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Background The socioeconomic impact of rare diseases has been mostly studied at the macrolevel, but evidence at the microlevel is lacking, which overshadows health-related social inequalities affecting people with rare diseases, namely, health selection effects. Aim This study presents an overview of employment and work ability in individuals living with rare diseases, two factors related to health selection effects. Methods A systematic literature review was conducted using the PRISMA checklist. Three electronic databases, PubMed, Embase, and Web of Science, were searched from 2013 to 2023. Eligible studies needed to investigate at least one work-related outcome measuring employment or work ability in individuals living with rare diseases and to compare it with a control group. Indeed, including only studies with matched or standardized control groups is essential for ensuring the reliability and validity of research findings. Results Of the 7,694 abstracts identified, 44 studies, including 34 rare diseases, met the inclusion criteria. Administrative databases were used to collect work-related data in 48% of the studies, and 73% of the studies employed matching methods for comparison. Overall, 52% of the studies focused solely on employment, 14% focused solely on work ability and 34% included both categories. Individuals with rare diseases were less likely to be employed or more likely to be unemployed than controls in 68% of the studies and 87% of the studies reported that individuals with rare diseases were more likely to be work disabled. Regarding work ability, 90% of the studies reported more missed work time in cases than in controls, and more perceived impairment at work was found in 100% of the studies. Discussion/conclusion These results show that individuals with rare diseases tend to have poor work outcomes, but methodological limitations hamper the understanding of health selection effects. Implications for future research and policy-making are discussed.

Introduction Cervical cancer remains a significant cause of morbidity and mortality among women globally, despite the availability of effective prevention tools. The use of self-sampling devices for human papillomavirus (HPV) testing is a promising strategy to increase screening participation, particularly in settings dominated by opportunistic models. Understanding women’s preferences regarding invitation methods and device design is essential to ensure effective and equitable programme implementation. This study explored the expectations, preferences, and perceived barriers of women aged 35 to 65 in the Valencian Community (VC), Spain, in anticipation of launching a population-based cervical screening program. Methods A qualitative study was conducted using four face-to-face focus groups involving 29 women, selected from the target population of the screening programme (healthy women aged 35-65 residing in the VC). The session combined an individual assessment (questionnaire and electronic response system of five self-sampling devices) with a structured group discussion. Preferences regarding invitation channels, test communication, and device usability were analyzed through descriptive statistics and thematic content analysis. Results Self-sampling was highly accepted, with 96.4% of women stating they would perform it at home. Preferred channels for both invitations and results were SMS and local health centers. Simplicity and ease of use were the key features of the device accepted by the largest number of women—FLOQSwab. Evalyn Brush was also positively valued for its attractive design and was the preferred option for some women. Participants expressed concerns about reliability and proper use, particularly among older women or those with limited body awareness. Familiarity with colorectal screening supported acceptance. Importantly, device selection emerged as a key factor in facilitating participation. The integration of digital technologies (SMS, health apps) was positively valued as a means of increasing accessibility, improving communication, and supporting equity in outreach efforts. Conclusion Self-sampling is a feasible and widely accepted strategy for cervical cancer screening. Effective implementation requires validated devices, culturally adapted information campaigns, and digital engagement tools to maximize participation and reduce inequalities. Plain Language Summary Cervical cancer can often be prevented with regular screening tests. However, in many places, only women who go to the doctor on their own get tested. This limits how many women are protected. This study looked at a new way to improve participation in cervical cancer screening. It explored what women think about using self-sampling devices (tools that allow women to collect their own samples for HPV testing at home). Researchers wanted to understand which devices women prefer and how they feel about getting invited to screening using digital tools like text messages or health apps. The study included 29 women aged 35 to 65 in the Valencian Community, Spain. They saw five different self-sampling devices and shared their opinions in group discussions. Most women (96%) said they would use self-sampling at home. They preferred simple devices that were easy to use. They also liked being contacted by SMS and having the option to return the sample to a health center. Some women had concerns about doing the test correctly and missing a chance to talk to a doctor. Others felt confident and said it reminded them of the home test for colon cancer. This study shows that self-sampling is well accepted and can help reach more women. Choosing the right device and using modern communication tools may increase screening and reduce health inequalities.

Objectives: This study presents a systematic review aimed at evaluating the effectiveness of virtual patients in enhancing clinical reasoning skills in medical education. A hybrid methodology was used, combining human reviewers and ChatGPT to assess the impact of conversational virtual patients on student learning outcomes and satisfaction. Methods: Various studies involving conversational virtual patients were analyzed to determine the effect of these digital tools on clinical competencies. The hybrid review process incorporated both human assessments and AI-driven reviews, allowing a comparison of accuracy between the two approaches. Results: Consistent with previous systematic reviews, our findings suggest that conversational virtual patients can improve clinical competencies, particularly in history-taking and clinical reasoning. Regarding student feedback, satisfaction tends to be higher when virtual patients’ interactions are more realistic, often due to the use of artificial intelligence (AI) and natural language processing (NLP) in the simulators. Furthermore, the study compares the accuracy of AI-driven reviews with human assessments, revealing comparable results. Conclusions: This research highlights AI’s potential to complement human expertise in academic evaluations, contributing to more efficient and consistent systematic reviews in rapidly evolving educational fields.

Objectives: Analyze the presence of acute stress response after adverse events in human talent in Colombian health institutions from 2017 to 2021. Methods: Cross-sectional study of prevalence, carried out on 838 members of the human talent in health (professionals, technicians, technologists, and auxiliaries) of Colombian health institutions in the study period with the application of the EASE instrument. Univariate analysis using descriptive statistical techniques, chi-square and Student’s t-test, and bivariate analysis with a Poisson regression model using the institucional SPSS v. 26. Results: The prevalence of adverse events in the last 5 years was 33.8%, presenting levels of acute stress qualifying as Medium-high emotional overload at 21.91%, while extreme acute stress was at 3.53%. The prevalence of risk for presenting acute stress after being involved in an adverse event was PR: 1.30 (CI: 1.24–1.36). Conclusion: Acute stress in human talent after adverse events is limiting health and care capacity and must be efficiently addressed by health institutions. Psychosocial risk is linked within the framework of the patient safety program and the institutional occupational health and safety management systems.

Background Cardiovascular diseases are becoming more frequent throughout the world. Adherence to both pharmacological and non-pharmacological treatment, as well as lifestyles, is important for good management and control of the disease. This study aims to explore the opinions and perceptions of patients with ischemic heart disease on the difficulties associated with therapeutic adherence. Methods An interpretive phenomenological study was carried out using focus groups and one semi-structured interview. The MAXQDA qualitative data analysis program was used for inductive interpretation of the group discourses and interview. Data were coded, and these were grouped by categories and then consolidated under the main themes identified. Results Two in-person focus groups and one remote semi-structured interview were performed. Twelve participants (6 men and 6 women) from the Hospital de San Juan de Alicante participated, two of them being family companions . The main themes identified were aspects related to the individual, heart disease, drug treatment, and the perception of the health care system. Conclusions Adhering to recommendations on healthy behaviors and taking prescribed medications for cardiovascular disease was important for most participants. However, they sometimes found polypharmacy difficult to manage, especially when they did not perceive the symptoms of their disease. Participants related the concept of fear to therapeutic adherence, believing that the latter increased with the former. The relationship with health professionals was described as optimal, but, nevertheless, the coordination of the health care system was seen as limited.

Background/Objectives: Schizophrenia Spectrum Disorder (SSD) represents a major challenge for healthcare systems due to its chronic nature, comorbid conditions, and high socioeconomic impact. Ensuring high-quality care for patients with SSD requires well-defined quality criteria based on consensus from healthcare professionals, patients, and caregivers. This study aims to identify and prioritize quality criteria for SSD care. Methods: A qualitative research approach was applied, including incorporating two focus groups—one with patients and caregivers (n = 7) and another with healthcare professionals (n = 8)—alongside the Delphi technique. The Delphi panel included 32 participants from psychiatry, primary care, mental health nursing, social work, and patient associations. The first round had an 88.9% response rate, while the second round achieved full participation (100%). The Delphi process was conducted and reported according to recommended guidelines for consensus methods (ACCORD checklist), specifying panel composition, rounds, predefined consensus thresholds, and controlled feedback between rounds. Results: A total of 26 quality criteria were ultimately selected, categorized into 16 identified barriers to effective care. Key priorities included early diagnosis protocols, coordinated multidisciplinary care, and improved access to specialized mental health services. Conclusions: The findings underscore the necessity of integrating patient experience into healthcare evaluation and highlight the potential for implementing a certification system to standardize SSD care across healthcare settings.

OBJECTIVES: To know the frequency and causes of low value surgical practices, according to the opinion of surgeons and anesthetists, and to determine their degree of knowledge about the Spanish “Choosing wisely” initiative. METHODS: Cross-sectional observational study, based on a self-administered online questionnaire through an opportunistic sample of 370 surgeons and anesthetists from three Spanish regions, contacted through Scientific Societies. The survey took part between July and December 2017. RESULTS: A patient profile requesting unnecessary practices was identified (female, 51−65 years old and unaffiliated disease). The frequency of requests was weekly or daily for 50.0% of the professionals, of whom 15.1% acknowledged succumbing to these pressures. To dissuade the patient, clinical reasons (47%) were considered the most effective. To increase control and safety in the case was the main reason to indicate them. The greatest responsibility for overuse was attributed to physicians, defensive medicine and mass media. Assessing professionals’ knowledge on unnecessary practices, an average of 5 correct answers out of 7 was obtained. Some 64.1% of the respondents were unaware of the Spanish “Choosing wisely” initiative. CONCLUSIONS: Low value surgical practices are perceived as a frequent problem, which requires an approach entailing intervention with patients and the media as well as professionals. Increase awareness on unnecessary surgical practices, and how to avoid them remain essential.

Background: Overuse reduces the efficiency of healthcare systems and compromises patient safety. Different institutions have issued recommendations on the indication of preoperative chest X-rays, but the degree of compliance with these recommendations is unknown. This study investigates the frequency and characteristics of the inappropriateness of this practice. Methods: This is a descriptive observational study with analytical components, performed in a tertiary hospital in the Community of Madrid (Spain) between July 2018 and June 2019. The inappropriateness of preoperative chest X-ray tests was analyzed according to “Choosing Wisely”, “No Hacer” and “Essencial” initiatives and the cost associated with this practice was estimated in Relative Value and Monetary Units. Results: A total of 3449 preoperative chest X-ray tests were performed during the period of study. In total, 5.4% of them were unjustified according to the “No Hacer” recommendation and 73.3% according to “Choosing Wisely” and “Essencial” criteria, which would be equivalent to 5.6% and 11.8% of the interventions in which this test was unnecessary, respectively. One or more preoperative chest X-ray(s) were indicated in more than 20% of the interventions in which another chest X-ray had already been performed in the previous 3 months. A higher inappropriateness score was also recorded for interventions with an American Society of Anesthesiologists (ASA) grade ≥ III (16.5%). The Anesthesiology service obtained a lower inappropriateness score than other Petitioning Surgical Services (57.5% according to “Choosing Wisely” and “Essencial”; 4.1% according to “No Hacer”). Inappropriate indication of chest X-rays represents an annual cost of EUR 52,122.69 (170.1 Relative Value Units) according to “No Hacer” and EUR 3895.29 (2276.1 Relative Value Units) according to “Choosing Wisely” or “Essencial” criteria. Conclusions: There was wide variability between the recommendations that directly affected the degree of inappropriateness found, with the main reasons for inappropriateness being duplication of preoperative chest X-rays and the lack of consideration of the particularities of thoracic interventions. This inappropriateness implies a significant expense according to the applicable recommendations and therefore a high opportunity cost.

To identify practices that do not add value, cause harm, or subject patients with chronic obstructive pulmonary disease (COPD) to a level of risk that outweighs possible benefits (overuse). A qualitative approach was applied. First, a multidisciplinary group of healthcare professionals used the Metaplan technique to draft and rank a list of overused procedures as well as self-care practices in patients with stable and exacerbated COPD. Second, in successive consensus-building rounds, description files were created for each \"do not do\" (DND) recommendation, consisting of a definition, description, quality of supporting evidence for the recommendation, and the indicator used to measure the degree of overuse. The consensus group comprised 6 pulmonologists, 2 general practitioners, 1 nurse, and 1 physiotherapist. In total, 16 DND recommendations were made for patients with COPD: 6 for stable COPD, 6 for exacerbated COPD, and 4 concerning self-care. Overuse poses a risk for patients and jeopardizes care quality. These 16 DND recommendations for COPD will lower care risks and improve disease management, facilitate communication between physicians and patients, and bolster patient ability to provide self-care.

Introduction: Un reto compartido es la mejora de la atención a la cronicidad y cuidados integrados y su impacto sanitario, laboral y social. BIOEF, UMH y MSD desde hace  8 años, comenzaron una colaboración para desarrollar un instrumento que hiciera operativo en el SNS los modelos internacionales de atención a la cronicidad. Actualmente, , IEMAC y IEXPAC son instrumentos de ayuda  a las organizaciones sanitarias y sociales, disponibles en (http://www.iemac.org). Short description of practice change implemented: IEMAC permite la autoevaluación de las organizaciones en relación con la cronicidad. Actúa como hoja de ruta identificando puntos fuertes y áreas de mejora en sus procesos de implementación de atención integrada, avanzando en el conocimiento experto, la innovación y proyectos colaborativos. IEXPAC contribuye a introducir el paradigma de “la experiencia de paciente y el cuidador” en las mejoras de la prestación y cuidados integrados con enfoque en mejora de resultados relevantes para la persona. Aim and theory of change: CCM ha demostrado mejores resultados en la atención a personas con enfermedades crónicas. IEMAC e IEXPAC facilitan su adopción por las organizaciones. Target: IEMAC dirigido a organizaciones sanitarias y sociales. IEXPAC, a personas con enfermedad crónica y cuidadores.. Timeline: IEMAC desde 2011 se utiliza por servicios de salud autonómicos (macro), áreas, distritos o departamentos (meso) o por centros y dispositivos asistenciales (micro). IEXPAC está disponible desde 2015. Highlights (innovación, Impacto y resultados): IEMAC, se articula en las 6 áreas del CCM, ha demostrado su capacidad para transformar el modelo de atención a la cronicidad. Este instrumento se aplica mediante una metodología de autoevaluación 13 de los 17 servicios de salud autonómicos se han evaluado con IEMAC. Hasta julio de 2018 hay registradas 108 evaluaciones, siendo 28 reevaluaciones (26%). IEMAC ha demostrado su potencial para medir cambios en el modelo asistencial y mejorar resultados. IEXPAC ha sido utilizado por más de 4000 pacientes en diversas patologías crónicas, mostrando capacidad discriminatoria según perfiles de pacientes, años de evolución de enfermedad, y patología. Comments on sustainability: La colaboración muestra fortalezas por su complementariedad y adaptación a nuevos retos de las organizaciones. Comments on transferability: IEMAC e IEXPAC se han utilizado fácilmente en distintos contextos, organizaciones y condiciones crónicas. Conclusions: IEMAC, ha sido valorado por gestores y clinicos como herramienta de planificación estratégica y operativa, adaptándose al contexto y ritmo de implementación del cambio organizacional. Algunas de ellas utilizan ambos instrumentos en sus procesos asistenciales y contratos de gestión (Osakidetza, ICS). Discussions: Las sesiones de autoevaluación crean un espacio de interacción profesional, de reflexión sobre valores, roles y competencias, intervenciones y procesos que evidencian la necesidad y compromiso de los equipos en mejorar la atención a la persona, avanzando en la interiorización del modelo de atención a la cronicidad. Lecciones aprendidas: Colaboración estable entre instituciones con diferentes roles y responsabilidades que han demostrado ser complementarios, con transparencia y evolucionando en el tiempo de acuerdo a las necesidades del entorno: cronicidad, experiencia del paciente y salud poblacional.