Escala para la identificación del paciente pediátrico crónico complejo (Escala PedCom). Estudio piloto / A scale for the identification of the complex chronic pediatric patient (PedCom Scale): A pilot study

Introducción y objetivos: La condición crónica compleja (CCC) es una realidad cada vez más prevalente en pediatría. Sin embargo, padecer una CCC no supone necesariamente ser un paciente crónico complejo (PCC). Desde esta perspectiva, nos propusimos el desarrollo de un instrumento (Escala PedCom) que facilitase la identificación del PCC. Material y métodos: Inicialmente se definieron aspectos generales para la clasificación de un paciente como PCC. Posteriormente se desarrollaron los ítems de la escala puntuándolos de 0,5 a 4 puntos. Se realizó análisis factorial confirmatorio (AFC) y se estudió la consistencia interna mediante alfa de Cronbach. La concordancia se evaluó mediante estudio intra- e interobservador. El gold standard fue la clasificación realizada por 2 evaluadores tras valoración de la historia clínica del paciente. El punto de corte para considerar al paciente como PCC se estableció mediante curva ROC. Resultados: La versión inicial incluyó 43 ítems con índice de validez de contenido global (IVC) de 0,94. Para el estudio se incluyeron 180 pacientes. Tras el AFC se eliminó un ítem, por lo que la versión final consta de 42 ítems con IVC de 0,95. El valor alfa de Cronbach fue 0,723. El índice de correlación intraclase del análisis test-retest fue de 0,998 y 0,996 para el estudio interobservador. El punto de corte para considerar a un paciente como PCC se estableció en 6,5 puntos, con el que se obtuvo una sensibilidad del 98% y especificidad del 94%. Conclusiones: La Escala PedCom es una herramienta de fácil uso enfocada a la identificación del PCC. En nuestra muestra, presentó adecuada consistencia interna y niveles adecuados de concordancia intra- e interobservador; con buenos resultados de sensibilidad y especificidad para la identificación del PCC. (AU)

Introduction and objectives: The complex chronic condition (CCC) is an increasingly prevalent reality in pediatrics. However, having a CCC does not necessarily mean being a complex chronic patient (CCP). From this perspective, we developed an instrument (PedCom Scale) that would facilitate the identification of the PCC. Material and methods: Initially, general aspects for the classification of patients as CCP were defined. Subsequently, the items of the scale were developed, scoring them from 0.5 to 4 points. We performed a confirmatory factor analysis (CFA) and the internal consistency was studied using alpha-Cronbach. Concordance was evaluated by intra- and inter-observer study. The gold standard was the classification performed by two evaluators after assessing the patient's medical history. The cut-off point for considering the patient as a CCP was established using the ROC curve. Results: The initial version included 43 items with a global content validity index (CVI) of 0.94. A total of 180 patients were included. After the CFA, one item was eliminated, so the final version consists of 42 items with an CVI of 0.95. The alpha-Cronbach value was 0.723. The intraclass correlation coefficient of the test–retest analysis was 0.998 and 0.996 for the inter-observer study. The cut-off point for considering a patient as a CCP was established at 6.5 points, with these results we obtained a sensitivity of 98% and specificity of 94%. Conclusions: The PedCom Scale is an easy-to-use tool focused on the identification of the CCP. In our sample, it presented satisfactory levels of internal consistency and adequate levels of intra- and inter-observer agreement, with good sensitivity and specificity for the identification of the PCC. (AU)

A scale for the identification of the complex chronic pediatric patient (PedCom Scale): A pilot study.

INTRODUCTION AND OBJECTIVES: The complex chronic condition (CCC) is an increasingly prevalent reality in pediatrics. However, having a CCC does not necessarily mean being a complex chronic patient (CCP). From this perspective, we developed an instrument (PedCom Scale) that would facilitate the identification of the CCP. MATERIAL AND METHODS: Initially, general aspects for the classification of patients as CCP were defined. Subsequently, the items of the scale were developed, scoring them from 0.5 to 4 points. We performed a confirmatory factor analysis (CFA) and the internal consistency was studied using alpha-Cronbach. Concordance was evaluated by intra- and inter-observer study. The gold standard was the classification performed by two evaluators after assessing the patient's medical history. The cut-off point for considering the patient as a CCP was established using the ROC curve. RESULTS: The initial version included 43 items with a global content validity index (CVI) of 0.94. A total of 180 patients were included. After the CFA, one item was eliminated, so the final version consists of 42 items with an CVI of 0.95. The alpha-Cronbach value was 0.723. The intraclass correlation coefficient of the test-retest analysis was 0.998 and 0.996 for the inter-observer study. The cut-off point for considering a patient as a CCP was established at 6.5 points, with this results we obtained a sensitivity of 98% and specificity of 94%. CONCLUSIONS: The PedCom Scale is an easy-to-use tool focused on the identification of the CCP. In our sample, it presented satisfactory levels of internal consistency and adequate levels of intra- and inter-observer agreement, with good sensitivity and specificity for the identification of the CCP.

Strategy for the rational design of asymmetric triply bridged dinuclear 3d-4f single-molecule magnets.

Three triply bridged M(II)-Dy(III) dinuclear complexes, [Ni(µ-L)(µ-OAc)Dy(NO(3))(2)] 1, [Zn(µ-L)(µ-OAc)Dy(NO(3))(2)] 2, and [Ni(µ-L)(µ-NO(3))Dy(NO(3))(2)]·2CH(3)OH 3 were prepared with a new and flexible compartmental ligand, N,N',N″-trimethyl-N,N″-bis(2-hydroxy-3-methoxy-5-methylbenzyl)diethylene triamine (H(2)L), containing N(3)O(2)-inner and O(4)-outer coordination sites. These complexes have diphenoxo/acetate (1 and 2) or diphenoxo/nitrate (3) asymmetric bridging fragments. Compounds 1 and 3 exhibit ferromagnetic interaction between Ni(2+) and Dy(3+) ions and frequency dependence of the out-of-phase (χ″(M)) alternating current (ac) susceptibility signal characteristic of single-molecule-magnet behavior. The energy barriers Δ/k(B) for compound 3 under zero and 1000 Oe applied direct current (dc) magnetic fields were estimated from the Arrhenius plots to be 7.6 and 19.1 K, respectively.

Neumohemotórax masivo espontáneo: Estudio de 3 casos / Spontaneous massive pneumohemothorax: A study of 3 cases

Se hace un resumen histórico sobre los neumphemotórax, señalando su importancia en medicina militar, las características principales de la enfermedad y los aspectos esenciales del tratamiento. Se informan los casos de tres militares jóvenes, a quienes se les realizó toracotomía de urgencia en el hospital militar central "Dr. Luis Díaz Soto" en poco mas de un año, llamando la atención sobre la gravedad de esta afección(AU)