02.09.01. Investigación y comunicación científica

Comparative Analysis of Complications and Results of Anterolateral Lumbar Interbody Fusion Approaches: A Spanish Multicenter Prospective Cohort Study

2026-11-11T09:11:35Z

Comparative Analysis of Complications and Results of Anterolateral Lumbar Interbody Fusion Approaches: A Spanish Multicenter Prospective Cohort Study Giner, Javier; Castro, Julián; Marimón, Isidro; Dalmau, Miquel-Rius; Carballal, Carlos-Fernández; Garbizu, José-Manuel; Domínguez, Ignacio; Mendiola, Antonio-Damián-Jover; Ribas, Juan-Christian; Hernández-García, César; Ferrández, Diego; Bordon, Gerd; Jiménez, Manuel; Valencia, Julio Degenerative lumbar disorders are commonly treated with lumbar interbody fusion, but comparative evidence among ALIF, OLIF, and XLIF remains limited. This prospective multicenter observational cohort study compared perioperative outcomes, complications, and patient-reported outcomes (PROMs) after single- or multi-level ALIF, OLIF, or XLIF in 242 consecutive adults (108, 75, and 59, respectively) treated at Spanish centers. Age and surgical indications differed significantly across groups (p < 0.05), reflecting indication-based approach selection. Primary outcomes were intra- and postoperative complications through 6 months; secondary outcomes included operative time, blood loss, visual analog scale (VAS) pain scores, and the Oswestry Disability Index (ODI). XLIF had the shortest operative time (median, 63 min) and lowest blood loss. Overall intra- and postoperative complication rates were 3.3% and 7.8%, with no significant overall differences among techniques, although patterns differed: vascular injuries were associated with ALIF, cage subsidence was more frequent after XLIF, neurological deficits occurred with similar frequency in the XLIF and OLIF groups, and OLIF had the lowest intraoperative rate. All groups showed significant VAS and ODI improvements, with greater 6-month gains after ALIF and OLIF than after XLIF. These approaches are effective but have distinct risk-benefit profiles, supporting individualized selection.

Structured Plus/Delta Debriefing with Graphical Feedback Versus Conversational Debriefing and Chest Compression Quality in Simulated Cardiopulmonary Resuscitation Among Nursing Students: A Quasi-Experimental Study

2026-11-11T09:11:36Z

Structured Plus/Delta Debriefing with Graphical Feedback Versus Conversational Debriefing and Chest Compression Quality in Simulated Cardiopulmonary Resuscitation Among Nursing Students: A Quasi-Experimental Study García-Álvarez, José-Manuel; García-Sánchez, Alfonso Background/Objectives: Chest compression quality is a key determinant of survival after cardiac arrest. Debriefing is an essential educational tool in cardiopulmonary resuscitation training; however, limited evidence exists regarding the comparative effectiveness of specific debriefing approaches incorporating objective feedback. The objective of this study was to evaluate whether a structured Plus/Delta debriefing approach incorporating graphical performance feedback was associated with greater improvements in chest compression quality parameters than unstructured conversational debriefing in nursing students. Methods: A pre-post quasi-experimental study with a control group was conducted in nursing students. Participants were assigned to experimental or control groups at the academic subgroup level. The experimental group received a structured Plus/Delta debriefing approach incorporating graphical performance feedback, whereas the control group received conversational debriefing. Performance outcomes were assessed before and after the intervention. The primary outcome was the time spent with compression rate, compression depth, and residual leaning simultaneously within their recommended ranges, expressed in seconds. Data were primarily analyzed using linear mixed-effects models to account for repeated measures and clustering. Sensitivity analyses using ANCOVA models adjusted for baseline values and age were performed to assess the robustness of the findings. Results: A total of 112 participants were included (n = 56 per group), with no baseline differences between groups. Improvements were observed in both groups, although they were larger in the experimental group. Mixed-effects models showed significant group × time interactions, with the experimental group showing greater improvements in the primary outcome (? = 91.40 s, 95% CI 82.51-100.28; p < 0.001). Significant group × time interactions were also observed for the secondary compression-quality outcomes. The percentage of total test duration during which all three parameters were simultaneously within the recommended ranges increased in both groups and showed a greater improvement in the experimental group. A complementary analysis using a fixed 120 s observation period showed a greater proportion of time with all three parameters simultaneously within the recommended ranges in the experimental group (50.7% ± 24.8% vs. 42.8% ± 11.0%; p = 0.042). ANCOVA sensitivity analyses adjusted for baseline values and age yielded results consistent with the primary analysis. Conclusions: A structured Plus/Delta debriefing approach incorporating graphical performance feedback was associated with greater improvements in the consistency of guideline-compliant chest compression performance than unstructured conversational debriefing in undergraduate nursing students during simulated CPR training. However, given the quasi-experimental design, group-level allocation, potential practice effects, residual confounding, and the inability to isolate the independent contributions of structured debriefing and graphical feedback, causal inference should be made with caution. Randomized controlled studies are needed to confirm these findings, evaluate their long-term effects, and determine whether similar findings are observed in other populations and settings.

Impact of coordination on care quality and health outcomes. SESPAS Report 2026

2026-09-18T05:51:02Z

Impact of coordination on care quality and health outcomes. SESPAS Report 2026 Vargas-Martínez, Ana-Magdalena; Duarte-Climents, Gonzalo; García-Mochón, Leticia; López-Santiago, Asensio Care coordination constitutes a fundamental pillar for improving the efficiency of healthcare systems and ensuring the sustainable use of resources. The aim of this chapter is to demonstrate the impact of various coordination strategies on clinical practice variability, continuity of care, patient safety, user satisfaction and experience, as well as on the efficiency and sustainability of health systems. Effective healthcare coordination does not rely on a single intervention, but rather on the synergy between clinical, organizational, technological, and financial components. Reducing unwarranted variations requires a multifaceted approach, including the promotion of evidence-based practice, ongoing professional education, the implementation of clinical audits, and the reinforcement of shared decision-making. At the organizational level, the successful implementation of integrated care models requires a systemic approach tailored to the local context, with a long-term vision that prioritizes patient health outcomes, quality of care, efficiency, and system sustainability.

[New models of collaboration within the primary care team: transversality and coordination. SESPAS Report 2026].

2026-09-18T05:51:03Z

[New models of collaboration within the primary care team: transversality and coordination. SESPAS Report 2026]. Satue-de-Velasco, Eduardo; Moreno-Valentin, Gustavo; Gallego-Royo, Alba; Sánchez-Gómez, María-Begoña To advance towards a more responsive, equitable and sustainable model of primary care, it is necessary, among other actions, to move beyond the traditional structure centred on the roles of nurses and physicians. The existence of the primary care team is grounded in the principles established in the Declaration of Alma-Ata (1978). This article analyses the factors that currently hinder its effectiveness, based on the needs it is expected to address, and proposes criteria that may contribute to its improvement and further development, focusing efforts on providing comprehensive care to individuals from an individual, family and community perspective. Such development is possible by giving greater prominence to collaborative clinical management processes, as well as to training, communication and intra-team coordination, together with the assumption by all team members of new professional profiles and competencies, so that each activity is carried out by the professional most competent to do so. This transformation redefines professional roles, resulting in an interdisciplinary and multiprofessional team that brings together nurses, physicians and administrative staff with other professional roles -established roles that are not yet fully integrated into primary care teams-, such as physiotherapists, pharmacists, dentists, psychologists and nursing assistants. The aim is to jointly address diagnoses, treatments and care, as well as complex care processes, thereby enhancing problem-solving capacity and expanding care delivery beyond the physical structure of the health centre.