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Considering current water situation, reuse is an effective solution to meet water demand and reduce pressure on conventional water sources. However, pharmaceutical and personal care products (PPCPs) in effluents from wastewater treatment plants (WWTPs) decrease their quality and suitability. With the aim of identifying and monitoring both the influence of PPCPs and the suitability of effluents to be reused, this study proposes the development of a composite indicator (CI) related to PPCP presence in WWTPs, through the common weight multi-criteria decision analysis (MCDA)–data envelopment analysis (DEA) model. Obtaining a CI for PPCPs is a novel approach in the published literature, showing a new perspective in PPCP management and their influence in wastewater treatment. Furthermore, this study proposes an improvement on MCDA-DEA model which maintains the initial hierarchy obtained for the units analyzed. The development of CI is based on information about the technological, environmental, social, and biological issues of WWTPs. Results show that 4 of the 33 WWTPs analysed had the best CI values, meaning that their effluents have lower environmental impact. The development of a CI related to PPCPs in WWTPs suggests that further steps are needed to manage the WWTP effluents. Hence, the need to implement preventive measures in WWTPs has been shown, even though the removal of PPCPs is not yet part of European law. This work highlights the importance of considering PPCPs as priority pollutants in wastewater management and reuse frameworks, to guarantee low environmental impact and adapt wastewater reuse based on a circular economy approach. This work has been supported by the Spanish Ministry of Economy and Competitiveness and the ERDF (European Regional Development Fund) through the project Eco2TOOLS (No. CGL2015-64454-C2-1-R, subproject Eco2RISK-DDS).

The prevalence of penetrating complications in Crohn's disease (CD) increases progressively over time, but evidence on the medical treatment in this setting is limited. The aim of this study was to evaluate the effectiveness of biologic agents in CD complicated with internal fistulizing disease.Adult patients with CD-related fistulae who received at least one biologic agent for this condition from the prospectively-maintained ENEIDA registry were included. Exclusion criteria involved those receiving biologics for perianal disease, enterocutaneous, rectovaginal, anastomotic or periostomal fistulae. The primary endpoint was fistula-related surgery. Predictive factors associated with surgery and fistula closure were evaluated by multivariate logistic regression and survival analyses.A total of 760 patients from 53 hospitals (673 receiving anti-TNFs, 69 ustekinumab, and 18 vedolizumab) were included. After a median follow-up of 56 months (IQR, 26-102), 240 patients required surgery, with surgery rates of 32%, 41%, 24% among those under anti-TNF, vedolizumab, or ustekinumab, respectively. Fistula closure was observed in 24% of patients. Older patients, ileocolonic disease, entero-urinary fistulae, or an intestinal stricture distal to the origin of the fistula were associated with a higher risk of surgery, while non-smokers, and combination therapy with an immunomodulator reduced this risk.Biologic therapy is beneficial in approximately three quarters of patients with fistulizing CD, achieving fistula closure in 24%. However, around one third still undergo surgery due to refractory disease. Some patient and lesion-related factors can identify patients who will obtain more benefit from these drugs.

Optimal management is usually at the top of the concerns in the context of water infrastructures. In the specific domain of wastewater treatment plants (WWTPs), European Directive 91/271 established the need of implementing a biological treatment of wastewater leading to an intensive construction of WWTPs in several European countries, which now present important problems of maintenance. These facilities are composed of different types of assets, which should be managed efficiently in order to optimize the performance of the processes as well as the maintenance and replacement costs of the equipment. In fact, the deterioration of these assets increases the operational risk and endangers the continuity of the service of these WWTPs. In this paper, the authors combine multicriteria methodologies (MCDM) and economic aspects of the equipment to define an appropriate technical–economical replacement policy. With the aim of developing a reference procedure in the wastewater sector, an approach has been made to blower pump, which is an equipment widely used in WWTPs to provide a continuous air flow to the reactor facilitating the elimination of organic matter and the nutrients contained in the wastewater. The proposal integrates aspects such as acquisition costs and corrective maintenance, interest rate, and amortization based on the condition of the equipment.

Management of Wastewater Treatment Plants (WWTPs) is a complex process, not only from a technical point of view but also from an economic point of view. There are several factors that influence the wastewater treatment process and can cause an increase in management costs. One of these factors is the treatment capacity, in particular the WWTPs’ oversizing problem. The difference between the design population equivalent (p.e.) and the actual p.e. treated generates imbalances in the wastewater treatment process costs. This paper analyses the influence that oversizing has on the maintenance costs for WWTPs in the Valencia region (Spain). Through an econometric approach, the behaviour of WWTPs including the oversizing variable has been modelled. Specifically, maintenance cost functions have been obtained to model the variability of maintenance costs according to oversizing influence. To date, this approach has not been considered in the published literature, reinforcing the novelty of this work. Results verify the significant influence of oversizing on maintenance costs in WWTPs. Modelling proposed in this work acts as an effective tool for WWTP managers to identify both the maintenance cost trend and how far the WWTP is from the design p.e. Likewise, results confirm the fact that WWTPs should work close to their design p.e. to improve the efficiency of the wastewater treatment process, reducing WWTPs’ costs.

Circular economy has become a very popular item in the last decades in many fields. Particularly, in the water and wastewater sector, since a lot of pressure has been put on water resources. Although the main target of the application of circular economy in this sector has been waste management, the current research intends to extend its application to other aspects. In this sense, it is highlighted the role that asset management could play in wastewater treatments plants extending the useful life of the equipment and the facilities, and how it could contribute to the circular economy, measuring the impact in economic and environmental terms. Making use of the Analytical Hierarchy Process (AHP) it can be observed that maintenance tasks are one of the most important factors to avoid equipment deterioration. This research offers valuable results that will be useful to assess the condition of the equipment helping the decision-makers to optimize the maintenance tasks and plan replacement strategies that will lead to accomplishing the principles of circular economy, increasing the service life span of the equipment, and reducing the repairing costs, and minimizing the environmental impact associated to the replacement of the equipment.

The operation and management of Wastewater Treatment Plants (WWTPs) is of paramount importance to guarantee the sustainability of water resources. Just like any other production process, wastewater treatment process involves different costs, such as: energy, personnel, maintenance and reagents. Regarding maintenance costs, they have become an issue of great concern to many operators in the last years. Maintaining the facilities in good condition ensures the proper performance of these infrastructures and reduces the risk of failures. It should be known that equipment breakdowns imply an increase in operating costs, with a high risk of generating an environmental damage due to the malfunction or the stoppage of the process. To address this situation, preventive maintenance polices are portrayed as the best strategies to reduce equipment breakdowns and repairs. Although maintenance costs are a relevant issue for wastewater treatment plant operators, there are not many studies that assess the influence of maintenance on the efficiency of the facilities. In order to fill this gap an empirical study is proposed for a sample of wastewater treatment plants facilities.

The present work analyses the existence of congestion in a set of wastewater treatment plants (WWTPs) for the first time. The study sample included 47 WWTPs managed by the same operator and located in the Valencia region (eastern Spain). The method of analysis consisted in applying a new statistical model to identify and correct congestion situations based on data envelopment analysis (DEA), which takes into account undesirable outputs and multiple projections. The results showed a strong concentration of congested WWTPs (48.94-57.45%). Furthermore, the necessary corrections to avoid the congestion statuses entailed an average input reduction between 57.03 and 74.13% and an average increase in desirable outputs between 46.08% and 50.08%. In addition, only plant size had a significant relationship with the correction levels. The remaining contextual variables (age, overcapacity and type of water and sludge line) failed to show any significant impact on those corrections. To conclude, policy recommendations to improve the management of WWTPs are put forward, notably improving the management of smaller plants, which concentrate the largest percentage of correction.

COVID-19; Immunosuppression; Inflammatory bowel disease COVID-19; Immunosupressió; Malaltia inflamatòria intestinal COVID-19; Inmunosupresión; Enfermedad inflamatoria intestinal (1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case−control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March−July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p < 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p < 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3−5.9), occupational risk (OR: 2.9; 95%CI: 1.8−4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2−2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09−0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution.

Wastewater treatment plants (WWTPs) represent a great opportunity within the framework of the circular economy. Not only are WWTPs an alternative source of water, but they can provide other valuable resources for other sectors such as water and energy. For instance, the nutrients contained in wastewater are of great importance for agriculture, since they can be used as fertilizers. In this sense, evaluating the efficiency of wastewater treatment processes makes it possible to identify those aspects that improve the performance of these infrastructures, thus ensuring their long-term sustainability. Most of the previous studies evaluate the efficiency based on the resources used and the total pollutant removal, this aspect does not consider that the quantity of pollutants that WWTPs are obliged to remove depend on the characteristics of the discharge location. To address this, an advanced efficiency model is applied to differentiate between the amount of pollutants that the Directive 91/271/EEC oblige to remove and the extra quantity of pollutants that WWTPs remove beyond the legal requirements. The results show that most of the facilities are able to remove a higher quantity of pollutants and, consequently, generate more resources for the society. The methodology and results of this study are of great interest to WWTP managers and administrations, encouraging the implementation of design-based solutions to maximize by-product collection in the wastewater treatment sector and improve the efficiency of these facilities.

There is a growing concern regarding the scarcity of natural resources. The levels of resource exploitation generated by the current system of production and consumption has led the European Commission to develop a set of guidelines that aim to reduce the pressure on natural resources. The set of guidelines proposed by the European Union is based on the transformation of the current linear economic system into a circular system in which resources and materials remain in the production system for longer. However, for this change to take effect, practical measures are required. This paper presents an industrial symbiosis approach as a practical application of a circular economy model. The aim of this paper is to develop a guide to successfully implement an industrial symbiosis network, demonstrating that industrial symbiosis can achieve the goals of a circular economy. To demonstrate this, an example of its implementation is provided in a region of Spain, which is responsible for producing approximately 95% of the total ceramics products in the nation. This study emphasises the set of barriers that need to be addressed in order to make new models a reality for business and consumers, society, and the environment.

Background and Aims The development programm UNIFI has shown promising results of ustekinumab in ulcerative colitis [UC] treatment which should be confirmed in clinical practice. We aimed to evaluate the durability, effectiveness, and safety of ustekinumab in UC in real life. Methods Patients included in the prospectively maintained ENEIDA registry, who received at least one intravenous dose of ustekinumab due to active UC [Partial Mayo Score [PMS]>2], were included. Clinical activity and effectiveness were defined based on PMS. Short-term response was assessed at Week 16. Results A total of 95 patients were included. At Week 16, 53% of patients had response [including 35% of patients in remission]. In the multivariate analysis, elevated serum C-reactive protein was the only variable significantly associated with lower likelihood of achieving remission. Remission was achieved in 39% and 33% of patients at Weeks 24 and 52, respectively; 36% of patients discontinued the treatment with ustekinumab during a median follow-up of 31 weeks. The probability of maintaining ustekinumab treatment was 87% at Week 16, 63% at Week 56, and 59% at Week 72; primary failure was the main reason for ustekinumab discontinuation. No variable was associated with risk of discontinuation. Three patients reported adverse events; one of them had a fatal severe SARS-CoV-2 infection. Conclusions Ustekinumab is effective in both the short and the long term in real life, even in a highly refractory cohort. Higher inflammatory burden at baseline correlated with lower probability of achieving remission. Safety was consistent with the known profile of ustekinumab.

The COVID-19 pandemic has forced major changes in the care of patients with inflammatory bowel disease (IBD). The articles by El Hajra et al. and Fernández Álvarez el al. show the modifications in patient management that were performed during the state of alarm in Spain.

Background and Aims Although commonly used in inflammatory bowel disease [IBD], thiopurines frequently cause intolerance, and switching to a second thiopurine has only been reported in some small series. Ours aims in this study were to evaluate the safety of switching to a second thiopurine in a large cohort, and to assess the impact of age on tolerance. Methods Adult IBD patients from the ENEIDA registry, who were switched to a second thiopurine due to adverse events [excluding malignancies and infections], were identified. At the beginning of thiopurine treatment, patients were divided by age into two groups: 18–50 and over 60 years of age. The rate and concordance of adverse events between the first and second thiopurines, treatment intolerance, and persistence with the second thiopurine were evaluated. Results A total of 1278 patients [13% over 60 years of age] were switched to a second thiopurine. At 12 months, the cumulative probability of switch intolerance was 43%, and persistence with treatment was 49%. Independent risk factors of switch intolerance were age over 60 years (odds ratio [OR] 1.49; 95% confidence interval [CI] 1.07–2.07; p = 0.017) , previous gastrointestinal toxicity [OR 1.4; 95% CI 1.11–1.78; p = 0.005], previous acute pancreatitis [OR 6.78; 95% CI 2.55–18.05; p Conclusions In a large series in clinical practice, switching to a second thiopurine proved to be a valid strategy. Tight monitoring of elderly IBD patients switching to a second thiopurine because of adverse events is recommended.

Aberrant DNA methylation detected in liquid biopsies is a promising approach for colorectal cancer (CRC) detection, including premalignant advanced adenomas (AA). We evaluated the diagnostic capability of serum NEUROG1 methylation for the detection of AA and CRC. A CpG island in NEUROG1 promoter was assessed by bisulfite pyrosequencing in a case-control cohort to select optimal CpGs. Selected sites were evaluated through a nested methylation-specific qPCR custom assay in a screening cohort of 504 asymptomatic family-risk individuals. Individuals with no colorectal findings and benign pathologies showed low serum NEUROG1 methylation, similar to non-advanced adenomas. Contrarily, individuals bearing AA or CRC (advanced neoplasia&mdash, AN), exhibited increased NEUROG1 methylation. Using &gt, 1.3518% as NEUROG1 cut-off (90.60% specificity), 33.33% of AN and 32.08% of AA were identified, detecting 50% CRC cases. Nonetheless, the combination of NEUROG1 with fecal immunochemical test (FIT), together with age and gender through a multivariate logistic regression resulted in an AUC = 0.810 for AN, and 0.796 for AA, detecting all cancer cases and 35&ndash, 47% AA (specificity 98&ndash, 95%). The combination of NEUROG1 methylation with FIT, age and gender demonstrated a convenient performance for the detection of CRC and AA, providing a valuable tool for CRC screening programs in asymptomatic individuals.

Background & Aims Most fulfillment and benchmarking information for colonoscopy quality indicators has been obtained from studies of primary screening colonoscopies. We analyzed differences in the fulfillment of colonoscopy quality indicators based on the indication for endoscopy. Methods We performed an observational, multicenter, cross-sectional study of 14,867 patients who underwent endoscopy procedures for gastrointestinal symptoms (40.3%), a positive result from a fecal immunochemical test (36.0%), postpolypectomy surveillance (15.3%), or primary screening (8.4%), from February 2016 through December 2017 at 14 centers in Spain. We evaluated rates of adequate colon cleansing, cecal intubation, adenoma detection, and colorectal cancer detection, among others. We used findings from primary screening colonoscopies as the reference standard. Results Fewer than 90% of patients had adequate bowel preparation; 83.1% of patients with gastrointestinal symptoms had adequate bowel preparation (odds ratio [OR] compared with patients with primary screening colonoscopies, 0.62; 95% CI, 0.49–0.78) and 85.3% of patients receiving postpolypectomy surveillance had adequate bowel preparation (OR, 0.71; 95% CI, 0.55–0.91). The cecal intubation rate was also lower in patients with gastrointestinal symptoms (93.1%) (OR, 0.34; 95% CI, 0.22–0.52). The adenoma detection rate was higher in patients with a positive result from a fecal immunochemical test (46.4%) (OR, 2.01; 95% CI, 1.71–2.35) and in patients undergoing postpolypectomy surveillance (48.2%) (OR, 1.41; 95% CI, 1.20–1.67). The highest proportion of patients with colorectal cancer was in the gastrointestinal symptom group (5.1%) (OR, 5.24; 95% CI, 2.30–11.93) and the lowest was in patients undergoing surveillance (0.8%) (OR, 0.83; 95% CI, 0.32–2.14). Conclusions Fulfillment of colonoscopy performance measures varies substantially by indication. Policies addressing performance measures beyond colonoscopy screening procedures should be developed. Benchmarking recommendations could be adjusted according to colonoscopy indication.

The water cycle, from catchment to discharge, is a sector that involves an important investment and operation and maintenance costs. In particular, sewage treatment is a challenge for governments because they are having to consider economic, environmental, and social aspects. Within the European Union, implementation of Directive 91/271/EEC is responsible for the location of wastewater treatment facilities in the territory, due to the requirement that all urban areas must have this infrastructure to reduce the environmental impact of treated water in water bodies. Different sizes of municipalities affect the design of each wastewater treatment plant (WWTP) and cause variations in the operation process. The presence of scale economies in this sector has a significant influence on the efficiency of the wastewater treatment process and has a direct impact on the operational costs. Based on the pursuit of economic and environmental efficiency, this analysis extends the scope of the current literature because it recommends a specific, population equivalent (p.e.) range for which it would be suitable to achieve efficiency in wastewater treatment facilities-shedding light on the open debate about scale economies in WWTPs.

Colorectal cancer (CRC) is the third most common cancer and the fourth cause of cancer-related mortality worldwide. In an attempt to raise awareness on this situation, and to implement preventive measures, March 31st has been established as international colorectal cancer awareness day. Our country, with the Spanish "Alianza para la Prevención del Cáncer de Colon", pioneered in 2008 an institution that brought together scientific and civil societies to pursue this goal. A stabilization, even a decrease in the incidence and mortality of this condition has been reported in western countries for the last few years, which may be attributed to a number of highly relevant factors.

The presence of pharmaceutical and personal care products and drugs of abuse (PPCPs) in wastewater treatment plants (WWTPs) indicates discharge of the effluent may not be suitable for the ecological balance of water ecosystems, such as wetlands. These PPCPs degrade water quality, considered as an ecosystem service (ES), provoking serious environmental impacts. Assessing the monetary value of PPCPs can be used as a proxy for environmental status of the ES of water quality (ESWQ). Considering PPCPs as non-desirable outputs of WWTPs, the shadow prices methodology has been implemented using directional distance function to measure the environmental avoided cost of removing salicylic acid (SA), methylparaben (MP), and THCOOH from WWTPs effluents discharged to Albufera Natural Park (Spain). The SA shows the highest shadow price (138.16 €/μg), followed by THCOOH (48.15 €/μg), and MP (30.66 €/μg). These values are interpreted as the environmental cost that would be avoided if SA, MP, and THCOOH were removed from WWTPs effluents. The non-parametric tests show that wastewater treatment technology, together with population equivalent (as a proxy of the size of urban areas) and seasonality are factors that influence shadow prices obtained. The approach used in this study highlights the use of PPCPs as status indicators of ESWQ quantified in monetary units. As a way to synthesize the essential concepts to implement the shadow prices approach, this study proposes a flow diagram to represent the relationship between all the factors involved in this work. The use of shadow prices methodology proves that removing SA, MP, and THCOOH is associated with a measurable improvement in the ESWQ of Albufera Natural Park. The findings of this study will be useful for plant managers in order to make decisions about the removal of PPCPs in WWTPs effluents., This work has been supported by the Spanish Ministry of Economy and Competitiveness and the ERDF (European Regional Development Fund) through the project Eco2TOOLS (No. CGL2015-64454-C2-1-R, subproject Eco2RISK-DDS)

Wastewater treatment plants (WWTPs) are aging and its effects on the process are more evident as time goes by. Due to the deterioration of the facilities, the efficiency of the treatment process decreases gradually. Within this framework, this paper proves the increase in the energy consumption of the WWTPs with time, and finds differences among facilities size. Accordingly, the paper aims to develop a dynamic energy cost function capable of predicting the energy cost of the process in the future. The time variable is used to introduce the aging effects on the energy cost estimation in order to increase the accuracy of the estimation. For this purpose, the evolution of energy costs will be assessed and modelled for a group of WWTPs using the methodology of cost functions. The results will be useful for the managers of the facilities in the decision making process.

The implementation of the Directive 91/271 / CEE resulted in the proliferation of new Wastewater Treatment Plants (WWTPs) all around Europe. These facilities, which are compound by a wide range of assets (civil works, electromechanical equipment, pipelines, etc.), are ageing and deteriorating having an impact on the efficiency of the process. It is founded that repairs and corrective maintenance costs have increased in the last years, due to the deterioration process. Therefore, the aim of the present study is to focus on the cost effects of the deterioration process of the facilities in different wastewater treatment technologies. The analysis of these impacts will allow the operators to make decisions on the convenience of applying a preventive maintenance program as well as the selection of the best time for the replacement of the equipment. These results will contribute to the technical and economic optimization of the wastewater treatment process, reducing, also its environmental effects. In order to achieve this purpose a model of the repairs and corrective maintenance cost will be developed for a group of WWTPs with extended aeration and activated sludge technologies, offering valuable results for the managers of the WWTPs in the decision making process.

Background: There is no information on the impact of age and gender on the diagnostic yield of different positivity thresholds for the fecal immunochemical test for hemoglobin (FIT). Objectives: To evaluate the performance of this test at distinct positivity cut-offs in a population -based colorectal cancer (CRC) screening program. Methods: CRC detection rate (DR), and analysis of resources were evaluated retrospectively, at different cut-offs of FIT (20, 25, 30, 35 and 40 tig Hb/g) respect to a reference value (15 tig Hb/g), according to age and gender, in a screening population of 10,611 participants of the ColonPrev study (Quintero. NEJM 2013). Results: At the reference cut-off value, 36 CRC and 252 advanced adenomas (AA) were diagnosed. Increasing the cut-off in women 60 years increasing cut-off at 25-30 tig Hb/g. In men >60 years, all increases in the cut-off affected the CRC DR, especially when the cut-off was increased from 35 to 40 tig Hb/g (CRC miss rate 25%). Conclusions: To improve the performance of FIT in CRC screening programs, FIT cut-offs could be individualized by age and gender. (C) 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Introduccion: La enfermedad inflamatoria intestinal (EII) es una afeccion cronica de etiologia no esclarecida cuya incidencia aumenta en nuestra sociedad1, 2. En un porcentaje elevado de casos su diagnostico se realiza en edades tempranas y precisa de un tratamiento continuado3, requiriendo en muchos casos politerapia medicamentosa con farmacos que presentan potenciales efectos adversos4, por lo que es necesario tras su indicacion realizar un seguimiento y una monitorizacion que valore la adhesion y la tolerancia en estos pacientes y que permita la deteccion precoz de sus posibles efectos adversos4, 5. En los ultimos anos se ha producido un incremento en el numero de unidades de atencion integral (UAI) dirigidas al manejo de la EII. Su actuacion se basa en un trabajo en equipo mediante el desarrollo de protocolos estandarizados en los que se detallan las acciones de cada miembro del equipo con la finalidad de conseguir un orden y una continuidad en el cuidado de los pacientes ...

Colonoscopy and fecal immunochemical testing (FIT) are accepted strategies for colorectal-cancer screening in the average-risk population. METHODS: In this randomized, controlled trial involving asymptomatic adults 50 to 69 years of age, we compared one-time colonoscopy in 26,703 subjects with FIT every 2 years in 26,599 subjects. The primary outcome was the rate of death from colorectal cancer at 10 years. This interim report describes rates of participation, diagnostic findings, and occurrence of major complications at completion of the baseline screening. Study outcomes were analyzed in both intention-to-screen and as-screened populations. RESULTS: The rate of participation was higher in the FIT group than in the colonoscopy group (34.2% vs. 24.6%, P, Supported by grants from Asociación Española contra el Cáncer (Fundación Científica and Junta de Barcelona), Instituto de Salud Carlos III (PI08/90717), FEDER funds, and Agència de Gestió d’Ajuts Universitaris i de Recerca (2009SGR849). Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) is funded by Instituto de Salud Carlos III. In the Basque Country, the study received additional grants from Obra Social de Kutxa, Diputación Foral de Gipuzkoa (DFG 07/5), Departamento de Sanidad del Gobierno Vasco, EITB-Maratoia (BIO 07/ CA/19), and Acción Transversal contra el Cáncer del CIBERehd (2008). In Galicia, this work was supported by Dirección Xeral de Innovación e Xestión da Saúde Pública, Conselleria de Sanidade, and Xunta de Galicia. Eiken Chemical of Japan and its Spanish representatives, Palex Medical and Biogen Diagnóstica, donated supplies and automated analyzers used for FIT

Resumen Introduccion El manejo de los pacientes con enfermedad inflamatoria intestinal (EII) se asocia a un importante consumo de recursos sanitarios. En el ano 2009 se creo en el CHUVI una consulta de enfermeria en patologia digestiva, con disponibilidad de atencion telematica. El notable incremento en esta area nos estimula a cuantificar el ahorro de lo que esta atencion puede suponer para el sistema de salud. Objetivos 1) Valorar los resultados de la puesta en marcha de una consulta telematica. 2) Valorar la capacidad de resolucion telematica por parte de enfermeria. 3) Estimar el posible ahorro de la consulta telematica de EII. Material y metodo Recogida de la actividad telematica de 2009 a 2011. Analisis estimado del ahorro sanitario, mediante la aplicacion de las tarifas por servicios sanitarios del SERGAS, para demandas originadas por aparicion de nueva clinica/brote de actividad de EII. Analisis de datos con SPSS 15.0 Resultados Existe un aumento lineal significativo de la resolucion telefonica de demandas por parte de enfermeria (p = 0,03) y una reduccion de las que precisan acudir a consulta medica (p De las demandas por brote (n = 452), solo han requerido atencion en el servicio de urgencias 65 (14,38%), precisando su ingreso 33 (7,3%). El calculo del ahorro medio estimado en 2009-2011 ascenderia de media a 73.603 €. Conclusiones Se objetiva un aumento de la capacidad de resolucion de la atencion telematica por parte de enfermeria. En cuanto al ahorro estimado, podemos concluir que la atencion telematica consigue un ahorro significativo de los costes sanitarios, que justifica la implementacion de una consulta de enfermeria en patologia digestiva.

BACKGROUND: Screening for colorectal cancer with sigmoidoscopy benefits from the fact that distal findings predict the risk of advanced proximal neoplasms (APNs). This study was aimed at comparing the existing strategies of postsigmoidoscopy referral to colonoscopy in terms of accuracy and resources needed. METHODS: Asymptomatic individuals aged 50-69 years were eligible for a randomized controlled trial designed to compare colonoscopy and fecal immunochemical test. Sigmoidoscopy yield was estimated from results obtained in the colonoscopy arm according to three sets of criteria of colonoscopy referral (from those proposed in the UK Flexible Sigmoidoscopy, Screening for COlon REctum [SCORE], and Norwegian Colorectal Cancer Prevention [NORCCAP] trials). Advanced neoplasm detection rate, sensitivity, specificity, and number of individuals needed to refer for colonoscopy to detect one APN were calculated. Logistic regression analysis was performed to identify distal findings associated with APN. All statistical tests were two-sided. RESULTS: APN was found in 255 of 5059 (5.0%) individuals. Fulfillment of UK (6.2%), SCORE (12.0%), and NORCCAP (17.9%) criteria varied statistically significantly (P < .001). The NORCCAP strategy obtained the highest sensitivity for APN detection (36.9%), and the UK approach reached the highest specificity (94.6%). The number of individuals needed to refer for colonoscopy to detect one APN was 6 (95% confidence interval [CI] = 4 to 7), 8 (95% CI = 6 to 9), and 10 (95% CI = 8 to 12) when the UK, SCORE, and NORCCAP criteria were used, respectively. The logistic regression analysis identified distal adenoma ≥10 mm (odds ratio = 3.77; 95% CI = 2.52 to 5.65) as the strongest independent predictor of APN. CONCLUSIONS: Whereas the NORCCAP criteria achieved the highest sensitivity for APN detection, the UK recommendations benefited from the lowest number of individuals needed to refer for colonoscopy.

The management of patients with inflammatory bowel disease (IBD) is associated with a significant use of healthcare resources. In 2009, a digestive diseases nursing consultation, with availability of health telematic media was created in our hospital (CHUVI). The important activity performed in this area encouraged us to quantify the cost savings for the care health system.1) To evaluate the results of the implementation of a telematic IBD consultation. 2) To assess the capacity for resolving problems by nurses. 3) To estimate the potential cost savings of telematic nursing consultation in IBD.We collected data on telematic activity from 2009 to 2011. The estimated cost saving was calculated by applying the fees for health services published by our National Health Service (SERGAS) for care in new outbreaks of IBD activity. Data were analyzed with SPSS 15.0 RESULTS: There was a significant linear increase on the resolution of telephone demands by nurses (P=.03) and an important decrease of demands needing medical advice (P.0001). Focusing on IBD outbreak claims (n=452), only 65 patients (14.38%) required medical attention in emergency services, and 33 (7.3%) were hospitalized. Altogether we calculated an average cost saving since 2009 to 2011 of 73,603€.We found a gradual increase in resolving telematic care demands by nurses. Telematic consultation can lead to significant cost savings, which justify the implementation of a digestive diseases nurse consultation.

Introduction: A system for monitoring the use of aphaeresis in the treatment of ulcerative colitis (UC), named system for monitoring aphaeresis in ulcerative colitis (SiMAC), was designed in 2006 in the Basque Country. In the present study, the opinion of the clinicians who participated in SiMAC was evaluated, in order to identify the barriers and gather suggestions that could improve implementation of this kind of system. Methods: A mixed questionnaire was designed, in order to gather clinicians' assessments of the SiMAC monitoring system. Results: The response rate was 73.9% (17/23). The data from 40.96% (159/388) of patients with UC treated with aphaeresis was recorded. The main reasons for not including the data from all treated patients were a lack of required data or not meeting the study inclusion criteria. Positive aspects of the SiMAC were identified, as the simplicity of data collection and its systematic, multi-center approach. The negative aspects mentioned were the use of a local computer application and the lack of time for health professionals to enter data. Discussion: The use of monitoring systems helps to formalize the introduction of technologies of little-known effectiveness; involve clinicians and medical societies in coming to agreement and obtaining information about the safety, effectiveness or efficiency of new technologies; and provide relevant information to health-care administrations for making decisions about the introduction of new technologies into healthcare practice. In order for a monitoring system to work, the process must be straightforward. A minimum set of key variables that are easy to collect must be selected, and an effort made to involve a range of stakeholders, especially institutions and scientific societies, to support the work group.

Maestría en Educación con Campo en Formación Docente en el Ambito Regional