Adaptación transcultural de un cuestionario de alimentación para niños de edad escolar en Córdoba, Argentina / Cross-cultural adaptation of a food questionnaire for schoolchildren in Córdoba, Argentina

Fundamentos: La evaluación de la ingesta en la niñez requiere instrumentos adecuados para la edad. Elobjetivo fue adaptar transculturalmente un cuestionario de alimentación para escolares desarrollado en Brasil(QUADA) y analizar su confiabilidad y validez para su aplicación en Córdoba, Argentina Métodos: El QUADA fue traducido al español y se reemplazaron las ilustraciones por alimentosrepresentativos localmente. Se realizaron pruebas de comprensión para evaluar interpretación de consignas eilustraciones y realizar modificaciones hasta llegar al cuestionario final: CuAE-24. Se evaluó la fiabilidad testretest aplicando el CuAE-24 dos veces el mismo día en una muestra de 113 escolares y se analizó la concordancia entre ambas aplicaciones usando test de Kappa. La validez se evaluó mediante la observación de la comida escolar (“gold standard”) el día anterior a la aplicación del CuAE-24, que fue contrastada con lasrespuestas de los escolares. Se calculó sensibilidad, especificidad, valores predictivos positivos (VPP) y negativos (VPN). Resultados: El CuAE-24 presenta 5 secciones (desayuno, media-mañana, comida, merienda, cena), con 76 alimentos ilustrados agrupados en 24 ítems. El test-retest presentó adecuada concordancia y se hallaron valores de sensibilidad, especificidad, VPP y VPN aceptables. Conclusiones: El CuAE-24 presenta validez y confiabilidad satisfactorias para utilizarse en investigaciones epidemiológicas en escolares de Córdoba, Argentina. (AU)

Background: Food intake assessment in childhood requires age-appropriate instruments. The objective was to analyze the cross-culturally adapt a food questionnaire for schoolchildren developed in Brazil (QUADA) andanalyze its reliability and validity for its application in Córdoba, Argentina.Methods: The QUADA was translated into Spanish and the illustrations were replaced by locally representative foods. Comprehension tests was carried out to evaluate interpretation of instructions and illustrations and to make modifications until reaching the final questionnaire: CuAE-24. To evaluate the testretest reliability, the CuAE-24 was applied twice the same day, in a sample of 113 schoolchildren. The Kappa test was used to analyze the concordance between both applications. The validity was analyzed by observing the school lunch (“gold standard”) the day before the application of the CuAE-24, which was contrasted with the responses of the schoolchildren. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated.Results: The CuAE-24 presents 5 sections (breakfast, mid-morning, lunch, snack, dinner), with 76 illustrated foods grouped into 24 items. The test-retest presented adequate concordance and acceptable sensitivity, specificity, PPV and NPV values were found in most of the items. Conclusions: The CuAE-24 presents satisfactory validity and reliability to be used in epidemiologicalresearches in schoolchildren in Córdoba, Argentina. (AU)

Evaluation of specific quality metrics to assess the performance of a specialised newborn transport programme.

There is a lack of consensus on quality indicators suitable for neonatal transport. The aim of this study is to make a proposal for specific quality indicators for newborn transport. A retrospective descriptive study was performed (2009 to 2015) where twenty-four indicators were selected, evaluated and classified according to the 6 dimensions of quality of the Institute of Medicine. Among the 24 evaluated quality metrics, there were 3 of them which needed a correction when evaluating neonatal transport performance, because they were significantly correlated with gestational age. They were (a) stabilisation time, (b) prevalence of newborn arterial hypotension (defined by gestational age) and (c) unnoticed hypothermia at referral hospital.Conclusion: Quality evaluation through the definition of specific metrics in newborn transport is feasible. These indicators should be defined or adjusted for newborn population to measure the actual performance of the transport service.What is Known:• Quality indicators may help in defining metrics for clinical practice, promoting benchmarking and defining areas of improvement.• Newborn characteristics call for a specialised care, and quality measure during newborn transport require specific metrics. Quality metrics for paediatric transport have been defined using Delphi method. Some of these measures need to be specific for newborn, due to their intrinsic characteristics.What is New:• Using evidence-based literature and our newborn transport experience, specific quality indicators for newborn transport are suggested.• Data analysis shows how some indicators need to be adjusted for gestational age.

Auditorías de seguridad en tiempo real en una unidad neonatal / Real-time safety audits in a neonatal unit

Introducción: Las auditorías en tiempo real son una herramienta de seguridad que apenas se ha aplicado anteriormente en el ámbito hospitalario. El objetivo del estudio fue determinar mediante auditorías si la información y el material necesario para la reanimación estaban disponibles para cada paciente de cuidados intensivos y si factores relacionados con el paciente, el momento o su ubicación en la unidad influyen en el cumplimiento de las recomendaciones. Material y métodos: Estudio observacional prospectivo realizado durante el año 2012 en una unidad neonatal nivel III-C. Dentro de un estudio más amplio de auditorías de recursos tecnológicos y procedimientos se incluyó la evaluación de la información escrita sobre el tubo endotraqueal, mascarilla y ambú de cada paciente y los laringoscopios del carro de parada. Dos veces por semana al azar se seleccionaba qué procedimiento o recurso se iba a evaluar. Se definió la variable uso global adecuado cuando todos los ítems evaluados eran correctos en el mismo procedimiento. Resultados: Se realizaron 17 auditorías que incluyeron 296 valoraciones. El coeficiente kappa interobservador fue 0,93. La frecuencia de uso global adecuado de la información y el material de reanimación fue de 62,50% (185/296). La mascarilla y ambú preparado en cada paciente fue la variable mejor cumplimentada (97,3%; p = 0,001). El uso global adecuado fue mejor en días festivos que en laborables (73,97 vs. 58,74%; p = 0,01) y el resto del año frente al verano (66,06 vs. 52%; p = 0,02). Conclusiones: Solo en el 62,5% de los casos toda la información y el material necesario para atender una situación crítica de forma urgente estaba fácilmente disponible. Gracias a las auditorías se identificaron oportunidades de mejora (AU)

Background: Random audits are a safety tool to help in the prevention of adverse events, but they have not been widely used in hospitals. The aim of the study was to determine, through random safety audits, whether the information and material required for resuscitation were available for each patient in a neonatal intensive care unit and determine if factors related to the patient, time or location affect the implementation of the recommendations. Material and methods: Prospective observational study conducted in a level III-C neonatal intensive care unit during the year 2012. The evaluation of written information on the endotracheal tube, mask and ambu bag prepared of each patient and laryngoscopes of the emergency trolley were included within a broader audit of technological resources and study procedures. The technological resources and procedures were randomly selected twice a week for audit. Appropriate overall use was defined when all evaluated variables were correctly programmed in the same procedure. Results: A total of 296 audits were performed. The kappa coefficient of inter-observer agreement was 0.93. The rate of appropriate overall use of written information and material required for resuscitation was 62.50% (185/296). Mask and ambu bag prepared for each patient was the variable with better compliance (97.3%, P=.001). Significant differences were found with improved usage during weekends versus working-day (73.97 vs. 58.74%, P=.01), and the rest of the year versus 3rd quarter (66.06 vs. 52%, P=.02). Conclusions: Only in 62.5% of cases was the information and the material necessary to attend to a critical situation urgently easily available. Opportunities for improvement were identified through the audits (AU)

[Real-time safety audits in a neonatal unit]. / Auditorías de seguridad en tiempo real en una unidad neonatal.

BACKGROUND: Random audits are a safety tool to help in the prevention of adverse events, but they have not been widely used in hospitals. The aim of the study was to determine, through random safety audits, whether the information and material required for resuscitation were available for each patient in a neonatal intensive care unit and determine if factors related to the patient, time or location affect the implementation of the recommendations. MATERIAL AND METHODS: Prospective observational study conducted in a level III-C neonatal intensive care unit during the year 2012. The evaluation of written information on the endotracheal tube, mask and ambu bag prepared of each patient and laryngoscopes of the emergency trolley were included within a broader audit of technological resources and study procedures. The technological resources and procedures were randomly selected twice a week for audit. Appropriate overall use was defined when all evaluated variables were correctly programmed in the same procedure. RESULTS: A total of 296 audits were performed. The kappa coefficient of inter-observer agreement was 0.93. The rate of appropriate overall use of written information and material required for resuscitation was 62.50% (185/296). Mask and ambu bag prepared for each patient was the variable with better compliance (97.3%, P=.001). Significant differences were found with improved usage during weekends versus working-day (73.97 vs. 58.74%, P=.01), and the rest of the year versus 3rd quarter (66.06 vs. 52%, P=.02). CONCLUSIONS: Only in 62.5% of cases was the information and the material necessary to attend to a critical situation urgently easily available. Opportunities for improvement were identified through the audits.