Objectives: The aim of this systematic review was to consolidate studies to determine whether root cause analysis (RCA) is an adequate method to decrease recurrence of avoidable adverse events (AAEs). Methods: A systematic search of databases from creation until December 2018 was performed using PubMed, Scopus and EMBASE. We included articles published in scientific journals describing the practical usefulness in and impact of RCA on the reduction of AAEs and whether professionals consider it feasible. The Mixed Methods Appraisal Tool was used to assess the quality of studies. Results: Twenty-one articles met the inclusion criteria. Samples included in these studies ranged from 20 to 1,707 analyses of RCAs, AAEs, recommendations, audits or interviews with professionals. The most common setting was hospitals (86%; n = 18), and the type of incident most analysed was AAEs, in 71% (n = 15) of the cases; 47% (n = 10) of the studies stated that the main weakness of RCA is its recommendations. The most common causes involved in the occurrence of AEs were communication problems among professionals, human error and faults in the organisation of the health care process. Despite the widespread implementation of RCA in the past decades, only 2 studies could to some extent establish an improvement in patient safety due to RCAs. Conclusions: RCA is a useful tool for the identification of the remote and immediate causes of safety incidents, but not for implementing effective measures to prevent their recurrence.

Consumption of moderate-to-heavy amounts of alcohol has been associated with lower risk of cardiovascular disease and diabetes. Although both diseases are main causes of the frailty syndrome, no previous study has assessed the association between alcohol-drinking patterns and risk of frailty in older adults. A prospective cohort study of 2,086 community-dwelling individuals aged 60 and older, recruited in 2008–2010, and followed through 2012, was carried out. Drinking patterns were self-reported at baseline. Moderate drinking was defined as alcohol intake less than 40g/day for men and less than 24g/day for women. A Mediterranean drinking pattern was defined as moderate alcohol intake, with wine preference (≥80% of alcohol proceeds from wine) and drinking only with meals. Study participants were followed through 2012 to ascertain incident frailty, defined as ≥2 of the following 4 Fried criteria: exhaustion, muscle weakness, low physical activity, and slow walking speed. Analyses were performed with logistic regression and adjusted for the main confounders. After a mean follow-up of 3.3 ( SD = 0.6) years, 292 participants with incident frailty were identified. Compared with nondrinkers, the odds ratio and its 95% confidence interval of frailty was 0.90 (0.65–1.25) for moderate drinkers. The corresponding results were 0.74 (0.48–1.16) for wine versus other beverage preference and 0.53 (0.31–0.92) for drinking only with meals versus only outside meals. Finally, compared with nondrinkers, the odds ratio (95% confidence interval) of frailty was 0.68 (0.47–0.99) for those adhering to the Mediterranean drinking pattern. Certain drinking patterns, in particular drinking only with meals and the Mediterranean drinking pattern, are associated with a lower risk of frailty in older adults.

Adverse healthcare-related events (AE) entail reduced patient safety. Estimating their frequency, characteristics, avoidability and impact is a means to identify targets for improvement in the qual...

Fundamentos: El modo en el que se consume alcohol en los países mediterráneos se encuentra en proceso de transición. El objetivo de este trabajo es describir los patrones de consumo en la población adulta española según las principales características sociodemográficas. Métodos: Estudio transversal con participantes de 15 años y más utlizando como fuente de información la Encuesta Nacional de Salud (ENS) 2011-2012 (n=20.608). Según la ingesta promedio de alcohol, se clasificó como de alto riesgo el consumo ≥40 g/día de alcohol en hombres o ≥24 g/día en mujeres. Se definió binge drinking el consumo de ≥6 bebidas estándar de alcohol (hombres) y ≥5 (mujeres) en 4-6 horas durante los últimos 12 meses. Se estimó la preferencia de bebida y la tendencia 1987-2012 (ENS respectivas). Se analizó su distribución con variables sociodemográficas mediante modelos ajustados de regresión logística. Resultados: El 1,3% de los sujetos encuestados fueron bebedores promedio de alto riesgo (2% de hombres y 0,7% de mujeres). En hombres fue más frecuente entre los 45-64 años (odds ratio (OR)=2,92 respecto a 15-29 años; IC 95%:1,59-5,38) y en los sujetos nacidos en España (OR=3,45; IC 95%: 1,59-7,69). En mujeres se observaron diferencias estadísticamente significativas según el nivel educativo, incrementándose a medida que aumentaba éste (p tendencia lineal <0,001). El 19,6% de hombres y 7,1% y de mujeres realizaron binge drinking en el último año. Este patrón disminuyó con la edad y se incrementó con el nivel de estudios en ambos sexos (p tendencia lineal <0,001). La prevalencia estandarizada de bebedores promedio de alto riesgo descendió desde un 18,8% en 1987 hasta el 1,3% en 2012. Conclusiones: El consumo de alcohol en España es compatible con el modelo de países en transición, donde el binge drinking es el que más contribuye al riesgo global. Se observa un importante descenso del consumo promedio de alto riesgo. La cerveza desplaza al vino como bebida preferente.