. Quantitative methods were used to gather data on the institutional presence of national health authorities on the web. An exploratory and descriptive research served to analyze and interpret data and information obtained quantitatively from different perspectives, including an analysis by country, and also by leading causes of death. A total of 18 web pages were analyzed. Information on leading causes of death was searched on websites of national health authorities in the week of August 10-14, 2015. The probability of finding information of national health authorities on the 10 leading causes of death in a country, among the top 10 results on Google, is 6.66%. Additionally, ten out the 18 countries under study (55%) do not have information ranked among the top results in Google when searching for the selected terms. Additionally, a total of 33 websites represent the sources of information with the highest visibility for all the search strategies in each country on Google for the ten leading causes of death in a country. Two websites, the National Library of Medicine and Wikipedia, occur as a result with visibility in the total of eighteen countries of the sample. Taking into consideration that providing reliable and quality information on these topics to the population should be one of the priorities of national health authorities, these results suggest that national health authorities need to take measures to try to better position their contents. El acceso a información médica confiable y de calidad y el asesoramiento médico adecuado pueden contribuir a una reducción drástica en las cifras de mortalidad de los países. Los gobiernos de las Américas se enfrentan a la oportunidad de continuar trabajando en este desafío, y la presencia institucional en sus sitios web debe jugar un papel clave en esta tarea. En un entorno donde el acceso a la información es esencial tanto para los profesionales de la salud como para los ciudadanos, es relevante analizar el papel de las autoridades sanitarias nacionales. Dado que los motores de búsqueda desempeñan un papel tan importante en el acceso a la información de salud, es importante saber específicamente, en relación con las autoridades sanitarias nacionales, si la información de salud que se ofrece está fácilmente disponible para la población y si esta información está bien clasificada en los motores de búsqueda. Se han utilizado métodos cuantitativos para recopilar datos sobre la presencia institucional de las autoridades sanitarias nacionales en la web. Una investigación exploratoria y descriptiva ha servido para analizar e interpretar datos e información obtenidos cuantitativamente desde diferentes perspectivas, incluido un análisis por país y también por las principales causas de muerte. Se han analizado un total de 18 páginas web. Se buscó información sobre las principales causas de muerte en los sitios web de las autoridades nacionales de salud en la semana del 10 al 14 de agosto de 2015. La probabilidad de encontrar información de las autoridades sanitarias nacionales sobre las 10 principales causas de muerte en un país, entre los 10 primeros resultados en Google, es del 6,66%. Además, diez de los 18 países estudiados (55%) no tienen información clasificada entre los mejores resultados en Google al buscar los términos seleccionados. Además, un total de 33 sitios web representan las fuentes de información con la mayor visibilidad para todas las estrategias de búsqueda en cada país en Google para las diez principales causas de muerte en un país. Dos sitios web, la Biblioteca Nacional de Medicina y Wikipedia, aparecen como resultado con visibilidad en el total de dieciocho países de la muestra. Teniendo en cuenta que brindar información confiable y de calidad sobre estos temas a la población debería ser una de las prioridades de las autoridades sanitarias nacionales, estos resultados sugieren que las autoridades sanitarias nacionales deben tomar medidas para tratar de posicionar mejor sus contenidos. L'accés a informació mèdica confiable i de qualitat i l'assessorament mèdic adequat poden contribuir a una reducció drástica en les dades de mortalitat dels països. Els governs de les Amèriques s'enfronten a l'oportunitat de continuar treballant en aquest desafiament, i la presència institucional en els seus llocs web ha de jugar un paper clau en aquesta tasca. En un entorn on l'accés a la informació és essencial tant per als professionals de la salut com per als ciutadans, és rellevant analitzar el paper de les autoritats sanitàries nacionals. Donat que els motors de recerca tenen un paper tan important en l'accés a la informació de salut, és important saber específicament, en relació amb les autoritats sanitàries nacionals, si la informació de salut que s'ofereix és fàcilment disponible per a la població i si aquesta informació està ben classificada en els motors de cerca. S'han utilitzat mètodes quantitatius per recopilar dades sobre la presència institucional de les autoritats sanitàries nacionals a la web. Una investigació exploratòria i descriptiva ha servit per analitzar i interpretar dades i informació obtingudes quantitativament des de diferents perspectives, inclosa una anàlisi per país i també per les principals causes de mort. S'han analitzat un total de 18 pàgines web. Es va buscar informació sobre les principals causes de mort en els llocs web de les autoritats nacionals de salut en la setmana del 10 al 14 d'agost de 2015. La probabilitat de trobar informació de les autoritats sanitàries nacionals sobre les 10 principals causes de mort en un país, entre els 10 primers resultats a Google, és del 6,66%. A més, deu dels 18 països estudiats (55%) no tenen informació classificada entre els millors resultats a Google en cercar els termes seleccionats. A més, un total de 33 llocs web representen les fonts d'informació amb la major visibilitat per a totes les estratègies de cerca a cada país a Google per les deu principals causes de mort en un país. Dos llocs web, la Biblioteca Nacional de Medicina i Wikipedia, apareixen com a resultat amb visibilitat en el total de 18 països de la mostra. Tenint en compte que oferir informació confiable i de qualitat sobre aquests temes a la població hauria de ser una de les prioritats de les autoritats sanitàries nacionals, aquests resultats suggereixen que les autoritats sanitàries nacionals han de prendre mesures per tractar de posicionar millor els seus continguts.

summary This study sought to assess the impact of health care professional (HCP) communication on breast cancer patients across the acute care process as perceived by patients. Methodological approach was based on eight focus groups conducted with a sample of patients (n ¼ 37) drawn from 15 Spanish Regions; thematic analysis was undertaken using the National Cancer Institute (NCI) framework of HCP communication as the theoretical basis. Relevant results of this study were the identification of four main communication components: (1) reassurance in coping with uncertainty after symptom detection and prompt access until confirmed diagnosis; (2) fostering involvement before delivering treatments, by anticipating information on practical and emotional illness-related issues; (3) guidance on the different therapeutic options, through use of clinical scenarios; and, (4) eliciting the feeling of emotional exhaustion after ending treatments and addressing the management of potential treatment-related effects. These communication-related components highlighted the need for a comprehensive approach in this area of cancer care.

Necessitats d'informació sanitària; Ciutadania; Professionals Necesidades de información sanitaria; Ciudadanía; Profesionales Needs for health information; Citizenship; Professionals En aquest estudi es presenten les necessitats d’informació sanitària de la ciutadania en comparació amb les necessitats que tenen els professionals; dades molt útils per a l'Observatori del Sistema de Salut de Catalunya per repensar els continguts informatius a compartir, el llenguatge que caldrà emprar, i els formats i canals que utlitzarà per adequar-los a les necessitats de la ciutadania. En este estudio se presentan las necesidades de información sanitaria de la ciudadanía en comparación con las necesidades que tienen los profesionales; datos muy útiles para el Observatori del Sistema de Salut de Catalunya para repensar los contenidos informativos a compartir, el lenguaje que es necesario utilizar y los formatos y canales que utilizará para adecuarlos a las necesidades de la ciudadanía.

Treball de fi de màster en Lingüística Teòrica i Aplicada Tutora: Rosa Estopà Bagot Aquest estudi se centra en la comunicació entre metges i pacients en processos oncològics per detectar els principals problemes que causen les barreres lingüístiques i cognitives que existeixen entre especialistes i llecs en la matèria. La descripció d’una mostra de documentació mèdica, l’anàlisi d’alguns recursos lingüístics destinats a pacients i familiars i un estudi de necessitats són els objectius principals de la recerca d’aquest treball. Els resultats obtinguts ens mostren que l’ús de la terminologia mèdica és un dels factors que impedeixen la bona comunicació en aquest tipus d’actes comunicatius, ja sigui a causa del baix nivell d’alfabetització per a la salut del pacient o familiar, o bé a causa de la complexitat lingüística del discurs mèdic especialitzat.

Comunicació; Informació clínica del pacient; Dades de salut Communication; Clinical information of a patient; Data health Comunicación; Información clínica del paciente; Datos de salud Es diu que vivim en la "societat de la informació" però, reflexionant-hi una mica, potser es tracta més aviat d’una "societat de dades", moltes dades, o potser "de dades i opinions". Però les dades, aïllades, no són informació (dades organitzades de manera útil per a un objectiu). En el camp de la salut les dades necessiten ser interpretades perquè puguin resultar útils, entenent el receptor com a persona vulnerable però autònoma i afavorint un entorn comunicatiu presidit per la confiança.

Multidisciplinary teams (MDTs) are considered the gold standard of cancer care in many healthcare systems, but a clear definition of their format, scope of practice and operational criteria is still lacking. The aims of this review were to assess the impact of MDTs on patient outcomes in cancer care and identify their objectives, organisation and ability to engage patients in their care. We conducted a systematic review of the literature in the Medline database. Fifty-one peer-reviewed papers were selected from November 2005 to June 2012. MDTs resulted in better clinical and process outcomes for cancer patients, with evidence of improved survival among colorectal, head and neck, breast, oesophageal and lung cancer patients in the study period. Also, it was observed that MDTs have been associated with changes in clinical diagnostic and treatment decision-making with respect to urological, pancreatic, gastro-oesophageal, breast, melanoma, bladder, colorectal, prostate, head and neck and gynaecological cancer. Evidence is consistent in showing positive consequences for patients' management in multiple dimensions, which should encourage the development of structured multidisciplinary care, minimum standards and exchange of best practices.

Communicating with the patient in clinical practice refers to the way in which the doctor and the patient interact both verbally and nonverbally, in order to achieve a shared understanding of problems and solutions. Traditional learning and assessment systems are overwhelmed when it comes to addressing the complex and multi-dimensional problems of professional practice. Problem Based Learning (PBL) has been put forward as an alternative to the mere reproduction of knowledge and pre-established patterns, enabling students to develop their own learning strategies to overcome problems in their future professional practice. The challenge is to determine how to assess the acquisition of clinical communication skills. The authors have recommended a summative assessment of clinical communication skills based on the combination of different methods. It highlights the importance of feedback-based formative assessment. This raises the need to develop and validate assessment scales in clinical communication at an undergraduate level. Based on this work, the authors put forward a "fanned out" assessment in terms of clinical communication skills in Medicine degrees, with the use of different instruments in a "spiraled" manner, where the greater the contact with clinical practice in the various degree and integral courses, the greater difficulty experienced, with the participation of all the stakeholders involved (self, hetero and peer assessment) without precluding the involvement of patients (real or simulated) in the design of assessment instruments

Comunicarse con el paciente en la práctica clínica hace referencia a la forma en que el médico y el paciente se relacionan mediante el lenguaje verbal y no verbal con el objeto de alcanzar una comprensión compartida de problemas y soluciones. El gran reto es determinar cómo evaluar el grado de adquisición de competencias en comunicación clínica. Los autores del presente trabajo proponen una evaluación sumativa de las competencias en comunicación clínica basado en la combinación de diferentes métodos. Se destaca la importancia de la evaluación formativa mediante feed-back. Se plantea la necesidad de desarrollar y validar escalas de evaluación en comunicación clínica en el ámbito de pre-grado

La comunicación forma parte de la actividad clínica y en ocasiones determina el éxito o fracaso del proceso asistencial. Sin embargo, no ha sido reconocida en los planes de estudio del Estado español hasta muy recientemente, sobre todo con el impulso del llamado 'Plan Bolonia'. En el año 2009 se aprobó en la Facultad de Medicina de la Universitat de Barcelona un nuevo plan docente que proponía incorporar la enseñanza de la comunicación en las materias clínicas y pre-clínicas, contabilizando entre 3 y 6 créditos europeos (ECTS), como competencia transversal. El presente artículo aborda el diseño de esta competencia, los pros y contras, cómo se inserta en diferentes asignaturas y cómo puede evaluarse.

Recent research has shown that patients frequently experience difficulties understanding health-relevant numerical concepts. A prominent example is denominator neglect, or the tendency to pay too much attention to numerators in ratios (e.g., number of treated patients who died) with insufficient attention to denominators (e.g., overall number of treated patients). Denominator neglect can lead to inaccurate assessments of treatment risk reduction and thus can have important consequences for decisions about health. Here, we reviewed a series of studies investigating (1) different factors that can influence patients’ susceptibility to denominator neglect in medical decision making—including numerical or language-related abilities; (2) the extent to which denominator neglect can be attenuated by using visual aids; and (3) a factor that moderates the effectiveness of such aids (i.e., graph literacy). The review spans probabilistic national U.S. and German samples, as well as immigrant (i.e., Polish people living in the United Kingdom) and undergraduate samples in Spain. Theoretical and prescriptive implications are discussed., These studies are part of the projects ‘‘Helping People with Low Numeracy to Understand Medical Information,’’ funded by the Foundation for Informed Medical Decision Making (United States) and the Max Planck Society (Germany), “How to Improve Understanding of Risks about Health (PSI2008-02019),” funded by the Ministerio de Ciencia e Innovación (Spain), “Helping Doctors and Their Patients Make Decisions about Health (PSI2011-22954)” funded by the Ministerio de Economía y Competitividad (Spain), and “Strategies to Improve Comprehensions of Risks about Health” (Proyecto de Movilidad; Acciones Integradas) funded by the Ministerio de Ciencia e Innovación (Spain).

The study aims to identify community pharmacists' (CPs) utilization of information and communication technology (ICT); to develop and characterize a typology of CPs’ utilization of ICT and to identify factors that can enhance or inhibit the use of these technologies. An online survey of the 7649 members of the Pharmacist Association of Barcelona who had a registered email account in 2006 was carried out. Factor analysis, cluster analysis and binomial logit modelling were undertaken. Multivariate analysis of the CPs’ responses to the survey (648) revealed two profiles of adoption of ICT. The first profile (40.75%) represents those CPs who place high emphasis on ICT within their practice. This group is therefore referred to as ‘integrated CPs’. The second profile (59.25%) represents those CPs who make less use of ICT and so are consequently labelled ‘non-integrated CPs’. Statistical modelling was used to identify variables that were important in predisposing CPs to integrate ICT with their work. From the analysis it is evident that responses to questions relating to ‘recommend patients going on line for health information’; ‘patients discuss or share their Internet health information findings’; ‘emphasis on the Internet for communication and dissemination’ and ‘Pharmacists Professional Association information’ play a positive and significant role in the probability of being an ‘integrated CP’. The integration of ICT within CPs' practices cannot be adequately understood and appreciated without examining how CPs are making use of ICT within their own practice, their organizational context and the nature of the pharmacists–client relationship., JRC.J.3-Information Society

Máster en Bioética y Derecho de la Universitat de (IX promoción 2006-2008), El objeto de estudio del presente trabajo era: analizar la ética comunicativa en un hospital terciario de 1200 camas ubicado en una ciudad de la Comunidad Autónoma Vasca. Los objetivos marcados eran: - Conseguir información de cómo se realizaba esa comunicación entre pacientes-usuarios/as y facultativos/as. - Clarificar los posibles problemas existentes en torno a la comunicación. - Conocer cuál era la percepción de los pacientes y sus familias, en relación a la comunicación médico-paciente-familia. - Conocer las circunstancias en las que se desarrollaba la comunicación médico-pacientefamilia.

INTRODUCCIÓ: L'any 1987 es va engegar en l'Hospital de Viladecans una experiència pilot que consistia en la integració dels especialistes de la xarxa d'assistència primària a l'hospital de referència. Es tractava de valorar l'impacte que aquesta integració tenia en l'atenció sanitària d'una població concreta. Aquest fet ens va donar l'oportunitat d'implementar un model basat en l'atenció a l'àrea d'hospitalització i d'urgències per especialistes en MI, actuant les altres especialitats mèdiques com a metges consultors en aquestes dues àrees.OBJECTIU: Es planteja l'estudi de la eficàcia i eficiència d'aquest model organitzatiu en termes de resultats assistencials.MÈTODE: Es dissenya un organigrama que afavoreixi la comunicació interdisciplinària i intercol·legial. Es dissenya una eina informàtica que permeti l'anàlisi continuat de l'activitat assistencial ambulatòria i d'hospitalització (programa Wincon). S'analitzen els resultats obtinguts des de l'any 1993 al 2004.RESULTATS: L'experiència basada en la integració dels especialistes a l'hospital comarcal, ha aconseguit una elevada efectivitat i eficiència amb un manteniment de la qualitat assistencial en l'àmbit de les especialitats mèdiques.L'organigrama intern ha afavorit una estreta relació entre les especialitats mèdiques i entre les diferents àrees de l'hospital (hospitalització, consultes externes i urgències) el que ha permès una màxima ambulatorització (baixa taxa d'altes per mil habitants) i una bona capacitat de resolució (derivacions inferiors al 5% en un hospital sense unitats de crítics, hematologia, oncologia ni nefrologia).Aquestes fites s'han aconseguit sense una davallada de la qualitat (baix índex de reclamacions tant hospitalàries com de consultes, baix nombre de morts evitables, elevada proporció de malalts amb tractament de confort en el moment de l'èxitus, baixa taxa d'infeccions nosocomials, elevada concordança diagnostica dels ingressos urgents i baixa proporció d'ingressos inadequats).Hem aconseguit una disminució de l'estada mitjana gràcies al control de la infecció nosocomial, l'elevada concordança diagnostica i la incorporació de la UFISS (unitat funcional interdisciplinària sociosanitaria) de Geriatria, malgrat l'envelliment de la població ingressada amb el conseqüent increment de la comorbilitat i complexitat.Hem mantingut una elevada efectivitat amb un increment del 67% del número d'altes alhora que hem mantingut un escàs número d'ingressos inadequats. Aquest increment s'ha produït sobretot en el grup de malalts majors de 80 anys.A nivell de l'activitat ambulatòria s'ha mantingut contacte estret amb l'AP (Atenció Primària), retornant informació sobre els pacients consultats, i s'ha implementat un circuit de diagnòstic ràpid (UDD) i un hospital de dia per pacients crònics (UAD). Tot i l'elevada freqüentació i baixes TRV (Taxa de reiteració de visites) s'ha anat consolidant el control de les patologies cròniques, el seguiment de les altes hospitalàries i el tractament precoç de les descompensacions lleus, així com el diagnòstic ambulatori, el que ens ha ajudat a evitar ingressos i reingressos tenint com a resultat una baixa taxa d'hospitalització per la nostra població.Totes aquestes fites s'han aconseguit malgrat la presència de problemàtiques greus: escassos recursos públics sociosanitàris i de malalts crítics en la nostra àrea, una mancança de recursos humans dintre del servei (rendiments del personal facultatiu per sobre del 85% de forma mantinguda) i una elevada freqüentació a l'atenció especialitzada.CONCLUSIONS: Per tot això podem concloure que l'organigrama basat en la integració dels especialistes dintre del servei de Medicina Interna de l'hospital ha sigut efectiu i eficient sense disminuir la qualitat, i que la posada en marxa d'una eina de gestió clínica com el programa "Wincon" per a codificació diagnostica, tant a consultes externes com a hospitalització, ens ha permès analitzar la casuística i ha contribuït a la detecció de problemes. Com resultat d'aquest anàlisi, hem pogut implementar les intervencions adequades (UAD, UDD, UFISS, protocols de derivació i col·laboració amb la primària, agendes de visita ràpida, consultes d'infermeria...)., RESUMENINTRODUCCIÓN: En el año 1987 se puso en marcha en el Hospital de Viladecans una experiencia piloto que consistía en la integración de los médicos especialistas adscritos a la atención primaria en el hospital de referencia. Se trataba de valorar el impacto que esta integración tenía en la atención sanitaria de una población concreta. Este hecho nos dio la oportunidad de implementar un modelo organizativo basado en la atención del área de hospitalización y urgencias por especialistas en MI, actuando los otros especialistas médicos como consultores en estas dos áreas.OBJETIVO: Se plantea el estudio de la eficacia y eficiencia de este modelo organizativo en términos de resultados asistenciales.MÉTODO: Se diseña un organigrama que favorezca la comunicación interdisciplinaria y intercolegial. Se diseña un programa informático que permita el análisis continuado de la actividad asistencial ambulatoria y de hospitalización (programa Wincon). Se analizan los resultados obtenidos entre los años 1993 y el 2004.RESULTADOS: La experiencia basada en la integración de los especialistas en el hospital comarcal, ha conseguido una elevada efectividad y eficiencia con un mantenimiento de la calidad asistencial en el ámbito de les especialidades medicas.El organigrama interno ha favorecido una estrecha relación entre las especialidades medicas y entre las diferentes áreas del hospital (hospitalización, consultes externes i urgencias), lo que ha permitido una máxima ambulatorización (baja tasa de altas por mil habitantes) y una buena capacidad de resolución (derivaciones inferiores al 5% en un hospital sin unidad de críticos, hematológica, oncológica ni nefrológica).Estos objetivos se han conseguido sin perjudicar la calidad (bajo índice de reclamaciones tanto hospitalarias como de consultas, bajo número de muertes evitables, elevada proporción de enfermos con tratamiento de confort en el momento de la muerte, baja tasa de infección nosocomial, elevada concordancia diagnóstica de los ingresos urgentes y baja proporción de ingresos inadecuados).Al mismo tiempo hemos conseguido disminuir la estancia media gracias al control de la infección nosocomial, a una elevada concordancia diagnostica y a la incorporación de la Unidad Funcional Interdisciplinaria Socio sanitaria (UFISS) de Geriatría. Y todo ello a pesar del envejecimiento de la población ingresada con el consecuente aumento de la comorbilidad y complejidad.Además hemos mantenido una elevada efectividad incrementando en un 67% el número de altas y manteniendo el número de ingresos inadecuados muy bajo. Este incremento ha sido a expensas de pacientes mayores de 80 años.A nivel de la actividad ambulatoria se ha mantenido un estrecho contacto con la AP, informando sobre los pacientes consultados y consensuando protocolos de derivación, e implementando un circuito ambulatorio de diagnóstico rápido (UDD) y un hospital de día para pacientes crónicos (UAD). A pesar de la elevada frecuentación y tasas de reiteración de visitas (TRV) bajas, se ha consolidado el control de les patologías crónicas, el seguimiento de las altas hospitalarias y el tratamiento precoz de les descompensaciones leves, así como el diagnostico ambulatorio. Todo esto nos ha ayudado a evitar ingresos y reingresos y ha alcanzar como resultado una baja tasa de hospitalización para nuestra población.Estos indicadores se han conseguido a pesar de la presencia de problemáticas graves: escasos recursos públicos socio sanitarios y de camas de críticos en nuestra área, una falta de recursos humanos dentro del servicio (rendimientos del personal facultativo superiores al 85% de forma mantenida) y una elevada frecuentación a la atención especializada de nuestra población de referencia.CONCLUSIÓN: Por todo esto podemos concluir que el organigrama basado en la integración de los especialistas dentro del servicio de Medicina Interna, ha sido efectivo y eficiente sin disminuir la calidad. Y que la puesta en marcha de una "herramienta" de gestión clínica como el programa "Wincon" para la codificación diagnóstica, tanto en consultes externes como en hospitalización, nos ha permitido analizar la casuística y ha contribuido a la detección de problemas. Como resultado de este análisis hemos podido implementar las intervenciones adecuadas (UAD, UDD, UFISS, protocolos de derivación y colaboración con AP, agendas de visita rápida, consultas de enfermería...)PALABRAS CLAVE: Organigrama, Case - mix (GRD), (ICD-9), Reingresos, Estancia media, Estancias de más de 30 días, Derivaciones, Mortalidad, Infección nosocomial, Alternativas a la hospitalización, Hospital de día, Consultas de enfermería, Circuito de diagnostico rápido, Índice de reiteración de visitas, Gestión asistencial., INTRODUCTION:In 1987 the Hospital of Viladecans launched a pilot project to integrate in the hospital all medical specialists working in primary health care centers. It focused on assessing the impact of this integration on health care delivery in a designated community, in order to learn how to facilitate the introduction of this model on a larger scale.The data make it possible to implement a model based on actual hospitalizations and emergencies attended by specialists in Intern Medicine, with other medical (not chirurgical) specialists acting as consultants in these two areas.OBJECTIVE:To investigate de efficacy and efficiency of this organizational model in terms of health care delivery.METHODS:We designed an organization chart that facilitates interdisciplinary communication between the various medical specialities as well as between the various layers in the hospital and we introduced an information tool that permits continuous analysis of health care delivery for ambulatory as well hospitalized patients (Wincon program) We analyzed the health care delivery statistics between 1993-2004.RESULTS:The integration of medical specialists in a regional hospital by organizing and structuring their activities has proved to be highly effective and efficient without loss of quality of care.The internal organizational structure stimulated a close relationship between medical specialists as well as between various hospital services (hospitalization, outpatients clinic and emergency unit) By consequence, the number of admissions could be reduced to a minimum (low discharge rate per 1000 inhabitants) as a maximum number of patients was seen in the outpatient clinic by a good resolution capacity (referral to the tertiary care hospital lower than 5%, in a hospital without intensive care units and without hematology, oncology and nephrology departments).These results have been achieved without loss of quality of medical care (low rates of complaints about hospital and outpatients care, high percentage of terminal care patients, low avoidable death rate, low rate of nosocomial infections, high diagnostic concordance in emergency admissions, and low index of inadequate admissions).At the same time, despite the increased age of the admitted population and consequently the increased complexity and co morbidity of the patients, a decrease in the median length of stay was achieved due to control of nosocomial infections, a high diagnostic concordance, and the incorporation of the geriatric interdisciplinary social-medical team (UFISS).Moreover, a high effectivity has been maintained with an increase of 67% in the number of discharges. These discharges occurred mainly among patients older than 80 years with major complex diseases, while maintaining a scarce number of inadequate admissions.The outpatient clinic activity has maintained a close relationship with the general practitioners, informing them about the referred patients, making referrals protocols, and implementing a rapid diagnostic circuit ( UDD) and a day clinic for chronic patients (UAD) . Despite the high consulting rate and working on low rate of repeated consultation (TRV), the control of chronic pathologies, the follow-up of discharged patients, and the early treatment of mild decompensations have been consolidated, as well as diagnosing patient in ambulatory care. All this has aided to avoid admissions and readmissions, leading to a low hospitalization rate of the population in our region.All this has been achieved despite some major drawbacks: scarce public health funding for elderly home care and few intensive care beds, as well as an understaffed hospital (facultative performance has been continuously above 85%) and a high rate of specialized consulting.CONCLUSION:Therefore it can be concluded that the organization chart, based on the specialists' integration within the department of Internal Medicine in our hospital has lead to a highly effectivity and efficiency without loss of quality. Moreover, the start of the "Wincon" program, that codifies diagnoses in the outpatient clinic as well as by admission in the hospital, has allowed to analyze the cases, and to detect some problems. This has lead to the implementation of adequate interventions (day care unit - UAD, interdisciplinary social-medical team - UFISS, protocols for referral, collaboration with general practitioners, facilities for rapid diagnosis, and nurse consulting hours .).KEY-WORDS:Organizational Models, Diagnosis-Related Groups, Patient Readmission, Median length of stay, Stays for over 30 days, Patient Transfer, Hospital Mortality, Nosocomial infections, Alternatives for hospitalization, "Ambulatory care facilities", Office visits, Patient Care Management.

Diferentes estudios han demostrado que, en ocasiones, los pacientes tienen dificultades a la hora de entender lo que el médico quiere comunicarles. El presente artículo intenta reflexionar sobre cuáles son los determinantes que pueden influir en el proceso de comunicación del riesgo en pacientes que tienen antecedentes familiares de cáncer y acuden a las Unidades de Consejo Genético en busca de asesoramiento. Existen estudios que señalan que los pacientes con antecedentes familiares de cáncer se preocupan por padecer dicha enfermedad. Sólo algunos de ellos han explorado cómo los pacientes entienden y perciben el concepto de riesgo y los posibles sesgos asociados a él. Como primeras aproximaciones, creemos que es necesario utilizar un lenguaje sencillo, claro y fácil de entender por parte de los pacientes, huyendo del lenguaje epidemiológico o médico. Del mismo modo es importante diseñar programas de formación psicoeducativos y material de soporte adecuado, así como el correcto manejo del counselling como herramienta principal de trabajo por parte de los profesionales y fomentar futuras investigaciones en este área determinada.

Per les especials característiques de funcionament i d'organització dels serveis de urgència (SU) la comunicació metge-pacient pot ser especialment dificultosa en aquest àmbit. Considerant que és important que el pacient estigui correctament informat per tal d'obtenir una adequada eficiència del seu tractament, es va plantejar la realització de la present tesi amb dos objectius: primer, descriure com és la prescripció i la informació farmacològica en els SU del nostre entorn, i segon proposar i valorar unes mesures de intervenció, dirigides tant al pacient com al metge, amb la finalitat de augmentar la qualitat de la prescripció i de la informació en els SU. L'estudi es va realitzar en dos fases diferenciades:- Primera fase: estudi descriptiu transversal multicèntric en sis SU de la comarca del Vallès Occidental (Barcelona), cinc SU d'Atenció Primària (AP) de l'Institut Català de la Salut i un SU hospitalari de l'Hospital Parc Taulí de Sabadell, entre novembre de 1999 i juliol de 2000. En aquesta fase es va observar que en el 34,8% dels pacients (n=746) i en el 48,4% dels pacients (n=891), el metge no coneixia si el pacient era o no al·lèrgic a algun medicament o si estava o no prenent medicació concomitant, respectivament. Tanmateix, només en el 46,4% de las prescripcions analitzades (n=1.258), el pacient sabia tota la pauta del tractament prescrit en el SU. La informació es va obtenir, principalment, mitjançant enquestes realitzades als pacients.- Segona fase: estudi quasi-experimental d'intervenció controlat sense aleatorització on es valorava l'eficàcia de uns pòsters i fulls informatius dirigits bàsicament als pacients, en els SU d'AP, però que també podien actuar de recordatori pels metges. Els missatges a transmetre per aquests elements de comunicació eren que el pacient informés al metge del SUM sobre les seves al·lèrgies i sobre la medicació que ja estava prenent, a més a més de què s'assegurés de que entenia bé les instruccions que li donava el metge. El període de recollida de dades va ser entre octubre de 2002 i abril de 2003. Per valorar l'eficàcia de la intervenció es va realitzar la prova de Breslow-Day i Tarone. Els pòsters i fulls informatius es van mostrar clarament efectius en augmentar el coneixement del metge del SU sobre la medicació concomitant (grup intervenció disminució, referent a la primera fase, del 25% de pacients en què el metge desconeixia aquest fet, front a una disminució del 12,5% del grup control) i especialment efectius en augmentar la comprensió sobre la pauta del tractament prescrit por part del pacient (increment en el grup intervenció, referent a la primera fase, del 16,8% de las prescripcions en que hi havia un coneixement total de la posologia per part del pacient, comparat amb una disminució del 1% del grup control). Així, com a conclusions principals, el present estudi va posar de manifest que existeix un escàs coneixement per part del metge dels SU de les al·lèrgies i medicació concomitant dels pacients, a més a més de una insuficient comprensió del tractament prescrit per part del pacient. Els pòsters i fulls informatius han contribuït a disminuir el desconeixement del metge de l'historial farmacoterapèutic del pacient i a augmentar la comprensió total de la pauta del tractament per part del pacient., Objective: To assess whether to distribute an informational poster/pamphlets to emergency services' patients may increase the knowledge of doctor about patients' allergy and concomitant medication and to increase the comprehension of patients about their prescription medication.Design: First phase: descriptive, cross-sectional, multicentric. Second phase: quasi-experimental, controlled, no randomized, multicentric.Setting: Five outpatient emergency services (ES) and one hospital ES in Vallès Occidental region (Barcelona).Participants: Patients with prescription medication seen at the ES between November of 1999 and July of 2000 (first phase), and between October of 2002 and April of 2003 (second phase).Intervention: To distribute the informational poster/pamphlets to intervention group patients.Main measurements: 1) Number of patients whom the doctor didn't know the patient's allergy and/or concomitant medication. 2) Number of prescriptions what the patient correctly identified prescription medication's dosage. The patients were interviewed. Statistical significance was examined by means chi-square test and Breslow-Day and Tarone test.Results: Data on 1233 patients, with an average age of 29 + 18 years, and 1766 prescription were collected. Compared with the first phase results, the intervention group decreased - 25,5% (IC95: 33,5-17,5) of patients whom the doctor didn't know the patient's concomitant medication and the control group decreased -12,5% (IC95: 19,8-5,2), p=0,024. Also, the intervention group incremented +16,8% (IC95: 9,8-23,8) of prescription what the patient correctly knew the prescription medication dosage and the control group decreased -1% (pConclusion: To distribute the informational poster/pamphlets to patients is effective to increase the patients' knowledge about their medication and to improve the doctors' information about concomitant medication of their patients.

Crear y validar en nuestro país un Cuestionario base que permita su uso para el análisis de la comunicación medico-paciente que pueda ser utilizado en diferentes circunstancias. Validación para su uso en residentes con pacientes estandarizados (PE).

One of the important developments in assisted reproductive technology is the technique of oocyte preservation, which enables women to preserve their eggs when there is a threat of becoming infertile in the future. In spite of the still experimental status of this procedure, fertility clinics widely recommend it to healthy women who wish to postpone childbearing for social reasons. Since in fertility clinic's websites appear extensive recommendations and promotion about this technology, it seems important to analyze their online persuasive communication. Our analysis applies a mixed methodology of content and discourse analysis from a framing theory perspective. It provides an in-depth analysis of the content of fertility clinics' websites in Spain, describing their communication/information strategies regarding fertility preservation for social reasons. The present article confirms the inconsistency that exists in terms of the clarity of the information given by these websites, since the information is framed intending to attract more women to the egg freezing services.

Background: Communication skills are not learnt innately. It is therefore necessary to both train and evaluate medical students in this area. Aim: To evaluate communication skills of fourth-year medical students with the use of a simulated patient (SP). Material and Methods: Four clinical scenarios (CS) for clinical interviews with simulated patients were designed: chronic and acute diseases, difficult and functional patients. Each student performed the four CS, and his communication skills were evaluated using our own questionnaire as agreed with the SP. The questionnaire included items on verbal and nonverbal communication, warmth, respect, specificity, assertiveness and empathy (rated from 0 to 10). The response variable was the arithmetic mean of the scores on each item. All students received a detailed evaluation report. Results: Sixty one students (32 men) performing 244 interviews, were evaluated. The overall mean score was 7.87 (4.62 to 9.03). The highest scores were for respect and specificity (7.57 and 7.15 respectively). The lowest were for empathy and nonverbal communication (6.44 and 6.84 respectively). The CS evaluations were 7.87 (chronic disease), 7.02 (difficult patient), 6.46 (acute disease) and 6.14 (functional pathology). Women had higher overall scores compared to men (7.26 and 6.51 respectively; p < 0.01) and a significantly higher score in all communication variables (p < 0.01). Conclusions: The overall assessment in clinical communication with SP is satisfactory although there is room for improvement, especially in empathy and nonverbal communication. Women had significantly higher scores than men.

Background In order to play an active role in their health care, patients need information and motivation. Current delivery systems limit patients’ involvement because they do not routinely provide them with enough details of their own clinical results, conditions and other important clinical data. The purpose of this study was to identify, from the perspective of patients, which topics matter the most, who should be communicating them, and when and how should they be provided. Methods We conducted a qualitative, phenomenological study analysing the content of subjective experiences, feelings and behaviours. We organized two focus groups with 13 participants and 15 in-depth interviews. Transcripts of the focus groups and interviews were checked for accuracy and then entered into Atlas ti™ v7.5.13 qualitative software. Two independent researchers performed a qualitative inductive content analysis to classify the data in two levels: themes and categories. Results The qualitative analysis provided 377 units of meaning synthesized into 22 categories and six themes: hospitalization procedure, Health Literacy relating to the patient’s condition, information content, satisfaction, professional-patient relationship, and patient proactivity. Patients described which information they wished for, when they needed it, and who would provide it, usually related to actions such as admission, discharge or diagnostic tests. Oral information was more difficult to comprehend than the written kind, as patients can check written information several times if needed. Nurses were the most available professionals, and patients found easier to relate to them and ask them questions. Moreover, patients identified physicians as those professionals responsible for providing clinical information. Conclusions Our results showed that patients suffered from poor Health Literacy regarding their personal condition, as they were unable to describe the symptoms, the type of tests being performed or their results, and some of them also had difficulties in naming the specific disease or comorbidities they had. During the hospitalization process, patients were in good shape to come with doubts and actively asked for more information. Healthcare organizations and professionals were offered the chance to ensure the correct communication and comprehension to their patients.

Background Metaphors in communication can serve to convey individuals’ backgrounds, contexts, experiences, and worldviews. Metaphors used in a health care setting can help achieve consensual communication in professional–patient relationships. Patients use metaphors to describe symptoms, or how disease affects them. Health professionals draw on shared understanding of such metaphors to better comprehend and meet patient needs, and to communicate information that patients can more easily integrate into their lives. This study incorporated a theoretical framework based on four worldviews, each with an underlying foundational metaphor (root metaphor). The use of these root metaphors (formism, mechanism, contextualism, and organicism) can have an explanatory function and serve to impart new meanings, as each type of metaphor can lead to a particular interpretation. The study aimed to extract and discuss the root metaphors, with a view to analyzing the communication between health professionals and patients. Methods In a case study in Spain over a six-month period, we analyzed the content of recorded, transcribed interviews conducted by one nurse with 32 patients who had chronic illnesses. We inductively extracted five categories that emerged from the interviews: blood sugar, cholesterol, exercise, blood pressure, and diet. We then examined these categories from the standpoint of each of the four root metaphors using two approaches: A series (deductive) and an emergent (inductive) approach. Results The results show that the nurse tended to primarily use two worldviews: mechanism and formism. In contrast, patients tended to favor mechanism when discussing cholesterol, blood pressure, and blood sugar levels, whereas contextualism was predominant when the category was diet or exercise. Conclusions This study adds to the existing literature on health professionals and patients’ communication. It shows how the use of Pepper’s root metaphors help to analyze the communication between the nurse and patients. Furthermore, it shows they are both using different root metaphors when they are talking about illness and treatments especially regarding blood sugar, cholesterol, exercise, blood pressure, and diet. Further qualitative and quantitative studies are needed to solidly these findings. Electronic supplementary material The online version of this article (10.1186/s12909-017-1059-0) contains supplementary material, which is available to authorized users.