Propuesta de un Manual de “Urgencias Médicas, Diagnóstico y Tratamiento” para Internos

A descriptive cross-sectional study, with a qualitative approach, was carried out with the aim of proposing a manual of medical emergencies, diagnosis and treatment, used for consultation and easy to handle. With it, a solution to a scientific problem, existing in the health area, is achieved. It was carried out in the Santa Clara University Polyclinic during the period from September 8 th 2007 to January 12 th 2009 and consists of 14 chapters, plus annexes and a list of the abbreviations used. It was assessed by a group of prestigious specialists who expressed their criteria about it (including the design). Highly significant results were obtained since the average percentage of acceptance per aspects was 99.3 percent (good quality). The methods used were those of a qualitative investigation (diagnostic questionnaire to fifth and sixth year students, semi-structured interview to keys informants and the triangulation of sources) that showed little mastery and preparation on the essential elements for the handling of medical emergencies. The manual was implemented in the Santa Clara University Polyclinic. The surveys indicated a high level of satisfaction among the students. They stated that the manual deals with the principal medical emergencies in a simple, integrated, abridged and attainable form, taking into account the level it was aimed at.Se realizó un estudio descriptivo transversal con enfoque cualitativo con el objetivo de proponer un manual de urgencias médicas, diagnóstico y tratamiento -de fácil manejo, para consultas- que soluciona un problema científico presente en el área de salud. Se realizó en el Policlínico Universitario “Santa Clara” en el período comprendido desde el 8 de septiembre de 2007 al 12 de enero de 2009 y consta de 14 capítulos, anexos y relación de abreviaturas empleadas. Fue valorado por un grupo de prestigiosos especialistas que emitieron su criterio (incluido el diseño); se encontraron resultados altamente significativos pues el por ciento de aceptación por aspectos promedio fue de 99.3% (buena calidad). Los métodos aplicados fueron los correspondientes a la investigación cualitativa (cuestionario diagnóstico a los estudiantes de 5to y 6to años, entrevista semi-estructurada a informantes claves y la triangulación de fuentes) y aportaron poco dominio y preparación sobre los elementos primordiales para el manejo de las urgencias médicas. El manual se utilizó en el Policlínico Universitario “Santa Clara” y se constató, a través de las encuestas, un alto grado de satisfacción por parte de los estudiantes, que plantean que el manual aborda las principales urgencias médicas de una forma sencilla, integrada, resumida y asequible al nivel para el que está concebido

Higher COVID-19 pneumonia risk associated with anti-IFN-α than with anti-IFN-ω auto-Abs in children

We found that 19 (10.4%) of 183 unvaccinated children hospitalized for COVID-19 pneumonia had autoantibodies (auto-Abs) neutralizing type I IFNs (IFN-alpha 2 in 10 patients: IFN-alpha 2 only in three, IFN-alpha 2 plus IFN-omega in five, and IFN-alpha 2, IFN-omega plus IFN-beta in two; IFN-omega only in nine patients). Seven children (3.8%) had Abs neutralizing at least 10 ng/ml of one IFN, whereas the other 12 (6.6%) had Abs neutralizing only 100 pg/ml. The auto-Abs neutralized both unglycosylated and glycosylated IFNs. We also detected auto-Abs neutralizing 100 pg/ml IFN-alpha 2 in 4 of 2,267 uninfected children (0.2%) and auto-Abs neutralizing IFN-omega in 45 children (2%). The odds ratios (ORs) for life-threatening COVID-19 pneumonia were, therefore, higher for auto-Abs neutralizing IFN-alpha 2 only (OR [95% CI] = 67.6 [5.7-9,196.6]) than for auto-Abs neutralizing IFN-. only (OR [95% CI] = 2.6 [1.2-5.3]). ORs were also higher for auto-Abs neutralizing high concentrations (OR [95% CI] = 12.9 [4.6-35.9]) than for those neutralizing low concentrations (OR [95% CI] = 5.5 [3.1-9.6]) of IFN-omega and/or IFN-alpha 2

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)