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Serveur d'exploration sur la grippe en Espagne

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Community Assessment of COPD Health Care (COACH) study: a clinical audit on primary care performance variability in COPD care.

Identifieur interne : 000074 ( Main/Exploration ); précédent : 000073; suivant : 000075

Community Assessment of COPD Health Care (COACH) study: a clinical audit on primary care performance variability in COPD care.

Auteurs : María Abad-Arranz [Espagne] ; Ana Moran-Rodríguez [Espagne] ; Enrique Mascar S Balaguer [Espagne] ; Carmen Quintana Velasco [Espagne] ; Laura Abad Polo [Espagne] ; Sara Nú Ez Palomo [Espagne] ; Jaime Gonzálvez Rey [Espagne] ; Ana María Fernández Vargas [Espagne] ; Antonio Hidalgo Requena [Espagne] ; Jose Manuel Helguera Quevedo [Espagne] ; Marina García Pardo [Espagne] ; Jose Luis Lopez-Campos [Espagne]

Source :

RBID : pubmed:29970023

Descripteurs français

English descriptors

Abstract

BACKGROUND

A thorough evaluation of the adequacy of clinical practice in a designated health care setting and temporal context is key for clinical care improvement. This study aimed to perform a clinical audit of primary care to evaluate clinical care delivered to patients with COPD in routine clinical practice.

METHODS

The Community Assessment of COPD Health Care (COACH) study was an observational, multicenter, nationwide, non-interventional, retrospective, clinical audit of randomly selected primary care centers in Spain. Two different databases were built: the resources and organization database and the clinical database. From January 1, 2015 to December 31, 2016 consecutive clinical cases of COPD in each participating primary care center (PCC) were audited. For descriptive purposes, we collected data regarding the age at diagnosis of COPD and the age at audit, gender, the setting of the PCC (rural/urban), and comorbidities for each patient. Two guidelines widely and uniformly used in Spain were carefully reviewed to establish a benchmark of adequacy for the audited cases. Clinical performance was analyzed at the patient, center, and regional levels. The degree of adequacy was categorized as excellent (> 80%), good (60-80%), adequate (40-59%), inadequate (20-39%), and highly inadequate (< 20%).

RESULTS

During the study 4307 cases from 63 primary care centers in 6 regions of the country were audited. Most evaluated parameters were judged to fall in the inadequate performance category. A correct diagnosis based on previous exposure plus spirometric obstruction was made in an average of 17.6% of cases, ranging from 9.8 to 23.3% depending on the region. During the audited visit, only 67 (1.6%) patients had current post-bronchodilator obstructive spirometry; 184 (4.3%) patients had current post-bronchodilator obstructive spirometry during either the audited or initial diagnostic visit. Evaluation of dyspnea was performed in 11.1% of cases. Regarding treatment, 33.6% received no maintenance inhaled therapies (ranging from 31.3% in GOLD A to 7.0% in GOLD D). The two most frequently registered items were exacerbations in the previous year (81.4%) and influenza vaccination (87.7%).

CONCLUSIONS

The results of this audit revealed a large variability in clinical performance across centers, which was not fully attributable to the severity of the disease.


DOI: 10.1186/s12874-018-0528-4
PubMed: 29970023
PubMed Central: PMC6029063


Affiliations:

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Le document en format XML

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<name sortKey="Fernandez Vargas, Ana Maria" sort="Fernandez Vargas, Ana Maria" uniqKey="Fernandez Vargas A" first="Ana María" last="Fernández Vargas">Ana María Fernández Vargas</name>
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<name sortKey="Helguera Quevedo, Jose Manuel" sort="Helguera Quevedo, Jose Manuel" uniqKey="Helguera Quevedo J" first="Jose Manuel" last="Helguera Quevedo">Jose Manuel Helguera Quevedo</name>
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<term>Middle Aged</term>
<term>Multicenter Studies as Topic</term>
<term>Observational Studies as Topic</term>
<term>Retrospective Studies</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr">
<term>Adulte d'âge moyen</term>
<term>Espagne</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mâle</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Études multicentriques comme sujet</term>
<term>Études observationnelles comme sujet</term>
<term>Études rétrospectives</term>
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<keywords scheme="Wicri" type="geographic" xml:lang="fr">
<term>Espagne</term>
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</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<p>
<b>BACKGROUND</b>
</p>
<p>A thorough evaluation of the adequacy of clinical practice in a designated health care setting and temporal context is key for clinical care improvement. This study aimed to perform a clinical audit of primary care to evaluate clinical care delivered to patients with COPD in routine clinical practice.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>METHODS</b>
</p>
<p>The Community Assessment of COPD Health Care (COACH) study was an observational, multicenter, nationwide, non-interventional, retrospective, clinical audit of randomly selected primary care centers in Spain. Two different databases were built: the resources and organization database and the clinical database. From January 1, 2015 to December 31, 2016 consecutive clinical cases of COPD in each participating primary care center (PCC) were audited. For descriptive purposes, we collected data regarding the age at diagnosis of COPD and the age at audit, gender, the setting of the PCC (rural/urban), and comorbidities for each patient. Two guidelines widely and uniformly used in Spain were carefully reviewed to establish a benchmark of adequacy for the audited cases. Clinical performance was analyzed at the patient, center, and regional levels. The degree of adequacy was categorized as excellent (> 80%), good (60-80%), adequate (40-59%), inadequate (20-39%), and highly inadequate (< 20%).</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>RESULTS</b>
</p>
<p>During the study 4307 cases from 63 primary care centers in 6 regions of the country were audited. Most evaluated parameters were judged to fall in the inadequate performance category. A correct diagnosis based on previous exposure plus spirometric obstruction was made in an average of 17.6% of cases, ranging from 9.8 to 23.3% depending on the region. During the audited visit, only 67 (1.6%) patients had current post-bronchodilator obstructive spirometry; 184 (4.3%) patients had current post-bronchodilator obstructive spirometry during either the audited or initial diagnostic visit. Evaluation of dyspnea was performed in 11.1% of cases. Regarding treatment, 33.6% received no maintenance inhaled therapies (ranging from 31.3% in GOLD A to 7.0% in GOLD D). The two most frequently registered items were exacerbations in the previous year (81.4%) and influenza vaccination (87.7%).</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>CONCLUSIONS</b>
</p>
<p>The results of this audit revealed a large variability in clinical performance across centers, which was not fully attributable to the severity of the disease.</p>
</div>
</front>
</TEI>
<pubmed>
<MedlineCitation Status="MEDLINE" Owner="NLM">
<PMID Version="1">29970023</PMID>
<DateCompleted>
<Year>2019</Year>
<Month>06</Month>
<Day>03</Day>
</DateCompleted>
<DateRevised>
<Year>2019</Year>
<Month>06</Month>
<Day>03</Day>
</DateRevised>
<Article PubModel="Electronic">
<Journal>
<ISSN IssnType="Electronic">1471-2288</ISSN>
<JournalIssue CitedMedium="Internet">
<Volume>18</Volume>
<Issue>1</Issue>
<PubDate>
<Year>2018</Year>
<Month>07</Month>
<Day>03</Day>
</PubDate>
</JournalIssue>
<Title>BMC medical research methodology</Title>
<ISOAbbreviation>BMC Med Res Methodol</ISOAbbreviation>
</Journal>
<ArticleTitle>Community Assessment of COPD Health Care (COACH) study: a clinical audit on primary care performance variability in COPD care.</ArticleTitle>
<Pagination>
<MedlinePgn>68</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1186/s12874-018-0528-4</ELocationID>
<Abstract>
<AbstractText Label="BACKGROUND">A thorough evaluation of the adequacy of clinical practice in a designated health care setting and temporal context is key for clinical care improvement. This study aimed to perform a clinical audit of primary care to evaluate clinical care delivered to patients with COPD in routine clinical practice.</AbstractText>
<AbstractText Label="METHODS">The Community Assessment of COPD Health Care (COACH) study was an observational, multicenter, nationwide, non-interventional, retrospective, clinical audit of randomly selected primary care centers in Spain. Two different databases were built: the resources and organization database and the clinical database. From January 1, 2015 to December 31, 2016 consecutive clinical cases of COPD in each participating primary care center (PCC) were audited. For descriptive purposes, we collected data regarding the age at diagnosis of COPD and the age at audit, gender, the setting of the PCC (rural/urban), and comorbidities for each patient. Two guidelines widely and uniformly used in Spain were carefully reviewed to establish a benchmark of adequacy for the audited cases. Clinical performance was analyzed at the patient, center, and regional levels. The degree of adequacy was categorized as excellent (> 80%), good (60-80%), adequate (40-59%), inadequate (20-39%), and highly inadequate (< 20%).</AbstractText>
<AbstractText Label="RESULTS">During the study 4307 cases from 63 primary care centers in 6 regions of the country were audited. Most evaluated parameters were judged to fall in the inadequate performance category. A correct diagnosis based on previous exposure plus spirometric obstruction was made in an average of 17.6% of cases, ranging from 9.8 to 23.3% depending on the region. During the audited visit, only 67 (1.6%) patients had current post-bronchodilator obstructive spirometry; 184 (4.3%) patients had current post-bronchodilator obstructive spirometry during either the audited or initial diagnostic visit. Evaluation of dyspnea was performed in 11.1% of cases. Regarding treatment, 33.6% received no maintenance inhaled therapies (ranging from 31.3% in GOLD A to 7.0% in GOLD D). The two most frequently registered items were exacerbations in the previous year (81.4%) and influenza vaccination (87.7%).</AbstractText>
<AbstractText Label="CONCLUSIONS">The results of this audit revealed a large variability in clinical performance across centers, which was not fully attributable to the severity of the disease.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y">
<Author ValidYN="Y">
<LastName>Abad-Arranz</LastName>
<ForeName>María</ForeName>
<Initials>M</Initials>
<AffiliationInfo>
<Affiliation>Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Avda. Manuel Siurot, s/n, 41013, Seville, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Moran-Rodríguez</LastName>
<ForeName>Ana</ForeName>
<Initials>A</Initials>
<AffiliationInfo>
<Affiliation>UGC-DCCU Bahía de Cádiz-La Janda, Cadiz, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Mascarós Balaguer</LastName>
<ForeName>Enrique</ForeName>
<Initials>E</Initials>
<AffiliationInfo>
<Affiliation>Centro de Salud Fuente de San Luis, Valencia, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Quintana Velasco</LastName>
<ForeName>Carmen</ForeName>
<Initials>C</Initials>
<AffiliationInfo>
<Affiliation>Centro de Salud Perpetuo Socorro, Huesca, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Abad Polo</LastName>
<ForeName>Laura</ForeName>
<Initials>L</Initials>
<AffiliationInfo>
<Affiliation>Centro de Salud Illueca, Sector Calatayud, Zaragoza, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Núñez Palomo</LastName>
<ForeName>Sara</ForeName>
<Initials>S</Initials>
<AffiliationInfo>
<Affiliation>Centro de Salud Torrelaguna, Madrid, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Gonzálvez Rey</LastName>
<ForeName>Jaime</ForeName>
<Initials>J</Initials>
<AffiliationInfo>
<Affiliation>Centro de Salud Matamá, Vigo, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Fernández Vargas</LastName>
<ForeName>Ana María</ForeName>
<Initials>AM</Initials>
<AffiliationInfo>
<Affiliation>Centro de Salud La Victoria, Málaga, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Hidalgo Requena</LastName>
<ForeName>Antonio</ForeName>
<Initials>A</Initials>
<AffiliationInfo>
<Affiliation>Centro de Salud de Lucena, Córdoba, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Helguera Quevedo</LastName>
<ForeName>Jose Manuel</ForeName>
<Initials>JM</Initials>
<AffiliationInfo>
<Affiliation>Centro de Salud Bajo Asón, Ampuero, Cantabria, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>García Pardo</LastName>
<ForeName>Marina</ForeName>
<Initials>M</Initials>
<AffiliationInfo>
<Affiliation>Centro de Salud de Inca, Mallorca, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Lopez-Campos</LastName>
<ForeName>Jose Luis</ForeName>
<Initials>JL</Initials>
<Identifier Source="ORCID">0000-0003-1703-1367</Identifier>
<AffiliationInfo>
<Affiliation>Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Avda. Manuel Siurot, s/n, 41013, Seville, Spain. lcampos@separ.es.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. lcampos@separ.es.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<CollectiveName>COACH study investigators</CollectiveName>
</Author>
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<Language>eng</Language>
<PublicationTypeList>
<PublicationType UI="D016428">Journal Article</PublicationType>
<PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType>
</PublicationTypeList>
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<Year>2018</Year>
<Month>07</Month>
<Day>03</Day>
</ArticleDate>
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<Country>England</Country>
<MedlineTA>BMC Med Res Methodol</MedlineTA>
<NlmUniqueID>100968545</NlmUniqueID>
<ISSNLinking>1471-2288</ISSNLinking>
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<CitationSubset>IM</CitationSubset>
<MeshHeadingList>
<MeshHeading>
<DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D054869" MajorTopicYN="N">Clinical Audit</DescriptorName>
<QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName>
<QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D019983" MajorTopicYN="N">Guideline Adherence</DescriptorName>
<QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D015337" MajorTopicYN="N">Multicenter Studies as Topic</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D064887" MajorTopicYN="N">Observational Studies as Topic</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D011320" MajorTopicYN="N">Primary Health Care</DescriptorName>
<QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName>
<QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D029424" MajorTopicYN="N">Pulmonary Disease, Chronic Obstructive</DescriptorName>
<QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName>
<QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName>
<QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D013030" MajorTopicYN="N" Type="Geographic">Spain</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D013147" MajorTopicYN="N">Spirometry</DescriptorName>
<QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName>
</MeshHeading>
</MeshHeadingList>
<KeywordList Owner="NOTNLM">
<Keyword MajorTopicYN="Y">COPD</Keyword>
<Keyword MajorTopicYN="Y">Clinical audit</Keyword>
<Keyword MajorTopicYN="Y">Primary care</Keyword>
<Keyword MajorTopicYN="Y">Quality of care</Keyword>
<Keyword MajorTopicYN="Y">Variability</Keyword>
</KeywordList>
<InvestigatorList>
<Investigator ValidYN="Y">
<LastName>Lopez-Campos</LastName>
<ForeName>Jose Luis</ForeName>
<Initials>JL</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Morán Rodríguez</LastName>
<ForeName>Ana</ForeName>
<Initials>A</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Mascarós Balaguer</LastName>
<ForeName>Enrique</ForeName>
<Initials>E</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Abad Arranz</LastName>
<ForeName>María</ForeName>
<Initials>M</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Fernández Vargas</LastName>
<ForeName>Ana M</ForeName>
<Initials>AM</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Hidalgo Requena</LastName>
<ForeName>Antonio</ForeName>
<Initials>A</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Helguera Quevedo</LastName>
<ForeName>José Manuel</ForeName>
<Initials>JM</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Núñez Palomo</LastName>
<ForeName>Sara</ForeName>
<Initials>S</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Fernández Vargas</LastName>
<ForeName>Ana María</ForeName>
<Initials>AM</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Elorza Maza</LastName>
<ForeName>Beatriz</ForeName>
<Initials>B</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Pulido Vázquez</LastName>
<ForeName>Cristina</ForeName>
<Initials>C</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>de Haro Muñoz</LastName>
<ForeName>Eloy</ForeName>
<Initials>E</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Pérez Ortiz</LastName>
<ForeName>Enrique</ForeName>
<Initials>E</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>López Verde</LastName>
<ForeName>Fernando</ForeName>
<Initials>F</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Guirado Hidalgo</LastName>
<ForeName>Francisco José</ForeName>
<Initials>FJ</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Martínez Ríos</LastName>
<ForeName>Irene</ForeName>
<Initials>I</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Lopez López</LastName>
<ForeName>Jose María</ForeName>
<Initials>JM</Initials>
</Investigator>
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<LastName>Lara González</LastName>
<ForeName>Juan Antonio</ForeName>
<Initials>JA</Initials>
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<Investigator ValidYN="Y">
<LastName>Navarro González</LastName>
<ForeName>Juan Carlos</ForeName>
<Initials>JC</Initials>
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<LastName>Del Rey Pérez</LastName>
<ForeName>Manolo</ForeName>
<Initials>M</Initials>
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<LastName>Resa Alcalá</LastName>
<ForeName>Manuel</ForeName>
<Initials>M</Initials>
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<LastName>Franco Reins</LastName>
<ForeName>Ramon Nicolas</ForeName>
<Initials>RN</Initials>
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<LastName>Rabaneda Bueno</LastName>
<ForeName>Raúl</ForeName>
<Initials>R</Initials>
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<LastName>Galván Espinosa</LastName>
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<LastName>Cerón</LastName>
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<LastName>Núñez Montenegro</LastName>
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<LastName>Contreras</LastName>
<ForeName>Eugenio</ForeName>
<Initials>E</Initials>
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<ForeName>Andra</ForeName>
<Initials>A</Initials>
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<Initials>B</Initials>
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<LastName>Sanchís Yago</LastName>
<ForeName>Beatriz</ForeName>
<Initials>B</Initials>
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<Initials>C</Initials>
</Investigator>
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<LastName>Lanuzzelli Barroso</LastName>
<ForeName>Clara</ForeName>
<Initials>C</Initials>
</Investigator>
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<LastName>López Mas</LastName>
<ForeName>Clara</ForeName>
<Initials>C</Initials>
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<Investigator ValidYN="Y">
<LastName>Rubio Castro</LastName>
<ForeName>Daniel</ForeName>
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<LastName>García Pardo</LastName>
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<Initials>M</Initials>
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<LastName>Rojo Calderón</LastName>
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<LastName>Rueda Alonso</LastName>
<ForeName>Esperanza</ForeName>
<Initials>E</Initials>
</Investigator>
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<LastName>Bermejo Ruiz</LastName>
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<Initials>H</Initials>
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<Initials>JC</Initials>
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<LastName>Sainz de Rozas Arpide</LastName>
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<Initials>L</Initials>
</Investigator>
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<LastName>Fernández Lerones</LastName>
<ForeName>María Jesús</ForeName>
<Initials>MJ</Initials>
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<LastName>Gonzálvez Rey</LastName>
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<LastName>Romero de Ávila Cabezón</LastName>
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<Initials>G</Initials>
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<LastName>Chapela Villa</LastName>
<ForeName>Carlos</ForeName>
<Initials>C</Initials>
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<LastName>Otero González</LastName>
<ForeName>Ruth</ForeName>
<Initials>R</Initials>
</Investigator>
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<LastName>Parada Jorgal</LastName>
<ForeName>Jose Ramón</ForeName>
<Initials>JR</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Valle González</LastName>
<ForeName>Irene</ForeName>
<Initials>I</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Espantoso Romero</LastName>
<ForeName>Maite</ForeName>
<Initials>M</Initials>
</Investigator>
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<LastName>Friande Pereira</LastName>
<ForeName>Susana</ForeName>
<Initials>S</Initials>
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<LastName>Montero Costa</LastName>
<ForeName>Alejandra</ForeName>
<Initials>A</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Jorge Formariz</LastName>
<ForeName>Alicia</ForeName>
<Initials>A</Initials>
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<LastName>Hernández Regalado</LastName>
<ForeName>Ana Isabel</ForeName>
<Initials>AI</Initials>
</Investigator>
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<LastName>Rey López</LastName>
<ForeName>Ana Maria</ForeName>
<Initials>AM</Initials>
</Investigator>
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<LastName>Val</LastName>
<ForeName>Ángel Alonso</ForeName>
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</Investigator>
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<LastName>Laguna</LastName>
<ForeName>Ángel Luis</ForeName>
<Initials>ÁL</Initials>
</Investigator>
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<LastName>Quijada Monso</LastName>
<ForeName>Ángel</ForeName>
<Initials>Á</Initials>
</Investigator>
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<LastName>Casado Aguado</LastName>
<ForeName>Ángeles</ForeName>
<Initials>Á</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Bordzynska Michalska</LastName>
<ForeName>Beata</ForeName>
<Initials>B</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Orozco Carratalá</LastName>
<ForeName>Beatriz</ForeName>
<Initials>B</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Solans Aisa</LastName>
<ForeName>Beatriz</ForeName>
<Initials>B</Initials>
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<LastName>Mateo Pascual</LastName>
<ForeName>Carmen</ForeName>
<Initials>C</Initials>
</Investigator>
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<LastName>Vieira Pascual</LastName>
<ForeName>Carmen</ForeName>
<Initials>C</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Alvarez Alonso</LastName>
<ForeName>Cristina</ForeName>
<Initials>C</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>García Lombardia</LastName>
<ForeName>Cristina</ForeName>
<Initials>C</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>González Gallardo</LastName>
<ForeName>David</ForeName>
<Initials>D</Initials>
</Investigator>
<Investigator ValidYN="Y">
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