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    "textoCompleto" => "<p class="elsevierStylePara">EuroNeoStat is a European project&#44; financed entirely by one million Euros from the European Commission Health and Consumer Protection Directorate General &#40;DG Sanco&#41;&#44; within the VI Research Framework Programme for 2006 to 2008&#46; Neonatal units from 23 European countries work together on this project&#44; which is led from our country&#46; Its overall objective is to create a European information system that monitors the short- and long-term outcomes of extremely low birth-weight infants &#40;ELBWI&#41; attended at the units taking part&#44; in order to improve the quality and safety of care provided and so improve their development&#46;</p><p class="elsevierStylePara">Currently&#44; premature birth must be a health priority&#44; given its high prevalence and its grave family&#44; social&#44; individual and health-care consequences&#44; as well as its economic impact&#46; These babies not only require long stays in neonatal intensive care units &#40;NICUs&#41;&#44; but often require rehospitalisation&#44; along with multiple preventive&#44; therapeutic and rehabilitatory interventions&#44; which drain the always limited health-care resources available&#46; All this means that this project is extremely relevant both for health-care delivery and in social and economic terms&#46;</p><p class="elsevierStylePara">Although the end aim of Perinatology is to avoid premature birth&#44; this target has not been attainable&#46; In fact&#44; the same as in Europe as a whole <span class="elsevierStyleSup"> 1</span>&#44; premature birth rates have increased in our country&#44; such that in three decades they have almost doubled &#40;from 4-5 &#37; to the current 7-8 &#37;&#41; <span class="elsevierStyleSup">2</span>&#46; In addition&#44; ELBWI&#44; under 1&#44;500 grams at birth&#44; though only accounting for 1-2 &#37; of all births&#44; have high specific mortality &#40;15-20 &#37;&#41; and morbidity &#40;10-20 &#37;&#41;&#44; which means they contribute greatly both to neonatal and child mortality <span class="elsevierStyleSup"> 3</span> and to childhood disability&#46; It should also not be forgotten that&#44; although these rates depend on maternal health and the perinatal care received&#44; specific morbi-mortality is the outcome&#44; among other factors&#44; of the quality of neonatal care&#46;</p><p class="elsevierStylePara">In NICUs&#44; monitoring and life-support techniques have not only increased survival <span class="elsevierStyleSup"> 4</span>&#44; but have avoided some of these patients suffering injuries that would lead eventually to long-term disability&#46; Despite this&#44; an overall 10 &#37; of ELBWI are gravely disabled&#59; and a further 10 &#37;&#44; moderately disabled <span class="elsevierStyleSup">5&#44;6</span>&#46; In addition&#44; 20-30 &#37; of the most immature babies have a cognitive or attention deficiency or delayed psycho-motor development <span class="elsevierStyleSup">7</span>&#46;</p><p class="elsevierStylePara">If the outcomes are to be improved&#44; then those factors of risk that can be modified must be identified&#44; the care process needs to be analysed and the results for one unit&#44; region or country need to be compared with reference populations&#46; In addition to intra-institution analysis&#44; as long as explicit and homogeneous indicators and criteria are followed&#44; inter-institution comparisons can also be conducted <span class="elsevierStyleSup"> 8</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Networking</span></p><p class="elsevierStylePara">The systematic prospective gathering of homogeneous indicators enables inter-centre comparisons to be made&#44; for use in epidemiological control and evaluation of the quality of care delivered to these patients at such high risk&#46; Various experiences of networking exist&#44; which have tackled and resolved the problem of specific information on ELBWI &#40;table 1&#41;&#46; The best known of these is the Vermont-Oxford Neonatal Network &#40;VON&#41; in the United States <span class="elsevierStyleSup"> 8</span>&#46; Among us&#44; most Spanish NICUs take part in the SEN-1500 initiative coordinated by the Spanish Neonatology Society &#40;www&#46;se-neonatal&#46;es&#41; and some take part in the EuroNeoNet &#40;<a href="http&#58;&#47;&#47;www&#46;euroneonet&#46;org" class="elsevierStyleCrossRefs">www&#46;euroneonet&#46;org</a>&#41;&#46;</p><p class="elsevierStylePara"><img src="37v65n01-13091413tab01.gif"></img></p><p class="elsevierStylePara">All these neonatal networks are voluntary collaborations between neonatal units&#44; with a data-gathering structure based on close monitoring of each case till death or hospital discharge&#46; They all collect data on risk factors&#44; interventions and complications in the care process&#44; and on outcomes&#44; all of which are variables closely linked to the quality of health-care delivery&#46; The value of all this is based on the following premises&#58;</p><p class="elsevierStylePara">1&#41;The mortality of ELBWI reaches 50-60 &#37; of neonatal mortality and 40-50 &#37; of infant mortality&#44; figures which rise still further for long-term morbidity&#46;</p><p class="elsevierStylePara">2&#41;ELBWI only account for 1-2 &#37; of all neonates&#44; and are wholly identifiable&#44; as they are all born in hospital and attended in NICUs&#46;</p><p class="elsevierStylePara">3&#41;Their outcomes are related to initial blood flow &#40;degree of immaturity&#41;&#44; as well as to the quality of perinatal and neonatal care received&#46;</p><p class="elsevierStylePara">4&#41;There are highly effective antenatal and perinatal strategies &#40;e&#46;g&#46; corticoids and exogenous surfactant&#41; that are not always used <span class="elsevierStyleSup">9</span>&#46; That is to say&#44; there are differences in strategies for managing these patients and room for improvement in currently used procedures&#46;</p><p class="elsevierStylePara">5&#41;Survivors may present with neurological or respiratory disabilities that require prolonged follow-up with multiple therapy and rehabilitation interventions and&#47;or hospital readmission&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">EuroNeoNet</span></p><p class="elsevierStylePara">The EuroNeoNet &#40;European Neonatal Network&#41; was created in 2002 as an information system on ELBWI and is linked to the European Society of Neonatology&#47;European Society of Paediatric Research &#40;ESN&#47;ESPR&#59; www&#46; espr&#46;info&#41;&#46; Its mission is to try to see that every ELBWI cared for in Europe receives the best neonatal care possible&#44; regardless of his&#47;her place of birth&#46; To achieve this&#44; EuroNeoNet is based on four initiatives&#44; the pillars of the virtual platform&#58;</p><p class="elsevierStylePara">1&#41;Standardised comparison of perinatal outcomes and of monitoring of each participating unit with the rest &#40;external auditing or &#34;benchmarking&#34;&#41;&#44; without data identifying individuals or institutions being included in any case&#46;</p><p class="elsevierStylePara">2&#41;Promotion of the safety of patients attended&#46;</p><p class="elsevierStylePara">3&#41;Ongoing virtual training of professionals &#40;&#34;E-learning&#34;&#41;&#46;</p><p class="elsevierStylePara">4&#41;Independent clinical trials&#44; not promoted by the pharmaceutical industry&#46;</p><p class="elsevierStylePara">To overcome the operational difficulties of implementing information systems&#44; new Internet information and communication technology is essential&#46; It enables us to&#58;</p><p class="elsevierStylePara">1&#41;Introduce and send data directly by e-mail or straight to the web site&#44; with guaranteed protection meeting all possible requisites for data confidentiality and security&#46;</p><p class="elsevierStylePara">2&#41;Extract autonomously and by computer data for quality control&#46;</p><p class="elsevierStylePara">3&#41;Spread more quickly and efficiently initiatives to improve health-care quality&#46;</p><p class="elsevierStylePara">With all the above&#44; the aim is to create a culture of continual improvement of health-care quality&#44; by means of the networking of the professionals involved&#44; which promotes the safety of the patients attended in the NICUs&#44; prioritises health care focusing on the family and on caring for the neonate&#39;s development&#44; and favours the spread of prophylactic and therapeutic strategies based on the best scientific evidence available&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">EuroNeoStat</span></p><p class="elsevierStylePara">The management committee of EuroNeoNet&#44; with the experience accumulated since 2002&#44; decided to put forward a proposal for developing an epidemiological project to the 2005 Public Health Call of the EC &#40;proposal number A&#47;790698&#44; contract 2005&#47;16&#41;&#44; under the title &#34;European Information System for monitoring short- and long-term morbidity in order to improve quality of care and patient safety for extremely low birth-weight infants&#34;&#46; The initiative was approved for the period 2006-8 and is known by the acronym&#44; EuroNeoStat&#46;</p><p class="elsevierStylePara">This European project is&#44; as well as an epidemiological watch study of the EC&#39;s Health and Consumer Protection Directorate General on the consequences of premature birth&#44; a project to research into health systems on the health care delivered to ELBWI in the units taking part&#46; The strategic objective is to develop an Information System to control and improve the quality of health care delivered to very immature neonates &#40;&#60; 32 weeks gestation&#41; or extremely low birth-weight infants &#40;&#60; 1&#44;500 gr&#46;&#41;&#46; To achieve this&#44; a number of neonatal and post-neonatal indicators of morbi-mortality were created&#44; with the aim of&#58;</p><p class="elsevierStylePara">1&#41;Gathering data to compare outcomes from the neonatal units taking part with those from other institutions &#40;external auditing&#41;&#46; This is designed to identify areas with opportunities for improvement of results of the care process&#44; as well as to have data available to make clear the success of the initiatives undertaken &#40;internal auditing&#41;&#46;</p><p class="elsevierStylePara">2&#41;Developing indicators so that health organisations can evaluate health programmes and priorities for planning&#44; promotion and evaluation of short- and long-term care of ELBWI&#46;</p><p class="elsevierStylePara">3&#41;Finding the clinical variability of the care process and its outcomes&#44; so as to analyse the best way of applying and promoting health care&#46;</p><p class="elsevierStylePara">4&#41;Pushing forward consensus in the health policies and strategies to be used in caring for ELBWI&#46;</p><p class="elsevierStylePara">Concretely&#44; the aim is to obtain data on at least 4&#44;000 ELBWI per year&#44; from at least 50 NICUs in 23 European countries&#44; coming both from the institutions that are part of the consortium &#40;see Appendix&#41; and neonatal networks&#44; whether local&#44; regional &#40;Liverpool&#44; Basque Country and Navarre etc&#46;&#41; or national ones &#40;Austria&#44; Switzerland&#44; Portugal etc&#46;&#41; that are prepared to contribute to the project&#46;</p><p class="elsevierStylePara"><img src="37v65n01-13091413tab02.gif"></img></p><p class="elsevierStylePara">As well as perinatal data&#44; and following the line marked out by Dr&#46; Johnson <span class="elsevierStyleSup"> 10</span>&#44; a minimum of monitoring data will be developed and introduced in selected units to evaluate the state of health of infants who survive for 24 months&#44; at corrected postnatal age&#46;</p><p class="elsevierStylePara">Three work-groups have been set up to take the project forward&#58; on perinatal data&#44; on monitoring and on safety of the patient&#44; led by Adolf Valls i Soler&#44; Michael Weindling and Harry Molendijk&#44; respectively&#46; In addition&#44; the Bilbao coordinating centre has taken on a graduate in Statistics&#44; a Computer expert&#44; a clerical assistant&#44; a secretary and an epidemiologist who works half-time&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">EuroNeoSafe</span></p><p class="elsevierStylePara">EuroNeoStat also includes an initiative&#44; called EuroNeoSafe&#44; to promote the safety of the ELBWI attended in the NICUs&#46; This initiative aims to develop a culture that places the safety of these tiny patients first by minimising medication errors <span class="elsevierStyleSup">11</span> or other mistakes&#44; a frequent cause of neonatal morbi-mortality <span class="elsevierStyleSup">12</span>&#46; As well as spreading information on these questions&#44; it hopes to create a system of voluntary communication of adverse incidents or near-incidents&#46; The purpose is not to find the guilty party&#44; as error is human&#44; but to analyse and clarify an incident&#39;s causes and put forward corrective mechanisms to reduce the frequency and consequences of this kind of error&#46;</p><p class="elsevierStylePara">In summary&#44; in order to tackle successfully initiatives aimed at improving outcomes in the process of perinatal care of the most immature and vulnerable neonates&#44; collaborative networking&#44; an attitude of constructive criticism and thorough comparative analysis of the outcomes and incidents in the health-care process are indispensable&#46;</p><hr></hr><p class="elsevierStylePara"><span class="elsevierStyleBold"> Correspondence&#58;</span> Dr&#46; Adolf Valls i Soler&#46;<br></br> Neonatal Unit&#46; Hospital de Cruces&#46;<br></br> Plaza de Cruces&#44; s&#47;n&#46;<br></br> 48903 Barakaldo-Bilbao&#44; Bizkaia&#44; Spain&#46;<br></br> E-mail&#58; avalls&#64;hcru&#46;osakidetza&#46;net<br></br><br></br> Date sent&#58; 15 May&#44; 2006&#46;</p>"
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EuroNeoStat. A European information system on the outcomes of care for extremely low birth-weight infants
EuroNeoStat. Un sistema europeo de información sobre los resultados
A. Valls-i-Solera, JI. Pijoána, C R. Pallás Alonsob, J. de la Cruz Bértolob
a Neonatal and Clinical Epidemiology Unit, Hospital de Cruces, Barakaldo-Bilbao, Spain.
b Neonatal and Clinical Epidemiology Unit, Hospital 12 de Octubre, Madrid, Spain.
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but often require rehospitalisation&#44; along with multiple preventive&#44; therapeutic and rehabilitatory interventions&#44; which drain the always limited health-care resources available&#46; All this means that this project is extremely relevant both for health-care delivery and in social and economic terms&#46;</p><p class="elsevierStylePara">Although the end aim of Perinatology is to avoid premature birth&#44; this target has not been attainable&#46; In fact&#44; the same as in Europe as a whole <span class="elsevierStyleSup"> 1</span>&#44; premature birth rates have increased in our country&#44; such that in three decades they have almost doubled &#40;from 4-5 &#37; to the current 7-8 &#37;&#41; <span class="elsevierStyleSup">2</span>&#46; In addition&#44; ELBWI&#44; under 1&#44;500 grams at birth&#44; though only accounting for 1-2 &#37; of all births&#44; have high specific mortality &#40;15-20 &#37;&#41; and morbidity &#40;10-20 &#37;&#41;&#44; which means they contribute greatly both to neonatal and child mortality <span class="elsevierStyleSup"> 3</span> and to childhood disability&#46; It should also not be forgotten that&#44; although these rates depend on maternal health and the perinatal care received&#44; specific morbi-mortality is the outcome&#44; among other factors&#44; of the quality of neonatal care&#46;</p><p class="elsevierStylePara">In NICUs&#44; monitoring and life-support techniques have not only increased survival <span class="elsevierStyleSup"> 4</span>&#44; but have avoided some of these patients suffering injuries that would lead eventually to long-term disability&#46; Despite this&#44; an overall 10 &#37; of ELBWI are gravely disabled&#59; and a further 10 &#37;&#44; moderately disabled <span class="elsevierStyleSup">5&#44;6</span>&#46; In addition&#44; 20-30 &#37; of the most immature babies have a cognitive or attention deficiency or delayed psycho-motor development <span class="elsevierStyleSup">7</span>&#46;</p><p class="elsevierStylePara">If the outcomes are to be improved&#44; then those factors of risk that can be modified must be identified&#44; the care process needs to be analysed and the results for one unit&#44; region or country need to be compared with reference populations&#46; In addition to intra-institution analysis&#44; as long as explicit and homogeneous indicators and criteria are followed&#44; inter-institution comparisons can also be conducted <span class="elsevierStyleSup"> 8</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Networking</span></p><p class="elsevierStylePara">The systematic prospective gathering of homogeneous indicators enables inter-centre comparisons to be made&#44; for use in epidemiological control and evaluation of the quality of care delivered to these patients at such high risk&#46; Various experiences of networking exist&#44; which have tackled and resolved the problem of specific information on ELBWI &#40;table 1&#41;&#46; The best known of these is the Vermont-Oxford Neonatal Network &#40;VON&#41; in the United States <span class="elsevierStyleSup"> 8</span>&#46; Among us&#44; most Spanish NICUs take part in the SEN-1500 initiative coordinated by the Spanish Neonatology Society &#40;www&#46;se-neonatal&#46;es&#41; and some take part in the EuroNeoNet &#40;<a href="http&#58;&#47;&#47;www&#46;euroneonet&#46;org" class="elsevierStyleCrossRefs">www&#46;euroneonet&#46;org</a>&#41;&#46;</p><p class="elsevierStylePara"><img src="37v65n01-13091413tab01.gif"></img></p><p class="elsevierStylePara">All these neonatal networks are voluntary collaborations between neonatal units&#44; with a data-gathering structure based on close monitoring of each case till death or hospital discharge&#46; They all collect data on risk factors&#44; interventions and complications in the care process&#44; and on outcomes&#44; all of which are variables closely linked to the quality of health-care delivery&#46; The value of all this is based on the following premises&#58;</p><p class="elsevierStylePara">1&#41;The mortality of ELBWI reaches 50-60 &#37; of neonatal mortality and 40-50 &#37; of infant mortality&#44; figures which rise still further for long-term morbidity&#46;</p><p class="elsevierStylePara">2&#41;ELBWI only account for 1-2 &#37; of all neonates&#44; and are wholly identifiable&#44; as they are all born in hospital and attended in NICUs&#46;</p><p class="elsevierStylePara">3&#41;Their outcomes are related to initial blood flow &#40;degree of immaturity&#41;&#44; as well as to the quality of perinatal and neonatal care received&#46;</p><p class="elsevierStylePara">4&#41;There are highly effective antenatal and perinatal strategies &#40;e&#46;g&#46; corticoids and exogenous surfactant&#41; that are not always used <span class="elsevierStyleSup">9</span>&#46; That is to say&#44; there are differences in strategies for managing these patients and room for improvement in currently used procedures&#46;</p><p class="elsevierStylePara">5&#41;Survivors may present with neurological or respiratory disabilities that require prolonged follow-up with multiple therapy and rehabilitation interventions and&#47;or hospital readmission&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">EuroNeoNet</span></p><p class="elsevierStylePara">The EuroNeoNet &#40;European Neonatal Network&#41; was created in 2002 as an information system on ELBWI and is linked to the European Society of Neonatology&#47;European Society of Paediatric Research &#40;ESN&#47;ESPR&#59; www&#46; espr&#46;info&#41;&#46; Its mission is to try to see that every ELBWI cared for in Europe receives the best neonatal care possible&#44; regardless of his&#47;her place of birth&#46; To achieve this&#44; EuroNeoNet is based on four initiatives&#44; the pillars of the virtual platform&#58;</p><p class="elsevierStylePara">1&#41;Standardised comparison of perinatal outcomes and of monitoring of each participating unit with the rest &#40;external auditing or &#34;benchmarking&#34;&#41;&#44; without data identifying individuals or institutions being included in any case&#46;</p><p class="elsevierStylePara">2&#41;Promotion of the safety of patients attended&#46;</p><p class="elsevierStylePara">3&#41;Ongoing virtual training of professionals &#40;&#34;E-learning&#34;&#41;&#46;</p><p class="elsevierStylePara">4&#41;Independent clinical trials&#44; not promoted by the pharmaceutical industry&#46;</p><p class="elsevierStylePara">To overcome the operational difficulties of implementing information systems&#44; new Internet information and communication technology is essential&#46; It enables us to&#58;</p><p class="elsevierStylePara">1&#41;Introduce and send data directly by e-mail or straight to the web site&#44; with guaranteed protection meeting all possible requisites for data confidentiality and security&#46;</p><p class="elsevierStylePara">2&#41;Extract autonomously and by computer data for quality control&#46;</p><p class="elsevierStylePara">3&#41;Spread more quickly and efficiently initiatives to improve health-care quality&#46;</p><p class="elsevierStylePara">With all the above&#44; the aim is to create a culture of continual improvement of health-care quality&#44; by means of the networking of the professionals involved&#44; which promotes the safety of the patients attended in the NICUs&#44; prioritises health care focusing on the family and on caring for the neonate&#39;s development&#44; and favours the spread of prophylactic and therapeutic strategies based on the best scientific evidence available&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">EuroNeoStat</span></p><p class="elsevierStylePara">The management committee of EuroNeoNet&#44; with the experience accumulated since 2002&#44; decided to put forward a proposal for developing an epidemiological project to the 2005 Public Health Call of the EC &#40;proposal number A&#47;790698&#44; contract 2005&#47;16&#41;&#44; under the title &#34;European Information System for monitoring short- and long-term morbidity in order to improve quality of care and patient safety for extremely low birth-weight infants&#34;&#46; The initiative was approved for the period 2006-8 and is known by the acronym&#44; EuroNeoStat&#46;</p><p class="elsevierStylePara">This European project is&#44; as well as an epidemiological watch study of the EC&#39;s Health and Consumer Protection Directorate General on the consequences of premature birth&#44; a project to research into health systems on the health care delivered to ELBWI in the units taking part&#46; The strategic objective is to develop an Information System to control and improve the quality of health care delivered to very immature neonates &#40;&#60; 32 weeks gestation&#41; or extremely low birth-weight infants &#40;&#60; 1&#44;500 gr&#46;&#41;&#46; To achieve this&#44; a number of neonatal and post-neonatal indicators of morbi-mortality were created&#44; with the aim of&#58;</p><p class="elsevierStylePara">1&#41;Gathering data to compare outcomes from the neonatal units taking part with those from other institutions &#40;external auditing&#41;&#46; This is designed to identify areas with opportunities for improvement of results of the care process&#44; as well as to have data available to make clear the success of the initiatives undertaken &#40;internal auditing&#41;&#46;</p><p class="elsevierStylePara">2&#41;Developing indicators so that health organisations can evaluate health programmes and priorities for planning&#44; promotion and evaluation of short- and long-term care of ELBWI&#46;</p><p class="elsevierStylePara">3&#41;Finding the clinical variability of the care process and its outcomes&#44; so as to analyse the best way of applying and promoting health care&#46;</p><p class="elsevierStylePara">4&#41;Pushing forward consensus in the health policies and strategies to be used in caring for ELBWI&#46;</p><p class="elsevierStylePara">Concretely&#44; the aim is to obtain data on at least 4&#44;000 ELBWI per year&#44; from at least 50 NICUs in 23 European countries&#44; coming both from the institutions that are part of the consortium &#40;see Appendix&#41; and neonatal networks&#44; whether local&#44; regional &#40;Liverpool&#44; Basque Country and Navarre etc&#46;&#41; or national ones &#40;Austria&#44; Switzerland&#44; Portugal etc&#46;&#41; that are prepared to contribute to the project&#46;</p><p class="elsevierStylePara"><img src="37v65n01-13091413tab02.gif"></img></p><p class="elsevierStylePara">As well as perinatal data&#44; and following the line marked out by Dr&#46; Johnson <span class="elsevierStyleSup"> 10</span>&#44; a minimum of monitoring data will be developed and introduced in selected units to evaluate the state of health of infants who survive for 24 months&#44; at corrected postnatal age&#46;</p><p class="elsevierStylePara">Three work-groups have been set up to take the project forward&#58; on perinatal data&#44; on monitoring and on safety of the patient&#44; led by Adolf Valls i Soler&#44; Michael Weindling and Harry Molendijk&#44; respectively&#46; In addition&#44; the Bilbao coordinating centre has taken on a graduate in Statistics&#44; a Computer expert&#44; a clerical assistant&#44; a secretary and an epidemiologist who works half-time&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">EuroNeoSafe</span></p><p class="elsevierStylePara">EuroNeoStat also includes an initiative&#44; called EuroNeoSafe&#44; to promote the safety of the ELBWI attended in the NICUs&#46; This initiative aims to develop a culture that places the safety of these tiny patients first by minimising medication errors <span class="elsevierStyleSup">11</span> or other mistakes&#44; a frequent cause of neonatal morbi-mortality <span class="elsevierStyleSup">12</span>&#46; As well as spreading information on these questions&#44; it hopes to create a system of voluntary communication of adverse incidents or near-incidents&#46; The purpose is not to find the guilty party&#44; as error is human&#44; but to analyse and clarify an incident&#39;s causes and put forward corrective mechanisms to reduce the frequency and consequences of this kind of error&#46;</p><p class="elsevierStylePara">In summary&#44; in order to tackle successfully initiatives aimed at improving outcomes in the process of perinatal care of the most immature and vulnerable neonates&#44; collaborative networking&#44; an attitude of constructive criticism and thorough comparative analysis of the outcomes and incidents in the health-care process are indispensable&#46;</p><hr></hr><p class="elsevierStylePara"><span class="elsevierStyleBold"> Correspondence&#58;</span> Dr&#46; Adolf Valls i Soler&#46;<br></br> Neonatal Unit&#46; Hospital de Cruces&#46;<br></br> Plaza de Cruces&#44; s&#47;n&#46;<br></br> 48903 Barakaldo-Bilbao&#44; Bizkaia&#44; Spain&#46;<br></br> E-mail&#58; avalls&#64;hcru&#46;osakidetza&#46;net<br></br><br></br> Date sent&#58; 15 May&#44; 2006&#46;</p>"
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Información del artículo
ISSN: 16954033
Idioma original: Inglés
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2012 Octubre 3 1 4
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2006 Junio 947 0 947
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