Evaluating emergency physicians’ knowledge, attitudes, and experiences of FARC ex-combatants : a pilot study of Colombia’s emergency medicine teaching hospitals

Objectives: In the 2016 Peace Accord with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate 14,000 ex-combatants into the healthcare system. However, FARC ex-combatants have faced significant challenges in receiving healthcare, and little is known about physicians' abilities to address this population's healthcare needs. Methods: An electronic questionnaire sent to the Colombian Emergency Medicine professional society and teaching hospitals assessed physicians' knowledge, attitudes, and experiences with the FARC ex-combatant reincorporation process. Results: Among 53 participants, most were male (60.4%), and ∼25% were affected by the FARC conflict (22.6%). Overall knowledge of FARC reincorporation was low, with nearly two-thirds of participants (61.6%) scoring in the lowest category. Attitudes around ex-combatants showed low bias. Few physicians received training about reincorporation (7.5%), but 83% indicated they would like such training. Twenty-two participants (41.5%) had identified a patient as an ex-combatant in the healthcare setting. Higher knowledge scores were significantly correlated with training about reincorporation (r = 0.354, n = 53, P = 0.015), and experience identifying patients as ex-combatants (r = 0.356, n = 47, P = 0.014). Conclusion: Findings suggested high interest in training and low knowledge of the reincorporation process. Most physicians had low bias, frequent experiences with ex-combatants, and cared for these patients when they self-identify. The emergency department (ED) serves as an entrance into healthcare for this population and a potential setting for interventions to improve care delivery, especially those related to mental healthcare. Future studies could evaluate effects of care delivery following training on ex-combatant healthcare reintegration.Revista Internacional - Indexad

Characteristics of emergency medicine residency programs in Colombia

Introduction: Emergency medicine (EM) is in different stages of development around the world. Colombia has made significant strides in EM development in the last two decades and recognized it as a medical specialty in 2005. The country now has seven EM residency programs: three in the capital city of Bogotá, two in Medellin, one in Manizales, and one in Cali. The seven residency programs are in different stages of maturity, with the oldest founded 20 years ago and two founded in the last two years. The objective of this study was to characterize these seven residency programs. Methods: We conducted semi-structured interviews with faculty and residents from all the existing programs in 2013-2016. Topics included program characteristics and curricula. Results: Colombian EM residencies are three-year programs, with the exception of one four-year program. Programs accept 3-10 applicants yearly Only one program has free tuition and the rest charge tuition. The number of EM faculty ranges from 2-15. EM rotation requirements range from 11-33% of total clinical time. One program does not have a pediatric rotation. The other programs require 1-2 months of pediatrics or pediatric EM. Critical care requirements range from 4-7 months. Other common rotations include anesthesia, general surgery, internal medicine, obstetrics, gynecology, orthopedics, ophthalmology, radiology, toxicology, psychiatry, neurology, cardiology, pulmonology, and trauma. All programs offer 4-6 hours of protected didactic time each week. Some programs require Advanced Cardiac Life Support, Pediatric Advanced Life Support and Advanced Trauma Life Support, with some programs providing these trainings in-house or subsidizing the cost. Most programs require one research project for graduation. Resident evaluations consist of written tests and oral exams several times per year. Point-of-care ultrasound training is provided in four of the seven programs. Conclusion: As emergency medicine continues to develop in Colombia, more residency programs are expected to emerge. Faculty development and sustainability of academic pursuits will be critically important. In the long term, the specialty will need to move toward certifying board exams and professional development through a national EM organization to promote standardization across programs. © 2017 Patiño et al

Characteristics of Emergency Medicine Residency Programs in Colombia

Introduction: Emergency medicine (EM) is in different stages of development around the world. Colombia has made significant strides in EM development in the last two decades and recognized it as a medical specialty in 2005. The country now has seven EM residency programs: three in the capital city of Bogotá, two in Medellin, one in Manizales, and one in Cali. The seven residency programs are in different stages of maturity, with the oldest founded 20 years ago and two founded in the last two years. The objective of this study was to characterize these seven residency programs. Methods: We conducted semi-structured interviews with faculty and residents from all the existing programs in 2013–2016. Topics included program characteristics and curricula. Results: Colombian EM residencies are three-year programs, with the exception of one four-year program. Programs accept 3–10 applicants yearly. Only one program has free tuition and the rest charge tuition. The number of EM faculty ranges from 2–15. EM rotation requirements range from 11–33% of total clinical time. One program does not have a pediatric rotation. The other programs require 1–2 months of pediatrics or pediatric EM. Critical care requirements range from 4–7 months. Other common rotations include anesthesia, general surgery, internal medicine, obstetrics, gynecology, orthopedics, ophthalmology, radiology, toxicology, psychiatry, neurology, cardiology, pulmonology, and trauma. All programs offer 4–6 hours of protected didactic time each week. Some programs require Advanced Cardiac Life Support, Pediatric Advanced Life Support and Advanced Trauma Life Support, with some programs providing these trainings in-house or subsidizing the cost. Most programs require one research project for graduation. Resident evaluations consist of written tests and oral exams several times per year. Point-of-care ultrasound training is provided in four of the seven programs. Conclusion: As emergency medicine continues to develop in Colombia, more residency programs are expected to emerge. Faculty development and sustainability of academic pursuits will be critically important. In the long term, the specialty will need to move toward certifying board exams and professional development through a national EM organization to promote standardization across programs

Colombian consensus recommendations for diagnosis, management and treatment of the infection by SARS-COV-2/ COVID-19 in health care facilities - Recommendations from expert´s group based and informed on evidence

La Asociación Colombiana de Infectología (ACIN) y el Instituto de Evaluación de Nuevas Tecnologías de la Salud (IETS) conformó un grupo de trabajo para desarrollar recomendaciones informadas y basadas en evidencia, por consenso de expertos para la atención, diagnóstico y manejo de casos de Covid 19. Estas guías son dirigidas al personal de salud y buscar dar recomendaciones en los ámbitos de la atención en salud de los casos de Covid-19, en el contexto nacional de Colombia

Efectos cardiovasculares debido al consumo de cannabinoides

Resumen: Objetivo: dar a conocer los efectos cardiovasculares secundarios al consumo de marihuana según lo reportado en la literatura médica. Métodos: se realizó una búsqueda con los términos MESH “Cannabis”, “Marijuana smoking” y “adverse effects” en la base de datos PubMed hasta el año 2016. Se obtuvieron 265 referencias. Se excluyeron cartas de editores, protocolos de investigación en proceso, población pediátrica (menores de 18 años), embarazadas, referencias en idiomas diferentes a inglés y español y se escogieron solo referencias relacionadas con efectos cardiovasculares. Resultados: se han establecido dos tipos de receptores de cannabinoides, los CB1 y los CB2, con localizaciones a nivel del sistema nervioso central, endotelial, renal y músculo liso. En la actualidad el consumo de marihuana ha venido en aumento y los médicos poco conocen de sus efectos y los diferentes nombres comerciales para esta sustancia. Existen efectos protectores a nivel vascular con detención de la progresión de la placa aterosclerótica y a la vez múltiples efectos no deseados como taquicardia, hipotensión y bradicardia. Múltiples reportes de caso documentan la relación de la marihuana con el infarto agudo de miocardio con o sin lesión de las arterias coronarias, así como con hemorragia subaracnoidea, pero no existen mecanismos claramente descritos que expliquen una relación directa con estos desenlaces. Conclusiones: se conoce la fisiopatología y los receptores donde actúan los cannabinoides generando efectos tanto protectores como dañinos. Existe fuerte correlación con enfermedad cardiovascular, principalmente síndrome coronario agudo, pero el mecanismo fisiopatológico aún no es claro. Abstract: Objective: To determine the cardiovascular side-effects of smoking marihuana according to that reported in the medical literature. Methods: A search was performed using the MeSH terms, “Cannabis”, “Marijuana smoking” and “adverse effects”, in the PubMed database up to the year 2016. A total of 265 references were obtained. The exclusion criteria were; Letters to the editor, protocols of research in process, paediatrics (less than 18 years), pregnancy, articles in languages other than English or Spanish. Only references associated with cardiovascular effects were collected. Results: Two types of cannabinoid receptors, CB1 and CB2, have been defined and are located in the central nervous system, as well as in endothelial, renal and smooth muscle. The consumption of marijuana is increasing, and doctors know little about its effects, as well as the different marketing names used for this substance. There are protective effects at vascular level, with the slowing down of atherosclerotic plaques, as well as the many undesired effects such as, tachycardia, hypotension, and bradycardia. Many case reports document the association of marijuana with acute myocardial infarction with or without coronary artery lesions, as well as with subarachnoid haemorrhage, but there are no clearly described mechanisms that could explain a direct relationship with these events. Conclusions: The pathophysiology is known, as well as where the cannabinoid receptors act to generate their protective and harmful effects. There is a strong association with cardiovascular disease, mainly acute coronary syndrome, but the pathophysiological is still not clear. Palabras clave: Marihuana, Efectos cardiovasculares, Cannabis, Infarto de miocardio, Keywords: Marihuana, Cardiovascular effects, Cannabis, Myocardial infarctio

Use of discrete event simulation and genetic algorithms to estimate the necessary resources to respond in a timely manner in the Medical Emergency System in Bogotá

Introducción Bogotá cuenta con un sistema de emergencias médicas de ambulancias públicas y privadas que responden a incidentes de salud. No se conoce, sin embargo, su suficiencia en cantidad, tipo y ubicación de recursos demandados. Objetivos A partir de los datos del sistema de emergencias médicas de Bogotá, Colombia, se buscó primero caracterizar la respuesta pre hospitalaria en paro cardiaco. Luego, con el modelo se buscó determinar cuál sería el menor número de recursos necesarios para responder antes de ocho minutos, teniendo en cuenta su ubicación, número y tipo. Métodos Se obtuvo una base de datos de incidentes reportados en registros administrativos de la autoridad sanitaria distrital de Bogotá (de 2014 a 2017). A partir de esa información, se diseñó un modelo híbrido basado en la simulación de eventos discretos y algoritmos genéticos para establecer la cantidad, tipo y ubicación geográfica de recursos, conforme a frecuencias y tipología de los eventos. Resultados De la base de datos, Bogotá presentó 938 671 envíos de ambulancias en el período. El 47,4% de prioridad alta, 18,9% media y 33,74% baja. El 92% de estos correspondieron a 15 de 43 códigos de emergencias médicas. Los tiempos de respuesta registrados fueron mayores a lo esperado, especialmente en paro cardiaco extra hospitalario (mediana de 19 minutos). En el modelo planteado, el mejor escenario requirió al menos 281 ambulancias, medicalizadas y básicas en proporción de 3:1 respectivamente para responder en tiempos adecuados. Conclusiones Los resultados sugieren la necesidad de incrementar los recursos que responden a estos incidentes para acercar estos tiempos de respuesta a las necesidades de nuestra población.Q3Q4https://orcid.org/0000-0002-5372-2459Revista Internacional - IndexadaCN

Healthcare access barriers for FARC ex-combatants in Colombia: qualitative perspectives from healthcare providers and FARC health promoters

Abstract Background Following the 2016 Peace Agreement with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate more than 13,000 guerrilla fighters into its healthcare system. Despite a subsidized healthcare insurance program and the establishment of 24 Espacios Territoriales de Capacitación y Reincorporación (ETCRs—Territorial Spaces for Training and Reintegration) to facilitate this transition, data has shown that FARC ex-combatants access care at disproportionately lower rates, and face barriers to healthcare services. Methods Semi-structured interviews were conducted with FARC health promoters and healthcare providers working in ETCRs to determine healthcare access barriers for FARC ex-combatants. Analysis was completed with a qualitative team-based coding method and barriers were categorized according to Julio Frenk’s Domains of Healthcare Access framework. Results Among 32 participants, 25 were healthcare providers and 7 self-identified as FARC health promoters. The sample was majority female (71.9%) and worked with the FARC for an average of 12 months in hospital, health center, medical brigade, and ETCR settings. Our sample had experiences with FARC across 16 ETCRs in 13 Departments of Colombia. Participants identified a total of 141 healthcare access barriers affecting FARC ex-combatants, which affected healthcare needs, desires, seeking, initiation and continuation. Significant barriers were related to a lack of resources in rural areas, limited knowledge of the Colombian health system, the health insurance program, perceived stigma, and transition process from the FARC health system. Conclusions FARC ex-combatants face significant healthcare access barriers, some of which are unique from other low-resource populations in Colombia. Potential solutions to these barriers included health insurance provider partnerships with health centers close to ETCRs, and training and contracting FARC health promoters to be primary healthcare providers in ETCRs. Future studies are needed to quantify the healthcare barriers affecting FARC ex-combatants, in order to implement targeted interventions to improve healthcare access.http://deepblue.lib.umich.edu/bitstream/2027.42/173489/1/12889_2020_Article_10062.pd

Supporting healthcare workers caring for excombatants: incentives among Colombian providers with FARC ex-combatants

Q2Q1Fuerzas Armadas Revolucionarias de Colombia (FARC)With the Peace Agreement between Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised healthcare to 13,000 ‘reincorporating’ FARC ex-combatants. Shortages of healthcare workers in reincorporation camps means this promise is in danger of going unfulfilled. More information is needed to determine incentives, disincentives, and recruitment of healthcare providers to address this shortage. Semi-structured interviews were conducted with healthcare providers across FARC reincorporation camps, and a multidisciplinary team conducted analysis in NVivo12 using a team-based coding method. Twenty-four healthcare professionals from 15 camps participated, of which 75% were female. Incentives to work with FARC included improved clinical skills, professional advancement, increased comfort with FARC, and contributing to the peace process. Disincentives included poor living conditions, lack of support, biases, familial commitments, and sacrificing career opportunities. Threefourths of the sample recommended working with FARC, and 92% reported a shortage of healthcare workers. Recruitment strategies included improved resources and specialised career development for healthcare workers, facilitating interactions between FARC and healthcare professionals outside clinical scenarios, and integrating medicine for vulnerable populations into health education. This study shows the impact that working with FARC ex-combatants can have on healthcare providers and tangible suggestions for increasing provider participation to address the healthcare worker shortage.https://orcid.org/0000-0002-1982-6799https://orcid.org/0000-0002-9013-5384https://orcid.org/0000-0002-5372-2459Revista Internacional - IndexadaA2N

Proposal of Predictive Model of Mortality in the Emergency Room in Addition to the Usual Triage System in a Teaching Hospital in Bogotá, Colombia

El triaje permite la priorización de pacientes según su urgencia médica, y de ahí que este artículo se proponga realizar un modelo estadístico correlacionado con la mortalidad para generar alertas desde el triaje con una cohorte prospectiva de 6438 adultos que ingresaron a urgencias del Hospital Universitario San Ignacio del 1/3/2018 al 28/2/2019. Se dividieron aleatoriamente los datos en entrenamiento y prueba. Sobre los datos de entrenamiento se ejecutó una regresión logística bivariada entre triaje y mortalidad y, luego, una regresión logística multivariada. Después, el modelo se redujo mediante pruebas de razón de verosimilitud. En los datos de prueba se realizaron áreas bajo la curva (ROC, por sus siglas en inglés) para el cálculo de punto de corte, que se evaluó con medidas de asociación. Hubo ROC para los modelos realizados y se halló el modelo triaje con una ROC de 0,82; “reducido”, con una ROC de 0,90, y “Edad + sistólica”, con una ROC de 0,87, sin diferencia significativa. Se seleccionó el “reducido” con una sensibilidad de 0,869; una especificidad de 0,842; una VPP de 0,066, y una VPN de 0,998. El punto de corte se seleccionó con un árbol de decisiones según las variables significativas, que encontró una mayor mortalidad en pacientes triaje 1-2, con TAS menor de 117 mmHg y mayores de 58 años. El modelo final podría funcionar como tamización para generar alarmas de mortalidad en triaje iguales.Pacientes del Hospital Universitario San IgnacioTriage allows priorization of patients according to their medical urgency. Multiple triage systems have been developed in the world. We propose a statistic model using triage to create an alert system related to mortality rates that could be used as a screening during triage. A prospective cohort of 6438 adults who came into Hospital Universitario San Ignacio’s emergency room between 03/01/2018 and /02/28/2019 was used. The data was divided into “training” and “testing”. A bivariate logistic regression between triage and mortality using “training” data was done. Afterwards a multivariate logistic regression was reduced, along with the previous information. In order to find the set point, an Area Under the Curve (ROC) was calculated using the “testing data”. The efficiency was evaluated using measures of association. Three different ROC models were created: “triage” showed an ROC-0.82, “reduced” an ROC-0.90 and “age+systolic” an ROC-0.87 not exhibiting significant difference. The reduced model was chosen, presenting sensitivity of 0.869, specificity of 0.842, PPV 0.062, NPV 0.998. A set point was chosen according to significant variables, and thus finding a higher mortality rate in those classified as triage 1-2, over 58 years old, presenting with SAP under 117mmHg. Our final model could be used as additional screening for patients within the same triage classification as an alert system for mortality.https://orcid.org/0000-0003-1513-897Xhttps://orcid.org/0000-0002-2478-0908https://orcid.org/0000-0002-5372-2459https://orcid.org/0000-0002-3606-2102https://orcid.org/0000-0002-3628-2551https://orcid.org/0000-0001-5680-7880https://orcid.org/0000-0001-9148-6111https://orcid.org/0000-0002-5388-8192https://orcid.org/0000-0001-8125-814Xhttps://orcid.org/0000-0002-5385-6967https://orcid.org/0000-0001-7816-9736https://orcid.org/0000-0001-9571-6834https://orcid.org/0000-0003-2887-3770Revista Nacional - IndexadaS

Characteristics of emergency medicine residency programs in Colombia

Introduction: Emergency medicine (EM) is in different stages of development around the world. Colombia has made significant strides in EM development in the last two decades and recognized it as a medical specialty in 2005. The country now has seven EM residency programs: three in the capital city of Bogotá, two in Medellin, one in Manizales, and one in Cali. The seven residency programs are in different stages of maturity, with the oldest founded 20 years ago and two founded in the last two years. The objective of this study was to characterize these seven residency programs. Methods: We conducted semi-structured interviews with faculty and residents from all the existing programs in 2013-2016. Topics included program characteristics and curricula. Results: Colombian EM residencies are three-year programs, with the exception of one four-year program. Programs accept 3-10 applicants yearly Only one program has free tuition and the rest charge tuition. The number of EM faculty ranges from 2-15. EM rotation requirements range from 11-33% of total clinical time. One program does not have a pediatric rotation. The other programs require 1-2 months of pediatrics or pediatric EM. Critical care requirements range from 4-7 months. Other common rotations include anesthesia, general surgery, internal medicine, obstetrics, gynecology, orthopedics, ophthalmology, radiology, toxicology, psychiatry, neurology, cardiology, pulmonology, and trauma. All programs offer 4-6 hours of protected didactic time each week. Some programs require Advanced Cardiac Life Support, Pediatric Advanced Life Support and Advanced Trauma Life Support, with some programs providing these trainings in-house or subsidizing the cost. Most programs require one research project for graduation. Resident evaluations consist of written tests and oral exams several times per year. Point-of-care ultrasound training is provided in four of the seven programs. Conclusion: As emergency medicine continues to develop in Colombia, more residency programs are expected to emerge. Faculty development and sustainability of academic pursuits will be critically important. In the long term, the specialty will need to move toward certifying board exams and professional development through a national EM organization to promote standardization across programs. © 2017 Patiño et al