Contributing factors for acute stress in healthcare workers caring for COVID-19 patients in Argentina, Chile, Colombia, and Ecuador.

This study analyzed the frequency and intensity of acute stress among health professionals caring for COVID-19 patients in four Latin American Spanish-speaking countries during the outbreak. A cross-sectional study involved a non-probability sample of healthcare professionals in four Latin American countries. Participants from each country were invited using a platform and mobile application designed for this study. Hospital and primary care workers from different services caring for COVID-19 patients were included. The EASE Scale (SARS-CoV-2 Emotional Overload Scale, in Spanish named Escala Auto-aplicada de Sobrecarga Emocional) was a previously validated measure of acute stress. EASE scores were described overall by age, sex, work area, and experience of being ill with COVID-19. Using the Mann-Whitney U test, the EASE scores were compared according to the most critical moments of the pandemic. Univariate and multivariate analysis was performed to investigate associations between these factors and the outcome 'acute stress'. Finally, the Kruskal-Wallis was used to compare EASE scores and the experience of being ill. A total of 1372 professionals responded to all the items in the EASE scale: 375 (27.3%) Argentines, 365 (26.6%) Colombians, 345 (25.1%) Chileans, 209 (15.2%) Ecuadorians, and 78 (5.7%) from other countries. 27% of providers suffered middle-higher acute stress due to the outbreak. Worse results were observed in moments of peak incidence of cases (14.3 ± 5.3 vs. 6.9 ± 1.7, p < 0.05). Higher scores were found in professionals in COVID-19 critical care (13 ± 1.2) than those in non-COVID-19 areas (10.7 ± 1.9) (p = 0.03). Distress was higher among professionals who were COVID-19 patients (11.7 ± 1) or had doubts about their potential infection (12 ± 1.2) compared to those not infected (9.5 ± 0.7) (p = 0.001). Around one-third of the professionals experienced acute stress, increasing in intensity as the incidence of COVID-19 increased and as they became infected or in doubt whether they were infected. EASE scale could be a valuable asset for monitoring acute stress levels among health professionals in Latin America.ClinicalTrials: NCT04486404.

Theory-driven, rapid formative research on quality improvement intervention for critical care of patients with COVID-19 in Argentina.

The challenges of implementing interventions in healthcare settings have been more apparent during the COVID-19 pandemic. This pre-implementation evaluation used a rapid qualitative approach to explore barriers and facilitators to an intervention in intensive care units in Argentina, aimed to promote the use of personal protection equipment, provide emotional support for professionals, and achieve patient flow goals. Data were collected using semi-structured interviews with health professionals of 15 public hospitals in Argentina. Normalization Process Theory was used to guide content analysis of the data. Participants identified potential barriers such as the incorporation of non-specialist staff, shortage of resources, lack of communication between groups and shifts. Potential facilitators were also identified: regular feedback and communication related to implementation, adequate training for new and non-specialist staff, and incentives (e.g., scholarships). The immediacy of the pandemic demanded rapid qualitative research, sharing actionable findings in real time.

Consenso: seguridad del paciente y las metas internacionales / Patient safety and the international goals: Consensus document

La seguridad del paciente es una de las dimensiones de la atención. Los avances médicos han tornado los procesos de atención cada vez más complejos, y, usualmente, hay una conjunción de circunstancias que confluyen para que ocurran errores. Los eventos adversos constituyen un problema grave de salud pública al ocasionar daños de diversos grados al paciente y a su familia, lo cual, además, lleva a incrementar el costo del proceso de atención y la estancia hospitalaria.La mayoría de los eventos adversos se producen en los hospitales, ya que, por su complejidad, su población está sometida a un mayor riesgo asociado a la atención. Se presenta este consenso con el objetivo de ofrecer herramientas cuya implementación contribuya a brindar una atención más segura.

Patient safety is one of the dimensions of care. Medical advances have made assistance processes more and more complex, and there isusually a combination of circumstances that converge for errors to occur. Adverse events constitute a serious public health problem, causing damages of varying degrees to the patient and his family, which also leads to an increase in the cost of the care process and hospital stay. Most of the adverse events occur in hospitals because their complexity is subject to a greater risk associated with care. That is why we present this consensus with the aim of offering tools whose implementation can contribute to provide a safer healthcare.

[Patient safety and the international goals: Consensus document]. / Consenso: seguridad del paciente y las metas internacionales.

Patient safety is one of the dimensions of care. Medical advances have made assistance processes more and more complex, and there is usually a combination of circumstances that converge for errors to occur. Adverse events constitute a serious public health problem, causing damages of varying degrees to the patient and his family, which also leads to an increase in the cost of the care process and hospital stay. Most of the adverse events occur in hospitals because their complexity is subject to a greater risk associated with care. That is why we present this consensus with the aim of offering tools whose implementation can contribute to provide a safer healthcare.

La seguridad del paciente es una de las dimensiones de la atención. Los avances médicos han tornado los procesos de atención cada vez más complejos, y, usualmente, hay una conjunción de circunstancias que confluyen para que ocurran errores. Los eventos adversos constituyen un problema grave de salud pública al ocasionar daños de diversos grados al paciente y a su familia, lo cual, además, lleva a incrementar el costo del proceso de atención y la estancia hospitalaria. La mayoría de los eventos adversos se producen en los hospitales, ya que, por su complejidad, su población está sometida a un mayor riesgo asociado a la atención. Se presenta este consenso con el objetivo de ofrecer herramientas cuya implementación contribuya a brindar una atención más segura.

Especialidad de Emergentología Pediátrica: ¡Bienvenida! / Pediatric emergency medicine specialty: Welcome!

La Emergentología Pediátrica se ha desarrollado en el mundo como una subespecialidad de la pediatría durante las últimas décadas. Los registros muestran una creciente necesidad de sus servicios. Esta orientación tuvo su empuje inicial en Estados Unidos de América y nuestro país ha continuado por el mismo camino, así como muchos otros países latinoamericanos. Aun así, habrá que intensificar su promoción y trabajar en el desarrollo de la investigación y la docencia relacionadas con el área para promover el bienestar de los niños, sus familias y de la sociedad en general.

Pediatric Emergency Medicine has developed around the world as a subspecialty of pediatrics. There is plenty of data reflecting a growing need for its services. The subspecialty was initiated in the United States and Argentina, together with other Latin American countries, followed the same path. Nevertheless, there is yet much to be done. It is necessary to strengthen its promotion and to stimulate research and teaching activities in order to continue improving the quality of care delivered to the pediatric population, their families and society as a whole.

[Pediatric emergency medicine specialty: Welcome!] / Especialidad de Emergentología Pediátrica: ¡Bienvenida!

Pediatric Emergency Medicine has developed around the world as a subspecialty of pediatrics. There is plenty of data reflecting a growing need for its services. The subspecialty was initiated in the United States and Argentina, together with other Latin American countries, followed the same path. Nevertheless, there is yet much to be done. It is necessary to strengthen its promotion and to stimulate research and teaching activities in order to continue improving the quality of care delivered to the pediatric population, their families and society as a whole.

La Emergentología Pediátrica se ha desarrollado en el mundo como una subespecialidad de la pediatría durante las últimas décadas. Los registros muestran una creciente necesidad de sus servicios. Esta orientación tuvo su empuje inicial en Estados Unidos de América y nuestro país ha continuado por el mismo camino, así como muchos otros países latinoamericanos. Aun así, habrá que intensificar su promoción y trabajar en el desarrollo de la investigación y la docencia relacionadas con el área para promover el bienestar de los niños, sus familias y de la sociedad en general.

Impacto de un programa de reducción de infección asociada a catéter en 9 unidades de cuidado intensivo pediátrico en Argentina / Impact of a program aimed at reducing catheter-related infections implemented in nine pediatric intensive care units in Argentina

Las infecciones asociadas a catéteres (IAC) conllevan elevada morbimortalidad, con el aumento del uso de recursos hospitalarios. Objetivo. Describir los resultados de un programa para disminuir la tasa de IAC en las unidades de cuidados intensivos pediátricos de Argentina. Población y métodos. Estudio colaborativo multicéntrico, clínico-epidemiológico, cuasi experimental, de intervención antes y después. Se incluyen niños con catéter venoso central internados en 9 unidades de cuidados intensivos pediátricos de la Ciudad Autónoma de Buenos Aires, conurbano y otras provincias desde junio de 2011 a abril de 2012. Se implementó un paquete de medidas basado en la educación del personal de salud para inserción de catéteres e higiene de manos y uso de listas de verificación con monitoreo de las medidas implementadas. Se compararon el número y la tasa anual de IAC y la tasa de uso de catéter venoso central previa y posterior a la implementación del programa (Stata 8.0). Resultados. El total de IAC preintervención fue de 117 vs. 74 en el pos. La tasa previa fue 8,6/1000 días de uso y la posintervención, de 5,8/1000 días, RR 0,82 (IC 95%: 0,68-0,98), p= 0,015. La tasa de uso de catéter venoso central se redujo de 54% a 49%, diferencia no significativa. Conclusiones. El programa logró un descenso significativo de las tasas de IAC. A partir de él, se implementó la vigilancia de las IAC en todas las unidades de cuidados intensivos pediátricos participantes. La educación y la vigilancia continua son necesarias para mantener y mejorar los resultados alcanzados.

Catheter-related infections (CRIs) cause a high level of morbidity and mortality with the increasing use of hospital resources. Objective. To describe the outcomes of a program implemented to reduce the rate of CRIs in pediatric intensive care units in Argentina. Population and methods. Collaborative, multi center, clinical-epidemiological, quasiexperimental, before-and-after intervention study. Children who had a central venous catheter during hospitalization in 9 pediatric intensive care units in the Autonomous City of Buenos Aires, Greater Buenos Aires, and other provinces between June 2011 and April 2012 were included. A bundle of measures based on health care staff training on catheter insertion, hand hygiene, and checklists was put into practice and implemented measures were monitored. The number and annual rate of CRIs and the rate of central venous catheter use before and after the program implementation were compared (Stata 8.0). Results. The total number of CRIs was 117 and 74 before and after the intervention, respectively. The rate of CRIs was 8.6/1000 days of central venous catheter use and 5.8/1000 days before and after the intervention, respectively; RR: 0.82 (95% confidence interval: 0.68-0.98), p= 0.015. The rate of central venous catheter use decreased from 54% to 49%, a non-significant difference. Conclusions. The program achieved a significant reduction in CRI rates. Based on the program, CRI surveillance was implemented in all participating pediatric intensive care units. Training and continuous surveillance are necessary to maintain and improve the outcomes accomplished with the program.

Impact of a program aimed at reducing catheter-related infections implemented in nine pediatric intensive care units in Argentina. / Impacto de un programa de reducción de infección asociada a catéter en 9 unidades de cuidado intensivo pediátrico en Argentina.

INTRODUCTION: Catheter-related infections (CRIs) cause a high level of morbidity and mortality with the increasing use of hospital resources. OBJECTIVE: To describe the outcomes of a program implemented to reduce the rate of CRIs in pediatric intensive care units in Argentina. POPULATION AND METHODS: Collaborative, multi center, clinical-epidemiological, quasiexperimental, before-and-after intervention study. Children who had a central venous catheter during hospitalization in 9 pediatric intensive care units in the Autonomous City of Buenos Aires, Greater Buenos Aires, and other provinces between June 2011 and April 2012 were included. A bundle of measures based on health care staff training on catheter insertion, hand hygiene, and checklists was put into practice and implemented measures were monitored. The number and annual rate of CRIs and the rate of central venous catheter use before and after the program implementation were compared (Stata 8.0). RESULTS: The total number of CRIs was 117 and 74 before and after the intervention, respectively. The rate of CRIs was 8.6/1000 days of central venous catheter use and 5.8/1000 days before and after the intervention, respectively; RR: 0.82 (95% confidence interval: 0.68-0.98), p= 0.015. The rate of central venous catheter use decreased from 54% to 49%, a non-significant difference. CONCLUSIONS: The program achieved a significant reduction in CRI rates. Based on the program, CRI surveillance was implemented in all participating pediatric intensive care units. Training and continuous surveillance are necessary to maintain and improve the outcomes accomplished with the program.

INTRODUCCIÓN: Las infecciones asociadas a catéteres (IAC) conllevan elevada morbimortalidad, con el aumento del uso de recursos hospitalarios. OBJETIVO: Describir los resultados de un programa para disminuir la tasa de IAC en las unidades de cuidados intensivos pediátricos de Argentina. POBLACIÓN Y MÉTODOS: Estudio colaborativo multicéntrico, clínico-epidemiológico, cuasi experimental, de intervención antes y después. Se incluyen niños con catéter venoso central internados en 9 unidades de cuidados intensivos pediátricos de la Ciudad Autónoma de Buenos Aires, conurbano y otras provincias desde junio de 2011 a abril de 2012. Se implementó un paquete de medidas basado en la educación del personal de salud para inserción de catéteres e higiene de manos y uso de listas de verificación con monitoreo de las medidas implementadas. Se compararon el número y la tasa anual de IAC y la tasa de uso de catéter venoso central previa y posterior a la implementación del programa (Stata 8.0). RESULTADOS: El total de IAC preintervención fue de 117 vs. 74 en el pos. La tasa previa fue 8,6/1000 días de uso y la posintervención, de 5,8/1000 días, RR 0,82 (IC 95%: 0,68-0,98), p= 0,015. La tasa de uso de catéter venoso central se redujo de 54% a 49%, diferencia no significativa. CONCLUSIONES: El programa logró un descenso significativo de las tasas de IAC. A partir de él, se implementó la vigilancia de las IAC en todas las unidades de cuidados intensivos pediátricos participantes. La educación y la vigilancia continua son necesarias para mantener y mejorar los resultados alcanzados.

Premio Salud Investiga 2016 / 2016 Investiga Health Award

La dirección de investigación para la salud (ex comisión nacional salud investiga) tiene dentro de sus objetivos el fomento a investigaciones éticas y de calidad, así como la promoción de la gestión del conocimiento en función de estos fines y en ocasión de cumplir el décimo aniversario de su creación, en 2012 se instituyeron los Premios salud investiga; destinados a distinguir a aquellos profesionales e instituciones que hayan obtenido becas de investigación ôcarrillo û oñativiaö, cuyos resultados hayan constituido un aporte para la toma de decisiones clínicas o sanitarias del nivel local, regional o nacional. En esta edición del total de postulaciones recibidas se preseleccionaron doce postulaciones por cumplir íntegramente con los requisitos solicitados para el concurso, de los cuales seis correspondieron a la categoría de estudio individual y el resto a la categoría multicentrico

Heat shock proteins HSP27 and HSP70 in unilateral obstructed kidneys.

Unilateral ureteropelvic junction obstruction (UPJO), a condition involving injury to the kidney, leads to vasoconstriction, macrophage infiltration, oxidative stress, and tubulointerstitial fibrosis. In the present study we analyzed in 22 children, the impact of UPJO on expression of HSP27 and HSP70 and related the changes to renal function and duration of obstruction. Kidney function was evaluated, and renal biopsies were obtained for immunohistochemical and western blot analyses at the time of surgery. Kidney tissue from 5 children of similar age, removed because of various malignancies, was used as control. Increased HSP27, with an expression pattern related to the duration of the obstruction, was noted in proximal tubules (PTs), cortical collecting ducts (CCDs), and medullary collecting ducts. Strong HSP27 staining in cytoplasm and nuclei of these segments appeared in children with kidney obstruction for 2.1+/-0.41 years. HSP70 showed a close spatial expression pattern with that of HSP27. The increased staining of HSP70 in PTs and CCDs was related to the decreased glomerular filtration rate. The constitutive/cognate form of HSP70 (HSC72) was absent. These results support the concept that HSP27 and HSP70 are involved in the adaptive response of the human kidney to congenital UPJO.