Alcance para Colombia de la declaración de la World Society of Emergency Surgery 2022 sobre el entrenamiento en cirugía digestiva mínimamente invasiva de emergencia / Scope for Colombia of the World Society of Emergency Surgery 2022 declaration on training in emergency minimally invasive digestive surgery

Introducción. El currículo para la formación del cirujano general exige precisión, ajuste al contexto y factibilidad. En 2022, la World Society of Emergency Surgery formuló cinco declaraciones sobre el entrenamiento en cirugía digestiva mínimamente invasiva de emergencia que puede contribuir a estos propósitos. El objetivo del presente artículo fue examinar el alcance de estas declaraciones para la educación quirúrgica en Colombia. Métodos. Se analizó desde una posición crítica y reflexiva el alcance y limitaciones para Colombia de cada una de las declaraciones de la World Society of Emergency Surgery, con base en la evidencia empírica publicada durante las últimas dos décadas en revistas indexadas nacionales e internacionales. Resultados. La evidencia empírica producida en Colombia durante el presente siglo permite identificar que el país cuenta con fundamentos del currículo nacional en cirugía general, formulado por la División de Educación de la Asociación Colombiana de Cirugía en 2021; un sistema de acreditación de la educación superior; un modelo de aseguramiento universal en salud; infraestructura tecnológica y condiciones institucionales que pueden facilitar la adopción exitosa de dichas declaraciones para el entrenamiento de los futuros cirujanos en cirugía digestiva mínimamente invasiva de emergencia. No obstante, su implementación requiere esfuerzos mayores e inversión en materia de simulación quirúrgica, cooperación institucional y fortalecimiento del sistema de recertificación profesional. Conclusión. La educación quirúrgica colombiana está en capacidad de cumplir con las declaraciones de la World Society of Emergency Surgery en materia de entrenamiento en cirugía digestiva mínimamente invasiva de emergencia.

Introduction. The general surgeon training curriculum requires precision, contextual fit, and feasibility. In 2022, the World Society of Emergency Surgery formulated five statements on training in emergency minimally invasive digestive surgery, which can contribute to these purposes. This article examines the scope of these declarations for surgical education in Colombia. Methods. The scope and limitations for Colombia of each of the statements of the World Society of Emergency Surgery were analysed from a critical and reflective position, based on empirical evidence published during the last two decades in national and international indexed journals. Results. The empirical evidence produced in Colombia during this century allows us to identify that the country has the foundations of the national curriculum in general surgery, formulated by the Education Division of the Colombian Association of Surgery in 2021; a higher education accreditation system; a universal health insurance model; technological infrastructure, and institutional conditions that can facilitate the successful adoption of said statements for the training of future surgeons in emergency minimally invasive digestive surgery. However, its implementation requires greater efforts and investment in surgical simulation, institutional cooperation, and strengthening of the professional recertification system. Conclusion. Colombian surgical education is able to comply with the declarations of the World Society of Emergency Surgery regarding training in emergency minimally invasive digestive surgery.

Repercussions of the Emergency neurological life support on scientific literature: a bibliometric study / Repercussões do Emergency neurological life support na literatura científica: um estudo bibliométrico

Abstract Background In 2012, the Neurocritical Care Society launched a compilation of protocols regarding the core issues that should be addressed within the first hours of neurological emergencies - the Emergency neurological life support (ENLS). Objective We aim to evaluate this repercussion through a bibliometric analysis. Methods We searched Scopus on October 2022 for articles mentioning ENLS. The following variables were obtained: number of citations; number of citations per year; number of publications per year; year of publication; research type; research subtype; country of corresponding author and its income category and world region; journal of publication and its 5-year impact factor (IF); and section where ENLS appeared. Results After applying eligibility criteria, we retrieved 421 articles, published from 2012 to 2022. The mean number of citations per article was 17.46 (95% Confidence Interval (CI) = 8.20-26.72), while the mean number of citations per year per article was 4.05 (95% CI = 2.50-5.61). The mean destiny journal 5-year IF was 5.141 (95% CI = 4.189-6.093). The majority of articles were secondary research (57.48%; n= 242/421) of which most were narrative reviews (71.90%; n= 174/242). High-Income countries were the most prominent (80.05%; n= 337/421 articles). There were no papers from low-income countries. There were no trials or systematic reviews from middle-income countries. Conclusion Although still low, the number of publications mentioning ENLS is increasing. Articles were mainly published in journals of intensive care medicine, neurology, neurosurgery, and emergency medicine. Most articles were published by authors from high-income countries. The majority of papers were secondary research, with narrative review as the most frequent subtype.

Resumo Antecedentes Em 2012, a Neurocritical Care Society lançou uma compilação de protocolos sobre as questões centrais que devem ser abordadas nas primeiras horas de emergências neurológicas - Emergency neurological life support (ENLS). Objetivo Avaliar a repercussão do ENLS por meio de uma análise bibliométrica. Métodos A base de dados Scopus foi utilizada em outubro de 2022 para a busca por artigos mencionando o ENLS. As seguintes variáveis foram obtidas: número de citações; número de citações por ano; número de publicações por ano; ano de publicação; tipo de pesquisa; país do autor correspondente e sua categoria de renda; revista de publicação e seu fator de impacto de 5 anos (IF); e seção onde o ENLS apareceu. Resultados Os 421 artigos incluídos foram publicados de 2012 a 2022. A média de citações por artigo foi de 17.46 (intervalo de confiança (IC) 95% = 8.20-26.72), enquanto a de citações por ano por artigo foi de 4.05 (IC95% = 2.50-5.61). O IF médio por revista foi de 5.14 (IC95% = 4.19-6.09). A maioria dos artigos era de pesquisa secundária (57.48%; n= 242/421), dos quais a maioria eram revisões narrativas (71.90%; n= 174/242). Os países de alta renda foram os mais prolíficos (80.05%; n= 337/421 artigos). Não houve publicações de países de baixa ou média renda. Conclusão Embora ainda baixo, o número de publicações mencionando o ENLS vem aumentando recentemente. A maioria dos artigos foram publicados em revistas de medicina intensiva, neurologia, neurocirurgia e medicina de emergência. Artigos de pesquisa secundária foram os mais comuns, com revisões narrativas sendo o subtipo mais frequente.

National survey regarding obstetricians' perspective of obstetric emergencies in Brazil

Abstract Introduction The maternal mortality rate in developing countries, such as Brazil, has significantly increased since 2020. Obstetric Emergencies (OE) account for 72.5% of these deaths. A national survey was conducted in Brazil to evaluate how gynecologists and obstetricians deal with OE and identify the main difficulties regarding theoretical/practical knowledge and structural resources. Methods An electronic questionnaire assessing resource availability, health teams, institutional protocols, and provision of OE training courses was completed by Brazilian obstetricians. Results More than 90 % of the questionnaire respondents reported treating a pregnant and/or puerperal patient with severe morbidity and that their health network has human resources, trained professionals, and structural resources required for this type of care. However, few respondents participate in continuing education programs (36 %) or specific training for the medical team (61.41 %). The implementation rates of obstetric risk identification protocols (33.09 %), a rapid response team (46.54 %), and boxes and emergency cart assembly teams (71.68 %) were determined. Conclusion A high Maternal Mortality Ratio (MMR) may be related to disorganized healthcare systems, low implementation of risk classification protocols for the care of severe maternal and fetal conditions, and lack of access to continued/specific training programs. The Brazilian MMR is multifactorial. According to obstetricians, Brazilian health services include care teams, essential medications, obstetric centers, and clinical analysis laboratories, though they lack systematized processes and permanent professional training for qualified care of OE.

Firework-related ocular trauma in Pernambuco, Brazil / Trauma ocular por fogos de artifício em Pernambuco, Brasil

ABSTRACT Purpose: This study aimed to describe the demographic and clinical characteristics of victims of fireworkrelated ocular trauma treated at the ophthalmologic emergency de partments of two reference centers in Pernambuco, Brazil, and to identify risk factors related to poor visual prognosis. Methods: We retrospectively evaluated the medical records of patients admitted in emergency departments with a report of firework-related trauma between January 2012 and December 2018. Data collected included patient's age, sex, place of origin, month and year of the accident, ocular structures affected, characteristics of the injuries, and type of treatment that patients received. For patients who were followed for >30 days, the final visual acuity and patient's origin were analyzed. Results: Three hundred and seventy eyes from 314 patients were included, of which 248 (79.0%) were male and 160 (51.0%) were from the metropolitan region of Recife. The mean patient age was 25.6 ± 18.8 years. In 56 (17.8%) patients, the ocular trauma was bilateral. A total of 152 (48.4%) cases occurred in June. The most affected sites were the eyelids in 91 (24.6%) eyes and ocular surface in 252 (68.1%). Surgical treatment was required in 87 (23.5%) eyes. After clinical and surgical management, 37 (10.0%) eyes presented final visual acuity of <20/400. Of these, 34 (91.9%) eyes were from patients from the countryside or from another state. Patients from the countryside presented higher risk of developing blindness after a firework trauma than those from the metropolitan area (odds ratio of 5.46). Conclusions: Victims of firework-related ocular trauma were mostly male, from the metropolitan region of Pernambuco state and mainly pediatric patients or economically active. Those coming from the countryside and other states had higher risk of developing blindness

RESUMO Objetivos: Descrever as características demográficas e clínicas das vítimas de trauma ocular por fogos de artifício atendidas nas emergências oftalmológicas de dois centros de referência em Pernambuco e identificar fatores relacionados a mau prognóstico visual. Métodos: Avaliação retrospectiva dos prontuários de pacientes admitidos na emergência oftalmológica com história de trauma por fogos de artifício entre janeiro de 2012 e dezembro de 2018. A coleta de dados incluiu idade, gênero, procedência, mês e ano do acidente, estruturas oculares acometidas e características das lesões, além do tipo de tratamento a que os pacientes foram submetidos. Naqueles pacientes acompanhados por mais de 30 dias, analisou-se a acuidade visual final e a associação com sua procedência. Resultados: Foram incluídos 370 olhos de 314 pacientes. Destes, 248 (79,0%) vítimas eram do sexo masculino e 160 (51,0%) da região metropolitana do Recife, com uma média de idade de 25.6 ± 18.8 anos. Em 56 (17,8%) dos casos o trauma foi bilateral. No mês de junho ocorreu um total de 152 (48,4%) casos. Os sítios mais acometidos foram pálpebras em 91 (24,6%) olhos e superfície ocular em 252 (68,1%). O tratamento cirúrgico foi necessário em 87 (23,5%) olhos. Após manejo clínico-cirúrgico, 37 (10.0%) olhos desenvolveram visão pior do que 20/400. Destes, 34 (91,9%) olhos eram de pacientes do interior do estado de Pernambuco ou de outro estado. Os pacientes provenientes do interior do estado apresentaram maior chance de desenvolver cegueira quando comparados aos que eram provenientes da região metropolitana (Odds Ratio de 5,46). Conclusões: As vítimas de trauma ocular por fogos de artificio foram em sua maioria do sexo masculino, procedentes da região metropolitana do estado e das faixas etárias pediátrica e economicamente ativa. Aqueles provenientes do interior ou de outros estados apresentaram maior chance de desenvolver cegueira.

A importância do ensino e aprendizagem de técnicas de primeiros socorros para leigos: revisão integrativa / The importance of teaching and learning first aid techniques for laypersons: integrative review / La importancia de la enseñanza y el aprendizaje de las técnicas de primeros auxilios para los profanos: revisión integradora

Objetivo: analisar, a importância do ensino e aprendizagem sobre técnicas de Primeiros Socorros para leigos. Métodos: revisão integrativa nas bases de dados LILACS, MEDLINE via PUBMED, BDENF, CINAHL, SCOPUS e biblioteca Cochrane, sem recorte de tempo. Os descritores utilizados foram.: "Educação da População", "Educação em saúde", "Primeiros Socorros" e "Emergências", em inglês foram delimitados e cruzados os descritores.: "Population Education", "Health Education", "First aid" e "Emergencies" os operadores booleanos AND e OR. A amostra foi composta por 11 artigos. Resultados: capacitações em primeiros socorros têm um impacto significativo principalmente ao se aplicar questionários pré e pós-intervenções, pois os erros cometidos anteriormente já se transformavam em acertos. Conclusão: as intervenções educativas realizadas em escolas e comunidades levam a propagação de conhecimento e aprendizagem, podendo assim tangenciar a formação de multiplicadores, resultando em uma sociedade informada.

Objective: to analyze, the importance of teaching and learning about First Aid techniques for lay people. Methods: integrative review in the databases LILACS, MEDLINE via PUBMED, BDENF, CINAHL, SCOPUS and Cochrane library, without a time cut. The descriptors used were: "Population Education", "Health Education", "First Aid" and "Emergencies", in English the Boolean operators AND and OR were delimited and crossed the descriptors: "Population Education", "Health Education", "First aid" and "Emergencies". The sample consisted of 11 articles. Results: first aid trainings have a significant impact mainly when applying pre- and post-intervention questionnaires, because the mistakes previously made were already transformed into successes. Conclusion: the educational interventions carried out in schools and communities lead to the propagation of knowledge and learning, thus being able to tangent the formation of multipliers, resulting in an informed society.

Objetivos:analizar, la importancia de la enseñanza y el aprendizaje de las técnicas de Primeros Auxilios para los profanos. Métodos:revisión integradora en las bases de datos LILACS, MEDLINE a través de PUBMED, BDENF, CINAHL, SCOPUS y biblioteca Cochrane, sin corte de tiempo. Los descriptores utilizados fueron: "Population Education", "Health Education", "First Aid" y "Emergencies", en inglés se delimitaron y cruzaron los siguientes descriptores: "Population Education", "Health Education", "First aid" y "Emergencies" los operadores booleanos AND y OR. La muestra estaba compuesta por 11 artículos. Resultados: las formaciones en primeros auxilios tienen un impacto significativo sobre todo cuando se aplican los cuestionarios previos y posteriores a la intervención, ya que los errores cometidos anteriormente se transformaron en aciertos. Conclusión: las intervenciones educativas llevadas a cabo en las escuelas y comunidades conducen a la propagación del conocimiento y el aprendizaje, pudiendo así tangibilizar la formación de multiplicadores, dando lugar a una sociedad informada.

Willingness of WHO staff to work in health emergencies in the African Region: opportunity for phased deployment of staff and ensure continuity of health services

A human resource base that ensures appropriate deployment of staff to emergencies, addressing different shock events in emergencies, without disrupting continuity of service is germane to a successful response. Consequently, the WHO Health Emergencies programme in the African Region, in collaboration with Africa Centre for Disease Control (ACDC) launched the African Volunteer Health Corps (AVoHC) and Strengthening and Utilization of Response Group for Emergencies (SURGE), an initiative aimed at ensuring a pool of timely responders. We explored the willingness of WHO staff to work in emergencies. A call for expression of interest to be part of the Elite Emergency Experts (Triple E) was published on 5th July 2022 via email and was open for 5 weeks. The responses were analyzed using simple descriptive statistics and presented with graphic illustrations. A total of 1253 WHO staff, from all the six WHO regions, cutting across all cadre, applied to the call. The applicants had various trainings and experiences in emergency and have responded to mostly disease outbreaks. Two-third of the applicants were males. This paper did not explore reasons for the willingness to work in emergencies. However, contrary to fears expressed in literature that health workers would not want to work in emergencies with potential for infections, the applicants have worked mostly in infectious emergencies. Literature identified some themes on factors that could impact on willingness of health workers to work in emergencies. These include concerns for the safety of the responders and impact of partners, child and elderly care, as well as other family obligations, which emergency planners must consider in planning emergency response.

Dificuldades enfrentadas pelos profissionais de saúde no atendimento de emergências em unidades básicas de saúde no Brasil / Difficulties faced by health professionals in emergency care in primary health care units in Brazil / Dificultades enfrentadas por los profesionales de salud en la atención de emergencias en unidades básicas de salud en Brasil

Objetivos: compreender as dificuldades enfrentadas pelos profissionais de saúde para o atendimento de casos de urgências/emergências em unidades básica de saúde e identificar as proposições de resolubilidade. Métodos: Pesquisa qualitativa, realizada com dez profissionais de saúde, em uma unidade básica de saúde do interior paulista. As entrevistas foram transcritas e analisadas utilizando-se a estratégia metodológica do Discurso do Sujeito Coletivo. Resultados: As dificuldades foram atreladas a fatores como despreparo da equipe, falta de infraestrutura, insumos e equipamentos, carência de profissional médico, pouca aproximação das unidades básicas de saúde com o setor de emergência hospitalar e escasso investimento do município para realização desses atendimentos. As proposições de melhorias destacaram a necessidade de capacitação dos profissionais de saúde, investimentos em recursos materiais e equipamentos, permanência de médico em período integral no serviço, implantação de protocolos de atendimento e empenho dos gestores. Conclusão: Os discursos evidenciaram que o serviço não tem condições de atender casos de urgência/emergência, em virtude do despreparo da equipe e da falta de recursos humanos e materiais. Além disso, não é prioridade do município oferecer condições mínimas para a realização deste atendimento nas unidades básicas de saúde, para que sejam integrantes da rede de atenção de Atenção às Urgências no Sistema Único de Saúde.

Objective: understand the difficulties health professionals face in urgency/emergency care at primary health care units and identify the propositions of problem-solving ability. Methods: Qualitative research, conducted with ten health professionals at a primary health care unit in the interior of São Paulo. The interviews were transcribed and analyzed using the methodological strategy of the collective subject discourse. Results: The difficulties were linked to factors such as unpreparedness of the team, lack of infrastructure, supplies and equipment, lack of medical professional, little cooperation between the primary health care units and the hospital emergency sector and scarce investment of the municipality to carry out these services. The proposals for improvements highlighted the need for training of health professionals, investments in material resources and equipment, full-time presence of physician at the service, implementation of care protocols and commitment of managers. Conclusion: The discourse showed that the service is not able to attend urgency/emergency cases, due to the unpreparedness of the team and the lack of human and material resources. In addition, the municipality does not prioritize the supply of minimum conditions for this care in primary health care units to make them part of the emergency care network in the Unified Health System.

Objetivo: comprender las dificultades enfrentadas por los profesionales de salud para la atención de casos de Urgencias/Emergencias en unidades básicas de salud e identificar las proposiciones de resolubilidad. Métodos: Investigación cualitativa, desarrollada con diez profesionales de salud, en una unidad básica de salud del interior paulista. Las entrevistas fueron transcritas y analizadas utilizando la estrategia metodológica del Discurso del Sujeto Colectivo. Resultados: Las dificultades fueron ligadas a factores como la falta de preparación del equipo, falta de infraestructura, insumos y equipamientos, carencia de profesional médico, poca aproximación de las unidades básicas de salud con el sector de emergencia hospitalaria y escasa inversión del municipio para realizar esas atenciones. Las propuestas de mejorías destacaron la necesidad de capacitación de los profesionales de salud, inversiones en recursos materiales y equipamientos, permanencia de médico a tiempo completo en el servicio, implantación de protocolos de atención y empeño de los gestores. Conclusión: Los discursos evidenciaron que el servicio no tiene condiciones de atender casos de urgencia/emergencia, en virtud de la falta de preparación del equipo y de la falta de recursos humanos y materiales. Además, no es prioridad del municipio ofrecer condiciones mínimas para la realización de esta atención en las unidades básicas de salud, para que sean integrantes de la red de atención de atención a las urgencias en el Sistema Único de Salud.

Traumatismos en neonatos que acuden al departamento de emergencias pediátricas: frecuencia, mecanismos y formas de presentación

Introduccion: La Organización Mundial de la Salud (OMS) estima que aproximadamente 100 niños mueren cada hora a causa de lesiones traumáticas. Objetivo: Describir la frecuencia, mecanismos y tipos de traumatismos en los neonatos en el departamento de emergencias pediátricas de un hospital. Materiales y métodos: Estudio observacional, descriptivo, transversal, ambispectivo. Se incluyeron neonatos con diagnóstico de traumatismo que acudieron al departamento de emergencias pediátricas de un hospital desde enero del 2015 a diciembre del 2019. Variables: edad, sexo, procedencia, peso de nacimiento, edad gestacional, tipo de parto, mecanismo y tipo de traumatismo y evolución, Los datos se analizaron en SPSS. El protocolo fue aprobado por el comité de ética. Resultados: Fueron incluidos 90 neonatos, la frecuencia de traumatismo fue del 1,4%, la media de la edad fue de 14,6 ±7,7 días. El 92% nacieron por parto vaginal ,27% macrosómicos. El mecanismo del trauma fue obstétrico en 75,6%, accidentes en la casa 23,3 %y 1 caso de accidente de tránsito. Los tipos de lesiones fueron fracturas de huesos largos, en 47,8%, lesión del plexo braquial 15,5% y traumatismo cráneo encefálico 13,33%. Fueron hospitalizados el 10%. Conclusiones: La frecuencia de traumatismo neonatal en la urgencia pediátrica fue del 1,4%. La edad media fue 14,6 ±7,7dias. El 75,6% fue de origen obstétrico y 23,3% accidentes en la casa y 1 caso de accidente de tránsito. Los tipos de lesiones fueron fracturas de huesos largos, 47,8%, lesión del plexo braquial 15,5% y 13,3% traumatismo cráneo encefálico 13,3%.

Introduction: The World Health Organization (WHO) estimates that approximately 100 children die every hour from traumatic injuries. Objective: To describe the frequency, mechanisms and types of trauma in neonates in the pediatric emergency department of a hospital. Materials and methods: This was an observational, descriptive, transversal, and ambispective study. Neonates with a diagnosis of trauma who presented to the pediatric emergency department of a hospital from January 2015 to December 2019 were included. Variables: age, sex, town of origin, birth weight, gestational age, type of delivery, mechanism and type of trauma and evolution, Data were analyzed in SPSS. The protocol was approved by the ethics committee. Results: 90 neonates were included, the frequency of trauma was 1.4%, the mean age was 14.6 ±7.7 days. 92% were born by vaginal delivery, 27% were macrosomic at birth. The mechanism of trauma was obstetric in 75.6%, accidents at home in 23.3% and there was 1 case of a traffic accident. The types of injuries were long bone fractures, seen in 47.8%, brachial plexus injury in 15.5%, and head trauma in 13.33%. 10% were hospitalized. Conclusions: The frequency of neonatal trauma in the pediatric emergency was 1.4%. The mean age was 14.6 ±7.7 days. 75.6% were obstetric in origin and 23.3% were accidents at home and 1 case of a traffic accident. The types of injuries were long bone fractures in 47.8%, brachial plexus injury in 15.5%, and head trauma in 13.3%.

Miedo a la muerte y a su proceso en personal de Pediatría durante la pandemia por COVID-19

Introducción: La evidencia obtenida en estudios previos señala que existe mayor ansiedad por el proceso de morir que, por la muerte misma, aunque falta mayor investigación. Objetivo: Analizar el miedo a la muerte y al proceso de morir propio y de otros en el servicio de Pediatría del Hospital Pablo Tobón Uribe. Metodología: Se realizó un estudio analítico transversal con la Escala de Miedo a la Muerte de Collett-Lester en 143 personas: 25,2 % pediatras generales y subespecialistas, 70,6 % profesionales de Enfermería y auxiliares, y 4,2 % terapeutas respiratorios. El análisis incluyó estadística descriptiva, pruebas de Chi2, U de Mann-Whitney, Fisher, T de Student, ANOVA y el Alfa de Cronbach. Resultados: los hallazgos del estudio sugieren que es menor el miedo a la propia muerte que el miedo a la muerte de otros, y no hay diferencia entre el miedo al proceso de morir propio y de otros. Es mayor el miedo a la muerte en enfermeras profesionales y menor en pediatras subespecialistas. Existe mayor miedo a la muerte en el servicio de UCI-UCE (media: 3,53 DS: 0,88) comparado con Urgencias (media: 2,66 DS: 0,59). Hay asociación entre el miedo a la muerte con: el sexo femenino (p = 0,000), tener una creencia religiosa (p = 0,048), y el cargo (p = 0,007). La escala tuvo muy alta fiabilidad (Alfa de Cronbach: 0,95). Discusión: es de aclarar que este estudio fue realizado durante el segundo año de la pandemia del COVID-19, cuando había menor temor, mayor conocimiento y vacunas, cuyos resultados se corresponden con otros estudios. Conclusión: en el presente estudio el mayor miedo a la muerte se asoció con ser mujer, tener creencia religiosa y laborar en UCI-UCE comparado con Urgencias.

Introduction: The evidence obtained from previous research suggests that there is more anxiety related to dying compared with death. Nevertheless, more research is needed. Objective: To analyze the fear of death and dying, oneself and others, in the pediatric service personnel at Pablo Tobón Uribe Hospital in Medellín. Methodology: This was a transversal analytic study to apply the Collett-Lester Fear of Death Scale on 143 people: 25,2 % were general pediatricians and subspecialists, 70,6 % were professional nurses and medical assistants, and 4,2 % were respiratory therapists. The analysis included descriptive statistics, Chi2 test, Mann-Whitney U test, Fisher, StudentsT, ANOVA and Cronbach's Alpha. Results: Here we report the mean of one's fear of death is lower than the fear of others' death. There is no difference when comparing the fear of one's process of dying mean, rather than when it's others. Fear of death is higher in professional nurses and lower in pediatric subspecialists. The study shows higher fear of death in the ICU-IMC services (mean: 3,53 SD: 0,88) compared with the emergency room (mean:2,66 SD: 0,59). There is a statistical association between fear of death and being a woman (p=0,000), having a religious belief (p=0,048) and job position (p=0,007). The scale has a high internal consistency (Cronbach's Alpha: 0,95). Discussion: It is important to mention that this research was conducted during the second year of the COVID-19 pandemic, when the fear had decreased, and with more knowledge and the vaccines were ready, the results are coherent with other papers. Conclusion: In this study the higher fear of death was associated with being a woman, having a religious belief and working in ICU-IMC compared to the emergency room.

Valoración inicial de enfermería en emergencias psiquiátricas: revisión sistemática / Initial nursing assessment in psychiatric emergencies: a systematic review / Avaliação inicial de enfermagem em emergências psiquiátricas: uma revisão sistemática

Un porcentaje significativo de las emergencias hospitalarias son psiquiátricas; por lo que, durante la práctica clínica diaria, el personal de enfermería debe atender a pacientes con síntomas mentales y signos conductuales. Para tomar decisiones que permitan afrontar dichas urgencias, el profesional de enfermería requiere realizar una adecuada valoración para establecer las necesidades reales del paciente. Objetivo. Identificar los instrumentos utilizados por el servicio de enfermería para una valoración inicial efectiva en emergencias psiquiátricas. Metodología. Se realizó una revisión sistemática cuya búsqueda se realizó en las bases de datos Scopus y PubMed. La ecuación empleada fue la base de datos Scopus se utilizaron (mental AND health AND diagnosis AND psychiatric AND emergency) OR (instruments AND diagnosis AND psychiatric AND emergencies); en PubMed se usaron (initial AND assessment AND psychiatric AND patients AND emergency AND diagnosis), a partir de metodo de busqyeda empleado se obtuvo un total de 802 fuentes que pasaron por un proceso de selección quedando para el análisis de 22 publicaciones. Conclusión. Las entrevistas y cuestionarios se erigen como una herramienta indispensable. Permiten establecer un vínculo directo con el paciente, identificar sus preocupaciones, síntomas y necesidades específicas, garantizando así su bienestar físico y emocional desde el inicio de la atención. El uso de las escalas de medición varía de acuerdo a la enfermedad del paciente, el sistema de clasificación más utilizada es la CIE-10 y que los registros clínicos sobre antecedentes familiares y de sustancias, además de los aspectos sociodemográficos, son los más usados y permiten visualizar el perfil general del paciente de emergencias psiquiátricas.

A significant percentage of hospital emergencies are psychiatric; therefore, during daily clinical practice, the nursing staff must attend patients with mental symptoms and behavioral signs. In order to make decisions to deal with such emergencies, the nursing professional requires an adequate assessment to establish the real needs of the patient. Objective. To identify the instruments used by the nursing service for an effective initial assessment in psychiatric emergencies. Methodology. A systematic review was carried out using the Scopus and PubMed databases. The equation used was the Scopus database (mental AND health AND diagnosis AND psychiatric AND emergency) OR (instruments AND diagnosis AND psychiatric AND emergencies); in PubMed (initial AND assessment AND psychiatric AND patients AND emergency AND diagnosis); from the search method used, a total of 802 sources were obtained which went through a selection process leaving 22 publications for analysis. Conclusion. Interviews and questionnaires are an indispensable tool. They allow establishing a direct link with the patient, identifying their concerns, symptoms and specific needs, thus guaranteeing their physical and emotional well-being from the beginning of care. The use of measurement scales varies according to the patient's disease; the most commonly used classification system is the ICD-10 and clinical records on family and substance history, in addition to sociodemographic aspects, are the most used and allow visualizing the general profile of the psychiatric emergency patient.

Uma porcentagem significativa das emergências hospitalares é psiquiátrica; portanto, durante a prática clínica diária, os enfermeiros devem atender a pacientes com sintomas mentais e sinais comportamentais. Para tomar decisões sobre como lidar com essas emergências, o profissional de enfermagem precisa fazer uma avaliação adequada para estabelecer as reais necessidades do paciente. Objetivo. Identificar os instrumentos utilizados pelo serviço de enfermagem para uma avaliação inicial eficaz em emergências psiquiátricas. Metodologia. Foi realizada uma revisão sistemática utilizando as bases de dados Scopus e PubMed. A equação utilizada foi a da base de dados Scopus (mental AND health AND diagnosis AND psychiatric AND emergency) OR (instruments AND diagnosis AND psychiatric AND emergencies); na PubMed (initial AND assessment AND psychiatric AND patients AND emergency AND diagnosis); a partir do método de busca utilizado, obteve-se um total de 802 fontes que passaram por um processo de seleção, restando 22 publicações para análise. Conclusões. As entrevistas e os questionários são uma ferramenta indispensável. Eles permitem estabelecer um vínculo direto com o paciente, identificar suas preocupações, sintomas e necessidades específicas, garantindo assim seu bem-estar físico e emocional desde o início do atendimento. O uso de escalas de medição varia de acordo com a doença do paciente. O sistema de classificação mais usado é o CID-10 e os registros clínicos sobre histórico familiar e de substâncias, além de aspectos sociodemográficos, são os mais usados e permitem visualizar o perfil geral do paciente de emergência psiquiátrica.

Adversidades no cotidiano de trabalho de um serviço de atendimento pré-hospitalar móvel de urgência / Adversities in the daily work of a pre-hospital mobile emergency care service / Adversidades en el cotidiano de trabajo de un servicio de atención prehospitalaria móvil de emergencia

Objetivo: identificar situações adversas no cotidiano de trabalho de profissionais de um serviço de atendimento pré-hospitalar móvel de urgência. Método: estudo qualitativo, fundamentado no referencial teórico de cotidiano de Michel de Certeau, realizado entre julho e outubro de 2020, por meio de entrevistas com 32 profissionais do Serviço de Atendimento Móvel de Urgência (SAMU) de Belo Horizonte, Minas Gerais. O tratamento dos dados foi realizado por análise temática e organizado utilizando-se o software MAXQDA®. Resultados: as situações adversas foram intempéries climáticas; situações de violência; pressão exercida por traficantes, familiares, transeuntes; despreparo dos profissionais e atendimentos em locais inóspitos, de difícil acesso, imprevisíveis, que podem desencadear possíveis incidentes durante os atendimentos aos usuários. Conclusão: a identificação das situações adversas deve fazer parte da rotina antes e durante os atendimentos e a implementação de medidas preventivas reduz os riscos de incidentes ao paciente.

Objective: to identify adverse situations in the daily work of professionals in a mobile emergency pre-hospital care service. Method: qualitative study, based on Michel de Certeau's daily theoretical framework, carried out between July and October 2020, through interviews with 32 professionals from the Mobile Emergency Care Service (SAMU) in Belo Horizonte, Minas Gerais. Data processing was carried out by thematic analysis and organized using the MAXQDA® software. Results: the adverse situations were bad weather; violence´s situations; pressure exerted by drug dealers, family members, passers-by; unpreparedness of professionals and assistance in inhospitable, difficult to access, unpredictable places, which can trigger possible incidents during assistance to users. Conclusions: the identification of adverse situations should be part of the routine before and during the assistences and the implementation of preventive measures reduces the risk of incidents for the patient.

Objetivo: identificar situaciones adversas en el cotidiano del trabajo de los profesionales de un servicio de atención prehospitalaria móvil de emergencia. Método: estudio cualitativo, basado en el marco teórico de cotidiano de Michel de Certeau, realizado entre julio y octubre de 2020, a través de entrevistas con 32 profesionales del Servicio Móvil de Atención de Emergencia (SAMU) en Belo Horizonte, Minas Gerais. El tratamiento de los datos se realizó por análisis temático y se organizó utilizando el software MAXQDA®. Resultados: las situaciones adversas fueron intemperies climáticas, situaciones de violencia; presión ejercida por narcotraficantes, familiares, transeúntes; falta de preparación de los profesionales y atención en lugares inhóspitos, de difícil acceso, impredecibles, que pueden desencadenar posibles incidentes durante la atención a los usuarios. Conclusiones: la identificación de situaciones adversas debe formar parte de la rutina antes y durante las consultas, y la implementación de medidas preventivas le reduce el riesgo de incidentes al paciente.

Formación con simulación clínica para manejo adecuado de emergencias obstétricas: revisión narrativa / Clinical simulation training for the adequate management of obstetrics emergencies: A narrative review

Las emergencias obstétricas son situaciones críticas que amenazan la salud de la madre y del bebé durante el embarazo o el parto. Este estudio se enfocó en validar la efectividad de la formación con simulación clínica en el manejo de estas situaciones. Realizamos una revisión narrativa de estudios publicados entre 2008 y 2022, recopilados de las bases de datos Scopus, ScienceDirect, MEDLINE/PubMed, Springer, SciELO y Google Scholar. Se recogieron y resumieron los datos de los estudios que cumplían con nuestros criterios de inclusión. Nuestros resultados subrayan que la simulación clínica se posiciona como una herramienta altamente eficaz en la formación de profesionales de la salud. Esta capacitación se traduce en mejoras significativas en diversos aspectos, incluyendo el rendimiento, los conocimientos, la confianza, la satisfacción, las actitudes, la autoeficacia, la capacidad para trabajar en equipo y las habilidades necesarias para enfrentar situaciones obstétricas críticas. Dentro de estas últimas destacan hemorragias posparto, eclampsia, distocia de hombros, paro cardíaco materno, prolapso del cordón umbilical y cesáreas. Esta formación disminuye los riesgos asociados con el aprendizaje en pacientes reales y cumple con los estándares éticos. La colaboración interdisciplinaria en el manejo de emergencias obstétricas se revela efectiva para brindar atención integral a los pacientes. Sin embargo, es fundamental enfatizar que para asegurar la seguridad del paciente y promover un enfoque de trabajo en equipo, es esencial que los profesionales de la salud reciban una formación adecuada y estén debidamente cualificados. A pesar de que la formación en simulación clínica es eficaz, su implementación puede resultar costosa y requerir recursos considerables. No obstante, consideramos que esta estrategia sigue siendo de un valor incalculable para la formación de profesionales en este campo. Investigaciones futuras de alta calidad contribuirán a fortalecer la evidencia sobre las mejores prácticas en la formación con simulación clínica en emergencias obstétricas.

Obstetric emergencies are critical situations that jeopardize the health of both the mother and the baby during pregnancy or childbirth. This study aimed to validate the effectiveness of clinical simulation training in managing these situations. We conducted a narrative review of studies published between 2008 and 2022, collected from databases including Scopus, Sciencedirect, PubMed, Springer, Scielo, and Google Scholar. Data from studies that met our inclusion criteria were meticulously gathered and summarized. Our findings strongly emphasize that clinical simulation emerges as a highly effective tool in the training of healthcare professionals. This training translates into substantial improvements in various aspects, including performance, knowledge, confidence, satisfaction, attitudes, self-efficacy, teamwork abilities, and the skills necessary to confront critical obstetric situations such as postpartum hemorrhage, eclampsia, shoulder dystocia, maternal cardiac arrest, umbilical cord prolapse, and cesarean sections. Importantly, this training reduces the inherent risks associated with learning on real patients and aligns with the highest ethical standards. Additionally, our results underscore that interdisciplinary collaboration in the management of obstetric emergencies proves to be an effective strategy for providing comprehensive patient care. However, it is crucial to highlight that, in order to ensure patient safety and promote a teamwork approach, it is imperative for healthcare professionals to receive adequate training and be duly qualified. Although we acknowledge that implementing clinical simulation training can entail significant costs and require substantial resources, we firmly believe that this strategy continues to hold immeasurable value in the education of professionals in this field. Ultimately, we anticipate that future high-quality research will further fortify the evidence base regarding best practices in clinical simulation training for obstetric emergencies, thus contributing to enhanced patient outcomes and the overall quality of healthcare in this critical domain.

Cuerpos extraños en esófago: revisión de 84 casos

La presencia de cuerpo extraño esofágico (CEE) es una urgencia habitual en gastroenterología. El protocolo en el manejo y la intervención endoscópica puede ser variable entre las instituciones. Objetivo: Definir características clínicas del CEE en adultos, su diagnóstico radiológico y endoscópico, y complicaciones a partir de una muestra de pacientes en un centro de gastroenterología. Materiales y métodos: serie de casos de pacientes que ingresaron desde urgencias y fueron interconsultados al servicio de gastroenterología con diagnóstico presuntivo de CEE. Se recolectaron variables clínicas, así como características, comorbilidades, tiempo de evolución y oportunidad diagnóstica, estudios confirmatorios, y complicaciones. Resultados: 84 sujetos, 70% hombres, promedio de edad 45 (rango:17-87; SD 12,5) años. En 98,8% de los pacientes se realizó endoscopía digestiva alta de modo urgente, con estancia intrahospitalaria promedio de 2,5 días. 93% sin patología de base asociada, en 6/84 (7,14%) pacientes se documentó patología esofágica estructural o funcional. 59/84 70,2%) pacientes consultaron en las primeras 24 horas, en 57,6% se confirmó endoscópicamente presencia de cuerpo extraño. En 67/84 (79,76%) pacientes se realizó radiografía previa a endoscopia, de los cuales, 62/67 (92,5%) con resultado anormal. 70% de los CEE confirmados fueron espinas de pescado. El sitio más frecuente de localización fue en región cricofaringea en el 90% de los casos. En 66/84 (78,6%) sujetos hubo ausencia de complicaciones, seguido de laceración profunda en 10/84 (11,9%) casos. En 3/84 (3,6%) casos se identificaron complicaciones con requerimiento quirúrgico. Conclusiones: La intervención endoscópica en las primeras 24 horas es un momento oportuno para identificación de complicaciones y brindar el tratamiento indicado.

The presence of esophageal foreign body (EFB) is a common emergency in gastroenterology. The protocol for management and endoscopic intervention can be variable among institutions. Objective: to define the clinical characteristics of EFB in adults, its radiological and endoscopic diagnosis, and complications based on a sample of patients in a gastroenterology center. Materials and methods: case series of patients admitted from the emergency department and referred to the gastroenterology department with a presumptive diagnosis of EFB. Clinical variables were collected, as well as characteristics, comorbidities, time of evolution and diagnostic opportunity, confirmatory studies, and complications. Results: 84 subjects, 70% men, mean age 45 (range: 17-87; SD 12.5) years. Urgent upper endoscopy was performed in 98.8% of the patients, with an average in-hospital stay of 2.5 days. 93% had no associated underlying pathology, in 6/84 (7.14%) patients structural or functional esophageal pathology was documented. 59/84 (70.2%) patients consulted in the first 24 hours, in 57.6% the presence of foreign body was confirmed endoscopically. In 67/84 (79.76%) patients radiography was performed prior to endoscopy, of which 62/67 (92.5%) had an abnormal result. Seventy percent of confirmed EFB were fish bones. The most frequent site of localization was in the cricopharyngeal region in 90% of the cases. In 66/84 (78.6%) subjects there was absence of complications, followed by deep laceration in 10/84 (11.9%) cases. In 3/84 (3.6%) cases complications requiring surgery were identified. Conclusions: Endoscopic intervention in the first 24 hours is an opportune moment to identify complications and provide the indicated treatment.

Emergências em Saúde Pública, desastres e risco: perspectivas e abordagens a partir das ciências sociais / Emergencies in Public Health, disasters, and risk: perspectives and approaches from the social sciences

RESUMO Emergências em Saúde Pública e desastres são eventos que causam impactos sobre a sociedade, afetando a vida e o cotidiano das pessoas, suas condições de saúde e segurança. As ciências sociais têm um papel fundamental na análise de tais eventos ao fornecerem uma perspectiva crítica acerca da dimensão das estruturas sociais, culturais, políticas e econômicas envolvidas. Neste artigo, buscou-se abordar os conceitos intercambiáveis de emergências em saúde pública e desastres, e suas inter-relações com os aspectos sociais, ao analisar como os teóricos sociais consideram o tema sob o enfoque do risco, a fim de melhor compreender os processos de vulnerabilização. Para tanto, foi realizado estudo exploratório que se concentrou nas abordagens sociológicas, conceituais e epistemológicas, buscando fornecer elementos para a construção de ideações, tecnologias e práticas que possam ser agregadas às ações de gestão do risco. Os resultados destacam a necessidade de (re)análises desses fenômenos a partir da ampliação da discussão em busca de uma maior aproximação entre as ciências sociais e as bases interdisciplinares, na direção da estruturação de arcabouço teórico mais consensual e plausível sobre as questões complexas observadas nas situações de emergências e desastres e seus impactos na sociedade contemporânea.

ABSTRACT Public health emergencies and disasters are events that impact society, affecting people's, live and their health and safety conditions. Social sciences play a fundamental role in the analysis of such events, by providing a critical perspective on the dimension of the social, cultural, political, and economic structures involved. This article seeks to address the interchangeable concepts of public health emergencies and disasters, and their interrelationships with social aspects, by analyzing how social theorists consider the issue from a risk perspective, in order to better understand the processes of vulnerability. To this end, an exploratory study was carried out that focused on sociological, conceptual, and epistemological approaches, seeking to provide elements for the construction of ideas, technologies and practices that can be added to risk management actions. The results highlight the need for (re)analyses of such phenomena from the broadening of the discussion in search of a greater approximation between the social sciences and the interdisciplinary bases, towards the structuring of a more consensual and plausible theoretical framework on the complex issues observed in the emergency and disaster situations and their impacts on contemporary society.

Prospecção das condições de trabalho do Samu-192 fluvial em cenários de crise a partir da resiliência no enfrentamento à Covid-19 no Alto Solimões / Investigation of the working conditions of the river-based SAMU-192 in crisis scenarios based on resilience in the face of COVID-19 in Alto Solimões

RESUMO Esta pesquisa teve como objetivo prospectar as condições de trabalho das equipes de socorro do Serviço de Atendimento Móvel de Urgência (Samu-192) fluvial das áreas ribeirinhas e costeiras da região do Alto-Solimões, a partir da análise sistêmica das atividades no serviço de embarcações popularmente chamadas de 'ambulanchas' durante os picos da Covid-19 no estado do Amazonas, quando o sistema de saúde funcionou sob o estresse provocado pela pandemia. Os dados foram obtidos a partir de um desenho transversal exploratório, baseado em dados qualitativos coletados por meio de entrevistas e observação do funcionamento normal do sistema antes da pandemia. A partir daí modelos de dois cenários foram elaborados mostrando o funcionamento do serviço de ambulanchas ao lidar com a pandemia de Covid-19 e o impacto nas condições de trabalho das equipes de socorro interprofissionais de socorro. Entrevistas remotas com trabalhadores das ambulanchas após a pandemia indicaram que a prospecção das condições de trabalho a partir das instâncias dos modelos corresponderam ao funcionamento real do sistema durante a pandemia de Covid-19.

ABSTRACT This research aimed to prospect the working conditions of the rescue teams of the Mobile Emergency Care Service (SAMU-192) at the fluvial areas of the Alto Solimoes region, trough the systemic analysis of the activities of the water ambulances service popularly called 'ambulanchas' during the peaks of COVID-19 in the state of Amazonas, when the health system functioned under stress caused by the pandemic. Data were obtained from an exploratory cross-sectional design, based on qualitative data collected through interviews and observation of the normal functioning of the system before the pandemic. From there, models of two scenarios were developed showing the functioning of the water ambulances service when coping with the COVID-19 pandemic and the impact on the working conditions of the interprofessional rescue teams. Remote interviews with workers after the pandemic indicated that the prospection of working conditions from the instances of the models corresponded to the real functioning of the system during the COVID-19 pandemic.

Complejidades de la atención anestésica de urgencia en el anciano

El envejecimiento es un largo proceso de carácter universal propio de los seres vivos. Es notorio su crecimiento a nivel de la población mundial y no resulta exclusivo para los países desarrollados. El paciente anciano presenta grandes retos debido a las alteraciones propiciadas por el proceso de envejecimiento, que se acompaña de disminución de la capacidad de respuesta con deterioro en grado desigual de una serie de funciones morfofisiológicas, psicológicas y bioquímicas. Por otra parte, la atención médica a pacientes portadores de afecciones quirúrgicas de urgencia desata desafíos al equipo de trabajo ante la necesidad de brindar al enfermo una asistencia con un mínimo de preparación, lo que conlleva identificar estado de salud en un periodo de tiempo aceptable, lograr una estabilización previa al acto quirúrgico y favorecer una recuperación satisfactoria. Por tales razones, se realizó esta revisión bibliográfica con el propósito de resaltar una serie de factores que acompañan el proceso de envejecimiento y sus implicaciones para el proceder anestésico.

Aging is a universal nature long process, typical of living beings. Its growth at the world population level is notorious and it is not exclusive to developed countries. The elderly patient presents great challenges due to the alterations caused by the aging process, which is accompanied by decreased response capacity with uneven deterioration of a series of morphophysiological, psychological and biochemical functions. On the other hand, medical care for patients with urgent surgical conditions unleashes challenges for the work team due to the need to provide the patient with assistance with a minimum of preparation, which entails identifying a state of health in an acceptable period of time, achieve stabilization prior to the surgical act and favor a satisfactory recovery. For these reasons, this bibliographical review was carried out to highlight a series of factors that take part in the aging process and its implications for the anesthetic procedure.

Characterization of patients with acutely decompensated cirrhosis who received care in different highly complex emergency services of Medellín, Colombia

Introduction. Cirrhosis is one of the ten leading causes of death in the Western hemisphere and entails a significant cost of health care. Objective. To describe the sociodemographic, clinical, and laboratory characteristics of patients older than 18 years who received care for acute decompensation of cirrhosis in the emergency services of three highly complex centers in Medellín, Colombia. Materials and methods. This was an observational retrospective cohort study from clinical records. The results were analyzed by frequency measures and represented in tables and graphics. Results. In total, 576 clinical records met the inclusion criteria; 287 were included for analysis, and 58.9% were men, with an average age of 64 (± 13.5) years. The most frequent causes of cirrhosis were alcohol intake (47.7%), cryptogenic or unspecified etiology (29.6%), and non-alcoholic fatty liver disease (9.1%). The main reasons for visiting the emergency department were the presence of edema and/or ascites (34.1%), suspicion of gastrointestinal bleeding (26.5%), abdominal pain (14.3%) and altered mental status (13.9%). The most frequent clinical manifestations of an acute decompensation of cirrhosis were ascites (45.6%), variceal hemorrhage (25.4%), hepatic encephalopathy (23.0%), and spontaneous bacterial peritonitis (5.2%). During their treatment, 56.1% of the patients received intravenous antibiotics; 24.0%, human albumin; 24.0%, vasoactive support, and 27.5%, blood products; 21.3% required management in an intensive or intermediate care unit, registering 53 deceased patients for a mortality of 18.5%. Conclusion. Patients who consult the emergency services due to acute decompensation of cirrhosis demand a high amount of health resources, frequently present associated complications, and a high percentage requires management in critical care units and shows a high in-hospital mortality rate.

Introducción. La cirrosis hace parte de las diez primeras causas de muerte en el hemisferio occidental y acarrea un importante costo en salud. Objetivo. Describir las características sociodemográficas, clínicas y de laboratorio, de los pacientes mayores de 18 años que recibieron atención por descompensación aguda de la cirrosis en los servicios de urgencias de tres centros de alta complejidad en Medellín, Colombia. Materiales y métodos. Se trata de un estudio observacional de cohorte. Los resultados se analizaron mediante medidas de frecuencia, y se representaron en tablas y gráficas. Resultados. En total, en 576 registros clínicos se cumplieron los criterios de inclusión; se incluyeron 287 para el análisis. El 58,9 % fueron hombres, con edad promedio de 64 (± 13,5) años. Las causas más frecuentes de cirrosis fueron: ingestión de alcohol (47,7 %), criptogénica o inespecífica (29,6 %) y enfermedad por hígado graso no alcohólico (9,1 %). Los principales motivos de consulta fueron: presencia de edemas, ascitis o ambas (34,1 %), sospecha de hemorragia digestiva (26,5 %), dolor abdominal (14,3 %) y alteración del estado mental (13,9 %). Los diagnósticos de complicación aguda más frecuentes fueron ascitis (45,6 %), hemorragia digestiva por várices esofágicas (25,4 %), encefalopatía hepática (23,0 %) y peritonitis bacteriana espontánea (5,2 %). El 56,1 % de los pacientes recibió antibióticos; el 24,0 %, albúmina humana; el 24,0 % medicamentos, y el 27,5 % hemoderivados. En el 21,3 % de los casos, se requirió hospitalización en la unidad de cuidados intensivos o en la de cuidados intermedios. Se registraron 53 decesos, para una mortalidad del 18,5 %. Conclusiones. Los pacientes que consultan a los servicios de urgencias por una descompensación aguda de la cirrosis demandan una gran cantidad de recursos, frecuentemente presentan complicaciones asociadas, requieren manejo en unidades de cuidado crítico y evidencian una alta tasa de mortalidad.

Sodio urinario como factor pronóstico para mortalidad en pacientes con falla cardiaca aguda descompensada

Introducción. En los pacientes con falla cardíaca, el sodio urinario se ha propuesto como marcador de gravedad y resistencia a los diuréticos, pero los resultados de los estudios reportados son heterogéneos. Objetivo. Evaluar el sodio en orina ocasional como factor pronóstico de mortalidad en pacientes con falla cardiaca descompensada. Materiales y métodos. Se realizó un análisis anidado de casos y controles de una cohorte prospectiva de falla cardíaca descompensada. El desenlace primario fue mortalidad a los 180 días. Se hizo un análisis bivariado para evaluar las variables que se asocian con la mortalidad. Se analizaron las diferencias de las variables clínicas entre los grupos con sodio urinario mayor o menor de 70 mEq/L. Resultados. Se incluyeron 79 pacientes de los cuales 15 fallecieron a los 180 días. La edad promedio fue de 68,9 años (DE: ±13,8), 30 eran mujeres (38 %). Quince pacientes (18,9 %) tuvieron un sodio en orina inferior a 70 mEq/L. En el análisis bivariado se encontró una asociación significativa de la mortalidad con las hospitalizaciones, la presión arterial sistólica inferior a 90 mm Hg, el uso de inotrópicos y el sodio urinario inferior a 70 mEq/L. Los pacientes con sodio urinario bajo habían estado hospitalizados con mayor frecuencia en el último año, tenían menores valores de sodio sérico y presión arterial al ingreso. Conclusión. Los pacientes con sodio urinario inferior a 70 mEq/L tienen características de mayor gravedad. En el análisis bivariado, el sodio urinario se asoció con mortalidad a los 180 días.

Introduction. Urinary sodium has been proposed as a prognostic marker and indicator of the diuretic response in patients with heart failure. However, study results are heterogeneous. Objective. To evaluate the spot urinary sodium level as a risk factor for mortality in patients with decompensated heart failure. Materials and methods. We conducted a case-control study nested in a prospective cohort of patients with decompensated heart failure. The primary outcome was mortality at 180 days. The risk factors associated with mortality were evaluated through a bivariate analysis. Differences in clinical variables between groups with urinary sodium greater than or lesser than 70 mEq/L were analyzed. Results. The study included 79 patients; 15 died at 180 days. Their mean age was 68.9 years (SD=± 13.8); 30 were women (38%), and 15 (18.9%) had urinary sodium <70 mEq/L. In the bivariate analysis, a significant association was found between mortality and past medical history of hospitalizations, SBP<90 mm Hg, the use of inotropes, and urinary sodium <70 mEq/L. Regarding clinical characteristics, patients with low urinary sodium level in the last year were hospitalized more frequently with hyponatremia and hypotension at admission. Conclusion. Patients with urinary sodium <70 mEq/L had more severe signs. In a bivariate analysis, urinary sodium was associated with mortality at 180 days.

Calidad de la atención estomatológica de urgencia en tiempos de COVID-19

Introducción: La evaluación de la calidad de la atención de salud tiene sus particularidades respecto a la calidad industrial o de servicios en sentido general. Objetivo: Evaluar la calidad de la atención estomatológica de urgencia en tiempos de COVID-19. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 6 estomatólogos, quienes laboraban durante el estudio en el Servicio de Urgencia Estomatológica del Policlínico Docente Josué País García de Santiago de Cuba, y de 120 usuarios seleccionados mediante un muestreo sistemático, atendidos en dicho servicio, desde octubre del 2020 hasta enero del 2022. Las variables analizadas fueron estructura, calidad de la atención y satisfacción. Se efectuó una evaluación externa y concurrente de la calidad de los componentes estructura, proceso y resultado. Se tomaron como referencia criterios implícitos y explícitos, descriptivos y normativos, indicadores y estándares. Asimismo, se emplearon la encuesta como método para la recogida de la información y el porcentaje como medida de resumen. Resultados: Se obtuvo que los componentes estructura y proceso fueron evaluados de adecuados; el primero, con 76,4 %, cifra por encima del estándar, y el segundo, con 100,0 % respecto a la competencia profesional, así como 72,2 % en el desempeño profesional. En cuanto al componente resultado, se alcanzó 81,8 % de satisfacción de los usuarios; sin embargo, la satisfacción de los proveedores fue inadecuada. Conclusiones: La calidad de la atención en el Servicio de Urgencia Estomatológica del Policlínico Docente Josué País García resultó adecuada.

Introduction: The evaluation of health care quality has its particularities regarding the industrial or services quality in general sense. Objective: To evaluate the quality of the emergency dental care in times of COVID-19. Methods: An observational, descriptive and cross-sectional study of 6 dentists who worked during the study in the Emergency Dental Service of Josué País García Teaching Polyclinic was carried out in Santiago de Cuba, and 120 users selected by means of a systematic sampling, assisted in this service from October, 2020 to January, 2022. The analyzed variables were structure, care quality and satisfaction. An external and concurrent evaluation of the quality in the components structure, process and result was carried out. Implicit and explicit, descriptive and normative, indicators and standard approaches were taken as reference. Also, the survey as method for collecting the information and the percentage as summary measure were used. Results: It was obtained that the components structure and process were evaluated as appropriate; the first one, with 76.4%, above the standard, and the second, with 100.0% regarding professional competence, as well as 72.2% in the professional performance. As for the component result, 81.8% of the users' satisfaction was reached; however, the satisfaction of suppliers was inadequate. Conclusions: The care quality in the Emergency Dental Service of Josué País García Teaching Polyclinic was appropriate.

Impacto en la atención médica en el Instituto de Medicina Tropical durante 4 meses de la Epidemia de Chikungunya

Introducción: La fiebre chikungunya (FCHIK) es una enfermedad emergente transmitida por mosquitos y causada por un alfavirus, el virus chikungunya (CHIKV). Aunque la mayoría de las personas se recuperan completamente en pocos días o semanas, algunos pacientes requieren hospitalización, pudiendo incluso desarrollar manifestaciones graves e incluso observarse un desenlace fatal. El objetivo del presente trabajo de investigación es describir las características de los pacientes atendidos en el Instituto de Medicina Tropical (IMT), en el marco de la actual Epidemia de Arbovirosis por Chikungunya. Materiales y Métodos: observacional, descriptivo, transversal con componente analítico, de pacientes de ambos sexos, atendidos en el IMT en sala de urgencia y en el área de hospitalización, con diagnóstico Confirmado o Sospechoso de FCHIK. Los datos fueron obtenidos de los sistemas informáticos del hospital (HIS). Resultados: Durante el periodo I (junio a octubre, 2022) fueron atendidos 19.645 pacientes (promedio de 3929 consultas mensuales) y durante el periodo II (noviembre 2022 a marzo 2023) 27.673 pacientes (promedio de 5.534,6 consultas mensuales); reflejando un incremento del 41% de consultas. El número de pacientes que requirieron hidratación y analgesia endovenosa fue incrementándose, con énfasis en los meses de enero, febrero y marzo (590, 781 y 608 casos, respectivamente). requiriendo consecuentemente el incremento de camas de hospitalización de 5 a 15 y de sillones de hidratación, de 10 a 15 sillones. Por otro lado, el número de pacientes que requirieron hospitalización se incrementó de 2 pacientes en el mes de noviembre a 54 pacientes en el mes de marzo. La letalidad fue significativamente superior en los >15 años, comparados con los ≤15 años: 12,5% (7/56) vs 2.9% (2/69), respectivamente (p<0.03. OR=4,8. (IC95%. 1 - 24.0). Conclusión: La epidemia de Chikungunya tuvo un importante impacto en la atención médica en el Instituto de Medicina Tropical, con un aumento significativo en la asistencia de pacientes febriles, traducida en alta tasa de pacientes atendidos en áreas de urgencias, y una pequeña proporción en área de internación. Este estudio subraya la importancia de una preparación adecuada y una respuesta rápida en el contexto de una epidemia para minimizar la repercusión en los servicios de atención médica hospitalaria.

Introduction: Chikungunya fever (CHIKF) is an emerging mosquito-borne disease caused by an alphavirus, chikungunya virus (CHIKV). Although most people fully recover in a few days or weeks, some patients require hospitalization and may even develop serious manifestations and even be fatal. The objective of this research work is to describe the characteristics of the patients treated at the Institute of Tropical Medicine (IMT), within the framework of the current Chikungunya Arbovirosis Epidemic. Materials and Methods: observational, descriptive, cross-sectional with an analytical component, of patients of both sexes, treated at the IMT in the emergency room and in the hospitalization area, with a confirmed or suspected diagnosis of FCHIK. Data were obtained from the hospital computer systems (HIS). Results: During period I (June to October 2022), 19,645 patients were attended (average of 3,929 monthly consultations) and during period II (November 2022 to March 2023) 27,673 patients (average of 5,534.6 monthly consultations); reflecting a 41% increase in inquiries. The number of patients who required intravenous hydration and analgesia increased, with emphasis on the months of January, February, and March (590, 781, and 608 cases, respectively). consequently requiring the increase of hospitalization beds from 5 to 15 and hydration chairs, from 10 to 15 chairs. On the other hand, the number of patients requiring hospitalization increased from 2 patients in November to 54 patients in March. Mortality was significantly higher in those >15 years, compared to those ≤15 years: 12.5% (7/56) vs 2.9% (2/69), respectively (p<0.03. OR=4.8. (IC95 %. 1 - 24.0) Conclusion: The Chikungunya epidemic had a significant impact on medical care at the Institute of Tropical Medicine, with a significant increase in the attendance of febrile patients, translated into a high rate of patients treated in emergency areas. and a small proportion in the hospitalization area. This study underscores the importance of adequate preparation and rapid response in the context of an epidemic to minimize the impact on hospital medical care services.