Disability Degree Assessment: A Comprehensive Approach According to Royal Decree 888/2022

BACKGORUND AND OBJECTIVE

Royal Decree 888/2022 establishes that the evaluation of disability situations is carried out by multiprofessional teams responsible for assessing and recognizing the degree of disability. The participation of professionals in the healthcare and social fields can be valuable in providing reports from which the necessary data for the proper assessment of disability can be obtained, with the ultimate goal of providing comprehensive assistance to people with disabilities.

MATERIALS AND METHODS

An analysis and summary of Royal Decree 888/2022, which has recently come into effect, is performed, focusing on the most relevant aspects for professionals in the healthcare and social fields.

RESULTS

The recognition and classification of the degree of disability are the responsibility of the autonomous communities, and the assessments are issued by multiprofessional teams. To do this, four components are evaluated using the criteria outlined in the annexes of the Royal Decree itself. Each criterion generates a score that is combined to obtain a single score, the Final Disability Degree of the Person.

CONCLUSIONS

The pathology that causes the disability must have been previously diagnosed by the Healthcare System and considered permanent. Its evaluation is based on the evidence of objective clinical findings that are documented and supported by clinical reports. For this reason, it is important to maintain an accurate medical history, document reviews, and provide all relevant evidence.

Implementation of a traceability system and safe manufacturing medications in a clean room

OBJECTIVE

To describe the process of implementing a traceability and safe drug manufacturing system in the clean room of a Pharmacy Service to increase patient safety, in accordance with current legislation.

METHODS

The process was carried out between September 2021 and July 2022. The software program integrated all the recommended stages of the manufacturing process outlined in the "Good Practices Guide for Medication Preparation in Pharmacy Services" (GBPP). The following sections were parameterized in the software program: personnel, facilities, equipment, starting materials, packaging materials, standardized work procedures, and quality controls.

RESULTS

A total of 50 users, 4 elaboration areas and 113 equipments were included. 435 components were parameterized (195 raw materials and 240 pharmaceutical specialties), 54 packaging materials, 376 standardized work procedures (123 of them corresponding to sterile medicines and 253 to non-sterile medicines, of which 52 non-sterile were dangerous), in addition 17 were high risk, 327 medium risk, 32 low risk, and 13 quality controls.

CONCLUSIONS

The computerization of the production process has allowed the implementation of a traceability and secure drug manufacturing system in a controlled environment in accordance with current legislation.

Research ethics: From principles to practical aspects

Any research conducted on human beings or human biological samples requires a prior ethical assessment to avoid risks and problems for all involved parties. The legislation in this regard is very broad and emphasizes the safeguarding of patient rights in relation to the universal principles of autonomy, beneficence and justice. The present article reviews the regulations applicable to clinical trials, observational studies with drugs, biobank projects or any other type of study that may be conducted in the health care field. It also addresses the role of research ethics committees, data protection and the foundations of scientific integrity.

Royal Decree 601/2019 on justification and optimization: Practical aspects

The Royal Decree 601/2019 of 18th October is the result of the partial transposition into the Spanish legal system of the Euratom Directive 59/2013. This Royal Decree includes the mandates of the Directive related to the need to justify and optimize medical exposure, including that of asymptomatic people, proposal of stricter requirements regarding the information that must be provided to the patient, registration and notification of the doses of medical-radiological procedures, use of reference levels for diagnosis and the availability of dose-indicating devices. The article reviews the most relevant aspects and novelties related to the principles of justification, optimization, dose control and the obligations derived from the right to information and consent. This Royal Decree considers essential for radiologists to develop a high level of competence and a new list of responsibilities and functions, which are detailed and analysed in this article.

[Analysis of the legal framework on food supplements for menopause in Spanish community pharmacies]

OBJECTIVE

To analyze the legal framework for the marketing of specific food supplements prescribed and indicated for menopause symptoms, so that it is verified if according to the effects on health that they produce, should be considered in the category of food supplements, or in others included in our legal system.

METHOD

An exhaustive review of the legal frameworks applicable to food supplements used both in Spain and in Europe, collecting those aspects that are related to legal concepts such as the definition of medicine for human use, medicine based on medicinal plants, or the so-called "frontier products".

RESULTS

There is a large number of products that can be called "frontier products", they can fit into different product categories, they can fit into different product categories, since some of the plants in their formulation are also authorized for use as industrial medicines or medicines based on traditional medicinal plants.

CONCLUSIONS

There are currently specific food supplements for menopause that raise reasonable doubts about their inclusion in other legal categories, both as medicines for human use, or as herbal medicines, so the legislator would need to enable more agile mechanisms and more frequent reviews of the new certainties that science finds, and that can change the status of these products.

[Legislaction, ethics and kidney transplantation.]

Kidney transplantation (KT) is the best therapeutic option for patients with end-stage renal disease in terms of survival, quality of life and cost-effectiveness. The fundamental difference of KT with respect to other therapies is that the process depends on the availability of organs for clinical use, availability that is insufficient to cover the increasing transplantation needs of the population. Another relevant feature of transplantation is that it entails a risk of transmission of diseases from donor to recipient, a risk that can be minimized, but not completely eliminated. Due to its characteristics and its unique nature (the human being), KT requires a specific regulation that guarantees the protection of all those who participate in the process: donors and their families, patients in need of a transplant, recipients of organs and healthcareprofessionals involved. In this article, we reviewthe ethical-legal standards that regulate the practice of kidney donation and transplantation at the international level and analyze the ethical-legal framework that is applicable in Spain.

[Euthanasia laws in Spain and in the world: Medical aspects]

Objetivo

Comparar la ley española de eutanasia y suicidio asistido con las que existen en otros países.

Diseño

Revisión sistemática de la bibliografía.

Fuentes de datos

Se buscaron en Medline/PubMed, EMBASE y Biblioteca Cochrane los estudios que contuvieran en su título o resumen los descriptores «eutanasia» o «suicidio asistido» y además «legislación» o «ley», entre 2002 y final de 2020.

Selección de estudios La búsqueda encontró 1.647 estudios y tras su cribado se valoraron 663, de los cuales 30 se incluyeron en la revisión. Se rechazaron estudios en los que solo constaran opiniones o no aportaran datos sobre la eutanasia/suicidio asistido en los países que los tienen regulados.

Extracción de datos

Se registraron los criterios que regulan la aceptación o rechazo de una petición de eutanasia o suicidio asistido en España y en los demás países en que están despenalizados.

Resultados

Las regulaciones de la eutanasia en el mundo pueden agruparse en tres: leyes que permiten la eutanasia y el suicidio asistido (Países Bajos, Bélgica, Canadá, algunos estados de Australia, Nueva Zelanda, España), en las que la ley solo permite el suicidio asistido (EE. UU.) y en las que se admite únicamente el suicidio asistido y en base a sentencias judiciales, sin legislación específica (Suiza, Alemania).

Conclusiones

Aunque hay diferencias, las leyes a las que más se asemeja la ley española de eutanasia son las de Países Bajos y Bélgica, por lo que es previsible que la casuística de eutanasia y sus cifras en España se parezcan en el futuro a las de estos países.

Telemedicine, ethics, and law in times of COVID-19. A look towards the future

The health emergency in Spain caused by COVID-19 was of such a magnitude that on March 14, 2020, a state of alarm was declared that lasted for more than three months. This ongoing pandemic has affected a vast number of people. Among the measures taken to reduce the risk of contagion, visits to health centers have been reduced and virtual consultations have increased. Once the pandemic ends, it will be necessary to consider whether telemedicine should be limited to periods of health crises or whether it could become a new way of practicing medicine. Telemedicine lacks specific regulations and has loopholes that leave physicians with a considerable degree of insecurity. This article analyzes the limits, precautions, and legal standards of the use of telemedicine.

School lunch menus in Spain. A review on recommendations and policy

INTRODUCTION

An appropriate diet in childhood is essential for suitable growth and development, but it is also essential for preventing the development of non-communicable diseases in later stages. The School stage is fundamental. A significant proportion of students in Spain make use of the school lunch. We review the current situation in Spain, as well as public policy on school lunch and a nationwide review of specific legislation on each Autonomous Community.

MATERIAL AND METHODS

National public policy and specific considerations in every Autonomous Community were reviewed. Only considerations on the composition of the school menu were considered.

RESULTS

There are relatively recent state regulations but on school lunch menus also specific to each Autonomous Community. In general, and within a certain heterogeneity, they refer to the distribution of the diet and foods to be restricted. They usually provide guidelines, examples of daily menus, and graphic representations. Regarding school menus, there is a trend towards improvement in nutritional adequacy, but there is still room to improve. There are certain aspects related to the best solutions yet to be elucidated: management model, type of supervision, sustainability and local consumption, as well as school lunch schedules.

CONCLUSIONS

The nutritional contributions made in the school canteens are qualitatively and quantitatively important. In addition, it must fulfill educational and social equity functions. Although these concerns address specific recommendation in every Autonomous Community, there is huge heterogeneity on practical implementations.

[School lunch menus in Spain. A review on recommendations and policy]

INTRODUCTION

An appropriate diet in childhood is essential for suitable growth and development, but it is also essential for preventing the development of non-communicable diseases in later stages. The School stage is fundamental. A significant proportion of students in Spain make use of the school lunch. We review the current situation in Spain, as well as public policy on school lunch and a nationwide review of specific legislation on each Autonomous Community.

MATERIAL AND METHODS

National public policy and specific considerations in every Autonomous Community were reviewed. Only considerations on the composition of the school menu were considered.

RESULTS

There are relatively recent state regulations but on school lunch menus also specific to each Autonomous Community. In general, and within a certain heterogeneity, they refer to the distribution of the diet and foods to be restricted. They usually provide guidelines, examples of daily menus, and graphic representations. Regarding school menus, there is a trend towards improvement in nutritional adequacy, but there is still room to improve. There are certain aspects related to the best solutions yet to be elucidated: management model, type of supervision, sustainability and local consumption, as well as school lunch schedules.

CONCLUSIONS

The nutritional contributions made in the school canteens are qualitatively and quantitatively important. In addition, it must fulfill educational and social equity functions. Although these concerns address specific recommendation in every Autonomous Community, there is huge heterogeneity on practical implementations.

[Implemented actions in the Spanish National Health System to improve patient safety culture]

BACKGROUND

The Ministry of Health, Consumption and Social Welfare (MHCSW) since 2005 has been promoting, in collaboration with the Autonomous Communities (AC) and the Scientific Societies (SC), among them the Spanish Society for Healthcare Quality (SSHCQ), the Patient Safety Strategy (PSS). PSS 2015-2020 develops relevant aspects of patient safety (PS), such as risk management, reporting and learning systems (RLS), as well as promoting an adequate response when an adverse event (AE) unexpectedly occurs. The present work describes the current situation of the different AC in relation to these topics.

MATERIAL AND METHODS

A Descriptive study, based on a survey developed ad hoc within the framework of the agreement between the MHCSW and SSHCQ, was conducted at national level. The questions' topics, prepared by consensus of the work team, considered the implementation of RLS and AE analysis, and legal protection for professionals involved in an AE in the AC.

RESULTS

A total of 17 surveys were collected (16 AC and INGESA). All ACs had a RLS, a structure to support PS activities but very heterogeneous. Some ACs had a response plan to an AE and had established a coordination protocol with legal services to support patients and professionals involved in an AE. Some ACs had enacted some laws and regulations to facilitate PS culture.

CONCLUSIONS

The ACs have risk management structures that lead the plans in PS, reporting and learning systems and have experience in the analysis of near miss and AE. However, a regulatory change that increases the legal safety of professionals to provide an adequate response to the AEs is a priority. This challenge should involve leaders of health organizations, scientific societies and professional associations, national and regional health authorities as it has been done in other European countries.

[What regulations have launched autonomous communities to going forward on patient safety culture in healthcare organizations?]

INTRODUCTION

Patient Safety Culture is based on learning from incidents, developing preventive strategies to reduce the likelihood to happen and recognizing and accompanying those who have suffered unnecessary and involuntary harm derived from the health care received. To go ahead on patient safety culture entails facilitating the implementation of these behaviors and attitudes in healthcare professionals. Objective was to describe the regulations of some autonomous communities and national proposals for regulations changes.

MATERIAL AND METHODS

Search of normative changes made in the autonomous communities of Catalonia, Navarra and the Basque Country. Proposals for legislative changes at national level were agreed.

RESULTS

Activities and normative changes made in the autonomous communities of Catalonia, Navarre and the Basque Country are described and proposals for normative changes at the national level at short-term and long-term changes are made. In such a way that it is easier to advance in creating culture of patient safety in the whole National Health System CONCLUSION: Currently there is no global regulation that facilitates to advance in patient safety culture. Changes at the national legislation level are essential. It is at the Inter-territorial Council where the proposed legislative amendment should be defined, promoted by the representatives of the health systems of the autonomous communities.

[Autonomy and heteronomy, a necessary alliance to address smoking cessation. Views of professionals and patients]

OBJECTIVE

To explore the perception of professionals and patients with regard to ethical issues involved in addressing the habit of smoking in primary care consultations.

METHOD

A qualitative study was designed, consisting of 12 semi-structured interviews with professionals, 7 interviews with patients and 2 focus groups with 6 professionals and 7 primary care patients (a total of 32 participants). An intentional sampling was conducted, including profiles of professionals and patients of both sexes, different ages and experience in relation to smoking. A content analysis was performed with an inductive analytical approach from data to the creation of theoretical categories.

RESULTS

Four main categories were identified: 1) ethical issues related to the responsibility of the professional when treating patients who smoke; 2) issues related to attitude to patients who smoke; 3) issues related to fair and equitable distribution of resources and to the role of the different levels of government in relation to the control of smoking; and 4) issues related to smokers' autonomy regarding their habit and smoking cessation.

CONCLUSIONS

An alliance is needed between the ethics that support the autonomy of patients who smoke and the regulation of tobacco consumption. This approach should be included in clinical training programmes dealing with tobacco use, dependence and cessation.

What we need to know about dense breasts: implications for breast cancer screening

High breast density and its relationship to the risk of breast cancer has become a hot topic in the medical literature and in the lay press, especially in the United States, where it has brought about changes in the legal framework that require radiologists to inform clinicians and patients about breast density. Radiologists, who are mainly responsible for this information, need to know the scientific evidence and controversies regarding this subject. The discussion is centered on the real importance of the risk, the limitation that not having standardized methods of measurement represents, and the possible application of complementary screening techniques (ultrasound, magnetic resonance imaging, or tomosynthesis) for which clear recommendations have yet to be established. We need controlled studies that evaluate the application of these techniques in women with dense breasts, including the possibility that they can lead to overdiagnosis.

[Surveillance in Spain 3 years since the enactment of the Public Health Law]

In 2014, the Epidemiological Surveillance Working Group of the Sociedad Española de Epidemiología (Spanish Society of Epidemiology), carried out a descriptive study in order to evaluate the level of development of the Spanish Public Health Law since its enactment in 2011. A survey collecting data on the existence of information systems and other aspects pertaining to each surveillance section included in the law was sent to all 19 autonomous communities and cities. All regional authorities reported the presence of an information system for communicable diseases, and six also reported an information system for social factors. 18 reported that at least one chronic disease was subject to surveillance and 14 confirmed surveillance of some of its determinants. They all systematically analysed the data derived from the communicable diseases. There is room for improvement in Public Health surveillance in Spain, and action should be aimed at the main health problems.

[Biomedical research: guidance on how to take the first research steps]

The expanding body of regulations that affect biomedical research both in Spain and the rest of Europe have led to an increasing amount administrative work for obtaining approvals before a study can start. The complexity of the requirements will depend on the study design: clinical trials with medicines or other health care products are subject to the most highly developed regulations, whereas those affecting studies of noninvasive procedures are less complex. Between the 2 extremes, a range of requirements can complicate the clinical researcher's task. In this article we seek to provide instructions according to the type of study being planned and to explain relevant legislation.

[How is the implementation of the new legal framework for health care affecting HIV-infected immigrants in an irregular situation in Spain?]

INTRODUCTION

The entry into force of Royal Decree (RD) 16/2012 in Spain in September 2012 led to the exclusion of the group of irregular immigrants from the National Healthcare System. With this work, GESIDA attempts to measure the impact of the entry into force of the RD in relation to its application by the Autonomous Communities (CCAA), and how it has affected the health care of irregular immigrants infected with HIV.

METHODS

Information was requested from the 17 CCAA of the existence of measures to ensure the care and treatment of people with HIV infection that were left unprotected because of the implementation of the RD. Likewise, a survey was conducted on health professionals and NGOs involved in the care of these people, to find out how it has affected the implementation of the RD to their daily healthcare work and the availability of information on regulations to implement it.

RESULTS

The response of the CCAA was variable, hardly contributing, in some cases, to mitigate the negative effect of the RD. To this is added a complex bureaucracy to access the benefits offered by some regions, often inaccessible to the most vulnerable subjects. Lack of information for health-care professionals and NGOs involved in the care of immigrants, hinders access of this population to health care and the establishment of control measures for diseases with an impact on the public health.

CONCLUSIONS

The RD 16/2012 has had a negative impact on daily healthcare working, generating the appearance of deep inequities throughout the country.

Current legal framework and practical aspects of oxygen therapy during air travel

It is unusual for pulmonologists to be familiar with the European and US regulations governing the administration of oxygen during air travel and each airline's policy in this respect. This lack of knowledge is in large part due to the scarcity of articles addressing this matter in specialized journals and the noticeably limited information provided by airlines on their websites. In this article we examine the regulations, the policies of some airlines and practical aspects that must be taken into account, so that the questions of a patient who may need to use oxygen during a flight may be answered satisfactorily.