Frequency of ambulatory care adverse events in Latin American countries: the AMBEAS/PAHO cohort study.

OBJECTIVE: Determine the frequency and preventability of adverse events (AEs) from available information sources in selected ambulatory care (AC) sites in Latin America (LA). DESIGN: Multinational observational cohort was conducted to determine the period prevalence (retrospective focus) and the cumulative incidence (prospective focus) of AEs. SETTING: Outpatient clinics in Mexico, Peru, Brazil and Colombia. PARTICIPANTS: A random selection of 2080 patients. INTERVENTIONS: The existence of AE was decided based on trigger information provided by the patient and crossing the data with each patient's medical history. MAIN OUTCOME MEASURES: AE occurrences 6 months prior (prevalence) and 42 days after (incidence) the patient receiving AC were identified. AE type and preventability were also described. RESULTS: Two thousand eighty patients participated in the study. AEs prevalence was 5.2% (108/2080) [95% confidence interval (CI) 4.2-6.1%], and cumulative incidence was 2.4% (42/1757) (95% CI 1.7-3.1%). AEs considered preventable were 44% (55/108) of prevalence period, and 52.4% (22/42) of incidence period. Preventability was associated with patient socioeconomic status (OR 3.5, 95% CI 1.4-8.8), medication error (OR 0.1, 95% CI 0.0-0.4), diagnostic error (OR 0.1, 95% CI 0.0-0.8) and a minor impact on the patient (OR 0.2 95% CI 0.1-0.9). CONCLUSION: The frequency of AE in ambulatory settings in LA is in the high-frequency range of research focused on the prevalence of AEs. Fifty percent was preventable. This study provides an approach for assessing the frequency and preventability of AE in order to enhance patient safety in LA.

[Association between the cervico-vaginal inflammatory cytology and the intraepithelial cervical lesion in patients from a sexual and reproductive health clinic in Bogotá, Colombia, 1999-2003]. / Asociación de la citologia cervico- vaginal inflamatoria con la lesión intraepitelial cervical en pacientes de una clinica de salud sexual y reproductiva en Bogotá, Colombia 1999- 2003.

OBJECTIVES: Cervical cancer is the most common malignancy affecting Colombian women. Pap smear screening is used for its early detection. Early stages of cervical cancer can be expressed by the presence of inflammatory atypia in the Pap smear. The main objective of this study is to evaluate the role of inflammatory atypia in Pap smear as a marker of squamous intraepithelial lesions (SIL), given that it is not clear how to deal with the presence of inflammatory cells in Pap smear. MATERIALS AND METHODS: A cross sectional study was carried out to establish the operative characteristics of the cervical Pap smear in the colposcopy clinic of the Clínica Piloto Profamilia, Bogotá, between January 1999 and December 2003. We compared patients with biopsies reporting SIL and those with a benign report in the pathologic study. We evaluated sensitivity the and the specificity of the Pap smear in different cutting points compared to the pathology report as gold standard. RESULTS: The prevalence found was 48,7 % for low grade - Squamous Intrepithelial Lesions (SIL) and 9,7 % for high grade - SIL. The best performance for the Pap smear test to detect SIL was when the atypical squamous cells of undetermined significance (ASCUS) were considered as abnormal. Severe inflammatory atypia were associated to SIL in a similar way as to ASCUS. CONCLUSIONS: Sensitivity of the Pap smear as a screening test decreases when excluding Pap smears reporting ASCUS as a cutting point. In our environment, we recommend to report inflammatory atypia on the Pap smear test stratified by severity until the role of severe inflammatory atypia for the diagnosis of SIL is defined.