MODELO DIDÁCTICO DEL CONTENIDO DE METODOLOGÍA DE LA INVESTIGACIÓN EN SALUD

Se exponen los resultados de una investigación acción participativa sobre el desempeño del profesional de la salud de la provincia de Las Tunas, en la que se indaga su producción científica, el perfil de investigación científica de su modelo de formación en las diferentes figuras del posgrado, así como el dominio que estos poseen de la metodología de la investigación en general, y en particular, de la investigación en salud. Se presenta un modelo contextualizado del contenido esencial de metodología de la investigación en salud, que sirvió de base en la confección de un programa bajo una concepción transdisciplinaria y flexible que permite su adaptación a la diversidad de profesionales y a los diferentes niveles del posgrado. Se pudo constatar, luego de la aplicación del programa, un impacto positivo en la calidad y cantidad de la producción científica, así como en la actitud ante la investigación científica. ABSTRACT It deals with the results of an action and participatory research about the performance of the health professional in Las Tunas province, which explores their scientific production, its training model in the research profile in different postgraduate levels, as well as the mastery of research methodology in general and particularly in health research they possess. It is portrayed a contextualized model of the substance content of research methodology in health, which was the basis for the preparation of a syllabus under a transdisciplinary and flexible design which allows its adaptation to the diversity of professionals and the different levels of postgraduate courses. It was found after the implementation of the syllabus a positive impact on the quality and quantity of scientific production as well as the attitude towards the scientific research. KEYWORDS: Action research, scientific production, didactic model, research methodology

Una propuesta de clasificación de las investigaciones en salud

Se realizó una investigación documental sobre el tema de la clasificación de las investigaciones en salud, mediante un muestreo estratificado por tipos de investigaciones. Se analizaron 35 artículos que cumplieron el criterio de autoría reconocida en el tema, publicación en editoriales de impacto y alto nivel de actualidad, tanto nacional, como internacional. Las posibles causas de incoherencias y ambigüedades en las clasificaciones fueron indagadas por el estudio histórico-lógico, en cuya solución se elaboró una propuesta de escala para medir la evidencia científica de las investigaciones según su clasificación, que deviene en una clasificación mutuamente excluyente y exhaustiva

La clasificación de las investigaciones en salud. ¿Única o diversa?

Se realizó una investigación documental sobre el tema de la clasificación de las investigaciones en salud, mediante un muestreo estratificado por tipos de investigaciones, se analizaron 35 artículos que cumplieron el criterio de autoría reconocida en el tema, publicación en editoriales de impacto y alto nivel de actualidad, tanto nacional como internacional. Las posibles causas de incoherencias y ambigüedades en las clasificaciones fueron indagadas por el estudio histórico-lógico. Se concluyó que es posible elaborar un modelo de clasificación de investigaciones en salud simple, pero con rigor científico, que permita su gradual introducción en el postgrado académico

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit