Translation and linguistic validation of the Sheffield Profile for Assessment and Referral for Care (SPARC) to Colombian Spanish.

OBJECTIVES: We aimed to translate and linguistically and cross-culturally validate Sheffield Profile for Assessment and Referral for Care (SPARC) in Spanish for Colombia (SPARC-Sp). METHODS: The linguistic validation of SPARC followed a standard methodology. We conducted focus groups to assess the comprehensibility and feasibility. The acceptability was assessed using a survey study with potential users. RESULTS: The comprehensibility assessment showed that additional adjustments to those made during the translation-back-translation process were required to apply SPARC-Sp in rural and low-schooled populations. It also identified the need for alternative administration mechanisms for illiterate people. The acceptability survey showed that potential users found SPARC-Sp as not only acceptable but also highly desirable. However, they desired to expand the number of items in all domains. SIGNIFICANCE OF RESULTS: Beyond the semantic and conceptual validity attained through the back-translation process, actual cultural validity could be acquired thanks to the comprehensibility tests. Although extending the instrument is something potential users would like to do, it would make it less feasible to utilize the SPARC-Sp in clinical settings. Nonetheless, the instrument might benefit from the inclusion of a domain that evaluates challenges encountered when accessing the health-care system. For communities lacking literacy, alternate administration methods must also be considered.

Misconduct in medical students.

Medical students, subject to unique challenges and stressors, frequently engage in misconduct. In this observational study, carried out in a medical school in Colombia, we developed a survey to explore the association between misconduct and stress, potential stressors and other possible contributing factors, such as sex, age and academic year. Of the 433 students that responded to our survey, 97.9% did not fully disagree with at least one of the mentioned misconducts and 99.8% admitted to at least one transgression. Based on a scale we developed, 61.4% of the students consistently agreed with misconduct and 44.9% frequently engaged in misconduct. A logistic regression model suggests that being male (OR 1.90, CI 95% 1.27-2.84) and stress (OR 1.04, CI 95% 1.01-1.06) may increase the likelihood of misconduct. In a subgroup of students, excluding those in their last year of studies, higher academic semester (OR 1.25, CI 95%: 1.10-1.42) may also be a risk factor for misconduct. Most of the observed variation in the data, however, is not explained by these factors. Other modifiers, such as student personality and sub-culture, may play a greater role in determining misconduct. The proportion of medical students that engage in misconduct is very high and warrants the attention of the medical education community.

Recursos utilizados y calidad de vida de los pacientes críticamente enfermos egresados de la unidad de cuidados intensivos / Expenditure of resources and quality of life in critically ill patients discharged from the intensive care unit

Objetivo: determinar la magnitud del cambio en la calidad de vida percibida, relacionada con la salud y los recursos administrados en los pacientes egresados de las unidades de cuidado intensivo. Material y métodos: se realizó un estudio multicéntrico de cohorte concurrente en pacientes críticamente enfermos en las unidades de cuidado intensivo (UCI) del Hospital Universitario Clínica San Rafael, Hospital Militar Central, Hospital de San José, Fundación Santa Fe de Bogotá y Clínica del Country, de Bogotá, y la Fundación Valle de Lilly, de Cali. Durante el periodo comprendido entre noviembre de 2004 y octubre de 2006, se enrolaron 291 pacientes, a quienes se les realizaron mediciones de severidad mediante el APACHE II, evaluación de las intervenciones en los primeros tres días mediante el TISS 28, aplicación del SF36 con un recordatorio de cuatro semanas para determinar la calidad de vida relacionada con la salud previa al ingreso a la unidad y posteriormente, a los seis meses de egreso de la unidad, para evaluar el cambio en la calidad de vida relacionada con la salud en cada una de las ocho dimensiones que evalúa el SF36 V.2, determinación de la mortalidad a los 28 días y a los seis meses de egreso de la unidad. El cálculo de tamaño de muestra se efectuó para encontrar diferencias de cinco puntos en cualquiera de las dimensiones, para muestras dependientes y con unas pérdidas por seguimiento y mortalidad estimadas en un 15%. Resultados: la mortalidad al egreso de UCI se situó en un 11,8%, a los 28 días en un 17,1% y finalmente, a los seis meses en un 25%; 176 pacientes contestaron a los seis meses nuevamente la encuesta del SF36. En los tres grupos de pacientes se observó un deterioro tanto clínico como estadísticamente significativo en el rol físico; sin embargo, en la estratificación por grupos de enfermedades por la cual se había ingresado al paciente, se observó que los pacientes de trauma deterioran la calidad de vida en todas las dimensiones con las siguientes diferencias: función física: 33.6, p (0.001); rol físico: 54.5, p <(0.001); dolor corporal: 47.5, p <(0.001); salud general: 32.4, p <(0.001); vitalidad: 32.5, p <(0.001); función social: 42, p <(0.001); rol emocional: 34.4, p <(0.001) y salud mental: 29.1, p <(0.001). En cuanto a los recursos administrados evaluados por la puntuación del TISS 28 y promedios de estancia, se observaron diferencias significativas en los pacientes con trauma, cuando se compararon con los pacientes ingresados por enfermedades de tipo médico y de tipo quirúrgico, teniendo los pacientes de trauma mayor intervención, y por ende mayores costos de atención, pero menores estancias; no se encontraron diferencias significativas en cuanto a la severidad entre los pacientes con enfermedades de tipo médico, de tipo quirúrgico y de trauma. Conclusiones: en nuestro medio, los pacientes de trauma que ingresan a las unidades de cuidado intensivo presentan un significativo deterioro clínico en la calidad de vida relacionada con la salud, en las ocho dimensiones evaluadas seis meses después del egreso, tiempo suficiente en el cual su condición física y mental se ha estabilizado; adicionalmente, estos pacientes consumen de manera significativa mayores recursos cuando se les compara con los pacientes con enfermedades de tipo médico y quirúrgico, lo que demuestra que el trauma en nuestro medio resulta costoso en todos los sentidos: en la atención inicial, demandando mayor uso de recursos, en los resultados obtenidos a largo plazo, en lo referente a la calidad de vida relacionada con la salud y en el tipo de pacientes afectados, quienes por lo general, son pacientes jóvenes con capacidad productiva.

Objective: to determine the magnitude of the change in the perceived quality of life related with health conditions and with the administered resources, in patients discharged from the intensive care units. Methods and material: a multicentric, concurrent cohort study was made in critically ill patients at the intensive care units (ICU) of the Hospital Universitario Clinica San Rafael, Hospital Militar Central, Hospital de San Jose, Fundacion Santa Fe de Bogotá, and Clinica del Country of Bogota, and La Fundacion Valle de Lilly of Cali, Colombia. During the period between November 2004 and October 2006, 291 patients were enrolled. The severity of their condition was assessed by means of APACHE II. The interventions performed during the first three days were assessed by means of TISS 28. The SF36 was applied with a reminder of 4 weeks in order to determine the quality of life with regard to the health condition prior to admission into the unit. It was also applied six months after discharge from the unit, in order to evaluate changes in the quality of life with regard to health in each one of eight dimensions assessed by SF36 V.2. Mortality was determined at 28 days and six months after discharge from the unit. Calculation of the sample size was made to find differences of 5 points in any of the dimensions, for dependent samples and with losses due to follow-up and mortality estimated at 15%. Results: mortality was 11,8% at discharge from the ICU, 17,1% at 28 days, and 25% at six months. 176 patients answered the SF36 survey at six months. Clinical and statistically significant deterioration of the physical role was observed. Nevertheless, when stratification was performed according to the type of disease due to which the patient had been admitted into the ICU, it was found that the quality of life of patients with trauma worsened with regard to all dimensions: physical function: 33.6, p (0.001); physical role: 54.5, p<(0.001); corporal pain: 47.5, p <(0.001); general health: 32.4, p < (0.001); vitality: 32.5, p <(0.001); social function: 42, p<(0.001); emotional role: 34.4 p<(0.001) and mental health: 29.1, p <(0.001). With regard to the administered resources evaluated by the TISS 28 score and averages of stay, significant differences in patients with trauma were observedwith regard to patients admitted due to diseases of medical and surgical type. Trauma patients received more intervention and therefore were more costly, but had shorter ICU stays. There were no significant differences with regard to severity between patients with diseases of medical type, surgical type and trauma. Conclusions: In our milieu, trauma patients admitted into intensive care units show a significant clinical deterioration in their quality of life related with health, in the eight dimensions assessed six months after discharge. This period of time is considered to be enough for the stabilization of their physical and mental condition. Moreover, utilization of resources by these patients is significantly greater than that of patients with diseases of medical of surgical type. This demonstrates that, in our milieu, trauma is expensive in every sense: its initial attention demands greater use of resources; its long-term consequences with regard to quality of life are more serious, taking into account the fact that these patients are generally young people with productive capacity.

Funding agencies in low- and middle-income countries: support for knowledge translation.

OBJECTIVE: The aim was to describe how selected health research funding agencies active in low- and middle-income countries promote the translation of their funded research into policy and practice. METHODS: We conducted inductive analysis of semi-structured interviews with key informants from a purposive sample of 23 national and international funding agencies that fund health research in Brazil, Colombia, India, the Philippines, South Africa and Thailand. We also surveyed web sites. FINDINGS: We found a commitment to knowledge translation in the mandate of 18 of 23 agencies. However, there was a lack of common terminology. Most of the activities were traditional efforts to disseminate to a broad audience, for example using web sites and publications. In addition, more than half (13 of 23) of the agencies encouraged linkage/exchange between researchers and potential users, and 6 of 23 agencies described "pull" activities to generate interest in research from decision-makers. One-third (9 of 23) of funding agencies described a mandate to enhance health equity through improving knowledge translation. Only 3 of 23 agencies were able to describe evaluation of knowledge translation activities. Furthermore, we found national funding agencies made greater knowledge translation efforts when compared to international agencies. CONCLUSION: Funding agencies are engaged in a wide range of creative knowledge translation activities. They might consider their role as knowledge brokers, with an ability to promote research syntheses and a focus on health equity. There is an urgent need to evaluate the knowledge translation activities of funding agencies.