Opinions Related to the Potential Application of Artificial Intelligence (AI) by the Responsible in Charge of the Administrative Management Related to the Logistics and Supply Chain of Medical Stock in Health Centers in North of Chile.

The research evaluated the opinion of those in charge of the administrative management of the logistics and supply chain of medical and pharmaceutical stocks of health care centers in the north of Chile and a potential improvement of their operations through the use of artificial intelligence (AI). The identification of the problem arose from the empirical analysis, where serious deficiencies in the manual handling and management of the stock of medicines and hospital supplies were evidenced. This deficiency does not allow a timely response to the demand of the logistics and supply chain, causing stock ruptures in health centers. Based on this finding, we asked ourselves how AI was observed as the most efficient tool to solve this difficulty. The results were obtained through surveys of personnel in charge of hospital and pharmacy supplies. The questions focused on the level of training, seniority in positions related to the problem, knowledge of regulations, degree of innovation in the procedures used in logistics and supply chain and procurement. However, a very striking fact was related to the importance of the use of AI, where, very surprisingly, 64.7% considered that it would not help to reduce human errors generated in the areas analyzed.

Validez y confiabilidad de la escala de Tal modificada en niños chilenos: Estudio multicéntrico / Validity and reliability of the modified Tal score in Chilean children: A multicenter study

Introducción: En pediatría, evaluar la gravedad de la obstrucción bronquial es determinante; por esto, se han creado escalas de puntuación clínica, como la escala de Tal modificada. El objetivo fue determinar su validez y confiabilidad en niños atendidos en unidades de emergencia de Concepción, Chile. Población y métodos: Estudio de cohorte prospectivo. Se incluyeron niños < 36 meses con diagnóstico de bronquitis y/o bronquiolitis durante meses de invierno y primavera de 2015. La validez de criterio concurrente se determinó mediante la correlación entre el puntaje de la escala y la saturación de oxígeno, como estándar de referencia. La validez predictiva se evaluó mediante la asociación entre el puntaje de la escala y la probabilidad de nueva atención en la Unidad de Emergencia dentro de 7 días. Se calculó el área bajo la curva mediante curva ROC. La confiabilidad entre kinesiólogos y médicos se determinó mediante el coeficiente de correlación intraclase (CCI). Un valor de p < 0,05 se consideró estadísticamente significativo. Resultados: Se evaluaron 102 niños; se observó correlación débil entre la puntuación de la escala y la saturación de oxígeno en kinesiólogos (Rho= -0,41). Existió asociación entre la puntuación y la probabilidad de nueva atención en centros de emergencia. El área bajo la curva medida por ambos profesionales fue > 0,80. La confiabilidad interobservador entre médicos y kinesiólogos presentó correlación débil (CCI= 0,17). Conclusiones: La escala de Tal modificada presenta una adecuada validez predictiva, pero pobre validez al correlacionarla con la saturación de oxígeno y una débil confiabilidad interobservador.

Introduction: In pediatrics, it is decisive to assess the severity of bronchial obstruction; to this end, different clinical scoring scales have been developed, including the modified Tal score. The objective of this study was to determine its validity and reliability in children seen at two emergency departments of Concepción, Chile. Population and methods: Prospective, cohort study. Children younger than 36 months old diagnosed with bronchitis and/or bronchiolitis during the winter and spring months of 2015 were included. Concurrent criterion validity was determined based on the correlation between the score and oxygen saturation, as a reference standard. Predictive validity was assessed based on the association between the score and the probability of a new visit to the emergency department in the following 7 days. The area under the ROC curve was estimated. Reliability between kinesiologists and physicians was established based on the intraclass correlation coefficient (ICC). A p value < 0.05 was considered statistically significant. Results: A total of 102 children were assessed; a weak correlation between the score and oxygen saturation was observed among kinesiologists (Rho = -0.41). An association was observed between the score and the probability of a new visit to the emergency department. The area under the curve measured by both health care providers was > 0.80. Inter-observer reliability between physicians and kinesiologists showed a weak correlation (ICC = 0.17). Conclusions: The modified Tal score shows an adequate predictive validity, but a poor validity when correlated to oxygen saturation, and a weak inter-observer reliability.

Validity and reliability of the modified Tal score in Chilean children. A multicenter study. / Validez y confiabilidad de la escala de Tal modificada en niños chilenos. Estudio multicéntrico.

INTRODUCTION: In pediatrics, it is decisive to assess the severity of bronchial obstruction; to this end, different clinical scoring scales have been developed, including the modified Tal score. The objective of this study was to determine its validity and reliability in children seen at two emergency departments of Concepción, Chile. POPULATION AND METHODS: Prospective, cohort study. Children younger than 36 months old diagnosed with bronchitis and/or bronchiolitis during the winter and spring months of 2015 were included. Concurrent criterion validity was determined based on the correlation between the score and oxygen saturation, as a reference standard. Predictive validity was assessed based on the association between the score and the probability of a new visit to the emergency department in the following 7 days. The area under the ROC curve was estimated. Reliability between kinesiologists and physicians was established based on the intraclass correlation coefficient (ICC). A p value < 0.05 was considered statistically significant. RESULTS: A total of 102 children were assessed; a weak correlation between the score and oxygen saturation was observed among kinesiologists (Rho = -0.41). An association was observed between the score and the probability of a new visit to the emergency department. The area under the curve measured by both health care providers was > 0.80. Inter-observer reliability between physicians and kinesiologists showed a weak correlation (ICC = 0.17). CONCLUSIONS: The modified Tal score shows an adequate predictive validity, but a poor validity when correlated to oxygen saturation, and a weak inter-observer reliability.

Introducción: En pediatría, evaluar la gravedad de la obstrucción bronquial es determinante; por esto, se han creado escalas de puntuación clínica, como la escala de Tal modificada. El objetivo fue determinar su validez y confiabilidad en niños atendidos en unidades de emergencia de Concepción, Chile. Población y métodos: Estudio de cohorte prospectivo. Se incluyeron niños < 36 meses con diagnóstico de bronquitis y/o bronquiolitis durante meses de invierno y primavera de 2015. La validez de criterio concurrente se determinó mediante la correlación entre el puntaje de la escala y la saturación de oxígeno, como estándar de referencia. La validez predictiva se evaluó mediante la asociación entre el puntaje de la escala y la probabilidad de nueva atención en la Unidad de Emergencia dentro de 7 días. Se calculó el área bajo la curva mediante curva ROC. La confiabilidad entre kinesiólogos y médicos se determinó mediante el coeficiente de correlación intraclase (CCI). Un valor de p < 0,05 se consideró estadísticamente significativo. Resultados: Se evaluaron 102 niños; se observó correlación débil entre la puntuación de la escala y la saturación de oxígeno en kinesiólogos (Rho= -0,41). Existió asociación entre la puntuación y la probabilidad de nueva atención en centros de emergencia. El área bajo la curva medida por ambos profesionales fue > 0,80. La confiabilidad interobservador entre médicos y kinesiólogos presentó correlación débil (CCI= 0,17). Conclusiones: La escala de Tal modificada presenta una adecuada validez predictiva, pero pobre validez al correlacionarla con la saturación de oxígeno y una débil confiabilidad interobservador.

Reliability and validity of measuring scale for postoperative complications in third molar surgery.

BACKGROUND: Third molar removal surgery is the most frequently performed surgery in the oral and maxillofacial field with a wide range of items in the quantification of postoperative complications. For their measure, in 2014 a previous scale design was presented. The aim of this study was to determine the reliability and validity of a scale designed to measure and quantify postoperative complications in third molar surgery (TMS). METHODS: A cross-sectional study of a measurement model was designed. Sixty-two patients (mean age 20.5 ± 6.6 years; 36 women) underwent TMS in three Chilean hospitals. In the postoperative check-up on the 7th day, a maxillofacial surgeon and a surgical resident performed independent postoperative assessments, applying the scale. A confirmatory factor analysis was conducted to obtain validity, internal consistency, interobserver reliability and a score to categorize the severity of complications using structural equation model analysis. RESULTS: Nine patients (14.5%) had complications. The scale was defined by two components: "Secondary complication" and "Infection" (Cronbach's alpha 0.71; Interobserver reliability 87.7%) and three categories of postoperative complication: "without or mild", "moderate" and "severe". CONCLUSION: This study presents a reliability and validity scale called "Surgical complication assessment scale in TMS".

Propiedades psicométricas de las escalas de gravedad de obstrucción bronquial en pediatría: Revisión sistemática y metaanálisis / Psychometric properties of scales used for grading the severity of bronchial obstruction in pediatrics: A systematic review and meta-analysis

Introducción. En pediatría, es determinante establecer precozmente la gravedad de la obstrucción bronquial (GOB). Objetivo. Evaluar las propiedades psicométricas de escalas de medición de GOB en pacientes pediátricos. Población y método. Revisión sistemática de estudios sobre validez y confiabilidad de escalas de GOB realizados en niños menores de 3 años. Se buscó en Medline, WoS, EMBASE, SciELO, Google Scholar. Los coeficientes de correlación de cada artículo fueron metaanalizados mediante el modelo de efectos aleatorios para determinar la validez de criterio y la confiabilidad a través de promedios ponderados de los coeficientes según el tamaño de la muestra. Resultados. Se incluyeron 9 artículos con un total de 2699 niños; 3 artículos presentaron calidad metodológica buena o excelente. Cuatro artículos determinaron la validez de criterio concurrente considerando la saturación de oxígeno; coeficiente de correlación ponderado -0,627 (IC 95%: de -0,767 a -0,431; p < 0,001); 2 artículos determinaron la validez de criterio convergente; coeficiente de correlación ponderado 0,809 (IC 95%: de 0,721 a 0,871; p < 0,001); 6 artículos determinaron la confiabilidad interobservador; coeficiente de correlación ponderado de 0,500 para kappa y 0,891 para coeficiente de correlación intraclase. Conclusión. La evaluación de las propiedades psicométricas para apoyar la utilidad de escalas para la estimación del constructo GOB mostró una validez de criterio de moderada a adecuada. El porcentaje de acuerdo entre observadores respecto de la medida observada (GOB) se muestra adecuado; sin embargo, hay que considerar las debilidades presentadas en el diseño de los artículos, lo cual podría afectar a la validez interna de los resultados.

Introduction. In pediatrics, identifying the severity of bronchial obstruction in an early manner is a decisive factor. Objective. To assess the psychometric properties of the scales for grading the severity of bronchial obstruction in pediatric patients. Population and Method. This was a systematic review of studies on the validity and reliability of scales for grading the severity of bronchial obstruction conducted in infants and children younger than 3 years old. The search was conducted in Medline, WoS, EMBASE, SciELO, and Google Scholar. The correlation coefficient corresponding to each article was included in a random effects model to establish the criterion validity and reliability using the weighted averages of coefficients as per the sample size. Results. A total of 9 articles were included, which accounted for 2699 children; 3 articles had an adequate or excellent methodological quality. Four articles established the concurrent criterion validity considering oxygen saturation, with a weighted correlation coefficient of -0.627 (95% confidence interval --#91;CI--#93;: -0.767 to -0.431, p 0.001); 2 articles established the convergent criterion validity, with a weighted correlation coefficient of 0.809 (95% CI: 0.721 to 0.871, p < 0.001); 6 articles established the inter-observer reliability, with a weighted correlation coefficient of0.500for kappa and 0.891 for the intraclass correlation coefficient. Conclusion. The assessment of psychometric properties to support the use of scales for grading the construct "severity of bronchial obstruction" showed a moderate to adequate criterion validity. The percentage of agreement among observers in terms of the studied measure (severity of bronchial obstruction) was adequate; however, weaknesses such as the article design should be taken into account since it may affect the internal validity of results.

Psychometric properties of scales used for grading the severity of bronchial obstruction in pediatrics: A systematic review and meta-analysis. / Propiedades psicométricas de las escalas de gravedad de obstrucción bronquial en pediatría. Revisión sistemática y metaanálisis.

INTRODUCTION: In pediatrics, identifying the severity of bronchial obstruction in an early manner is a decisive factor. OBJETIVE: To assess the psychometric properties of the scales for grading the severity of bronchial obstruction in pediatric patients. POPULATION AND METHOD: This was a systematic review of studies on the validity and reliability of scales for grading the severity of bronchial obstruction conducted in infants and children younger than 3 years old. The search was conducted in Medline, WoS, EMBASE, SciELO, and Google Scholar. The correlation coefficient corresponding to each article was included in a random effects model to establish the criterion validity and reliability using the weighted averages of coefficients as per the sample size. RESULTS: A total of 9 articles were included, which accounted for 2699 children; 3 articles had an adequate or excellent methodological quality. Four articles established the concurrent criterion validity considering oxygen saturation, with a weighted correlation coefficient of -0.627 (95% confidence interval [CI]: -0.767 to -0.431, p < 0.001); 2 articles established the convergent criterion validity, with a weighted correlation coefficient of 0.809 (95% CI: 0.721 to 0.871, p < 0.001); 6 articles established the inter-observer reliability, with a weighted correlation coefficient of0.500for kappa and 0.891 for the intraclass correlation coefficient. CONCLUSION: The assessment of psychometric properties to support the use of scales for grading the construct "severity of bronchial obstruction" showed a moderate to adequate criterion validity. The percentage of agreement among observers in terms of the studied measure (severity of bronchial obstruction) was adequate; however, weaknesses such as the article design should be taken into account since it may affect the internal validity of results.

INTRODUCCIÓN: En pediatría, es determinante establecer precozmente la gravedad de la obstrucción bronquial (GOB). OBJETIVO: Evaluar las propiedades psicométricas de escalas de medición de GOB en pacientes pediátricos. POBLACIÓN Y MÉTODO: Revisión sistemática de estudios sobre validez y confiabilidad de escalas de GOB realizados en niños menores de 3 años. Se buscó en Medline, WoS, EMBASE, SciELO, Google Scholar. Los coeficientes de correlación de cada artículo fueron metaanalizados mediante el modelo de efectos aleatorios para determinar la validez de criterio y la confiabilidad a través de promedios ponderados de los coeficientes según el tamaño de la muestra. RESULTADOS: Se incluyeron 9 artículos con un total de 2699 niños; 3 artículos presentaron calidad metodológica buena o excelente. Cuatro artículos determinaron la validez de criterio concurrente considerando la saturación de oxígeno; coeficiente de correlación ponderado -0,627 (IC 95%: de -0,767 a -0,431; p < 0,001); 2 artículos determinaron la validez de criterio convergente; coeficiente de correlación ponderado 0,809 (IC 95%: de 0,721 a 0,871; p < 0,001); 6 artículos determinaron la confiabilidad interobservador; coeficiente de correlación ponderado de 0,500 para kappa y 0,891 para coeficiente de correlación intraclase. CONCLUSIÓN: La evaluación de las propiedades psicométricas para apoyar la utilidad de escalas para la estimación del constructo GOB mostró una validez de criterio de moderada a adecuada. El porcentaje de acuerdo entre observadores respecto de la medida observada (GOB) se muestra adecuado; sin embargo, hay que considerar las debilidades presentadas en el diseño de los artículos, lo cual podría afectar a la validez interna de los resultados.

Initial results of a doctorate in medical sciences program at a regional university / Resultados iniciales de un programa de doctorado en ciencias médicas de una universidad

The number of doctoral programs in the biomedical field has risen in recent decades, but with a concentration in Santiago and little expansion into the provinces. The aim of this article is to describe the initial results obtained by the Doctorate in Medical Sciences program of the Universidad de La Frontera, Chile. Observational study, conducted in the Department of Surgery at the Universidad de La Frontera, Chile. All cohorts in the program from 2008 to 2015 were included. The outcome variables were: Graduation rate and scientific productivity of the graduates (WoS and SciELO publications). Other variables of interest were: academic faculty productivity (WoS and SciELO publications), and characteristics of students who entered the program (age, sex, origin, profession, previous graduate training and number of years of formal university education). Descriptive statistics were applied. During the evaluation period, of a total of 17 qualified, 8 doctorates have been granted (1.6 per year), a graduation rate of 47.1 %. The research productivity for 2010-2015 was 14.1 publications per graduate (8.4 WoS and 5.7 SciELO) and 43.8 publications per academic (41.2 WoS and 2.6 SciELO). In the period, 55 professionals applied and 27 were accepted (49.1 % rate acceptance). Initial results of the Doctorate in Medical Sciences program of the Universidad de La Frontera, Chile are presented.

El número de programas de doctorado en el área biomédica ha crecido en las últimas décadas, aunque la mayoría se concentra en Santiago, con un escaso desarrollo en regiones. El objetivo de este artículo es describir los resultados iniciales obtenidos por el programa de Doctorado en Ciencias Médicas de la Universidad de La Frontera. Estudio observacional, descriptivo; realizado en el Departamento de Cirugía de la Universidad de La Frontera. Se incluyeron la totalidad de las cohortes que han ingresado al programa, desde 2008 a 2015. Las variables de los resultados fueron: Tasa de graduación y productividad de los graduados (publicaciones WoS y SciELO). Otras variables de interés fueron: productividad del Claustro (publicaciones WoS y SciELO); y características de los alumnos que ingresaron al programa (edad, sexo, origen, profesión, formación de postgrado previa y número de años de formación universitaria formal). Se aplicó estadística descriptiva. Durante el período evaluado, de un total de 17 habilitados, se graduaron 8 doctores (1,6 por año), tasa de graduación de 47,1 %. La productividad para el período 2010-2015 fue de 14,1 publicaciones por graduado (8,4 WoS y 5,7 SciELO); y 43,8 publicaciones por miembro del Claustro (41,2 WoS y 2,6 SciELO). En el período analizado postularon 55 profesionales, siendo aceptados un total de 27 (49,1 % de aceptación). Se presentan los resultados iniciales del programa de Doctorado en Ciencias Médicas de la Universidad de La Frontera.

Insuficiencia venosa crónica en trabajadores sin factores de riesgo que permanecen horas prolongadas en bipedestación / Chronic venous insufficiency in workers without risks factors who remain long hours standing

La insuficiencia venosa crónica (IVC) es na patología prevalente en la sociedad actual. Los problemas derivados de ella, son una causa importante de gasto económico y absentismo laboral. Las condiciones laborales actuales, como jornadas de larga duración, con largas horas en bipedestación, inadecuada carga de pesos y malas condiciones de humedad y temperatura, contribuyen al desarrollo de esta patología. En este trabajo se ha realizado una revisión sistemática de la bibliografía existente en relación a la insuficiencia venosa crónica y el tiempo en bipedestación de las jornadas laborales. Para determinar el nivel de evidencia de los estudios evaluados, se han seguido los criterios del Scottish Intercollegiate Guidelines Network (SIGN). En particular, se ha concluido que existe una asociación significativamente positiva entre el tiempo prolongado en bipedestación y el riesgo de padecer insuficiencia venosa crónica. Sin embargo, la literatura actual no permite establecer un umbral que determine el número de horas considerado como bipedestación prolongada. Para poder valorar si la insuficiencia venosa crónica debería considerarse una enfermedad profesional, es necesario diseñar y llevar a cabo nuevos estudios de investigación en esta dirección. Estos estudios son necesarios para poder establecer evidencias de cara a concienciar a la sociedad y generar campañas de prevención y promoción de la salud que disminuyan los costes económicos y mejoren la calidad de vida de la población

The chronic venous insufficiency (CVI) is a prevalent pathology in the today’s society. The arising problems represent an important cause of economic costs and absenteeism in the workplace. Current working conditions, such as long working hours, standing for long periods of time, inadequate load weight as well as bad humidity and temperature conditions, contribute to the development of this pathology. In this essay, a systematic review of existing bibliography related to chronic venous insufficiency and standing up long time at working hours has been conducted. In order to determine the evidence level of the evaluated studies the criteria established by the Scottish Intercollegiate Guidelines Network (SIGN) has been considered. In particular, a significant positive link between long period of time standing and a risk for suffering chronic venous insufficiency has been found. However, the existing literature is not specific enough to establish a threshold that determines the number of working hours required to be considered an extreme period of time standing. In order to determine if the chronic venous insufficiency should be considered an occupational disease, it is required to design and conduct further research on this topic. These studies are necessary to establish new evidence in order to make the society aware and generate new health prevention and promotion campaigns so that economic costs and quality of life could continue improving

Revisiones sistemáticas de la literatura. Qué se debe saber acerca de ellas / Systematic reviews of the literature: what should be known about them

Una revisión sistemática (RS), es un artículo de «síntesis de la evidencia disponible», en el que se realiza una revisión de aspectos cuantitativos y cualitativos de estudios primarios, con el objetivo de resumir la información existente respecto de un tema en particular. Los investigadores luego de recolectar los artículos de interés; los analizan, y comparan la evidencia que aportan con la de otros similares. Las razones que justifican la realización de una RS son: cuando existe incertidumbre en relación al efecto de una intervención debido a que existe evidencia contrapuesta respecto de su real utilidad; cuando se desea conocer el tamaño del efecto de una intervención; y, cuando se desea analizar el comportamiento de una intervención en subgrupos de sujetos. El objetivo de este manuscrito es realizar una puesta al día sobre los conceptos básicos, indicaciones, fortalezas y debilidades de las RS; así como del desarrollo de una RS, los potenciales sesgos más relevantes a ser tenidos en cuenta en este tipo de diseños, y los conceptos básicos referentes al meta análisis. Se incluyen, además, dos ejemplos de RS; de utilidad para los cirujanos que con cierta frecuencia se encuentran con este tipo de diseño cuando realizan búsquedas de evidencia científica en bases de revistas biomédicas (AU)

A systematic review (SR) is an article on the «synthesis of the available evidence», in which a review is performed on the quantitative and qualitative aspects of primary studies, with the aim of summarising the existing information on a particular topic. After collecting the articles of interest the researchers then analyse them and compare the evidence they provide with that from similar ones. The reasons for justifying performing an SR are: when there is uncertainty as regards the effect of an intervention due to there being existing evidence against its real usefulness; when it is desired to know the magnitude of the effect of an intervention; and, when it is desired to analyse the behaviour of an intervention in subject sub-groups. The aim of this article is to perform an update on the basic concepts, indications, strengths and weaknesses of SRs, as well as the development of an SR, the most important potential biases to be taken into account in this type of design, and the basic concepts as regards the meta-analysis. Two examples of SR are also included, of use for surgeons, who often come across this type of design when searching for scientific evidence in biomedical journal bases (AU)

Lista de verificación para el reporte de estudios observacionales descriptivos: iniciativa MINCIR / Checklist for reporting of descriptive observational studies: MINCIR initiative

Los estudios observacionales descriptivos (EOD) constituyen al menos el 70% de los artículos publicados en las distintas revistas científicas del ámbito de la cirugía; y, a pesar de ello, no existen instrumentos para guiar a los escritores en el reporte de resultados, como tampoco para colaborar con los revisores con este tipo de artículos. El objetivo de este estudio es diseñar y construir un sistema de verificación para el reporte de resultados con EOD. Estudio bietápico con metodología cualitativa. En una primera etapa, se diseñó una propuesta, mediante la recopilación de ítems y dominios a partir de una extensa revisión de la literatura relacionada. En la segunda, se construyó una lista de verificación, aplicando reducción de ítems y dominios a través de un panel de 45 expertos en metodología de investigación, académicos clínicos, revisores y editores de revistas biomédicas; aplicando de este modo validez de fachada y de contenido. Los ítems y dominios incorporados a la lista fueron aquellos en los que se logró más de un 80% de acuerdo entre los participantes (36 de 45). Se generó de este modo un instrumento compuesto por 19 ítems, agrupados en 4 dominios. Se diseñó y construyó una lista de verificación que ayudará al reporte de resultados con EOD.

Descriptive observational studies (DOE) constitute at least 70% of the published articles in various scientific journals in the field of surgery, and despite this, there are no instruments to guide writers and to assist reviewers in the result report with DOE. The aim of this study is to design and build a checklist for reporting results with EOD. Two-stage study with qualitative methodology. In a first stage, a proposal was designed, by collecting items and domains from an extensive review of the literature. In the second one, an instrument was developed by applying reduction items and domains through a panel of 45 experts in research methodology, clinical academics, reviewers and editors of biomedical journals, thereby applying facade and content validity. The items and domains incorporated into the final instrument were those which achieved over 80% agreement between the participants (36 of 45). In this way an instrument composed of 19 items and grouped into four domains was created. A checklist that will help to report the results using DOE was designed and built.

[Systematic reviews of the literature: what should be known about them]. / Revisiones sistemáticas de la literatura. Qué se debe saber acerca de ellas.

A systematic review (SR) is an article on the «synthesis of the available evidence¼, in which a review is performed on the quantitative and qualitative aspects of primary studies, with the aim of summarising the existing information on a particular topic. After collecting the articles of interest the researchers then analyse them and compare the evidence they provide with that from similar ones. The reasons for justifying performing an SR are: when there is uncertainty as regards the effect of an intervention due to there being existing evidence against its real usefulness; when it is desired to know the magnitude of the effect of an intervention; and, when it is desired to analyse the behaviour of an intervention in subject sub-groups. The aim of this article is to perform an update on the basic concepts, indications, strengths and weaknesses of SRs, as well as the development of an SR, the most important potential biases to be taken into account in this type of design, and the basic concepts as regards the meta-analysis. Two examples of SR are also included, of use for surgeons, who often come across this type of design when searching for scientific evidence in biomedical journal bases.

Analgesia in patients with acute abdominal pain.

BACKGROUND: For decades, the indication of analgesia in patients with Acute Abdominal Pain (AAP) has been deferred until the definitive diagnosis has been made, for fear of masking symptoms, generating a change in the physical exploration or obstructing the diagnosis of a disease requiring surgical treatment. This strategy has been questioned by some studies that have shown that the use of analgesia in the initial evaluation of patients with AAP leads to a significant reduction in pain without affecting diagnostic accuracy. OBJECTIVES: To determine whether the evidence available supports the use of opioid analgesics in the diagnostic process of patients with AAP. SEARCH STRATEGY: Trials were identified through searches in Cochrane Controlled Trials Register (CENTRAL) (The Cochrane Library, issue 2, 2009), MEDLINE (1966 to 2009) and EMBASE (1980 to 2009). A randomised controlled trial (RCT) filter for a MEDLINE search was applied (with appropriate modification for an EMBASE search). Trials also were identified through "related articles". The search was not limited by language or publication status. SELECTION CRITERIA: All published RCTs which included adult patients with AAP, without gender restriction, comparing any opioids analgesia regimen with the non-use of analgesic before any intervention and independent of the results. DATA COLLECTION AND ANALYSIS: Two independent reviewers assessed the studies identified via the electronic search. Articles that were relevant and pertinent to the aims of the study were selected and their respective full-text versions were collected for subsequent blinded evaluation. The allocation concealment was considered in particular as an option to diminish the biases.The data collected from the studies were reviewed qualitatively and quantitatively using the Cochrane Collaboration statistical software RevMan 5.0. After performing the meta-analysis, the chi-squared test for heterogeneity was applied. In situations of significant clinical heterogeneity, statistical analyses were not applied to the pool of results. In situations of heterogeneity, the random effect model was used to perform the meta-analysis of the results. A sensitivity analysis was also applied based on the evaluation to the methodological quality of the primary studies. MAIN RESULTS: Eight studies fulfilled the inclusion criteria. Differences with use of opioid analgesia were verified in variables: Change in the intensity of the pain, change in the patients comfort level. AUTHORS' CONCLUSIONS: The use of opioid analgesics in the therapeutic diagnosis of patients with AAP does not increase the risk of diagnosis error or the risk of error in making decisions regarding treatment.

[Use of opioid analgesics in diagnosis and decision-making in patients with acute nontraumatic abdominal pain. A systematic review of the literature]. / Utilización de analgésicos opiáceos en el proceso diagnóstico y de toma de decisiones sobre pacientes con dolor abdominal agudo no traumático. Revisión sistemática de la literatura.

INTRODUCTION: The use of analgesics during the diagnosis and decision-making process in patients with acute nontraumatic abdominal pain is controversial. The aim of the present study was to determine whether the use of opioid analgesics in patients with acute nontraumatic abdominal pain increases the risk of diagnostic error. METHOD: We performed a systematic review of the literature. Randomized clinical trials (RTCs) comparing the use of opioid analgesics with placebo administered before any procedure in patients with acute nontraumatic abdominal pain were included. There was no restriction on language. RTCs unrelated to this subject were excluded. The variables analyzed were age, gender, and the percentage of adverse effects, appendicitis, changes on physical examination and diagnostic error, modification of pain severity measured by a visual analog scale, and methodological quality of the studies. A search was performed in the MEDLINE and Cochrane databases, using MeSH terms. Each article was analyzed by applying a methodological quality score through which weighted means were applied for each variable. The Chi-square and Student's t-test were applied to compare the groups. RESULTS: Six articles meeting the selection criteria were found. The mean methodological quality score was 21.6 points. The studies represented a population of 363 patients treated with opioids and 336 patients treated with placebo. There were no differences in the mean age of the patients (39.4 vs 39.6 years), distribution by gender, prevalence of acute appendicitis (23.3% vs 24%) or diagnostic error (15.6% vs 21.1%; p = 0.0637). Differences were found in the variable of pain reduction (27.2 vs 7.2 mm, respectively; p = 0.0167). CONCLUSIONS: The use of opioid analgesics in patients with acute nontraumatic abdominal pain does not increase the risk of diagnostic error and reduces pain during the decision-making process.

Utilización de analgésicos opiáceos en el proceso diagnóstico y de toma de decisiones sobre pacientes con dolor abdominal agudo no traumático. Revisión sistemática de la literatura / Use of opioid analgesics in diagnosis and decision-making in patients with acute nontraumatic abdominal pain. A systematic review of the literature

Introducción. Hay controversia acerca del uso de analgesia durante el proceso diagnóstico y la toma de decisiones sobre pacientes con dolor abdominal agudo no traumático (DAA). El objetivo de este estudio es determinar si el uso de analgésicos opiáceos (AO) en pacientes con DAA puede incrementar el riesgo de error diagnóstico. Método. Revisión sistemática de la literatura. Se incluyeron ensayos clínicos aleatorizados (ECA), sin restricción idiomática, que comparasen el uso de AO o placebo en pacientes con DAA, administrados antes de cualquier intervención. Fueron excluidos los ECA con temática no atingente. Las variables consideradas fueron la edad, el sexo, los porcentajes de efectos adversos, apendicitis, cambios al examen físico y error diagnóstico, la modificación de la intensidad del dolor medido por escala visual analógica y la calidad metodológica de los estudios. Se realizó una búsqueda en las bases de datos MEDLINE y Cochrane, utilizando términos MeSH. El análisis de cada artículo fue realizado aplicando una puntuación de calidad metodológica mediante la que se calcularon promedios ponderados para cada variable. Se aplicaron las pruebas estadísticas de la χ² y de la t de Student para comparación de grupos. Resultados. Se encontraron 6 artículos que cumplían los criterios de selección cuya puntuación de calidad metodológica promedio fue de 21,6. Los estudios incluyen a una población de 363 pacientes tratados con opiáceos y 336 con placebo, sin diferencias en promedio de edad (39,4 y 39,6 años), distribución por sexos, prevalencia de apendicitis aguda (el 23,3 y el 24%) ni error diagnóstico (el 15,6 y el 21,1%; p = 0,0637). Se verificó que había diferencias en la variable reducción del dolor (27,2 y 7,2 mm, respectivamente; p = 0,0167). Conclusiones. El uso de AO en pacientes con DAA no incrementa el riesgo de error diagnóstico y reduce el dolor durante el proceso de toma de decisiones (AU)

Introduction. The use of analgesics during the diagnosis and decision-making process in patients with acute nontraumatic abdominal pain is controversial. The aim of the present study was to determine whether the use of opioid analgesics in patients with acute nontraumatic abdominal pain increases the risk of diagnostic error. Method. We performed a systematic review of the literature. Randomized clinical trials (RTCs) comparing the use of opioid analgesics with placebo administered before any procedure in patients with acute nontraumatic abdominal pain were included. There was no restriction on language. RTCs unrelated to this subject were excluded. The variables analyzed were age, gender, and the percentage of adverse effects, appendicitis, changes on physical examination and diagnostic error, modification of pain severity measured by a visual analog scale, and methodological quality of the studies. A search was performed in the MEDLINE and Cochrane databases, using MeSH terms. Each article was analyzed by applying a methodological quality score through which weighted means were applied for each variable. The Chi-square and Student's t-test were applied to compare the groups. Results. Six articles meeting the selection criteria were found. The mean methodological quality score was 21.6 points. The studies represented a population of 363 patients treated with opioids and 336 patients treated with placebo. There were no differences in the mean age of the patients (39.4 vs 39.6 years), distribution by gender, prevalence of acute appendicitis (23.3% vs 24%) or diagnostic error (15.6% vs 21.1%; p = 0.0637). Differences were found in the variable of pain reduction (27.2 vs 7.2 mm, respectively; p = 0.0167). Conclusions. The use of opioid analgesics in patients with acute nontraumatic abdominal pain does not increase the risk of diagnostic error and reduces pain during the decision-making process (AU)

[Intercultural health care policy from the perspective of health care providers and Mapuche clients]. / Política de Salud Intercultural: perspectiva de usuarios mapuches y equipos de salud en la IX región, Chile.

BACKGROUND: Intercultural health is becoming an emergent topic in the design of health care programs for Mapuche people of Chile. This process faces important challenges such as the scarce theoretical support about the meaning of intercultural health and their practical consequences for providers and clients. AIM: To explore the perception in providers and Mapuche clients about intercultural health. MATERIAL AND METHODS: A survey performed in 11 counties with the highest concentration of Mapuche people, of the IX region of Chile. The perception about the development of a new health policy specially designed for Mapuche patients was surveyed in 399 Mapuche patients and 64 providers of primary health care centers. RESULTS: Mapuche clients considered, as the main regional challenges, the indifference and discrimination of health care teams towards Mapuche patients, aggravated by the indifference of authorities. Providers considered that the main problem was a lack of knowledge about Mapuche culture and skills to deal with this ethnic group. Patients and providers agreed on the need to use Mapuche dialect in health care attentions, to coordinate actions with traditional healers and to accept ethnical therapeutic practices. CONCLUSIONS: There is scarce agreement between providers and Mapuche clients about the need for an special intercultural health policy, its contents, and the regional conditions for its implementation and development.

Nursing leadership in Chile: a concept in transition.

The purposes of this two-year research study were to uncover Chilean nurses' perspectives of the elements that comprise leadership, and to identify challenges faced by nurse leaders in modern health administration. The research question is, What are the structural components that define and characterize nursing leadership in Chile? Nine nurses from different professional backgrounds volunteered to take part in audiorecorded successive interviews. The research methodology was a kind of grounded theory. Findings suggest that leadership is characterized mainly by exerting a positive influence on others based on good communication, knowledge of management, and a futurist vision of the nursing profession. Crisis and transition in nursing leadership were associated with external and internal forces, such as reforms in healthcare organizations and changes in the nursing conceptual framework.