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        "titulo" => "Organization of Tuberculosis Control in Spain&#58; Evaluation of a Strategy Aimed at Promoting the Accreditation of Tuberculosis Units"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Para un buen control de la tuberculosis &#40;TB&#41;&#44; incluyendo la detecci&#243;n precoz y el manejo adecuado de los casos&#44; una de las claves es disponer de personal especializado y una buena coordinaci&#243;n entre diferentes estamentos&#46; Su buen control requiere&#44; adem&#225;s&#44; disponer no solo de m&#233;dicos expertos sino de un n&#250;mero adecuado de personal de enfermer&#237;a especializado&#44; as&#237; como de una buena estructura y organizaci&#243;n de los servicios y responsables que la llevan a cabo<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1-4</span></a>&#46; En pa&#237;ses con baja incidencia de TB como Espa&#241;a&#44; donde ya hay muchos m&#225;s m&#233;dicos de Atenci&#243;n Primaria &#40;AP&#41; que casos de TB&#44; es recomendable que se centralicen las actividades referentes a la TB y al estudio de contactos &#40;EECC&#41; en unidades especializadas<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">5</span></a>&#46; El documento marco para la eliminaci&#243;n de la TB en pa&#237;ses de baja incidencia destaca la importancia de contar con un equipo de coordinaci&#243;n central&#44; unidades especializadas para el diagn&#243;stico y tratamiento de la TB y el nivel apropiado de centralizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Con el objetivo de mejorar el control de la TB&#44; la Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica &#40;SEPAR&#41; impuls&#243; la acreditaci&#243;n de unidades de tuberculosis &#40;UTB&#41; dedicadas al tratamiento&#44; seguimiento y prevenci&#243;n de la enfermedad&#46; Si bien el n&#250;mero de casos ha descendido notablemente&#44; la TB sigue teniendo importancia cl&#237;nica&#46; Su manejo muchas veces no es f&#225;cil y se ha complicado con la presencia de formas resistentes a los medicamentos m&#225;s eficaces&#46; Por ello&#44; es necesario contar con unidades b&#225;sicas&#44; pero tambi&#233;n con expertos y unidades especializadas que pueden aconsejar y dirigir tratamientos complejos&#44; estudiar los contactos de los casos y coordinarse con otras especialidades o niveles asistenciales&#46; Desde la SEPAR se busca la creaci&#243;n y posterior acreditaci&#243;n de UTB funcionales y multidisciplinarias&#44; en el sentido de agrupar especialidades&#44; profesionales y entidades que est&#225;n implicadas en el manejo de esta enfermedad<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6&#44;7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Conocer qui&#233;nes son los especialistas encargados del diagn&#243;stico&#44; tratamiento y del EECC de los pacientes con TB pulmonar y extrapulmonar y c&#243;mo se coordinan diferentes estamentos podr&#237;a ayudar a proponer estrategias para mejorar la organizaci&#243;n de las UTB&#46; Con ello se dar&#237;a un paso importante para el control de la TB en Espa&#241;a&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Por ello&#44; el objetivo del estudio fue conocer c&#243;mo se organizan los servicios de neumolog&#237;a y los profesionales dedicados a la TB en Espa&#241;a para controlar la enfermedad&#44; antes y despu&#233;s de la acreditaci&#243;n de UTB por parte de SEPAR&#44; a fin de analizar la efectividad de esta iniciativa&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Dise&#241;o y per&#237;odo</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudio observacional descriptivo transversal de base poblacional pre- y postacreditaci&#243;n en la atenci&#243;n especializada en Espa&#241;a del 1 de octubre de 2014 al 31 de diciembre de 2016 y del 1 de enero de 2017 al 28 de febrero de 2018&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">&#193;mbito</span><p id="par0030" class="elsevierStylePara elsevierViewall">Servicios de neumolog&#237;a de los hospitales de Espa&#241;a a trav&#233;s de una encuesta <span class="elsevierStyleItalic">online</span> autoadministrada dirigida a los jefes de servicio o secci&#243;n de neumolog&#237;a registrados por SEPAR &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>139&#41;&#46; La encuesta se administr&#243; antes y despu&#233;s del inicio de la acreditaci&#243;n de UTB&#46; Se enviaron 3 correos electr&#243;nicos desde la SEPAR para la encuesta pre- y 3 m&#225;s para la post- en los que se invitaba a responderlas y se llam&#243; por tel&#233;fono a los que no se pudo contactar mediante el correo electr&#243;nico&#46; En algunos casos los jefes de servicio o secci&#243;n de neumolog&#237;a derivaron la encuesta a otros servicios dedicados a la TB&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La iniciativa consisti&#243; en la acreditaci&#243;n como unidad asistencial de TB por parte de la SEPAR a todas las unidades que lo solicitaban y que reun&#237;an una serie de criterios preestablecidos<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">6</span></a>&#46; Se acreditaron un total de 26 UTB desde el a&#241;o 2015&#44; que fueron clasificadas en funci&#243;n de la complejidad en unidades b&#225;sicas&#44; especializadas o especializadas de alta complejidad&#46; Los criterios y requisitos de acreditaci&#243;n en cada una de estas categor&#237;as se clasificaron siguiendo las siguientes l&#237;neas y objetivos estrat&#233;gicos&#58; actividad asistencial&#44; recursos t&#233;cnicos y humanos&#44; disponibilidad de laboratorio de micobacterias&#44; capacidad de realizar EECC&#44; formaci&#243;n y actividad investigadora<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">6</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Variables y fuentes de informaci&#243;n</span><p id="par0040" class="elsevierStylePara elsevierViewall">La informaci&#243;n se obtuvo de una encuesta dise&#241;ada espec&#237;ficamente para ello &#40;<a class="elsevierStyleCrossRef" href="#sec0065">Ap&#233;ndice A</a>&#41;&#44; la cual se elabor&#243; teniendo en cuenta los criterios de acreditaci&#243;n de UTB de la SEPAR&#46; Se recogieron variables demogr&#225;ficas de los encuestados &#40;especialidad&#44; centro de trabajo&#44; tipo de centro&#44; ciudad&#44; provincia&#44; &#225;rea de influencia y comunidad aut&#243;noma&#41;&#44; epidemiol&#243;gicas &#40;n&#250;mero total de TB atendidos al a&#241;o&#44; de casos multirresistentes y monorresistentes y conclusi&#243;n final del tratamiento&#41;&#44; especialista responsable del tratamiento de la TB pulmonar&#44; TB extrapulmonar y pedi&#225;trica &#40;neum&#243;logo&#44; internista&#44; infect&#243;logo&#44; pediatra&#44; otros&#41;&#44; existencia de un referente de TB&#44; coordinaci&#243;n con AP y otros circuitos de derivaci&#243;n&#44; existencia de unidad espec&#237;fica de TB&#44; presencia de gestora de casos y de residentes&#44; notificaci&#243;n a Salud P&#250;blica &#40;SP&#41;&#44; posibilidad de suministrar tratamiento directamente observado &#40;TDO&#41;&#44; realizaci&#243;n de censo y EECC y especialista responsable del mismo &#40;AP&#44; neumolog&#237;a&#44; medicina interna&#44; infecciosas&#44; medicina preventiva&#41;&#44; cribado de infecci&#243;n tuberculosa latente en pacientes con factores de riesgo&#44; participaci&#243;n con el Programa Integrado de Investigaci&#243;n en Tuberculosis &#40;PII-TB&#41; y acreditaci&#243;n como UTB por la SEPAR&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Definiciones&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Referente de TB&#58; persona responsable y de referencia de la unidad con capacidad de coordinaci&#243;n y colaboraci&#243;n con otros m&#233;dicos neum&#243;logos y de otras especialidades&#44; as&#237; como con el personal de enfermer&#237;a<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">6</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Gestor de casos&#58; personal de enfermer&#237;a referente de TB que favorece la organizaci&#243;n&#44; coordinaci&#243;n y comunicaci&#243;n dentro de la UTB y fuera de esta&#46; Es el nexo entre los distintos actores implicados en el diagn&#243;stico&#44; tratamiento y seguimiento tanto de la enfermedad como de la infecci&#243;n tuberculosa latente y puede&#44; as&#237;&#44; centralizar toda la informaci&#243;n referente a los casos y a los contactos de TB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Paciente con factores de riesgo&#58; incluye a aquellas personas que han tenido contacto reciente con enfermos con TB y a las personas con afecciones o comportamientos que debilitan el sistema inmunitario<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">8</span></a>&#46;</p></li></ul></p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lisis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de las variables antes y despu&#233;s de la acreditaci&#243;n&#46; Se compararon las encuestas entre centros acreditados y no acreditados&#44; utilizando la m&#225;s reciente en el caso de que el centro hubiese cumplimentado ambas&#46; Se calcularon medianas y rangos intercuart&#237;licos &#40;RI&#41; para las variables continuas y proporciones para las categ&#243;ricas&#46; Se compararon las variables categ&#243;ricas a nivel univariado mediante el test de chi-cuadrado o la prueba exacta de Fisher si no se cumpl&#237;an los criterios del chi-cuadrado&#44; considerando un valor <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 como estad&#237;sticamente significativo&#46; Se calcularon los factores asociados a acreditarse por la SEPAR mediante un an&#225;lisis de regresi&#243;n log&#237;stica comparando los centros que se acreditaron con los que no lo hicieron&#46; Como medida de asociaci&#243;n se utiliz&#243; la <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41;&#44; con un intervalo de confianza del 95&#37; &#40;IC&#41; y un valor de significaci&#243;n estad&#237;stica <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Para determinar el ajuste del modelo se utiliz&#243; el test de Hosmer y Lemeshow&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Consideraciones &#233;ticas</span><p id="par0075" class="elsevierStylePara elsevierViewall">Todos los datos se trataron de forma estrictamente confidencial siguiendo en todo momento los principios &#233;ticos de la Declaraci&#243;n de Helsinki<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a>&#44; la Ley espa&#241;ola de Protecci&#243;n de Datos 15&#47;1999<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a> y el Reglamento de la Uni&#243;n Europea n&#46;&#176; 2016&#47;679 General de Protecci&#243;n de Datos<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a>&#46; El proyecto se present&#243; y aprob&#243; por el Comit&#233; de &#201;tica e Investigaci&#243;n Cl&#237;nica del Institut Municipal d&#8217;Assist&#232;ncia Sanit&#224;ria&#44; n&#250;mero 2013&#47;5389&#47;I&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">De los 139 servicios o secciones de neumolog&#237;a de Espa&#241;a contactados&#44; 76 &#40;54&#44;7&#37;&#41; respondieron la encuesta preacreditaci&#243;n realizada entre 2014 y 2016 y 60 &#40;43&#44;2&#37;&#41; la encuesta postacreditaci&#243;n contestada entre los a&#241;os 2017 y 2018&#46; Un total de 93 centros contestaron al menos una encuesta&#44; 43 de los cuales respondieron ambas encuestas&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Las 76 encuestas preacreditaci&#243;n proced&#237;an de 16&#47;17 &#40;94&#44;1&#37;&#41; comunidades aut&#243;nomas y 33&#47;50 &#40;66&#37;&#41; provincias de Espa&#241;a&#46; El 90&#44;8&#37; &#40;69&#47;76&#41; pertenec&#237;an a servicios o secciones de neumolog&#237;a y 7&#47;76 &#40;9&#44;2&#37;&#41; a medicina interna o infecciosas&#46; El 42&#44;1&#37; &#40;32&#41; y 52&#44;6&#37; &#40;40&#41; formaban parte de hospitales con m&#225;s de 500 y de 100-500 camas&#44; respectivamente&#46; La mediana global de casos de TB en los a&#241;os 2014&#44; 2015 o 2016 fue de 28 &#40;RI 10&#44;5-52&#44;5&#41; por centro encuestado y el 84&#44;2&#37; &#40;64&#41; de ellos recog&#237;an el resultado final del tratamiento&#46; En un mayor porcentaje de los centros la TB pulmonar era atendida por neum&#243;logos &#40;59&#44;2&#37;&#41;&#44; mientras que la extrapulmonar era tratada por medicina interna en un 57&#44;9&#37; de ellos&#46; En el 72&#44;4&#37; de los centros &#40;55&#41; se realiz&#243; censo de los contactos y en el 60&#44;5&#37; el EECC&#46; En el 64&#44;5&#37; &#40;49&#41; exist&#237;a un referente de TB&#44; el 63&#44;2&#37; &#40;48&#41; se coordinaban con AP y el 61&#44;8&#37; &#40;47&#41; con niveles asistenciales superiores&#46; El 34&#44;2&#37; &#40;26&#41; ya estaban organizados como UTB&#44; el 42&#44;1&#37; &#40;32&#41; dispon&#237;an de gestora de casos y el 94&#44;7&#37; &#40;72&#41; notificaban m&#225;s del 75&#37; de los casos a SP&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Seg&#250;n procedencia geogr&#225;fica&#44; las 60 encuestas postacreditaci&#243;n proced&#237;an de 15&#47;17 &#40;88&#44;2&#37;&#41; comunidades aut&#243;nomas y 26&#47;50 &#40;52&#37;&#41; provincias&#46; El 86&#44;7&#37; &#40;52&#47;60&#41; pertenec&#237;an a servicios o secciones de neumolog&#237;a y 8&#47;60 &#40;13&#44;3&#37;&#41; a medicina interna o infecciosas&#46; El 45&#44;0&#37; &#40;27&#41; y 50&#44;0&#37; &#40;30&#41; formaban parte de hospitales con m&#225;s de 500 y de 100-500 camas&#44; respectivamente&#46; La mediana de casos de TB en los a&#241;os 2017 o 2018 fue de 20 &#40;RI 14&#44;5-45&#44;5&#41; por centro y hasta el 86&#44;7&#37; &#40;52&#41; recog&#237;an el resultado final del tratamiento&#46; Se hizo el censo de los contactos en el 68&#44;3&#37; de los centros &#40;41&#41; y se realiz&#243; el EECC en el 61&#44;7&#37; de ellos&#46; En el 68&#44;3&#37; &#40;41&#41; exist&#237;a un referente de TB&#44; el 73&#44;3&#37; &#40;44&#41; se coordinaban con AP y el 63&#44;3&#37; &#40;38&#41; con niveles asistenciales superiores&#46; El 36&#44;7&#37; &#40;22&#41; ya estaban organizados como UTB&#44; el 46&#44;7&#37; &#40;28&#41; dispon&#237;an de gestora de casos y el 91&#44;7&#37; &#40;55&#41; notificaban m&#225;s del 75&#37; de los casos a SP&#46; De los 40 centros no acreditados&#44; 21 &#40;52&#44;5&#37;&#41; manifestaban que les gustar&#237;a acreditarse como UTB&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 1</a> compara las principales variables recogidas en la encuesta antes y despu&#233;s de la acreditaci&#243;n&#46; No se observaron cambios significativos en los diferentes &#225;mbitos de atenci&#243;n y coordinaci&#243;n entre la encuesta pre- y postacreditaci&#243;n&#44; aunque s&#237; se mejoraba la recogida de conclusiones finales&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">De todos los centros que respondieron la encuesta&#44; se acreditaron como UTB 20 centros y 15 de estos respondieron ambas encuestas&#46; Al comparar los resultados de la encuesta antes y despu&#233;s de la acreditaci&#243;n de UTB en estos 15 centros&#44; no se observaron diferencias en la organizaci&#243;n antes y despu&#233;s de haberse acreditado &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">En la comparaci&#243;n entre los 20 centros acreditados y los 73 no acreditados&#44; observamos que existen diferencias estad&#237;sticamente significativas entre ellos&#46; Entre los acreditados hubo un porcentaje mayor de centros que recogen la conclusi&#243;n final de los casos&#44; que se coordinan con la AP&#44; que cuentan con un referente de TB y con circuitos de derivaci&#243;n a otros servicios de mayor complejidad&#46; Tambi&#233;n se observa una mayor proporci&#243;n de centros que manejan pacientes con TB multirresistente&#47;extremadamente resistente&#44; que tienen capacidad para facilitar TDO en el centro o en otras entidades&#44; que realizan el EECC y que cuentan con la figura de la gestora de casos&#46; Los centros acreditados est&#225;n ubicados en solamente 9 comunidades aut&#243;nomas y la mayor&#237;a de estos centros ya constitu&#237;an una UTB y participaban aportando casos al PII-TB &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Al comparar los 20 centros que se acreditaron con los 73 que no lo hicieron&#44; el modelo de regresi&#243;n log&#237;stica indica que las variables asociadas a acreditarse como UTB fueron constituir una UTB &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#44;68&#59; IC95&#37;&#58; 3&#44;84-133&#44;74&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y disponer de circuitos de derivaci&#243;n a otros servicios de mayor complejidad &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44;53&#59; IC95&#37;&#58; 1&#44;12-64&#44;80&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;038&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 3</a>&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discusi&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">Este estudio ha permitido conocer mejor c&#243;mo se aborda la TB en Espa&#241;a por parte de los servicios y secciones de neumolog&#237;a y otros profesionales dedicados a esta enfermedad y tambi&#233;n ha permitido observar qu&#233; diferencias hay entre los centros que se acreditaron y los que no&#46; Seg&#250;n las respuestas de las encuestas&#44; el manejo de la TB pulmonar es llevado a cabo&#44; sobre todo&#44; por neum&#243;logos y la extrapulmonar&#44; por internistas&#46; En una alta proporci&#243;n&#44; se realiza seguimiento de los casos hasta finalizar el tratamiento&#44; se manejan resistencias y enfermedades asociadas y se facilita TDO a los pacientes&#46; No obstante&#44; debe mejorarse el censo y el EECC por parte de los servicios de neumolog&#237;a o de medicina preventiva y&#44; aunque el porcentaje de casos notificados a SP es elevado&#44; se han identificado centros donde la notificaci&#243;n es menor del 75&#37;&#44; a pesar de ser una enfermedad de declaraci&#243;n obligatoria&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Los resultados obtenidos mediante las encuestas autoadministradas muestran que no se observaron diferencias importantes en las distintas variables de atenci&#243;n y coordinaci&#243;n entre los centros que respondieron la encuesta pre- y aquellos que respondieron la encuesta postacreditaci&#243;n&#46; Por otro lado&#44; aquellos centros que se acreditaron y contestaron ambas encuestas &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; tampoco presentaron diferencias en la organizaci&#243;n antes y despu&#233;s de la acreditaci&#243;n&#46; Por &#250;ltimo&#44; al comparar los centros que se acreditaron con los que no lo hicieron&#44; se observaron diferencias estad&#237;sticamente significativas en variables organizativas y de atenci&#243;n de los pacientes&#46; El an&#225;lisis multivariado indica que constituir una UTB y disponer de circuitos de derivaci&#243;n a otros servicios de mayor complejidad est&#225; asociado con el hecho de acreditarse como UTB&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">La falta de mejoras significativas entre los centros acreditados por la SEPAR cuando se comparan sus caracter&#237;sticas antes y despu&#233;s de la acreditaci&#243;n podr&#237;a atribuirse a que dichos centros ya abordaban la TB de forma efectiva y correcta antes de solicitar la acreditaci&#243;n&#46; Adem&#225;s&#44; se trata de un tama&#241;o muestral peque&#241;o con bajo poder estad&#237;stico&#46; S&#237; que se encuentran diferencias entre los centros seg&#250;n estuvieran acreditados o no&#44; y esto podr&#237;a deberse a que se acreditan mayoritariamente aquellos centros que ya cuentan con una mayor organizaci&#243;n y mejores indicadores&#46; La acreditaci&#243;n implica revisar y desempe&#241;ar acciones para mejorar el manejo y control de la enfermedad&#44; as&#237; como evaluar y reorganizar el personal y las actividades realizadas en el centro&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Como limitaci&#243;n del estudio&#44; se debe citar la imposibilidad de verificar las respuestas y que las encuestas postacreditaci&#243;n se realizaron solo 2 a&#241;os m&#225;s tarde del inicio de las acreditaciones y puede que se precise m&#225;s tiempo para que aumente el n&#250;mero de UTB acreditadas y se pueda evaluar su evoluci&#243;n&#46; De todos modos&#44; las UTB acreditadas podr&#237;an servir de est&#237;mulo para la acreditaci&#243;n de otras unidades&#46; En cuanto al contenido de la encuesta&#44; podr&#237;a evaluarse en mayor profundidad el manejo y abordaje de los pacientes inmunodeprimidos &#40;tratamientos biol&#243;gicos&#44; ancianos&#8230;&#41; por parte de las UTB&#44; ya que se trata de un colectivo especialmente vulnerable&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Se ha visto que en las grandes ciudades de pa&#237;ses de baja incidencia de TB se puede aumentar la eficiencia de los programas de control mejorando su organizaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1&#44;4</span></a>&#46; En relaci&#243;n con los resultados obtenidos&#44; otros autores tambi&#233;n han relacionado el control de la TB con una mejora organizativa basada en la creaci&#243;n de UTB&#46; M&#225;s concretamente&#44; un estudio en Barcelona evalu&#243; el impacto de la creaci&#243;n de UTB en la ciudad y pudo concluir que la intervenci&#243;n mejoraba el EECC<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a>&#59; lo mismo que se observa en este estudio comparando los centros que se acreditaron con los que no lo hicieron&#46; Resultados similares se observaron en el Programa TB de Galicia&#44; organizado en torno a 7 UTB<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">12</span></a>&#46; Todos estos estudios destacaban como puntos clave para la organizaci&#243;n del manejo de la enfermedad la centralizaci&#243;n de la atenci&#243;n de la TB&#44; el papel de la enfermer&#237;a gestora de casos y la coordinaci&#243;n y comunicaci&#243;n entre los diferentes &#225;mbitos y profesionales implicados<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1&#44;3</span></a>&#46; En todos estos aspectos presentaron mejores indicadores aquellas unidades que se acreditaron&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">La Comunidad Aut&#243;noma de Madrid llev&#243; a cabo una evaluaci&#243;n del control de la TB y encontr&#243; elevados porcentajes de p&#233;rdida de seguimiento de los casos y un n&#250;mero bajo de EECC realizados&#46; Los autores destacaron la necesidad de centralizar el seguimiento de los enfermos y los EECC en UTB para mejorar los resultados obtenidos<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">13</span></a>&#46; Otras publicaciones recomiendan que&#44; debido a que la baja incidencia no permite acumular experiencia entre los profesionales de la AP&#44; se centralice la atenci&#243;n a la TB y se cuente con grupos de profesionales especializados en constante comunicaci&#243;n y coordinados entre ellos<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">5&#44;14-16</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Igualmente&#44; un estudio realizado en el Reino Unido concluy&#243; que un buen control de la enfermedad depende de que exista un n&#250;mero adecuado de especialistas dedicados a la TB&#46; Se identific&#243; como una estrategia de control de la enfermedad contar con una enfermera dedicada a la TB por cada 40 pacientes<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">2</span></a>&#46; Este estudio no permite establecer comparaciones adecuadas&#44; pero el porcentaje de centros con enfermeras gestoras de casos y referentes de TB fue mucho mayor en aquellas unidades que se acreditaron&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En la misma l&#237;nea&#44; el consenso sobre el control de la TB en las grandes ciudades elaborado por un grupo de trabajo que representa a varias grandes ciudades de la Uni&#243;n Europea destaca la importancia de organizarse para garantizar el acceso de los pacientes e incluir suficiente personal y experiencia&#44; as&#237; como promover una fuerte colaboraci&#243;n y coordinaci&#243;n entre sectores<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Por otra parte&#44; una revisi&#243;n sistem&#225;tica sobre intervenciones que mejoran la adherencia y los resultados del tratamiento de la TB concluy&#243; que la administraci&#243;n de TDO&#44; juntamente con la educaci&#243;n del paciente&#44; aumenta la adherencia y las tasas de &#233;xito del tratamiento<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Es relevante destacar que&#44; aunque la TB es una enfermedad de declaraci&#243;n obligatoria&#44; en algunos centros de Espa&#241;a existe subnotificaci&#243;n de casos a SP&#44; lo que supone una complicaci&#243;n para el control de la enfermedad&#46; Un estudio de Gim&#233;nez-Duran et al&#46; demostr&#243; la existencia de subnotificaci&#243;n en las Islas Baleares a partir de las prescripciones de f&#225;rmacos antituberculosos<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> y otro de Morales-Garc&#237;a et al&#46; observ&#243; en 16 centros espa&#241;oles una importante subnotificaci&#243;n y destac&#243; que los centros que contaban con enfermera gestora de casos tuvieron tasas de notificaci&#243;n del 100&#37;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">19</span></a>&#44; lo que refuerza la importancia de esta figura en las UTB&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Seg&#250;n un estudio desarrollado en California&#44; implementar una evaluaci&#243;n sistem&#225;tica anual y un proceso de mejora mediante el uso de indicadores en los programas de control de la TB mejoraba los resultados<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a>&#46; Ello respaldar&#237;a el que las unidades acreditadas implementasen indicadores a modo de herramientas para la mejora de los resultados en los centros acreditados&#46; Una encuesta administrada a 31 pa&#237;ses de la UE y del Espacio Econ&#243;mico Europeo para conocer sus estrategias de control de la TB detect&#243; que las acciones prioritarias eran&#58; llegar a grupos de poblaci&#243;n vulnerable&#44; detecci&#243;n de TB activa en grupos de alto riesgo&#44; implementaci&#243;n de registros electr&#243;nicos&#44; EECC&#44; control de la TB multirresistente y centralizaci&#243;n de la atenci&#243;n<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Todos los estudios mencionados respaldan el uso de los indicadores relacionados con la organizaci&#243;n como la figura de la enfermer&#237;a gestora de casos&#44; la realizaci&#243;n de EECC&#44; el tratamiento correcto&#44; la administraci&#243;n de TDO o la coordinaci&#243;n con otros servicios y profesionales<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">22&#44;23</span></a>&#46; La acreditaci&#243;n de unidades monogr&#225;ficas es una iniciativa de la SEPAR mediante la cual otorga un sello de garant&#237;a en t&#233;rminos de calidad a partir de una serie de criterios objetivos que coinciden con los indicadores utilizados en los estudios anteriores<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">6</span></a>&#46; Adem&#225;s&#44; la creaci&#243;n de las UTB puede contribuir a la estrategia End TB de la Organizaci&#243;n Mundial de la Salud<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Aunque se han detectado varios aspectos positivos como la recogida de conclusi&#243;n final&#44; notificaci&#243;n a SP&#44; manejo de resistencias y control de enfermedades asociadas o iatrogenia&#44; tambi&#233;n se han detectado aspectos mejorables&#46; Entre estos &#250;ltimos deben citarse que haya un referente en TB&#44; que se organice el censo y la realizaci&#243;n de EECC&#44; que se disponga de circuitos de derivaci&#243;n y coordinaci&#243;n y que haya enfermer&#237;a gestora de casos&#46; Esta &#250;ltima recomendaci&#243;n&#44; primordial para la gesti&#243;n de la TB&#44; destaca entre los puntos de mejora en las UTB acreditadas&#46; Las diferencias significativas en los resultados y funcionamiento entre las unidades acreditadas y las que no lo est&#225;n deber&#237;a servir de est&#237;mulo a estas &#250;ltimas para mejorar su funcionamiento e intentar alcanzar los criterios exigidos para la acreditaci&#243;n&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusiones</span><p id="par0180" class="elsevierStylePara elsevierViewall">Este estudio permite conocer c&#243;mo se organiza actualmente el manejo y control de la TB en Espa&#241;a y cu&#225;l ha sido el impacto de la acreditaci&#243;n de UTB por parte de la SEPAR&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Se precisa una supervisi&#243;n cercana de las UTB a partir de indicadores anuales simples que faciliten&#44; incluso&#44; la autoevaluaci&#243;n&#46; La mejora progresiva de la efectividad de las UTB&#44; junto con un aumento tambi&#233;n progresivo de las acreditaciones&#44; tanto de nuevas solicitudes como de ascenso del nivel de complejidad y de reacreditaciones&#44; contribuir&#237;a a la mejora de la organizaci&#243;n del control de la TB en Espa&#241;a&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Financiaci&#243;n</span><p id="par0190" class="elsevierStylePara elsevierViewall">Este trabajo ha sido financiado mediante la beca de la Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica SEPAR 114&#47;2013 &#40;IP&#58; Joan Pau Millet&#41;&#44; Espa&#241;a&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicto de intereses</span><p id="par0195" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introducci&#243;n</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Un buen control de la tuberculosis &#40;TB&#41; requiere disponer de personal multidisciplinario bien coordinado&#46; El objetivo fue evaluar el impacto de la acreditaci&#243;n de unidades de TB &#40;UTB&#41; fomentada por la Sociedad Espa&#241;ola de Neumolog&#237;a &#40;SEPAR&#41; y ver las diferencias entre los centros que se acreditaron y los que no&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos&#46; Dise&#241;o</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional descriptivo basado en una encuesta autoadministrada entre octubre de 2014 y febrero de 2018 a 139 responsables de neumolog&#237;a registrados por SEPAR&#44; antes y despu&#233;s de la acreditaci&#243;n&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Variables</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">demogr&#225;ficas&#44; epidemiol&#243;gicas y sobre estudio de contactos&#44; entre otras&#46; An&#225;lisis&#58; descriptiva b&#225;sica&#44; c&#225;lculo de medianas para variables continuas y proporciones para categ&#243;ricas&#46; Se compararon las variables mediante el test chi-cuadrado y regresi&#243;n log&#237;stica&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Resultados</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La tasa de respuesta fue del 54&#44;7 y del 43&#44;2&#37; en el per&#237;odo pre- y postacreditaci&#243;n de UTB&#44; respectivamente&#46; No se observaron cambios en los diferentes &#225;mbitos de atenci&#243;n y coordinaci&#243;n entre la encuesta pre- y postacreditaci&#243;n&#44; ni tampoco en la organizaci&#243;n&#44; al analizar los centros acreditados&#46; Al comparar los centros que se acreditaron con los que no&#44; se detectaron diferencias significativas con relaci&#243;n a recogida de conclusi&#243;n final&#44; manejo de resistencias&#44; coordinaci&#243;n con otros servicios&#44; estudios de contactos o tratamiento directamente observado&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se ha objetivado c&#243;mo abordan la TB diferentes profesionales&#44; se han detectado aspectos positivos y otros mejorables&#44; y se han observando indicadores de mejor funcionamiento en los centros que se acreditaron frente a los que no lo hicieron&#46; Se precisa una supervisi&#243;n cercana de las UTB para mejorar su efectividad&#46;</p></span>"
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            "identificador" => "abst0030"
            "titulo" => "Conclusiones"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Well-coordinated multidisciplinary teams are essential for better tuberculosis &#40;TB&#41; control&#46; Our objective was to evaluate the impact of Spanish Society of Pneumology &#40;SEPAR&#41; accreditation of TB Units &#40;TBU&#41; and to determine differences between the accredited and non-accredited centers&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material and methods&#46; Design</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Observational descriptive study based on a self-administered survey from October 2014 to February 2018 completed by 139 heads of respiratory medicine departments collected by SEPAR&#44; before and after TBU accreditation&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Variables</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">demographic&#44; epidemiological and contact tracing &#40;CT&#41; variables&#44; among others&#46; Analysis&#58; basic descriptive analysis&#44; and calculation of medians for continuous variables and proportions for categorical variables&#46; The variables were compared using the Chi-squared test and logistic regression&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The response rate was 54&#46;7&#37; and 43&#46;2&#37; in the pre- and post-TBU accreditation period&#44; respectively&#46; No differences were observed in the care and coordination variables between the pre- and post-accreditation survey&#44; nor in the organization when only accredited centers were analyzed&#46; When we compared the accredited and non-accredited centers&#44; significant differences were detected in the collection of the final conclusion&#44; management of resistance&#44; coordination with other departments&#44; contact tracing&#44; and directly observed treatment&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The approach of different professionals with regard to TB has been addressed&#46; Positive aspects and areas for improvement have been detected&#44; and better results were observed in the accredited versus non-accredited centers&#46; A closer supervision of TBUs is necessary to improve their effectiveness&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Material and methods&#46; Design"
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            "identificador" => "abst0045"
            "titulo" => "Variables"
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          3 => array:2 [
            "identificador" => "abst0050"
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            "identificador" => "abst0055"
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          0 => array:4 [
            "apendice" => "<p id="par0205" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></p>"
            "etiqueta" => "Ap&#233;ndice A"
            "titulo" => "Encuesta <span class="elsevierStyleItalic">online</span> auto-administrada dirigida a los jefes de Servicio o Secci&#243;n de Neumolog&#237;a de Espa&#241;a registrados por SEPAR"
            "identificador" => "sec0065"
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      0 => array:8 [
        "identificador" => "tbl0010"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">AP&#58; Atenci&#243;n Primaria&#59; MDR&#58; multirresistente&#59; pac&#46;&#58; pacientes&#59; PII-TB&#58; Programa Integrado de Investigaci&#243;n en Tuberculosis&#59; RI&#58; rango intercuart&#237;lico&#59; SEPAR&#58; Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica&#59; TB&#58; tuberculosis&#59; TDO&#58; tratamiento directamente observado&#59; UTB&#58; unidad de tuberculosis&#59; VIH&#58; virus de la inmunodeficiencia humana&#59; XDR&#58; extremadamente resistente&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Encuesta preacreditaci&#243;n &#40;2014-16&#41; N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Encuesta postacreditaci&#243;n &#40;2017-18&#41; N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Servicios de Neumolog&#237;a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;500 camas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32 &#40;42&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;100 camas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extrahospitalario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mediana &#40;RI&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Casos de TB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;10&#44;5-52&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;14&#44;5-45&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;630<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MDR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;888<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Monorresistentes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0-4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0-2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;345<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Recoge conclusi&#243;n final</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">64 &#40;84&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;688&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Conclusi&#243;n final a&#241;o anterior</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65 &#40;85&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo TB pulmonar</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neum&#243;logo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">39 &#40;65&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Interna&#47;Infecciosas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;13&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;10&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ambos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20 &#40;26&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;23&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de TB extrapulmonar</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">0&#44;531&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neum&#243;logo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;22&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;26&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Interna&#47;Infecciosas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44 &#40;57&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34 &#40;56&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ambos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12 &#40;15&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;15&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de TB pedi&#225;trica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;967&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pediatra&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">64 &#40;86&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">51 &#40;85&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No tiene pediatr&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;12&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de pacientes&#58;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Monorresistentes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;97&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;98&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MDR&#47;XDR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Notificaci&#243;n a Salud P&#250;blica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">TDO en el centro</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">TDO otras entidades</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hospital</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;500 camas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;46&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>100-500 camas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;100 camas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extrahospitalario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mediana &#40;RI&#41;&#58;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Casos de TB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44 &#40;25-129&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35 &#40;20-125&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Monorresistentes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;1-5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;1-6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;710<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Recoge conclusi&#243;n final</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;93&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Conclusi&#243;n final a&#241;o anterior</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de TB pulmonar</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">0&#44;519&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neum&#243;logo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;73&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Interna&#47;Infecciosas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ambos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4 &#40;26&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de TB extrapulmonar</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;717&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neum&#243;logo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;53&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Interna&#47;Infecciosas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ambos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de TB pedi&#225;trica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;505&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pediatra&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;86&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;73&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No tiene pediatr&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;20&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de pacientes&#58;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Monorresistentes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MDR&#47;XDR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12 &#40;80&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;224<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VIH&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;66&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;73&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Patolog&#237;as asociadas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Iatrogenia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Referente de TB</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Coordinaci&#243;n con AP</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12 &#40;80&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;86&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Circuitos de mayor complejidad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;86&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">14 &#40;93&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Son UTB</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11 &#40;73&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">13 &#40;86&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;651<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gestora de casos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Notificaci&#243;n a Salud Publica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>26-50&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>51-75&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;75&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">TDO en el centro</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">TDO otras entidades</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;80&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;598<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Realiza estudio de contactos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Censa los contactos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;86&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Deriva los contactos a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neumolog&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;46&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;53&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Interna&#47;Infecciosas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Preventiva&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vigilancia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extrahospitalario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Casos de TB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Recoge conclusi&#243;n final</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Conclusi&#243;n final a&#241;o anterior</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de TB pulmonar</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No tiene pediatr&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;12&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de pacientes&#58;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Monorresistentes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MDR&#47;XDR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;25 &#40;0&#44;44-63&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VIH&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Patolog&#237;as asociadas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Iatrogenia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66 &#40;90&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Referente de TB</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Coordinaci&#243;n con AP</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Circuitos de mayor complejidad</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#44;53 &#40;1&#44;12-64&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Son UTB</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29 &#40;31&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;16&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Cribado de pac&#46; con factores riesgo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Participa en PII-TB</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;70&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12 &#40;16&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de diferentes variables asistenciales y de coordinaci&#243;n recogidas en la encuesta antes y despu&#233;s de la acreditaci&#243;n entre las unidades de tuberculosis acreditadas por SEPAR y las no acreditadas &#40;2014-2018&#41;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Campos encuesta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Fecha de cumplimentaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Cumplimentado por&#58; Nombre y apellidos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Especialidad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Servicio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Nombre del Centro de Trabajo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tipo de centro &#40;Hospitalario &#60; 100 camas &#47; Hospitalario 100-500 camas &#47; Hospitalario &#62; 500 camas &#47; Extrahospitalario&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ciudad del Centro de Trabajo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Provincia del Centro de Trabajo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#193;rea de influencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Poblaci&#243;n total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">N&#250;mero de casos de Tuberculosis atendidos&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Qui&#233;n realiza el tratamiento de la tuberculosis pulmonar y pleural en su centro&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">N&#250;mero de casos de MDR-TB&#58;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero de casos de Monorresistentes&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#191;Se recogen las conclusiones finales de los enfermos&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#191;Podr&#237;an saber lo que pas&#243; con los pacientes del 2016&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#191;Qui&#233;n realiza el tratamiento de la tuberculosis extrapulmonar &#40;excluida la pleural&#41; en su centro&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Qui&#233;n realiza el tratamiento de la tuberculosis pedi&#225;trica en su centro&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Existen circuitos claros de coordinaci&#243;n con Atenci&#243;n Primaria&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Existe una figura de referente en Tuberculosis en su centro&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Tiene capacidad de manejo de pacientes monorresistentes&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Existen circuitos claros de derivaci&#243;n a otros servicios asistenciales de mayor complejidad&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#191;Ya constituyen Unidad espec&#237;fica de tuberculosis&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Posibilidad de facilitar medicaci&#243;n y dar TDO en el centro&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estudio de contactos&#58; Se hace un censo de los contactos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estudio de contactos&#58; &#191;Se estudian directamente&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estudio de contactos&#58; en caso de remitirse&#44; &#191;a d&#243;nde se remiten&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cu&#225;l es el porcentaje de casos con al menos un contacto estudiado&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Realizan cribado y seguimiento de pacientes con factores de riesgo &#40;indigentes&#44; ADVP&#44; VIH&#44; tratamientos biol&#243;gicos&#44; etc&#46;&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Disponen de enfermera gestora de casos&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Disponen de residentes en formaci&#243;n&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Porcentaje estimado de casos notificados a Salud P&#250;blica&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#191;Ha participado aportando casos en la base de datos del PII-TB de SEPAR en 2014&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Se ha acreditado como Unidad de Tuberculosis por la SEPAR&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comentarios que quieran hacerse acerca de los datos expuestos&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Tiene capacidad de manejo de pacientes MDR&#47;XDR&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Tiene capacidad de manejo de pacientes VIH&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Tiene capacidad de manejo de pacientes con patolog&#237;as asociadas&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Tiene capacidad de manejo de pacientes con Iatrogenia&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Posibilidad de facilitar medicaci&#243;n y dar TDO en otras entidades&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Disponen de enfermera gestora de casos y de contactos&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Disponen de enfermera gestora de contactos&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Si a&#250;n no se ha acreditado &#191;Querr&#237;a acreditarse como Unidad de Tuberculosis por la SEPAR&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:24 [
            0 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Control of tuberculosis in large cities in developed countries&#58; An organizational problem"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;A&#46; Cayl&#224;"
                            1 => "A&#46; Orcau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1741-7015-9-127"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Med&#46;"
                        "fecha" => "2011 Nov 28"
                        "volumen" => "9"
                        "paginaInicial" => "127"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22122865"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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Organización del control de la tuberculosis en España: evaluación de una estrategia dirigida a fomentar la acreditación de unidades de tuberculosis
Organization of Tuberculosis Control in Spain: Evaluation of a Strategy Aimed at Promoting the Accreditation of Tuberculosis Units
Sílvia Bruguerasa,b,c,
Corresponding author
silviabruguerastorrella@gmail.com

Autor para correspondencia.
, Llanos Roldána, Teresa Rodrigob,d,e, José-María García-Garcíad,f, Joan A. Caylàd,e, Francisco Javier García-Pérezd,g, Àngels Orcaua,b,e, Isabel Mir Viladrichh, Antón Penas-Truquei, Joan Pau Milleta,b,e,j
a Servicio de Epidemiología, Agència de Salut Pública de Barcelona (ASPB), Barcelona, España
b Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP (CIBERESP), Instituto de Salud Carlos III, Madrid, España
c Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva, Universitat Autònoma de Barcelona, Barcelona, España
d Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira, Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
e Fundación de la Unidad de Investigación en Tuberculosis de Barcelona (fUITB), Barcelona, España
f Hospital Universitario San Agustín, Avilés (Asturias), España
g Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, España
h Servicio de Neumología, Hospital Son Llatzer, Palma de Mallorca, España
i Unidad de Tuberculosis, Hospital Universitario Lucus Augusti, Lugo, España
j Serveis Clínics, Barcelona, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Para un buen control de la tuberculosis &#40;TB&#41;&#44; incluyendo la detecci&#243;n precoz y el manejo adecuado de los casos&#44; una de las claves es disponer de personal especializado y una buena coordinaci&#243;n entre diferentes estamentos&#46; Su buen control requiere&#44; adem&#225;s&#44; disponer no solo de m&#233;dicos expertos sino de un n&#250;mero adecuado de personal de enfermer&#237;a especializado&#44; as&#237; como de una buena estructura y organizaci&#243;n de los servicios y responsables que la llevan a cabo<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1-4</span></a>&#46; En pa&#237;ses con baja incidencia de TB como Espa&#241;a&#44; donde ya hay muchos m&#225;s m&#233;dicos de Atenci&#243;n Primaria &#40;AP&#41; que casos de TB&#44; es recomendable que se centralicen las actividades referentes a la TB y al estudio de contactos &#40;EECC&#41; en unidades especializadas<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">5</span></a>&#46; El documento marco para la eliminaci&#243;n de la TB en pa&#237;ses de baja incidencia destaca la importancia de contar con un equipo de coordinaci&#243;n central&#44; unidades especializadas para el diagn&#243;stico y tratamiento de la TB y el nivel apropiado de centralizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Con el objetivo de mejorar el control de la TB&#44; la Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica &#40;SEPAR&#41; impuls&#243; la acreditaci&#243;n de unidades de tuberculosis &#40;UTB&#41; dedicadas al tratamiento&#44; seguimiento y prevenci&#243;n de la enfermedad&#46; Si bien el n&#250;mero de casos ha descendido notablemente&#44; la TB sigue teniendo importancia cl&#237;nica&#46; Su manejo muchas veces no es f&#225;cil y se ha complicado con la presencia de formas resistentes a los medicamentos m&#225;s eficaces&#46; Por ello&#44; es necesario contar con unidades b&#225;sicas&#44; pero tambi&#233;n con expertos y unidades especializadas que pueden aconsejar y dirigir tratamientos complejos&#44; estudiar los contactos de los casos y coordinarse con otras especialidades o niveles asistenciales&#46; Desde la SEPAR se busca la creaci&#243;n y posterior acreditaci&#243;n de UTB funcionales y multidisciplinarias&#44; en el sentido de agrupar especialidades&#44; profesionales y entidades que est&#225;n implicadas en el manejo de esta enfermedad<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6&#44;7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Conocer qui&#233;nes son los especialistas encargados del diagn&#243;stico&#44; tratamiento y del EECC de los pacientes con TB pulmonar y extrapulmonar y c&#243;mo se coordinan diferentes estamentos podr&#237;a ayudar a proponer estrategias para mejorar la organizaci&#243;n de las UTB&#46; Con ello se dar&#237;a un paso importante para el control de la TB en Espa&#241;a&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Por ello&#44; el objetivo del estudio fue conocer c&#243;mo se organizan los servicios de neumolog&#237;a y los profesionales dedicados a la TB en Espa&#241;a para controlar la enfermedad&#44; antes y despu&#233;s de la acreditaci&#243;n de UTB por parte de SEPAR&#44; a fin de analizar la efectividad de esta iniciativa&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Dise&#241;o y per&#237;odo</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudio observacional descriptivo transversal de base poblacional pre- y postacreditaci&#243;n en la atenci&#243;n especializada en Espa&#241;a del 1 de octubre de 2014 al 31 de diciembre de 2016 y del 1 de enero de 2017 al 28 de febrero de 2018&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">&#193;mbito</span><p id="par0030" class="elsevierStylePara elsevierViewall">Servicios de neumolog&#237;a de los hospitales de Espa&#241;a a trav&#233;s de una encuesta <span class="elsevierStyleItalic">online</span> autoadministrada dirigida a los jefes de servicio o secci&#243;n de neumolog&#237;a registrados por SEPAR &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>139&#41;&#46; La encuesta se administr&#243; antes y despu&#233;s del inicio de la acreditaci&#243;n de UTB&#46; Se enviaron 3 correos electr&#243;nicos desde la SEPAR para la encuesta pre- y 3 m&#225;s para la post- en los que se invitaba a responderlas y se llam&#243; por tel&#233;fono a los que no se pudo contactar mediante el correo electr&#243;nico&#46; En algunos casos los jefes de servicio o secci&#243;n de neumolog&#237;a derivaron la encuesta a otros servicios dedicados a la TB&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La iniciativa consisti&#243; en la acreditaci&#243;n como unidad asistencial de TB por parte de la SEPAR a todas las unidades que lo solicitaban y que reun&#237;an una serie de criterios preestablecidos<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">6</span></a>&#46; Se acreditaron un total de 26 UTB desde el a&#241;o 2015&#44; que fueron clasificadas en funci&#243;n de la complejidad en unidades b&#225;sicas&#44; especializadas o especializadas de alta complejidad&#46; Los criterios y requisitos de acreditaci&#243;n en cada una de estas categor&#237;as se clasificaron siguiendo las siguientes l&#237;neas y objetivos estrat&#233;gicos&#58; actividad asistencial&#44; recursos t&#233;cnicos y humanos&#44; disponibilidad de laboratorio de micobacterias&#44; capacidad de realizar EECC&#44; formaci&#243;n y actividad investigadora<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">6</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Variables y fuentes de informaci&#243;n</span><p id="par0040" class="elsevierStylePara elsevierViewall">La informaci&#243;n se obtuvo de una encuesta dise&#241;ada espec&#237;ficamente para ello &#40;<a class="elsevierStyleCrossRef" href="#sec0065">Ap&#233;ndice A</a>&#41;&#44; la cual se elabor&#243; teniendo en cuenta los criterios de acreditaci&#243;n de UTB de la SEPAR&#46; Se recogieron variables demogr&#225;ficas de los encuestados &#40;especialidad&#44; centro de trabajo&#44; tipo de centro&#44; ciudad&#44; provincia&#44; &#225;rea de influencia y comunidad aut&#243;noma&#41;&#44; epidemiol&#243;gicas &#40;n&#250;mero total de TB atendidos al a&#241;o&#44; de casos multirresistentes y monorresistentes y conclusi&#243;n final del tratamiento&#41;&#44; especialista responsable del tratamiento de la TB pulmonar&#44; TB extrapulmonar y pedi&#225;trica &#40;neum&#243;logo&#44; internista&#44; infect&#243;logo&#44; pediatra&#44; otros&#41;&#44; existencia de un referente de TB&#44; coordinaci&#243;n con AP y otros circuitos de derivaci&#243;n&#44; existencia de unidad espec&#237;fica de TB&#44; presencia de gestora de casos y de residentes&#44; notificaci&#243;n a Salud P&#250;blica &#40;SP&#41;&#44; posibilidad de suministrar tratamiento directamente observado &#40;TDO&#41;&#44; realizaci&#243;n de censo y EECC y especialista responsable del mismo &#40;AP&#44; neumolog&#237;a&#44; medicina interna&#44; infecciosas&#44; medicina preventiva&#41;&#44; cribado de infecci&#243;n tuberculosa latente en pacientes con factores de riesgo&#44; participaci&#243;n con el Programa Integrado de Investigaci&#243;n en Tuberculosis &#40;PII-TB&#41; y acreditaci&#243;n como UTB por la SEPAR&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Definiciones&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Referente de TB&#58; persona responsable y de referencia de la unidad con capacidad de coordinaci&#243;n y colaboraci&#243;n con otros m&#233;dicos neum&#243;logos y de otras especialidades&#44; as&#237; como con el personal de enfermer&#237;a<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">6</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Gestor de casos&#58; personal de enfermer&#237;a referente de TB que favorece la organizaci&#243;n&#44; coordinaci&#243;n y comunicaci&#243;n dentro de la UTB y fuera de esta&#46; Es el nexo entre los distintos actores implicados en el diagn&#243;stico&#44; tratamiento y seguimiento tanto de la enfermedad como de la infecci&#243;n tuberculosa latente y puede&#44; as&#237;&#44; centralizar toda la informaci&#243;n referente a los casos y a los contactos de TB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Paciente con factores de riesgo&#58; incluye a aquellas personas que han tenido contacto reciente con enfermos con TB y a las personas con afecciones o comportamientos que debilitan el sistema inmunitario<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">8</span></a>&#46;</p></li></ul></p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lisis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de las variables antes y despu&#233;s de la acreditaci&#243;n&#46; Se compararon las encuestas entre centros acreditados y no acreditados&#44; utilizando la m&#225;s reciente en el caso de que el centro hubiese cumplimentado ambas&#46; Se calcularon medianas y rangos intercuart&#237;licos &#40;RI&#41; para las variables continuas y proporciones para las categ&#243;ricas&#46; Se compararon las variables categ&#243;ricas a nivel univariado mediante el test de chi-cuadrado o la prueba exacta de Fisher si no se cumpl&#237;an los criterios del chi-cuadrado&#44; considerando un valor <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 como estad&#237;sticamente significativo&#46; Se calcularon los factores asociados a acreditarse por la SEPAR mediante un an&#225;lisis de regresi&#243;n log&#237;stica comparando los centros que se acreditaron con los que no lo hicieron&#46; Como medida de asociaci&#243;n se utiliz&#243; la <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41;&#44; con un intervalo de confianza del 95&#37; &#40;IC&#41; y un valor de significaci&#243;n estad&#237;stica <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Para determinar el ajuste del modelo se utiliz&#243; el test de Hosmer y Lemeshow&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Consideraciones &#233;ticas</span><p id="par0075" class="elsevierStylePara elsevierViewall">Todos los datos se trataron de forma estrictamente confidencial siguiendo en todo momento los principios &#233;ticos de la Declaraci&#243;n de Helsinki<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a>&#44; la Ley espa&#241;ola de Protecci&#243;n de Datos 15&#47;1999<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a> y el Reglamento de la Uni&#243;n Europea n&#46;&#176; 2016&#47;679 General de Protecci&#243;n de Datos<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a>&#46; El proyecto se present&#243; y aprob&#243; por el Comit&#233; de &#201;tica e Investigaci&#243;n Cl&#237;nica del Institut Municipal d&#8217;Assist&#232;ncia Sanit&#224;ria&#44; n&#250;mero 2013&#47;5389&#47;I&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">De los 139 servicios o secciones de neumolog&#237;a de Espa&#241;a contactados&#44; 76 &#40;54&#44;7&#37;&#41; respondieron la encuesta preacreditaci&#243;n realizada entre 2014 y 2016 y 60 &#40;43&#44;2&#37;&#41; la encuesta postacreditaci&#243;n contestada entre los a&#241;os 2017 y 2018&#46; Un total de 93 centros contestaron al menos una encuesta&#44; 43 de los cuales respondieron ambas encuestas&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Las 76 encuestas preacreditaci&#243;n proced&#237;an de 16&#47;17 &#40;94&#44;1&#37;&#41; comunidades aut&#243;nomas y 33&#47;50 &#40;66&#37;&#41; provincias de Espa&#241;a&#46; El 90&#44;8&#37; &#40;69&#47;76&#41; pertenec&#237;an a servicios o secciones de neumolog&#237;a y 7&#47;76 &#40;9&#44;2&#37;&#41; a medicina interna o infecciosas&#46; El 42&#44;1&#37; &#40;32&#41; y 52&#44;6&#37; &#40;40&#41; formaban parte de hospitales con m&#225;s de 500 y de 100-500 camas&#44; respectivamente&#46; La mediana global de casos de TB en los a&#241;os 2014&#44; 2015 o 2016 fue de 28 &#40;RI 10&#44;5-52&#44;5&#41; por centro encuestado y el 84&#44;2&#37; &#40;64&#41; de ellos recog&#237;an el resultado final del tratamiento&#46; En un mayor porcentaje de los centros la TB pulmonar era atendida por neum&#243;logos &#40;59&#44;2&#37;&#41;&#44; mientras que la extrapulmonar era tratada por medicina interna en un 57&#44;9&#37; de ellos&#46; En el 72&#44;4&#37; de los centros &#40;55&#41; se realiz&#243; censo de los contactos y en el 60&#44;5&#37; el EECC&#46; En el 64&#44;5&#37; &#40;49&#41; exist&#237;a un referente de TB&#44; el 63&#44;2&#37; &#40;48&#41; se coordinaban con AP y el 61&#44;8&#37; &#40;47&#41; con niveles asistenciales superiores&#46; El 34&#44;2&#37; &#40;26&#41; ya estaban organizados como UTB&#44; el 42&#44;1&#37; &#40;32&#41; dispon&#237;an de gestora de casos y el 94&#44;7&#37; &#40;72&#41; notificaban m&#225;s del 75&#37; de los casos a SP&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Seg&#250;n procedencia geogr&#225;fica&#44; las 60 encuestas postacreditaci&#243;n proced&#237;an de 15&#47;17 &#40;88&#44;2&#37;&#41; comunidades aut&#243;nomas y 26&#47;50 &#40;52&#37;&#41; provincias&#46; El 86&#44;7&#37; &#40;52&#47;60&#41; pertenec&#237;an a servicios o secciones de neumolog&#237;a y 8&#47;60 &#40;13&#44;3&#37;&#41; a medicina interna o infecciosas&#46; El 45&#44;0&#37; &#40;27&#41; y 50&#44;0&#37; &#40;30&#41; formaban parte de hospitales con m&#225;s de 500 y de 100-500 camas&#44; respectivamente&#46; La mediana de casos de TB en los a&#241;os 2017 o 2018 fue de 20 &#40;RI 14&#44;5-45&#44;5&#41; por centro y hasta el 86&#44;7&#37; &#40;52&#41; recog&#237;an el resultado final del tratamiento&#46; Se hizo el censo de los contactos en el 68&#44;3&#37; de los centros &#40;41&#41; y se realiz&#243; el EECC en el 61&#44;7&#37; de ellos&#46; En el 68&#44;3&#37; &#40;41&#41; exist&#237;a un referente de TB&#44; el 73&#44;3&#37; &#40;44&#41; se coordinaban con AP y el 63&#44;3&#37; &#40;38&#41; con niveles asistenciales superiores&#46; El 36&#44;7&#37; &#40;22&#41; ya estaban organizados como UTB&#44; el 46&#44;7&#37; &#40;28&#41; dispon&#237;an de gestora de casos y el 91&#44;7&#37; &#40;55&#41; notificaban m&#225;s del 75&#37; de los casos a SP&#46; De los 40 centros no acreditados&#44; 21 &#40;52&#44;5&#37;&#41; manifestaban que les gustar&#237;a acreditarse como UTB&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 1</a> compara las principales variables recogidas en la encuesta antes y despu&#233;s de la acreditaci&#243;n&#46; No se observaron cambios significativos en los diferentes &#225;mbitos de atenci&#243;n y coordinaci&#243;n entre la encuesta pre- y postacreditaci&#243;n&#44; aunque s&#237; se mejoraba la recogida de conclusiones finales&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">De todos los centros que respondieron la encuesta&#44; se acreditaron como UTB 20 centros y 15 de estos respondieron ambas encuestas&#46; Al comparar los resultados de la encuesta antes y despu&#233;s de la acreditaci&#243;n de UTB en estos 15 centros&#44; no se observaron diferencias en la organizaci&#243;n antes y despu&#233;s de haberse acreditado &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">En la comparaci&#243;n entre los 20 centros acreditados y los 73 no acreditados&#44; observamos que existen diferencias estad&#237;sticamente significativas entre ellos&#46; Entre los acreditados hubo un porcentaje mayor de centros que recogen la conclusi&#243;n final de los casos&#44; que se coordinan con la AP&#44; que cuentan con un referente de TB y con circuitos de derivaci&#243;n a otros servicios de mayor complejidad&#46; Tambi&#233;n se observa una mayor proporci&#243;n de centros que manejan pacientes con TB multirresistente&#47;extremadamente resistente&#44; que tienen capacidad para facilitar TDO en el centro o en otras entidades&#44; que realizan el EECC y que cuentan con la figura de la gestora de casos&#46; Los centros acreditados est&#225;n ubicados en solamente 9 comunidades aut&#243;nomas y la mayor&#237;a de estos centros ya constitu&#237;an una UTB y participaban aportando casos al PII-TB &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Al comparar los 20 centros que se acreditaron con los 73 que no lo hicieron&#44; el modelo de regresi&#243;n log&#237;stica indica que las variables asociadas a acreditarse como UTB fueron constituir una UTB &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#44;68&#59; IC95&#37;&#58; 3&#44;84-133&#44;74&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y disponer de circuitos de derivaci&#243;n a otros servicios de mayor complejidad &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44;53&#59; IC95&#37;&#58; 1&#44;12-64&#44;80&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;038&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 3</a>&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discusi&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">Este estudio ha permitido conocer mejor c&#243;mo se aborda la TB en Espa&#241;a por parte de los servicios y secciones de neumolog&#237;a y otros profesionales dedicados a esta enfermedad y tambi&#233;n ha permitido observar qu&#233; diferencias hay entre los centros que se acreditaron y los que no&#46; Seg&#250;n las respuestas de las encuestas&#44; el manejo de la TB pulmonar es llevado a cabo&#44; sobre todo&#44; por neum&#243;logos y la extrapulmonar&#44; por internistas&#46; En una alta proporci&#243;n&#44; se realiza seguimiento de los casos hasta finalizar el tratamiento&#44; se manejan resistencias y enfermedades asociadas y se facilita TDO a los pacientes&#46; No obstante&#44; debe mejorarse el censo y el EECC por parte de los servicios de neumolog&#237;a o de medicina preventiva y&#44; aunque el porcentaje de casos notificados a SP es elevado&#44; se han identificado centros donde la notificaci&#243;n es menor del 75&#37;&#44; a pesar de ser una enfermedad de declaraci&#243;n obligatoria&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Los resultados obtenidos mediante las encuestas autoadministradas muestran que no se observaron diferencias importantes en las distintas variables de atenci&#243;n y coordinaci&#243;n entre los centros que respondieron la encuesta pre- y aquellos que respondieron la encuesta postacreditaci&#243;n&#46; Por otro lado&#44; aquellos centros que se acreditaron y contestaron ambas encuestas &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; tampoco presentaron diferencias en la organizaci&#243;n antes y despu&#233;s de la acreditaci&#243;n&#46; Por &#250;ltimo&#44; al comparar los centros que se acreditaron con los que no lo hicieron&#44; se observaron diferencias estad&#237;sticamente significativas en variables organizativas y de atenci&#243;n de los pacientes&#46; El an&#225;lisis multivariado indica que constituir una UTB y disponer de circuitos de derivaci&#243;n a otros servicios de mayor complejidad est&#225; asociado con el hecho de acreditarse como UTB&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">La falta de mejoras significativas entre los centros acreditados por la SEPAR cuando se comparan sus caracter&#237;sticas antes y despu&#233;s de la acreditaci&#243;n podr&#237;a atribuirse a que dichos centros ya abordaban la TB de forma efectiva y correcta antes de solicitar la acreditaci&#243;n&#46; Adem&#225;s&#44; se trata de un tama&#241;o muestral peque&#241;o con bajo poder estad&#237;stico&#46; S&#237; que se encuentran diferencias entre los centros seg&#250;n estuvieran acreditados o no&#44; y esto podr&#237;a deberse a que se acreditan mayoritariamente aquellos centros que ya cuentan con una mayor organizaci&#243;n y mejores indicadores&#46; La acreditaci&#243;n implica revisar y desempe&#241;ar acciones para mejorar el manejo y control de la enfermedad&#44; as&#237; como evaluar y reorganizar el personal y las actividades realizadas en el centro&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Como limitaci&#243;n del estudio&#44; se debe citar la imposibilidad de verificar las respuestas y que las encuestas postacreditaci&#243;n se realizaron solo 2 a&#241;os m&#225;s tarde del inicio de las acreditaciones y puede que se precise m&#225;s tiempo para que aumente el n&#250;mero de UTB acreditadas y se pueda evaluar su evoluci&#243;n&#46; De todos modos&#44; las UTB acreditadas podr&#237;an servir de est&#237;mulo para la acreditaci&#243;n de otras unidades&#46; En cuanto al contenido de la encuesta&#44; podr&#237;a evaluarse en mayor profundidad el manejo y abordaje de los pacientes inmunodeprimidos &#40;tratamientos biol&#243;gicos&#44; ancianos&#8230;&#41; por parte de las UTB&#44; ya que se trata de un colectivo especialmente vulnerable&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Se ha visto que en las grandes ciudades de pa&#237;ses de baja incidencia de TB se puede aumentar la eficiencia de los programas de control mejorando su organizaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1&#44;4</span></a>&#46; En relaci&#243;n con los resultados obtenidos&#44; otros autores tambi&#233;n han relacionado el control de la TB con una mejora organizativa basada en la creaci&#243;n de UTB&#46; M&#225;s concretamente&#44; un estudio en Barcelona evalu&#243; el impacto de la creaci&#243;n de UTB en la ciudad y pudo concluir que la intervenci&#243;n mejoraba el EECC<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a>&#59; lo mismo que se observa en este estudio comparando los centros que se acreditaron con los que no lo hicieron&#46; Resultados similares se observaron en el Programa TB de Galicia&#44; organizado en torno a 7 UTB<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">12</span></a>&#46; Todos estos estudios destacaban como puntos clave para la organizaci&#243;n del manejo de la enfermedad la centralizaci&#243;n de la atenci&#243;n de la TB&#44; el papel de la enfermer&#237;a gestora de casos y la coordinaci&#243;n y comunicaci&#243;n entre los diferentes &#225;mbitos y profesionales implicados<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1&#44;3</span></a>&#46; En todos estos aspectos presentaron mejores indicadores aquellas unidades que se acreditaron&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">La Comunidad Aut&#243;noma de Madrid llev&#243; a cabo una evaluaci&#243;n del control de la TB y encontr&#243; elevados porcentajes de p&#233;rdida de seguimiento de los casos y un n&#250;mero bajo de EECC realizados&#46; Los autores destacaron la necesidad de centralizar el seguimiento de los enfermos y los EECC en UTB para mejorar los resultados obtenidos<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">13</span></a>&#46; Otras publicaciones recomiendan que&#44; debido a que la baja incidencia no permite acumular experiencia entre los profesionales de la AP&#44; se centralice la atenci&#243;n a la TB y se cuente con grupos de profesionales especializados en constante comunicaci&#243;n y coordinados entre ellos<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">5&#44;14-16</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Igualmente&#44; un estudio realizado en el Reino Unido concluy&#243; que un buen control de la enfermedad depende de que exista un n&#250;mero adecuado de especialistas dedicados a la TB&#46; Se identific&#243; como una estrategia de control de la enfermedad contar con una enfermera dedicada a la TB por cada 40 pacientes<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">2</span></a>&#46; Este estudio no permite establecer comparaciones adecuadas&#44; pero el porcentaje de centros con enfermeras gestoras de casos y referentes de TB fue mucho mayor en aquellas unidades que se acreditaron&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En la misma l&#237;nea&#44; el consenso sobre el control de la TB en las grandes ciudades elaborado por un grupo de trabajo que representa a varias grandes ciudades de la Uni&#243;n Europea destaca la importancia de organizarse para garantizar el acceso de los pacientes e incluir suficiente personal y experiencia&#44; as&#237; como promover una fuerte colaboraci&#243;n y coordinaci&#243;n entre sectores<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Por otra parte&#44; una revisi&#243;n sistem&#225;tica sobre intervenciones que mejoran la adherencia y los resultados del tratamiento de la TB concluy&#243; que la administraci&#243;n de TDO&#44; juntamente con la educaci&#243;n del paciente&#44; aumenta la adherencia y las tasas de &#233;xito del tratamiento<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Es relevante destacar que&#44; aunque la TB es una enfermedad de declaraci&#243;n obligatoria&#44; en algunos centros de Espa&#241;a existe subnotificaci&#243;n de casos a SP&#44; lo que supone una complicaci&#243;n para el control de la enfermedad&#46; Un estudio de Gim&#233;nez-Duran et al&#46; demostr&#243; la existencia de subnotificaci&#243;n en las Islas Baleares a partir de las prescripciones de f&#225;rmacos antituberculosos<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> y otro de Morales-Garc&#237;a et al&#46; observ&#243; en 16 centros espa&#241;oles una importante subnotificaci&#243;n y destac&#243; que los centros que contaban con enfermera gestora de casos tuvieron tasas de notificaci&#243;n del 100&#37;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">19</span></a>&#44; lo que refuerza la importancia de esta figura en las UTB&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Seg&#250;n un estudio desarrollado en California&#44; implementar una evaluaci&#243;n sistem&#225;tica anual y un proceso de mejora mediante el uso de indicadores en los programas de control de la TB mejoraba los resultados<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a>&#46; Ello respaldar&#237;a el que las unidades acreditadas implementasen indicadores a modo de herramientas para la mejora de los resultados en los centros acreditados&#46; Una encuesta administrada a 31 pa&#237;ses de la UE y del Espacio Econ&#243;mico Europeo para conocer sus estrategias de control de la TB detect&#243; que las acciones prioritarias eran&#58; llegar a grupos de poblaci&#243;n vulnerable&#44; detecci&#243;n de TB activa en grupos de alto riesgo&#44; implementaci&#243;n de registros electr&#243;nicos&#44; EECC&#44; control de la TB multirresistente y centralizaci&#243;n de la atenci&#243;n<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Todos los estudios mencionados respaldan el uso de los indicadores relacionados con la organizaci&#243;n como la figura de la enfermer&#237;a gestora de casos&#44; la realizaci&#243;n de EECC&#44; el tratamiento correcto&#44; la administraci&#243;n de TDO o la coordinaci&#243;n con otros servicios y profesionales<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">22&#44;23</span></a>&#46; La acreditaci&#243;n de unidades monogr&#225;ficas es una iniciativa de la SEPAR mediante la cual otorga un sello de garant&#237;a en t&#233;rminos de calidad a partir de una serie de criterios objetivos que coinciden con los indicadores utilizados en los estudios anteriores<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">6</span></a>&#46; Adem&#225;s&#44; la creaci&#243;n de las UTB puede contribuir a la estrategia End TB de la Organizaci&#243;n Mundial de la Salud<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Aunque se han detectado varios aspectos positivos como la recogida de conclusi&#243;n final&#44; notificaci&#243;n a SP&#44; manejo de resistencias y control de enfermedades asociadas o iatrogenia&#44; tambi&#233;n se han detectado aspectos mejorables&#46; Entre estos &#250;ltimos deben citarse que haya un referente en TB&#44; que se organice el censo y la realizaci&#243;n de EECC&#44; que se disponga de circuitos de derivaci&#243;n y coordinaci&#243;n y que haya enfermer&#237;a gestora de casos&#46; Esta &#250;ltima recomendaci&#243;n&#44; primordial para la gesti&#243;n de la TB&#44; destaca entre los puntos de mejora en las UTB acreditadas&#46; Las diferencias significativas en los resultados y funcionamiento entre las unidades acreditadas y las que no lo est&#225;n deber&#237;a servir de est&#237;mulo a estas &#250;ltimas para mejorar su funcionamiento e intentar alcanzar los criterios exigidos para la acreditaci&#243;n&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusiones</span><p id="par0180" class="elsevierStylePara elsevierViewall">Este estudio permite conocer c&#243;mo se organiza actualmente el manejo y control de la TB en Espa&#241;a y cu&#225;l ha sido el impacto de la acreditaci&#243;n de UTB por parte de la SEPAR&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Se precisa una supervisi&#243;n cercana de las UTB a partir de indicadores anuales simples que faciliten&#44; incluso&#44; la autoevaluaci&#243;n&#46; La mejora progresiva de la efectividad de las UTB&#44; junto con un aumento tambi&#233;n progresivo de las acreditaciones&#44; tanto de nuevas solicitudes como de ascenso del nivel de complejidad y de reacreditaciones&#44; contribuir&#237;a a la mejora de la organizaci&#243;n del control de la TB en Espa&#241;a&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Financiaci&#243;n</span><p id="par0190" class="elsevierStylePara elsevierViewall">Este trabajo ha sido financiado mediante la beca de la Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica SEPAR 114&#47;2013 &#40;IP&#58; Joan Pau Millet&#41;&#44; Espa&#241;a&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicto de intereses</span><p id="par0195" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "identificador" => "sec0035"
              "titulo" => "Consideraciones &#233;ticas"
            ]
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          "titulo" => "Resultados"
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        8 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Discusi&#243;n"
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        9 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conclusiones"
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        10 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Financiaci&#243;n"
        ]
        11 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conflicto de intereses"
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        12 => array:2 [
          "identificador" => "xack473753"
          "titulo" => "Agradecimientos"
        ]
        13 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-12-04"
    "fechaAceptado" => "2019-04-26"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1254379"
          "palabras" => array:7 [
            0 => "Acreditaci&#243;n"
            1 => "Centros sanitarios"
            2 => "Espa&#241;a"
            3 => "Estudio de contactos"
            4 => "Neumolog&#237;a"
            5 => "Organizaci&#243;n"
            6 => "Tuberculosis"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1254378"
          "palabras" => array:7 [
            0 => "Accreditation"
            1 => "Health centers"
            2 => "Spain"
            3 => "Contact tracing"
            4 => "Pneumology"
            5 => "Organization"
            6 => "Tuberculosis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introducci&#243;n</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Un buen control de la tuberculosis &#40;TB&#41; requiere disponer de personal multidisciplinario bien coordinado&#46; El objetivo fue evaluar el impacto de la acreditaci&#243;n de unidades de TB &#40;UTB&#41; fomentada por la Sociedad Espa&#241;ola de Neumolog&#237;a &#40;SEPAR&#41; y ver las diferencias entre los centros que se acreditaron y los que no&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos&#46; Dise&#241;o</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional descriptivo basado en una encuesta autoadministrada entre octubre de 2014 y febrero de 2018 a 139 responsables de neumolog&#237;a registrados por SEPAR&#44; antes y despu&#233;s de la acreditaci&#243;n&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Variables</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">demogr&#225;ficas&#44; epidemiol&#243;gicas y sobre estudio de contactos&#44; entre otras&#46; An&#225;lisis&#58; descriptiva b&#225;sica&#44; c&#225;lculo de medianas para variables continuas y proporciones para categ&#243;ricas&#46; Se compararon las variables mediante el test chi-cuadrado y regresi&#243;n log&#237;stica&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Resultados</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La tasa de respuesta fue del 54&#44;7 y del 43&#44;2&#37; en el per&#237;odo pre- y postacreditaci&#243;n de UTB&#44; respectivamente&#46; No se observaron cambios en los diferentes &#225;mbitos de atenci&#243;n y coordinaci&#243;n entre la encuesta pre- y postacreditaci&#243;n&#44; ni tampoco en la organizaci&#243;n&#44; al analizar los centros acreditados&#46; Al comparar los centros que se acreditaron con los que no&#44; se detectaron diferencias significativas con relaci&#243;n a recogida de conclusi&#243;n final&#44; manejo de resistencias&#44; coordinaci&#243;n con otros servicios&#44; estudios de contactos o tratamiento directamente observado&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se ha objetivado c&#243;mo abordan la TB diferentes profesionales&#44; se han detectado aspectos positivos y otros mejorables&#44; y se han observando indicadores de mejor funcionamiento en los centros que se acreditaron frente a los que no lo hicieron&#46; Se precisa una supervisi&#243;n cercana de las UTB para mejorar su efectividad&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Material y m&#233;todos&#46; Dise&#241;o"
          ]
          2 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Variables"
          ]
          3 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Well-coordinated multidisciplinary teams are essential for better tuberculosis &#40;TB&#41; control&#46; Our objective was to evaluate the impact of Spanish Society of Pneumology &#40;SEPAR&#41; accreditation of TB Units &#40;TBU&#41; and to determine differences between the accredited and non-accredited centers&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material and methods&#46; Design</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Observational descriptive study based on a self-administered survey from October 2014 to February 2018 completed by 139 heads of respiratory medicine departments collected by SEPAR&#44; before and after TBU accreditation&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Variables</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">demographic&#44; epidemiological and contact tracing &#40;CT&#41; variables&#44; among others&#46; Analysis&#58; basic descriptive analysis&#44; and calculation of medians for continuous variables and proportions for categorical variables&#46; The variables were compared using the Chi-squared test and logistic regression&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The response rate was 54&#46;7&#37; and 43&#46;2&#37; in the pre- and post-TBU accreditation period&#44; respectively&#46; No differences were observed in the care and coordination variables between the pre- and post-accreditation survey&#44; nor in the organization when only accredited centers were analyzed&#46; When we compared the accredited and non-accredited centers&#44; significant differences were detected in the collection of the final conclusion&#44; management of resistance&#44; coordination with other departments&#44; contact tracing&#44; and directly observed treatment&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The approach of different professionals with regard to TB has been addressed&#46; Positive aspects and areas for improvement have been detected&#44; and better results were observed in the accredited versus non-accredited centers&#46; A closer supervision of TBUs is necessary to improve their effectiveness&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Material and methods&#46; Design"
          ]
          2 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Variables"
          ]
          3 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "apendice" => array:1 [
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          0 => array:4 [
            "apendice" => "<p id="par0205" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></p>"
            "etiqueta" => "Ap&#233;ndice A"
            "titulo" => "Encuesta <span class="elsevierStyleItalic">online</span> auto-administrada dirigida a los jefes de Servicio o Secci&#243;n de Neumolog&#237;a de Espa&#241;a registrados por SEPAR"
            "identificador" => "sec0065"
          ]
        ]
      ]
    ]
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      0 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
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            "identificador" => "at1"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">AP&#58; Atenci&#243;n Primaria&#59; MDR&#58; multirresistente&#59; pac&#46;&#58; pacientes&#59; PII-TB&#58; Programa Integrado de Investigaci&#243;n en Tuberculosis&#59; RI&#58; rango intercuart&#237;lico&#59; SEPAR&#58; Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica&#59; TB&#58; tuberculosis&#59; TDO&#58; tratamiento directamente observado&#59; UTB&#58; unidad de tuberculosis&#59; VIH&#58; virus de la inmunodeficiencia humana&#59; XDR&#58; extremadamente resistente&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Encuesta preacreditaci&#243;n &#40;2014-16&#41; N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comunidades aut&#243;nomas</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Provincias</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Servicios de Neumolog&#237;a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;500 camas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extrahospitalario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mediana &#40;RI&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Casos de TB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;10&#44;5-52&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;630<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0-1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;888<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Monorresistentes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;345<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Recoge conclusi&#243;n final</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">64 &#40;84&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52 &#40;86&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;688&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Conclusi&#243;n final a&#241;o anterior</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo TB pulmonar</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neum&#243;logo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Interna&#47;Infecciosas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ambos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20 &#40;26&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;23&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de TB extrapulmonar</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">17 &#40;22&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;26&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Interna&#47;Infecciosas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">44 &#40;57&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34 &#40;56&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ambos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12 &#40;15&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">9 &#40;15&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de TB pedi&#225;trica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;967&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pediatra&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">64 &#40;86&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">51 &#40;85&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No tiene pediatr&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de pacientes&#58;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VIH&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Patolog&#237;as asociadas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Iatrogenia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Referente TB</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Coordinaci&#243;n con AP</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Circuitos de mayor complejidad</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Son UTB</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Gestora de casos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Notificaci&#243;n a Salud P&#250;blica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;25&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>26-50&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">TDO otras entidades</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Realiza estudio de contactos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Deriva los contactos a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Interna&#47;Infecciosas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Preventiva&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vigilancia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;7&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Cribado de pac&#46; con factores riesgo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Participa PII-TB</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;27&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;38&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Querr&#237;a acreditarse</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;73&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de TB extrapulmonar</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Interna&#47;Infecciosas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de TB pedi&#225;trica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;505&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pediatra&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;86&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;73&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No tiene pediatr&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;20&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de pacientes&#58;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Monorresistentes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MDR&#47;XDR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;80&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;224<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VIH&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;66&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;73&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Patolog&#237;as asociadas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Iatrogenia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Referente de TB</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Notificaci&#243;n a Salud Publica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">TDO otras entidades</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Realiza estudio de contactos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Servicios de Neumolog&#237;a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Casos de TB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Recoge conclusi&#243;n final</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59 &#40;80&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de TB extrapulmonar</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de TB pedi&#225;trica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pediatra&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No tiene pediatr&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Manejo de pacientes&#58;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Monorresistentes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MDR&#47;XDR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VIH&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Patolog&#237;as asociadas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Iatrogenia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66 &#40;90&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Referente de TB</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41 &#40;56&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Coordinaci&#243;n con AP</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">TDO en el centro</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">TDO otras entidades</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;020<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Realiza EECC</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41 &#40;56&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Censa los contactos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">61 &#40;65&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">45 &#40;61&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Deriva los contactos a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43 &#40;46&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;35&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36 &#40;49&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neumolog&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;25&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;45&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;20&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Interna&#47;Infecciosas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Preventiva&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;15&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vigilancia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;10&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Compartida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47 &#40;64&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">Tipo de centro &#40;Hospitalario &#60; 100 camas &#47; Hospitalario 100-500 camas &#47; Hospitalario &#62; 500 camas &#47; Extrahospitalario&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#193;rea de influencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Poblaci&#243;n total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#191;Qui&#233;n realiza el tratamiento de la tuberculosis pulmonar y pleural en su centro&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">N&#250;mero de casos de MDR-TB&#58;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#191;Se recogen las conclusiones finales de los enfermos&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#191;Podr&#237;an saber lo que pas&#243; con los pacientes del 2016&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Qui&#233;n realiza el tratamiento de la tuberculosis extrapulmonar &#40;excluida la pleural&#41; en su centro&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#191;Qui&#233;n realiza el tratamiento de la tuberculosis pedi&#225;trica en su centro&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Existen circuitos claros de coordinaci&#243;n con Atenci&#243;n Primaria&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Existe una figura de referente en Tuberculosis en su centro&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Tiene capacidad de manejo de pacientes monorresistentes&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Existen circuitos claros de derivaci&#243;n a otros servicios asistenciales de mayor complejidad&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Ya constituyen Unidad espec&#237;fica de tuberculosis&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Posibilidad de facilitar medicaci&#243;n y dar TDO en el centro&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estudio de contactos&#58; Se hace un censo de los contactos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Estudio de contactos&#58; &#191;Se estudian directamente&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Estudio de contactos&#58; en caso de remitirse&#44; &#191;a d&#243;nde se remiten&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Cu&#225;l es el porcentaje de casos con al menos un contacto estudiado&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Realizan cribado y seguimiento de pacientes con factores de riesgo &#40;indigentes&#44; ADVP&#44; VIH&#44; tratamientos biol&#243;gicos&#44; etc&#46;&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Disponen de enfermera gestora de casos&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#191;Disponen de residentes en formaci&#243;n&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#191;Porcentaje estimado de casos notificados a Salud P&#250;blica&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#191;Ha participado aportando casos en la base de datos del PII-TB de SEPAR en 2014&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#191;Se ha acreditado como Unidad de Tuberculosis por la SEPAR&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comentarios que quieran hacerse acerca de los datos expuestos&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Tiene capacidad de manejo de pacientes MDR&#47;XDR&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Tiene capacidad de manejo de pacientes VIH&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Tiene capacidad de manejo de pacientes con patolog&#237;as asociadas&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Tiene capacidad de manejo de pacientes con Iatrogenia&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Posibilidad de facilitar medicaci&#243;n y dar TDO en otras entidades&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Disponen de enfermera gestora de casos y de contactos&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#191;Disponen de enfermera gestora de contactos&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Si a&#250;n no se ha acreditado &#191;Querr&#237;a acreditarse como Unidad de Tuberculosis por la SEPAR&#63;&nbsp;\t\t\t\t\t\t\n
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                  "host" => array:1 [
                    0 => array:2 [
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                      ]
                    ]
                  ]
                  "host" => array:1 [
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                    0 => array:2 [
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                          "autores" => array:6 [
                            0 => "M&#46;L&#46; Moro"
                            1 => "D&#46; Resi"
                            2 => "B&#46; Lelli"
                            3 => "A&#46; Nicoli"
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                  "host" => array:1 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Tuberc Lung Dis&#46;"
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                        "volumen" => "9"
                        "paginaInicial" => "1355"
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                            5 => "E&#46; Jaramillo"
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Article information
ISSN: 03002896
Original language: Spanish
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