Production of Knowledge in the Master’s Program in Collective Health of the Faculty of Nursing at Universidad de Antioquia, 1996-2013

Objective. This work sought to characterize the scientific productionof the degree works in the Master’s in Collective Health (MCH)of the Faculty of Nursing at Universidad de Antioquia, during theperiod from 1996 to 2013. Methodology. Ours was a descriptive,observational study, based on documentary research and contentanalysis. The work analyzed the degree works presented inthe MCH since 1996 until 2013, reported in the library of theFaculty of Nursing, and the scientific articles published. Thesewere reviewed manually using an instrument containing thevariables of the characteristics of the works and articles. Results.Some 51 degree works were included, corresponding to eightcohorts from the Master’s in which 65 master’s students havegraduated and 61 professors have participated as counselors.The most common themes have been Gender and Health(27%) and Food and Nutrition Safety (16%). The most frequentpopulations object of study were women (14%) and populationgroups and/or community (14%). The methodologies used havebeen 90.2% qualitative, 3.9% quantitative, and 5.9% mixed. Atotal of 52.9% of the degree works were published as articles inscientific journals; of these, 46.49% corresponded to A2 journals,according to the classification by COLCIENCIAS. Conclusion. Thecharacteristics of the degree works show increased disseminationin scientific journals, as well as diversification in the populationsobject of study and progress in the dissemination of the knowledgegenerated in the MCH, thus, contributing to progress in collectivehealth in national and international settings.Objetivo. Caracterizar a produção científica dos trabalhos de grau da Mestrado em Saúde Coletiva (MSC) da Faculdade de Enfermagem da Universidade de Antioquia, no período 1996-2013. Metodologia. Estudo observacional, descritivo, fundamentado na investigação documentário e a análise de conteúdo. Analisaramse os trabalhos de grau sustentados na MSC desde 1996 até 2013 reportados na biblioteca da Faculdade de Enfermagem e os artigos científicos publicados. Revisaram-se manualmente e se utilizou um instrumento que continha as variáveis das características dos trabalhos e artigos. Resultados. Incluíram-se 51 trabalhos de grau, correspondentes a oito séries do Mestrado; nesta foram graduados 65 magísteres e participaram 61 professores como orientadores. As temáticas mais abordadas foram Gênero e Saúde (27%), e Segurança Alimentar e Nutricional (16%). As populações objeto de estudo mais frequentes foram mulheres (14%) e grupos populacionais e/ou comunidade (14%). As metodologias utilizadas foram 90.2% qualitativas, 3.9% quantitativa e 5.9% mista. 52.9% dos trabalhos de grau se publicou como artigo em revistas científicas; destes 46.49% correspondeu a revistas A2 segundo a classificação de COLCIENCIAS. Conclusão. As características dos trabalhos de grau mostram um aumento na difusão em revistas científicas, bem como diversificação nas populações objeto de estudo e avanços na difusão do conhecimento gerado na MSC, contribuindo desta forma ao avanço da saúde coletiva, tanto no âmbito nacional como internacional.Objetivo. Caracterizar la producción científica de los trabajos de grado de la Maestría en Salud Colectiva (MSC) de la Facultad de Enfermería de la Universidad de Antioquia, en el periodo 1996-2013. Metodología. Estudio observacional, descriptivo, fundamentado en la investigación documental y el análisis de contenido. Se analizaron los trabajos de grado sustentados en la MSC desde 1996 hasta 2013 reportados en la biblioteca de la Facultad de Enfermería y los artículos científicos publicados. Se revisaron manualmente y se utilizó un instrumento que contenía las variables de las características de los trabajos y artículos. Resultados. Se incluyeron 51 trabajos de grado, correspondientes a ocho cohortes de la Maestría; en esta han sido graduados 65 magísteres y han participado 61 profesores como orientadores. Las temáticas más abordadas han sido Género y Salud (27%), y Seguridad Alimentaria y Nutricional (16%). Las poblaciones objeto de estudio más frecuentes fueron mujeres (14%) y grupos poblacionales y/o comunidad (14%). Las metodologías utilizadas han sido 90.2% cualitativas, 3.9% cuantitativa y 5.9% mixta. El 52.9% de los trabajos de grado se publicó como artículo en revistas científicas; de estos el 46.49% correspondió a revistas A2 según la clasificación de COLCIENCIAS. Conclusión. Las características de los trabajos de grado muestran un aumento en la difusión en revistas científicas, así como diversificación en las poblaciones objeto de estudio y avances en la difusión del conocimiento generado en la MSC, contribuyendo de esta forma al avance de la salud colectiva, tanto en el ámbito nacional como internaciona

Situación laboral de los profesionales de enfermería de instituciones de salud, municipio de Medellín 1999

Situación labora

Manejo de la infección por Helicobacter pylori: apreciación crítica de la literatura

Introduction: Helicobacter pylori (H. pylori) infection is a public health problem due to its relationship with gastric cancer. The escalation of antibiotic resistance hampers an effective eradication, despite the availability of treatment options. Methods: A review of the literature was performed in the database PubMed between 01/01/2015 and 31/31/2016. Results: Twenty six articles were included. Sequential therapy stands outas a first line therapy for scenarios such as Colombia. The implementation of adjuvants may have a positive impact on eradication rates. Local epidemiology and cost-effectiveness studies are scarce. The results were analized by erradication therapies, coadyuvant treatment, guidelines and outcomes non mentioned in the guidelines. Conclusions: The correct use and knowledge of the different treatment options could reduce the costs for the health systems, the antibiotics resistance and could favor pathogen eradication. Further studies are required for establishing local recommendations.Introducción: la infección por Helicobacter pylori es un problema de salud pública, dada su relación con cáncer gástrico. El incremento de la resistencia bacteriana limita la erradicación efectiva, a pesar del empleo de diferentes esquemas de tratamiento. Métodos: revisión de la literatura en la base de datos Pubmed/Medline entre el 1 de enero de 2015 y el 31 de diciembre de 2016 sobre el manejo del Helicobacter pylori. Resultados: se incluyeron 26 artículos. La terapia secuencial sobresale como opción de tratamiento de primera línea para escenarios como Colombia. La implementación de coadyuvantes puede influir en las tasas de erradicación. Los estudios de epidemiología local y costoefectividad son escasos. Conclusiones: el uso y conocimiento adecuado de los esquemas de manejo puede disminuir los costos para el sistema, la resistencia antimicrobiana y favorecer la erradicación de patógenos. Se requieren estudios para generar recomendaciones locales

Una propuesta para reformar la salud

Se presenta una propuesta de reforma en salud para la Asamblea Nacional Constituyente convocada en Colombia para 1991. Se analizan algunos de los problemas más importantes del sector salud en este momento y se plantea alternativas se solución que deben ser discutidas y consignadas  en la nueva Carta Magna del país. Contiene dos ejes principales que orientan toda la propuesta: un concepto diferente de salud y la participación comunitaria en todas las esferas de la reproducción social de los diferentres grupos de población.Al final se representa al articulado correspondiente a los temas tratados

Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients

Background: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2: 1). Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days). Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.

Objective:To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).Background:AL after RC resection often results in a permanent stoma.Methods:This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.Results:This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).Conclusions:The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London