Hernando Gaitán-Duarte

Incidencia y Evitabilidad de Eventos Adversos en Pacientes Hospitalizados en tres Instituciones Hospitalarias en Colombia, 2006

Objetivo Determinar incidencia, clasificacion, evitabilidad e impacto de los Eventos Adversos (EA) para establecer su importancia como problema en algunos hospitales en Colombia. Metodologia Cohorte prospectiva de pacientes hospitalizados al menos 12 horas en 3 instituciones generales en Colombia. Se excluyeron pacientes psiquiatricos, presencia del EA antes del ingreso a la hospitalizacion indice. Con una diferencia estimada del 1 % (complejidad alta y media), significancia: 0,05 %, poder: 80 % relacion 2:1 se requerian minimo 6 557 pacientes. Fuente de informacion: historia clinica Fase I: traduccion y adaptacion de formularios. Fase II: vigilancia activa de eventos de tamizacion. Fase III: evaluacion de la asociacion del EA con el cuidado proveido, por un comite de especialistas, Variables: edad, genero y tipo de afiliacion al sistema de seguridad social, incidencia acumulada de EA, temporalidad, evitabilidad y discapacidad resultante naturaleza del EA. Resultados Fueron evaluados 6 688 sujetos durante el periodo de vigilancia. Se detectaron 505 pacientes con eventos de tamizacion positivos (7,9 % IC95 % 7,3-8,6). Un total de 310 sujetos presentaron al menos un evento adverso; Incidencia acumulada: (4,6 % IC95 % 4,1-5,1) durante la hospitalizacion. De estos se considero evitable el evento adverso en 189 sujetos (61 %, IC95 % 55-66). Ocurrio discapacidad permanente en 1,3 %. La mortalidad asociada al evento adverso fue de 6,4 % (20/310). Se incremento la hospitalizacion como consecuencia del EA un total de 1 072 dias. Conclusiones La incidencia de eventos adversos evitables fue relevante en los tres hospitales de Colombia.

Diagnostic accuracy of rapid tests for sexually transmitted infections in symptomatic women.

Objective To determine the diagnostic accuracy of tests developed for use at the point of care for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and syphilis in women having symptoms of lower urinary tract infection. Methods Cross-sectional study involving sexually active 14–49-year-old women with lower urinary tract infection symptoms consulting during 2010 at a private health clinic and at two public hospitals in Bogotá, Colombia. Pregnant women, those with a previous hysterectomy or those who received antibiotics during the previous 7 days were excluded. Sequential sampling was used; sample size: 1500 women. The ACON NG and CT duo test combo and the ACON individual test plates for NG and separately for CT were used. The QuickVue Chlamydia rapid test (RT) was also used. All of them were compared with nucleic acid amplification methods. The SD Bioline 3.0 and ACON test for syphilis were evaluated and compared with serological tests. Sensitivity and specificity were estimated. Results CT RTs had a sensitivity that ranged between 22.7% and 37.7% and specificity between 99.3% and 100%. Sensitivity for NG with ACON Duo was 12.5% and specificity 99.8%. Tests for syphilis had a sensitivity of 91.6–100% and a specificity of 99.7–97.8%. Conclusions The RTs studied are not useful for screening for NG at the point of care. In case of CT a recommendation about their use in routine care should be supported by a cost-effectiveness analysis. In screening populations at high risk of sexually transmitted infections or pregnant women, the RTs for syphilis should be used.

Actitudes del personal en la vigilancia de eventos adversos intrahospitalarios en Colombia

Objective Detecting adverse events (AE) is part of managing hospitalised patients’ safety. Suitable AE monitoring is affected by many factors regarding any particular institution and its workers. This article was aimed at describing the difficulties emerging from identifying and evaluating events and suggested interventions from the workers’ viewpoint.

Evaluación del Impacto en Costo-equidad del Sistema de Salud en Colombia 1998-2005

Objetivo Realizar un estudio de analisis economico de costo equidad, desde la perspectiva de la sociedad, para evaluar el impacto de la Ley 100/93 en Colombia, entre 1998 y el 2005. Metodologia Estudio de analisis economico, comparando los costos y la equidad en salud en Colombia, entre 1998 y 2005. Los datos se tomaron del Departamento Administrativo Nacional de Estadistica y de las Encuestas de Demografia y Salud, 2000 y 2005. La informacion sobre costos se tomo del Sistema de Cuentas Nacionales en Salud. La inequidad en salud se estimo segun el Indicador de Inequidad en Salud (IHI). Se hizo un analisis de costo equidad promedio e incremental para tres sub periodos, asi; 1998-1999, en el que ocurrio una disminucion del Producto Interno Bruto per capita en Colombia; 2000-2001, en el que se disminuyo el Gasto Total en Salud, y el sub periodo posterior a los dos anteriores. Resultados Se presento una tendencia a disminuir el IHI, aunque no fue estable durante todo el periodo. Hubo una relacion inversa entre la inequidad en salud y el Gasto Publico Total en Salud, y una relacion directa entre el gasto de bolsillo y la inequidad en salud ( Spearman , p<0.05). La mejor relacion de costo equidad incremental se aprecio para el segundo periodo, con respecto al primero. Conclusion Las fluctuaciones en la equidad y en la relacion de costo equidad incremental entre los periodos analizados sugieren una dependencia entre el gasto en salud y la equidad en salud en Colombia durante el periodo de estudio.

Confiabilidad y validez de la escala para homofobia en estudiantes de medicina

Resumen Introduccion Existen varias escalas para cuantificar homofobia en distintas poblaciones. Sin embargo, no se conoce la confiabilidad ni la validez de alguno de estos instrumentos en estudiantes universitarios colombianos. Asi, este trabajo busca estimar la confiabilidad (consistencia interna) y la validez de la Escala para Homofobia en estudiantes de medicina de una universidad privada de Bogota (Colombia). Metodo Estudio metodologico con 199 estudiantes de medicina de primero a quinto semestre que diligenciaron la Escala para Homofobia, el cuestionario de bienestar general, la Escala de Actitud ante Hombres Homosexuales y Mujeres Lesbianas (ATGL), WHO-5 (validez divergente) y la Escala de Francis para Actitud ante el Cristianismo (validez nomologica). Se calcularon correlaciones de Pearson, coeficiente de alfa de Cronbach, coeficiente omega (confiabilidad de constructo) y analisis factorial confirmatorio. Resultados La Escala para Homofobia mostro un coeficiente de alfa de Cronbach de 0,785, un coeficiente omega de 0,790 y una correlacion de Pearson con la ATGL de 0,844; con la WHO-5, −0,059; y con la Escala de Francis para Actitud ante el Cristianismo, 0,187. La Escala para Homofobia presento un factor relevante que dio cuenta del 44,7% de la varianza total. Conclusiones La Escala para Homofobia muestra una aceptable confiabilidad y validez. Nuevos estudios deben investigar la estabilidad de la escala y la validez nomologica frente a otros constructos.INTRODUCTION There are several scales to quantify homophobia in different populations. However, the reliability and validity of these instruments among Colombian students are unknown. Consequently, this work is intended to assess reliability (inner consistency) as well as the validity of the Scale for Homophobia in Medicine students from a private university in Bogotá (Colombia). METHODOLOGY Methodological study with 199 Medicine students from 1st to 5th semester that filled out the Homophobia Scale form, the general welfare questionnaire, the Attitude Towards Gays and Lesbians Scale (ATGL), WHO-5 (divergent validity) and the Francis Scale of Attitude Toward Christianity (nomologic validity). Pearsons correlations were computed, the Cronbachs alfa coefficient, the omega coefficient (constructs reliability) and confirmatory factorial analysis. RESULTS The Scale for Homophobia showed an alpha Cronbach coefficient of 0,785, an omega coefficient of 0,790 and a Pearson correlation with the ATGL of 0,844; with WHO-5, -0,059; and a Francis Scale of Attitude Toward Christianity, 0,187. The Scale toward Homophobia exhibited a relevant factor of 44,7% of the total variance. CONCLUSIONS The Scale for Homophobia showed acceptable reliability and validity. New studies should investigate the stability of the scale and the nomologic validity regarding other constructs.

Escala para medir la calidad de la recuperación postanestésica desde la perspectiva del usuario

Objetivo Desarrollar una escala valida para medir la calidad de recuperacion postanestesica desde la perspectiva de los pacientes (CdR). Metodos Se realizo en sujetos programados para cirugia electiva con clasificacion ASA I o II. Lugar: Hospital San Juan de Dios de Bogota, Clinica de Salud Sexual y Reproductiva Profamilia y Clinica Carlos Lleras del Seguro Social. Se realizo en cinco fases: I. Entrevistas semiestructuradas para conocer las diferentes categorias e item de calidad referidos por los pacientes (n=30); II. Categorizacion y analisis de contenidos para conocer los item relevantes (n=42); III. Validacion de apariencia (n=20). IV. Diseno y validacion de la escala, CdR (n=283): Analisis de factores principales, rotacion varimax. La consistencia interna se evaluo con el coeficiente Alpha de Cronbach. La validacion de criterio, concurrente y discriminante se hizo utilizando estadistica no parametrica; V. Evaluacion de reproducibilidad de la escala (n=100), mediante el coeficiente de concordancia de Kendal. Resultados CdR se construyo en espanol colombiano, con 14 items y 3 dominios, calidad general (8 items), sala de recuperacion (5 items) y dolor (1 items). Mostro buena consistencia interna (Cronbach = 0.8783). CdR se correlaciono positivamente (rho spearman>0.39) con 3 de 5 escalas. Discrimino diferencias por sexo, tipo de cirugia, sitio quirurgico y tipo de anestesia (Ji2 y K. Wallis, p<0.05). Tuvo buena reproducibilidad (Kendal=0,6378, p=0,033). Conclusion CdR es la primera escala valida para medir la calidad de la recuperacion postanestesica, construida solo desde la perspectiva de los pacientes.

The sexually transmitted infections and HIV/AIDS Cochrane review groups

![Graphic][1] Accurate diagnosis, treatment and prevention of HIV and sexually transmitted infections (STIs) should be priorities for health systems around the world. Untreated or undertreated STIs can lead to infertility, cancer, chronic pelvic pain, and facilitate HIV transmission.1 New and existing treatments, tests and prevention strategies therefore need to be rigorously evaluated to assess their benefits and harms as this information is important for clinical decision-making and policy and guideline development. This editorial introduces the new Sexually Transmitted Infections Cochrane Review (STICR) group, which aims to support authors in summarising evidence about interventions and diagnostic tests used for genital tract infections. The Cochrane Collaboration focuses on developing and maintaining systematic reviews of healthcare interventions to allow well-informed decisions about healthcare.2 A systematic review is an assessment and evaluation of all research studies that examine a particular clinical problem,3 using explicit, pre-stated methods that reduce bias, thus providing more reliable findings from which conclusions can be drawn and decisions made.4 The Cochrane Database of Systematic Reviews forms the main part of the Cochrane Library, and has over 5000 reviews. According to Journal Citation Reports its impact factor for 2012 was 5.78,5 and more than 50% of the world has free access to the Cochrane Library.6 The STICR group is one of 52 groups of the Cochrane Collaboration. Its … [1]: /embed/inline-graphic-1.gif

Evaluación de la Atención Integral al Pos-aborto en 13 Hospitales de Colombia

Objectives This work describes Post-abortion Care strategy (PAC) experience in 13 Colombian hospitals regarding three components (counselling, suitable treatment and family planning). Methods The study had quantitative (cross-sectional study) and qualitative components. Population: Colombian hospitals receiving PAC training between 1999 and 2002 and fulfilling inclusion and exclusion criteria. Sequential convenience sampling was used; 127 patients, 13 managers and 39 health-care providers were interviewed. Results 26,199 women were treated for incomplete abortion during the study period. 40 % were treated using Manual Vacuum Aspiration (MVA) and 60 % using sharp curettage (SC). Family planning counselling was provided for 99,8 % of MVA cases; however, only 57,3 % of SC cases received it. There were 9 uterine perforations using SC and none in MVA cases (Chi square: 2.16; p=0.14). There were 2 vagal reactions using MVA. Uterine evacuation was needed in 13 SC cases but in only one MVA case (Chi square: 6,25 p=0.01). Patient satisfaction levels with hospital treatment were evaluated: 90 % of those receiving MVA treatment reported being satisfied or very satisfied, compared to just 60 % of those treated with SC. All health-care providers and 12 out of 13 managers reported satisfaction with the PAC strategy and with 12 out of 13 managers as well. Conclusions MVA treatment was associated with less treatment-related morbidity and higher levels of satisfaction amongst patients. Most managers and all health-care providers stated their satisfaction with the PAC strategy.

A comparative analysis of costs of single and dual rapid HIV and syphilis diagnostics: results from a randomised controlled trial in Colombia

Background HIV and congenital syphilis are major public health burdens contributing to substantial perinatal morbidity and mortality globally. Although studies have reported on the costs and cost-effectiveness of rapid diagnostic tests (RDTs) for syphilis screening within antenatal care in a number of resource-constrained settings, empirical evidence on country-specific cost and estimates of single RDTs compared with dual RDTs for HIV and syphilis are limited. Methods A cluster randomised controlled study design was used to compare the incremental costs of two testing algorithms: (1) single RDTs for HIV and syphilis and (2) dual RDTs for HIV and syphilis, in 12 health facilities in Bogota and Cali, Colombia. The costs of single HIV and syphilis RDTs and dual HIV and syphilis RDTs were collected from each of the health facilities. The economic costs per woman tested for HIV and syphilis and costs per woman treated for syphilis defined as the total costs required to test and treat one woman for syphilis were estimated. Results A total of 2214 women were tested in the study facilities. Cost per pregnant woman tested and cost per woman treated for syphilis were US

Métodos estadísticos de evaluación de la concordancia y la reproducibilidad de pruebas diagnósticas

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