Reduction of catheter-associated bloodstream infections: Effectiveness of the continuous quality improvement method at a university hospital in Colombia / Reducción de las infecciones del torrente sanguíneo asociadas a catéter: efectividad del método de mejora continua de la calidad en un hospital universitario en Colombia

Abstract Introduction: Central Line-Associated Bloodstream Infections (CLABSI) are preventable and potential fatal events, frequent in critical patient care. By mid-2018 an increase was noted in the incidence rate of CLABSI at a high complexity institution in Colombia, demanding immediate interventions to lower those numbers. Objective: To assess the effectiveness of the continuous quality improvement methodology (CQI) to lower the incidence rate of CLABSI at a university hospital in Bogotá, Colombia. Methods: Longitudinal, prospective study implementing a multifaceted intervention in accordance with the CQI methodology. The project was developed at a high complexity university hospital in Bogotá, Colombia, between July 2018 and December 2019. A root cause analysis was consecutively conducted prioritizing contributing factors, gathering ideas for improvement, building a strategy and prioritizing the implementation plan. Results: The CQI methodology enabled the identification of areas susceptible of catheter insertion and management errors at the institution; additionally, it allowed for the prioritization of the areas requiring intervention through consecutive test cycles for improvement ideas. The reduction and sustainability of insertion-related CLABSI was accomplished three months after the start of the interventions, achieving a zero value. The implementation of improvement ideas aimed at reducing the events associated with catheter maintenance was also able to reduce the incidence to zero, until the end of the period of observation of the study. Conclusions: It is feasible to implement CQI in settings similar to the one herein described, in order to efficiently reduce CLABSIs.

Resumen Introducción: Las infecciones del torrente sanguíneo asociadas a catéter (ITS/AC) son eventos prevenibles y potencialmente fatales, comunes en el contexto del cuidado de pacientes críticos. A mediados de 2018 se presentó un incremento en la tasa de incidencia de ITS/AC en una institución colombiana de alta complejidad, obligando a realizar intervenciones inmediatas para lograr una reducción de estas cifras. Objetivo: Evaluar la efectividad del método de mejoramiento continuo de la calidad (MCC) para la reducción de la tasa de incidencia de ITS/AC en un hospital universitario en Bogotá, Colombia. Métodos: Estudio longitudinal, prospectivo, en el que se implementa una intervención multifacética siguiendo la metodología de MCC. El proyecto se desarrolló en un hospital universitario de alta de complejidad de Bogotá, Colombia, entre julio de 2018 y diciembre de 2019. Se realizaron consecutivamente un análisis de causa raíz, priorización de factores contribuyentes, recuperación de ideas de mejora, construcción de la estrategia y priorización del plan de implementación. Resultados: El método de MCC permitió la detección de zonas susceptibles de presentación de errores en la inserción de catéteres y su mantenimiento en la Institución, además permitió priorizar las áreas por intervenir mediante ciclos consecutivos de prueba para las ideas de mejora. Se logró la reducción y sostenibilidad de la ITS/AC asociada a inserción luego de tres meses de iniciar las intervenciones, logrando valores de cero. La implementación de ideas de mejora dirigidas a reducir los eventos relacionados con el mantenimiento de catéteres también logró reducirlos a cero hasta la terminación del periodo de observación de este estudio. Conclusiones: Es factible implementar MCC en contextos como el aquí presentado para reducir de manera eficiente las ITS/AC.

Uso de técnicas no farmacológicas para favorecer el estado emocional durante la aplicación del método Ponseti en pacientes pediátricos con pie equino varo congénito en Bogotá, Colombia / Non-pharmacological techniques to improve emotional state while using the Ponseti method in pediatric patients with congenital talipes equinovarus in Bogotá, Colombia

Introducción. Durante la aplicación del método Ponseti (MP), el niño puede mostrar incomodidad, tensión muscular o movimientos corporales que hacen del procedimiento una experiencia desagradable y estresante para pacientes, familiares y personal de salud.Objetivos. Describir los desenlaces de la aplicación de técnicas no farmacológicas (TNF) para el favorecer el estado emocional durante la atención estándar de pacientes con pie equino varo congénito (PEVC) tratados con el MP, el nivel de satisfacción del paciente y su familia con la atención recibida y la calidad de la atención en salud, y evaluar los posibles factores asociados al éxito de la aplicación de las TNF. Metodología. Estudio observacional descriptivo realizado en una cohorte de 21 niños atendidos en una clínica Ponseti de Bogotá (Colombia) entre febrero y noviembre de 2021. Las TNF se aplicaron en dos esquemas diferenciados por los sentidos estimulados. Los datos se describen usando medidas de tendencia central y de dispersión (prueba de Shapiro-Wilk), y la asociación exploratoria entre tener éxito en los esquemas de TNF y las variables se determinó con la prueba de chi-cuadrado (p≥0,05).Resultados. La mediana de edad fue 4,5 meses y el primer esquema de TNF fue exitoso en el 66,67% de los pacientes (97 consultas). El nivel de satisfacción de los cuidadores fue alto (86,07%). El equipo sanitario reportó que el procedimiento fue "extremadamente fácil" o "muy fácil" (86,07%-88,52%). Se identificaron como posibles factores asociados explor-atoriamente al éxito del primer esquema de TNF el sexo, antecedente de tratamiento con MP, y nivel de satisfacción del cuidador con la atención recibida.Conclusión. Las TNF mejoran el estado psicoemocional del niño, facilitando la aplicación del MP y aumentando la satisfacción del cuidador y del equipo sanitario con las sesiones de tratamiento

Introduction: Children may show discomfort, muscle tension or body movements while using the Ponseti method (PM), making the procedure an unpleasant and stressful experience for patients, family members, and health care personnel. Objectives: To describe the outcomes achieved following the use of non-pharmacological techniques (NPT) for emotional support when providing standard care to patients with congenital talipes equinovarus (CTEV) treated with the PM, as well as the level of patient and family satisfaction with the care received and the quality of health care, and to evaluate the possible factors associated with the success of the use of NPT.Methodology: Descriptive observational study conducted in a cohort of 21 children treated in a Ponseti clinic in Bogotá (Colombia) between February and November 2021. NPT were implemented in two schemes differentiated by the senses stimulated. Data are described using measures of central tendency and dispersion (Shapiro-Wilk test), and the exploratory association between having success with the NPT schemes and the variables was determined using the chi-square test (p≥0.05). Results: The median age was 4.5 months, and the first NPT scheme was successful in 66.67% of patients (97 consultations). The level of caregiver satisfaction was high (86.07%). The healthcare team reported that the procedure was "extremely easy" or "very easy" (86.07%-88.52%). Possible factors exploratorily associated with the success of the first NPT scheme were identified as gender, history of treatment with the PM, and level of caregiver satisfaction with the care received.Conclusion: NPT improve the psychoemotional state of the child, facilitating PM implementation, and increasing caregiver and healthcare team satisfaction with the treatment sessions

[Mental Health Care of Health Workers During Covid-19: Recommendations Based on Evidence and Expert Consensus]. / Cuidado de la salud mental del personal de salud durante COVID-19: recomendaciones basadas en evidencia y consenso de expertos.

INTRODUCTION: The crisis situation generated by COVID-19 and the measures adopted have generated social changes in the normal dynamics of the general population and especially for health workers, who find themselves caring for patients with suspected or confirmed infection. Recent studies have detected in them depression and anxiety symptoms and burnout syndrome, with personal and social conditions impacting their response capacity during the health emergency. Our aim was to generate recommendations for the promotion and protection of the mental health of health workers and teams in the first line of care in the health emergency due to COVID-19. METHODS: A rapid literature search was carried out in PubMed and Google Scholar, and an iterative expert consensus and through electronic consultation, with 13 participants from the areas of psychology, psychiatry and medicine; the grading of its strength and directionality was carried out according to the international standards of the Joanna Briggs Institute. RESULTS: Thirty-one recommendations were generated on self-care of health workers, community care among health teams, screening for alarm signs in mental health and for health institutions. CONCLUSIONS: The promotion and protection activities in mental health to face the health emergency generated by COVID-19 worldwide can include coordinated actions between workers, health teams and health institutions as part of a comprehensive, community care, co-responsible and sustained over time.

[Virtual and in-person accompaniment of hospitalized patients during the COVID-19 pandemic in ColombiaAcompanhamento virtual e presencial de pacientes hospitalizados durante a pandemia de COVID-19 na Colômbia]. / Acompañamiento virtual y presencial a pacientes hospitalizados durante la pandemia de COVID-19 en Colombia.

OBJECTIVE: To describe the results of a virtual and in-person accompaniment strategy based on person-centered care of patients hospitalized for suspected or confirmed disease due to the novel 2019 coronavirus (COVID-19). METHOD: Retrospective descriptive observational study conducted in five health facilities of the Colsanitas clinic network that implemented an accompaniment strategy with seven modalities: virtual information, personal mobile devices, virtual visits, contacts by other means, round-the-clock companion, in-person visit, and compassionate contact. Descriptive statistics were used for data analysis. RESULTS: The accompaniment strategy was used with 871 patients with hospital stays ranging from 1 to 90 days; 70% were positive for COVID-19. The families of 764 patients were contacted through 3984 calls in the virtual information modality; an average of 71 virtual visits per day occurred; 428 letters, voice messages, and videos, among others, were received; 114 patients had a round-the-clock companion; 154 patients had an in-person visit; and 20 families made a posthumous in-person visit to the patient. CONCLUSION: The results of the virtual and in-person accompaniment strategy with a person-centered approach showed that family involvement is important to patient care and improves communication and interaction among patients, families, and the healthcare team.

OBJETIVO: Descrever os resultados de uma estratégia de acompanhamento virtual e presencial, baseada no cuidado centrado na pessoa, durante o atendimento de pacientes internados por doença do novo coronavírus de 2019 (COVID-19) suspeita ou confirmada. MÉTODOS: Estudo observacional descritivo retrospectivo realizado em cinco instituições de saúde da rede clínica Colsanitas, que implementaram uma estratégia de acompanhamento com sete modalidades: informação virtual, dispositivos móveis pessoais, visitas virtuais, contatos por outros meios, acompanhante permanente, visita presencial e contato solidário. Foram utilizadas estatísticas descritivas para análise dos dados. RESULTADOS: A estratégia de acompanhamento foi aplicada em 871 pacientes com 1 a 90 dias de internação, dos quais 70% positivaram para COVID-19. Na modalidade de informação virtual, as famílias de 764 pacientes foram contatadas por meio de 3.984 ligações; em média, foram realizadas 71 visitas virtuais por dia; foram recebidas 428 cartas, mensagens de voz e vídeos, entre outros meios; 114 pacientes contaram com um acompanhante permanente; 154 pacientes receberam visita presencial; e 20 famílias fizeram uma visita presencial póstuma ao paciente. CONCLUSÕES: Os resultados da estratégia de acompanhamento virtual e presencial com abordagem centrada na pessoa mostraram que a participação da família é importante no cuidado ao paciente e melhora a comunicação e a interação entre paciente, família e equipe de saúde.

Mental health care of health workers during Covid-19: Recommendations based on evidence and expert consensus.

INTRODUCTION: The crisis situation generated by COVID-19 and the measures adopted have generated social changes in the normal dynamics of the general population and especially for health workers, who find themselves caring for patients with suspected or confirmed infection. Recent studies have detected in them depression and anxiety symptoms and burnout syndrome, with personal and social conditions impacting their response capacity during the health emergency. Our aim was to generate recommendations for the promotion and protection of the mental health of health workers and teams in the first line of care in the health emergency due to COVID-19. METHODS: A rapid literature search was carried out in PubMed and Google Scholar, and an iterative expert consensus and through electronic consultation, with 13 participants from the areas of psychology, psychiatry and medicine; the grading of its strength and directionality was carried out according to the international standards of the Joanna Briggs Institute. RESULTS: Thirty-one recommendations were generated on self-care of health workers, community care among health teams, screening for alarm signs in mental health and for health institutions. CONCLUSIONS: The promotion and protection activities in mental health to face the health emergency generated by COVID-19 worldwide can include coordinated actions between workers, health teams and health institutions as part of a comprehensive, community care, co-responsible and sustained over time.

Cuidado de la salud mental del personal de salud durante COVID-19: recomendaciones basadas en evidencia y consenso de expertos / Mental Health Care of Health Workers During Covid-19: Recommendations Based on Evidence and Expert Consensus

RESUMEN Introducción: La situación de crisis generada por la COVID-19 y las medidas adoptadas han generado cambios sociales en las dinámicas normales de la población general y en especial para los trabajadores de la salud, que se encuentran en atención del paciente con infección sospechada o confirmada. Estudios recientes han detectado en ellos síntomas depresivos y ansiosos y síndrome de burnout, afecciones personales y sociales que alteran su capacidad de respuesta durante la emergencia sanitaria. El objetivo es generar recomendaciones de promoción y protección de la salud mental de los trabajadores y equipos de salud dispuestos como primera línea de atención en la emergencia sanitaria por COVID-19. Métodos: Se realizó una búsqueda rápida de literatura en PubMed y Google Scholar, y un consenso de expertos iterativo y mediante consulta electrónica, con 13 participantes de las áreas de psicología, psiquiatría y medicina; la gradación de su fuerza y direccionalidad se realizó según las normas internacionales del Joanna Briggs Institute. Resultados: Se generaron 31 recomendaciones sobre el autocuidado del trabajador de la salud, el cuidado comunitario entre los equipos de salud, el cribado de signos de alarma en salud mental y para las instituciones sanitarias. Conclusiones: Las actividades de promoción y protección en salud mental para el afrontamiento de la emergencia sanitaria generada por la COVID-19 en todo el mundo pueden abarcar acciones articuladas entre el trabajador, los equipos de salud y las instituciones sanitarias como parte de un cuidado integral, comunitario, corresponsable y sostenidas en el tiempo.

ABSTRACT Introduction: The crisis situation generated by COVID-19 and the measures adopted have generated social changes in the normal dynamics of the general population and especially for health workers, who find themselves caring for patients with suspected or confirmed infection. Recent studies have detected in them depression and anxiety symptoms and burnout syndrome, with personal and social conditions impacting their response capacity during the health emergency. Our aim was to generate recommendations for the promotion and protection of the mental health of health workers and teams in the first line of care in the health emergency due to COVID-19. Methods: A rapid literature search was carried out in PubMed and Google Scholar, and an iterative expert consensus and through electronic consultation, with 13 participants from the areas of psychology, psychiatry and medicine; the grading of its strength and directionality was carried out according to the international standards of the Joanna Briggs Institute. Results:Thirty-one recommendations were generated on self-care of health workers, community care among health teams, screening for alarm signs in mental health and for health institutions. Conclusions: The promotion and protection activities in mental health to face the health emergency generated by COVID-19 worldwide can include coordinated actions between workers, health teams and health institutions as part of a comprehensive, community care, co-responsible and sustained over time.

Carcinógenos ocupacionales relevantes en Colombia, listado actualizado (2020) / Relevant occupational carcinogens in Colombia, 2020 updated list

RESUMEN Objetivo Actualizar la lista de carcinógenos ocupacionales relevantes para el contexto colombiano. Materiales y Métodos Se elaboró un listado único para el contexto colombiano a partir del Manual de Agentes Carcinógenos de los Grupos 1 y 2A de la IARC, de interés ocupacional para Colombia (2006) y del documento CAREX-2012 del Instituto Nacional de Cancerología. Estos documentos se compararon con los listados de carcinógenos ocupacionales relevantes a nivel internacional a partir de una revisión de literatura con las palabras "occupational carcinogens", "exposure" y"neoplasm". A su vez, estas publicaciones se cotejaron con la información disponible en el Programa de monografías en línea de la Agencia Internacional para la Investigación del Cáncer (IARC), hasta la monografía número 123. Resultados Se proponen 52 carcinógenos ocupacionales relevantes, 25 químicos, cuatro físicos, cuatro biológicos, ocho mezclas y once circunstancias de exposición. Conclusiones La actualización incluyó agentes físicos: radiación ultravioleta de la soldadura y Radón-222 y sus productos en descomposición (emisores de alfa partículas); mezclas: polvo de cuero, polvo de madera y aceite de esquisto; y circunstancias de exposición: humos de soldadura y contaminación del aire exterior y material particulado en aire contaminado exterior.

ABSTRACT Objective Update of relevant occupational carcinogens list in the Colombian context. Materials and Methods A unique list was prepared for the Colombian context from the Manual of Carcinogens of Groups 1 and 2A of the IARC, of occupational interest for Colombia, 2006 and the document CAREX-2012 of the National Cancer Institute. These documents were compared with lists of internationally relevant occupational carcinogens based on a literature review with words "occupational carcinogens", "exposure", and "neoplasm". Additionally, these publications were compared with the information available in the Online Monograph Program of the International Agency for Research on Cancer-IARC, up to monograph number 123. Results 52 relevant occupational carcinogens, 25 chemical, four physical, four biological, eight mixtures and eleven exposure circumstances are proposed. Conclusions the update included physical agents: ultraviolet radiation from welding and Radon-222 and their decomposition products (emitters of alpha particles); mixtures: leather dust, wood dust and shale oil; and exposure circumstances: fumes from welding and outside air pollution and particulate matter in outside polluted air.

Consenso Colombiano para la prevención, diagnóstico y manejo de condiciones trombóticas en pacientes adultos con COVID-19: aplicando el Marco de la Evidencia a la Decisión (EtD) GRADE / Colombian consensus for the prevention, diagnosis and treatment of thrombotic conditions in adult patients with COVID-19: applying GRADE Evidence to Decision (EtD) Frameworks

resumen está disponible en el texto completo

Abstract Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.

Hospital Adverse Event Reporting Systems: A Systematic Scoping Review of Qualitative and Quantitative Evidence.

INTRODUCTION: Reducing the incidence of reportable events with undesirable effects (REUE) is a priority in the hospital environment, which is why reporting systems have been implemented to identify and manage them. Information is required regarding the performance of reporting systems, barriers, or facilitators for reporting and strategies that improve passive reporting. METHODOLOGY: Systematic scoping review of the literature that included studies performed in the population exposed to the occurrence of REUE in the health system (teams, patients, and family). A search was performed in Cochrane Database of Systematic Reviews, Epistemonikos, MEDLINE (PubMed), MEDLINE In-Process and MEDLINE Daily Update, EMBASE, LILACS, and databases of the World Health Organization and Pan-American Health Organization. RESULTS: Fifteen studies were found, 1 systematic review, 2 clinical trials, 8 observational studies, 3 qualitative studies, and 1 mixed study. In 4 of them, the effectiveness of active versus passive reporting systems was compared. The measures to improve the passive systems were education about REUE, simplification of the reporting format, activities focused on increasing the motivation for self-report, adoption of self-report as an obligatory institutional policy, and using specific report formats for each service. CONCLUSIONS: There is information that allows to find differences between the performance of the active and passive reporting systems. The reviewed research articles found that passive techniques significantly underreported adverse events. It is recommended that institutions adopt both active and passive techniques in adverse event surveillance. New studies should be directed to answer the comparative efficiency of the reporting systems.

Uso de resúmenes de evidencia para informar el tratamiento farmacológico de personas con sospecha o diagnóstico de infección respiratoria por SARS-CoV-2/COVID-19 / Use of evidence summaries to inform pharmacological treatment of people with suspected or diagnosedSARS-CoV-2/COVID-19 respiratory infection

Resumen Introducción: debido a la emergencia del coronavirus SARS-CoV-2 desde diciembre del 2019, se ha generado un gran volumen de producción científica, en algún caso incierta o controvertida especialmente en el manejo farmacológico de los pacientes con esta infección; por lo tanto, se considera relevante buscar alternativas metodológicas para realizar su síntesis rigurosa, sistemática y de calidad, pero con menor tiempo de ejecución y menor costo. Objetivo: presentar la evidencia disponible respecto al manejo farmacológico de personas con sospecha o diagnóstico de infección respiratoria por SARS-CoV-2 (COVID-19) utilizando el método de revisiones sistemáticas rápidas (RS-R) en medicamentos poten- cialmente eficaces para su manejo. Metodología: se realizó una búsqueda sistemática y estructurada en Medline, Embase, Scopus, Cochrane Library, Clinical trials y Google Scholar en inglés. Los estudios incluidos fueron guías de práctica clínica, consensos, revisiones sistemáticas, metaanálisis, ensayos clínicos y otros estudios primarios. La búsqueda y extracción de datos se realizó por múltiples revisores, pero ninguna fue pareada. Resultados: dieciseis preguntas de interés clínico fueron resueltas, relacionadas con el uso en COVID-19 de lopinavir/ ritonavir, nelfinavir, oseltamivir, remdesivir, ribavirina, teicoplanina, umifenovir, favipiravir, tocilizumab, ivermectina y plasma convaleciente; también se evaluó el uso de medicamentos de soporte e incluidos en el manejo como la dexametasona, así como el uso concomitante de medicamentos que generaron dudas como son los AINES, los IECA y los ARA II. Conclusiones: los resúmenes de evidencia se muestran dentro del escenario de la pandemia como una buena alternativa metodológica para ofrecer información de calidad a corto plazo para los tomadores de decisiones.

Abstract Introduction: Due to the emergence of the SARS-CoV-2 coronavirus since December 2019, a large volume of scientific production has been generated, in some cases uncertain or controversial, especially in the pharmacological management of patients with this infection; therefore, it is considered a relevant search for methodological alternatives to carry out its rigorous, systematic and quality synthesis, but with less execution time and lower cost. Objective: To present the available evidence regarding the pharmacological management of people with suspected or diagnosed respiratory SARS-CoV-2 (COVID-19) using the method of rapid systematic reviews (RS-R) in potentially effective drugs for their management. Methodology: A systematic and structured search was conducted in Medline, Embase, Scopus, Cochrane Library, Clinical trials and Google Scholar in English. Studies included clinical practice guidelines, consensus, systematic reviews, meta-analyses, clinical trials, and other primary studies. Data search and extraction were performed by multiple reviewers, but none were paired. Results: Sixteen questions of clinical interest were resolved, related to the use in COVID-19 of lopinavir/ritonavir, nelfinavir, oseltamivir, remdesivir, ribavirin, teicoplanin, umifenovir, favipiravir, tocilizumab, ivermectin, convalescent plasma; the use of support management drugs such as dexamethasone were also evaluated, as well as the concomitant use of drugs that generated doubts, such as NSAIDs, ACEis, and ARA IIs. Conclusions: Summaries of evidence are within the pandemic scenario as a good methodological alternative to offer quality information in the short term for decision-makers.

Consenso colombiano para la prevención, el diagnóstico y el tratamiento de condiciones trombóticas en adultos con COVID-19: aplicando el Marco de la Evidencia a la Decisión (EtD) GRADE / Colombian consensus for the prevention, diagnosis and treatment of thrombotic conditions in adults with COVID-19: applying GRADE Evidence to Decision (EtD) Frameworks

Introducción estudios recientes han reportado fenómenos trombóticos o coagulopatía en pacientes con COVID-19. Hay posiciones divergentes en cuanto a la prevención, el diagnóstico y el tratamiento de estos fenómenos, y la práctica clínica actual está basada únicamente en deducciones por extensión a partir de estudios retrospectivos, series de casos, estudios observacionales y guías internacionales desarrolladas previas a la pandemia. Objetivo establecer una serie de recomendaciones sobre prevención, diagnóstico y manejo de las complicaciones trombóticas asociadas a COVID-19. Métodos se desarrolló una guía rápida en la que se aplicó el marco de la evidencia a la decisión (EtD) de GRADE y un sistema de participación iterativo, con análisis estadísticos y cualitativos de sus resultados. Resultados se generaron 31 recomendaciones clínicas enfocadas a: a) Pruebas de coagulación en adultos sintomáticos con sospecha de infección o infección confirmada por SARS-CoV-2; b) Tromboprofilaxis en personas adultas con diagnóstico de COVID-19 (escalas de riesgo, tromboprofilaxis de manejo ambulatorio, intrahospitalario y duración de tromboprofilaxis después del egreso de hospitalización), c) Diagnóstico y tratamiento de las complicaciones trombóticas y d) Manejo de personas con indicación previa a usar agentes anticoagulantes. Conclusiones las recomendaciones clínicas de este consenso orientan la toma de decisiones clínicas respecto a prevención, diagnóstico y tratamiento de fenómenos trombóticos en pacientes con COVID-19, y representan un acuerdo que ayudará a disminuir la dispersión en las prácticas clínicas acorde con el desafío que impone la pandemia.

Abstract Introduction: recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. Objective: to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: a rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.

Central venous catheter insertion and maintenance: Evidence-based clinical recommendations / Inserción y mantenimiento del catéter venoso central: recomendaciones clínicas basadas en la evidencia

OBJECTIVE: To share with clinicians supporting evidence of the safest and the most effective processes for central venous catheter insertion and maintenance as a strategy to prevent catheter-associated bloodstream infections. METHODS: A literature search was conducted in the Medline via PubMed, Embase Central and Lilacs databases based on a set of clinical questions aimed at improving safety and effectiveness at key moments in the process of central venous catheter insertion and maintenance. The rapid literature review methodology was used. The studies identified were assessed from the quality point of view, using the Joanna Briggs Institute (JBI) tools for qualitative and quantitative studies and for systematic reviews. Clinical practice guidelines were assessed using the AGREE II tool. The evidence is presented in the form of evidence-based clinical recommendations, which were graded in accordance with the JBI methodology. RESULTS: Twelve clinical evidence summaries containing evidence related to the safe and effective use of central venous catheters are presented, including the following topics: central venous catheter insertion (CVC), peripherally inserted central catheters (PICC), preoperative assessment, the use of analgesia, field preparation, choice between CVC or PICC, CVC care and maintenance, prevention of complications, and general considerations pertaining to the use of central venous catheters in oncologic patients and in parenteral nutrition. CONCLUSIONS: Recommendations on the safe and effective use of central venous access catheters in relation to CVC insertion and maintenance processes are presented in the evidence-based summary model. It is necessary to evaluate their implementation in health outcomes in the institutions where they are developed.

TITULO: INSERCIÓN Y MANTENIMIENTO DEL CATÉTER VENOSO CENTRAL: RECOMENDACIONES CLÍNICAS BASADAS EN LA EVIDENCIA. OBJETIVO: Presentar a los clínicos la evidencia que soporta los procesos más seguros y efectivos en la inserción y el mantenimiento del catéter venoso central (CVC), como estrategia en la prevención de las infecciones del torrente sanguíneo asociadas a catéter. METODOS: A partir de preguntas clínicas dirigidas a mejorar la seguridad y efectividad de los procesos de inserción y mantenimiento de catéter venoso, en los momentos clave, se hicieron búsquedas de literatura en las bases de datos Medline vía PubMed, Embase, Central y Lilacs. Se utilizó la metodología de revisión sistemática rápida de la literatura. Los estudios identificados fueron evaluados desde el punto de vista de la calidad con las herramientas para estudios cualitativos, cuantitativos y revisiones sistemáticas del Joanna Briggs Institute (JBI). Las guías de práctica clínicas fueron evaluadas con el instrumento AGREE II. La evidencia se presenta como recomendaciones clínicas basadas en la evidencia, a las cuales se les dio gradación, según la metodología del JBI. RESULTADOS: Se presentan 12 resúmenes clínicos que contienen la evidencia relacionada con el uso seguro y efectivo del catéter venoso central en cuanto a: las indicaciones, la inserción del catéter en venas centrales y en inserción periférica (PICC), la valoración prequirúrgica, el uso de analgesia, la preparación del campo, la selección entre CVC o PICC, el cuidado y mantenimiento de CVC, la prevención de complicaciones y consideraciones generales en el uso de catéter venoso central (CVC) en el paciente oncológico y en nutrición parenteral. CONCLUSIONES: Se presentan las recomendaciones para el uso seguro y efectivo de los catéteres de acceso venoso central con relación a los procesos de inserción y mantenimiento de CVC en el modelo de resúmenes basados en la evidencia. Es necesario hacer evaluación de la implementación de los mismos en resultados en salud en las instituciones donde se desarrollen.

Central venous catheter insertion and maintenance: Evidence-based clinical recommendations / Inserción y mantenimiento del catéter venoso central: recomendaciones clínicas basadas en la evidencia

RESUMEN Objetivo: presentar a los clínicos la evidencia que soporta los procesos más seguros y efectivos en la inserción y el mantenimiento del catéter venoso central (CVC), como estrategia en la prevención de las infecciones del torrente sanguíneo asociadas a catéter. Materiales y métodos: a partir de preguntas clínicas dirigidas a mejorar la seguridad y efectividad de los procesos de inserción y mantenimiento de catéter venoso, en los momentos clave, se hicieron búsquedas de literatura en las bases de datos Medline vía PubMed, Embase, Central y Lilacs. Se utilizó la metodología de revisión sistemática rápida de la literatura. Los estudios identificados fueron evaluados desde el punto de vista de la calidad con las herramientas para estudios cualitativos, cuantitativos y revisiones sistemáticas del Joanna Briggs Institute (JBI). Las guías de práctica clínicas fueron evaluadas con el instrumento AGREE II. La evidencia se presenta como recomendaciones clínicas basadas en la evidencia, a las cuales se les dio gradación, según la metodología del JBI. Resultados: se presentan 12 resúmenes clínicos que contienen la evidencia relacionada con el uso seguro y efectivo del catéter venoso central en cuanto a: las indicaciones, la inserción del catéter en venas centrales y en inserción periférica (PICC), la valoración prequirúrgica, el uso de analgesia, la preparación del campo, la selección entre CVC o PICC, el cuidado y mantenimiento de CVC, la prevención de complicaciones y consideraciones generales en el uso de catéter venoso central (CVC) en el paciente oncológico y en nutrición parenteral. Conclusiones: se presentan las recomendaciones para el uso seguro y efectivo de los catéteres de acceso venoso central con relación a los procesos de inserción y mantenimiento de CVC en el modelo de resúmenes basados en la evidencia. Es necesario hacer evaluación de la implementación de los mismos en resultados en salud en las instituciones donde se desarrollen.

ABSTRACT Objective: To share with clinicians supporting evidence of the safest and the most effective processes for central venous catheter insertion and maintenance as a strategy to prevent catheter-associated bloodstream infections. Materials and Methods: A literature search was conducted in the Medline via PubMed, Embase Central and Lilacs databases based on a set of clinical questions aimed at improving safety and effectiveness at key moments in the process of central venous catheter insertion and maintenance. The rapid literature review methodology was used. The studies identified were assessed from the quality point of view, using the Joanna Briggs Institute (JBI) tools for qualitative and quantitative studies and for systematic reviews. Clinical practice guidelines were assessed using the AGREE II tool. The evidence is presented in the form of evidence-based clinical recommendations, which were graded in accordance with the JBI methodology. Results: Twelve clinical evidence summaries containing evidence related to the safe and effective use of central venous catheters are presented, including the following topics: central venous catheter insertion (CVC), peripherally inserted central catheters (PICC), preoperative assessment, the use of analgesia, field preparation, choice between CVC or PICC, CVC care and maintenance, prevention of complications, and general considerations pertaining to the use of central venous catheters in oncologic patients and in parenteral nutrition. Conclusions: Recommendations on the safe and effective use of central venous access catheters in relation to CVC insertion and maintenance processes are presented in the evidence-based summary model. It is necessary to evaluate their implementation in health outcomes in the institutions where they are developed.

Differential Methylation in APOE (Chr19; Exon Four; from 44,909,188 to 44,909,373/hg38) and Increased Apolipoprotein E Plasma Levels in Subjects with Mild Cognitive Impairment.

BACKGROUND: Biomarkers are essential for identification of individuals at high risk of mild cognitive impairment (MCI) for potential prevention of dementia. We investigated DNA methylation in the APOE gene and apolipoprotein E (ApoE) plasma levels as MCI biomarkers in Colombian subjects with MCI and controls. METHODS: In total, 100 participants were included (71% women; average age, 70 years; range, 43⁻91 years). MCI was diagnosed by neuropsychological testing, medical and social history, activities of daily living, cognitive symptoms and neuroimaging. Using multivariate logistic regression models adjusted by age and gender, we examined the risk association of MCI with plasma ApoE and APOE methylation. RESULTS: MCI was diagnosed in 41 subjects (average age, 66.5 ± 9.6 years) and compared with 59 controls. Elevated plasma ApoE and APOE methylation of CpGs 165, 190, and 198 were risk factors for MCI (p < 0.05). Higher CpG-227 methylation correlated with lower risk for MCI (p = 0.002). Only CpG-227 was significantly correlated with plasma ApoE levels (correlation coefficient = -0.665; p = 0.008). CONCLUSION: Differential APOE methylation and increased plasma ApoE levels were correlated with MCI. These epigenetic patterns require confirmation in larger samples but could potentially be used as biomarkers to identify early stages of MCI.

Brain structural correlates of executive and social cognition profiles in behavioral variant frontotemporal dementia and elderly bipolar disorder.

An early stage of behavioral variant frontotemporal dementia (bvFTD) often displays a mix of behavioral disturbances and personality changes hindering a differential diagnosis from elderly bipolar disorder (BD), making this process a big challenge. However, no studies have compared these pathologies from neuropsychological and neuroanatomical perspectives. The aim of the present study was to compare the executive functions (EF) and social cognition profiles as well as the structural neuroimaging of bvFTD and elderly patients with BD. First, we compared the executive and social cognition performances of 16 bvFTD patients, 13 BD patients and 22 healthy controls. Second, we compared grey matter volumes in both groups of patients and controls using voxel-based morphometry. Lastly, we examined the brain regions where atrophy might be associated with specific impairments in bvFTD and BD patients. Compared to controls, bvFTD patients showed deficits in working memory, abstraction capacity, inhibitory control, cognitive flexibility, verbal fluency and theory of mind (ToM). Patients with BD showed lower performance than controls in terms of abstraction capacity and verbal inhibitory control. In bvFTD patients, atrophy of frontal, temporal and insular cortices was related to EF deficits. Atrophy of the amygdala, the hippocampus, the parahippocampal gyrus, the putamen, the insula, the precuneus, the right temporo-parietal junction and superior temporal pole was associated to ToM impairments. No significant associations between atrophy and EF performance were observed in BD patients. BvFTD patients showed greater EF and ToM deficits than BD patients. Moreover, compared to BD, bvFTD patients exhibited a significant decrease in GM volume in frontal, temporal and parietal regions. Our results provide the first comparison of EF, social cognition and neuroanatomical profiles of bvFTD and elderly BD patients. These findings shed light on differential diagnosis of these disorders and may have important clinical implications.

Cognitive Assessment Test: Validation of a Short Cognitive Test for the Detection of Mild Cognitive Disorder.

INTRODUCTION: Cognitive disorders are a clinical and research challenge; in particular, the mild cognitive disorder (MiCD) requires diagnostic suspicion and tools with adequate performance for its detection. The objective of this study was the validation of a short cognitive test (CATest) for the detection of MiCD in population of 50 years or more. METHODS: A diagnostic accuracy study was assembled and performed in a prospective cohort. A consecutive sample of 200 Colombian subjects who represented the whole spectrum of the condition of interest allowed us to reach the objective. Validity was determined by concurrent criteria. The cut points were determined by the ROC curves considering the best overall performance and accuracy of the test. RESULTS: CATest was validated to detection of MiCD at a cut-off point of 18. As a result, scores lower than 18 classified the participants as MiCD. At this cut-off point, CATest showed sensitivity of 84.3% (CI 76 to 90.16), specificity of 71.4% (CI 95% 61.8 to 79.43), positive predictive value of 75% ( 95% CI 66.79 to 82.42), and area under curve AUC 0.8518 (standard error SE 0.0265). DISCUSSION: CATest has an adequate performance as a short cognitive test for the detection of MiCD. Its performance is superior to MiniMental and similar to Montreal Cognitive test (MoCA) according to the data reported in the literature. The advantages over other tests are the evaluation of all cognitive domains, time of application, and easy interpretation of results. CATest is a free use alternative for MiCD detection.

A new subtype of hepatitis C virus genotype 1: complete genome and phylogenetic relationships of an Equatorial Guinea isolate.

Hepatitis C virus (HCV) is the leading cause of chronic liver disease and is associated with hepatocellular carcinoma. However, there have been few studies on the distribution and genetic diversity of HCV isolates in non-developed countries. Here, the complete genome sequence of an HCV genotype 1 isolate from Equatorial Guinea is reported, the first complete HCV-1 genome of African origin. Phylogenetic analysis revealed that this sequence always grouped with sequences of genotype 1, but did not group clearly with any subtype described so far. An analysis of partial NS5B gene sequences with additional sequences of African origin also failed to find close similarities between the new sequence and any previously known isolate. Genetic divergence of the coding region of this new sequence with respect to the recognized subtypes of HCV-1 ranged from 20 to 22%. It is proposed that this isolate is a representative of a new, distinct variant of HCV subtype 1.