Frontiers in human factors: integrating human factors and ergonomics to improve safety and quality in Latin American healthcare systems.

BACKGROUND: The importance of human factors/ergonomics (HFE) is well established in all high-reliability systems but only applied in the healthcare sector relatively recently. Across many sectors, low-/middle-income countries (LMICs) lag behind more economically developed countries in their application of this safety science, due to resource and, in some cases, awareness and expertise. Most previous applications of HFE related to occupational ergonomics rather than healthcare safety. METHODS: The paper details how the reputation of HFE is being developed within healthcare communities of Latin America (LatAm), through increasing awareness and understanding of its role as safety science in the healthcare sector. It starts by articulating the need for HFE and then provides examples from Mexico, Colombia and Peru. RESULTS: The practical examples for research and education illustrate a developing awareness of the relevance of HFE to the healthcare sectors in LatAm and an appreciation of its worth to improve health service quality and patient safety through healthcare community engagement. A new LatAm Network of HFE in Healthcare Systems (RELAESA) was formed in 2019, which has provided a platform for HFE advice during the COVID-19 pandemic. CONCLUSION: There is a real opportunity in LatAm and other LMIC health services to make more rapid and sustainable progress in healthcare-embedded HFE than has been experienced within healthcare services of more developed nations.

Comparing workload and performance during demanding push force and mental tasks.

BACKGROUND: The effects of performing occupational tasks that demand physical and mental efforts in combined and simultaneous approaches are unknown, especially when pushing force is analyzed as a physical effort and solving arithmetic problems as a mental effort. OBJECTIVE: In this study, physical and mental demands were simulated in a lab environment to assess the workload. METHODS: Using a push force dynamometer, the maximum push force strength of each participant was recorded, and the physical demand was simulated exerting the push force in low, medium, and high levels. Mental demands were simulated solving arithmetic tasks in low, medium, and high levels. Two experimental conditions were defined: (1) task with combined physical and mental workload (performing physical demands first and mental demands after) and (2) task in a simultaneous way (performing both demands at the same time. NASA-TLX Traditional and RAW were applied to assess the workload. RESULTS: The time to complete the tasks was significantly longer in the combined than the simultaneous approach, and performance was significantly higher in the combined than the simultaneous tasks. CONCLUSION: The combined approach obtained better results than simultaneous and Traditional NASA-TLX presented a significantly higher level of global workload index than RAW.

Ergonomic Maturity Model: A tool for integrating ergonomics/human factors into organizations.

BACKGROUND: Currently, there is a need for models, methods, and tools that allow ergonomics/human factor (E/HF) practitioners to assess the level of E/HF integration into organizations from a macroergonomics perspective. OBJECTIVE: This paper aims to propose the Ergonomic Maturity Model (EMM) and the tools for its application as a framework for integrating E/HF in organizations. METHODS: The EMM is a macroergonomic tool that allows stakeholders to evaluate the degree of development and integration of E/HF in the organization based on a participatory and macroergonomic approach. The EMM classifies organizations into five gradual levels of maturity: Ignorance, Understanding, Experimentation, Regular use, and Innovation. RESULTS: In this paper, we provide a three-stage procedure for guiding the application of the EMM: preparation of the evaluation, evaluation, and improvement plan and implementation. We include four tools developed specifically for applying EMM in organizations: evaluation matrix, weighting questionnaire, quick questionnaire, and prioritization matrix. Also, we present a Colombian floriculture company's case study to exemplify the use of the EMM. CONCLUSIONS: The EMM provides a framework for integrating E/HF into organizations from the macroergonomics approach. E/HF practitioners can find in the EMM a tool to help them channel the actions taken by the different organizational actors to improve the safety, health, well-being, and performance of work systems. Finally, it should be noted that further studies on the reliability and validity of the EMM are needed, which would contribute to demonstrating that the EMM can effectively and successfully guide change in E/HF maturity levels in organizations.

Integration of human factors/ergonomics in healthcare systems: A giant leap in safety as a key strategy during Covid-19.

In this article, we present a model for integrating Human Factors/Ergonomics (HFE) into healthcare systems to make them more robust and resilient. We believe that to increase the impact of HFE during and after the Covid-19 pandemic this integration should be carried out simultaneously at all levels (micro, meso, and macro) of the healthcare system. This new model recognizes the interrelationship between HFE and other system characteristics such as capacity, coverage, robustness, integrity, and resilience. We hope that the model will serve as a reference for a giant leap to design and improve the safety and effectiveness of healthcare services from a holistic (systems) perspective.

Improving Working Conditions Using the Ergonomic Checkpoints Tool: Application in a Colombian Meat Processing Plant.

OCCUPATIONAL APPLICATIONSIntegrating ergonomics (or human factors) in production and service processes is a topic of interest for ergonomics researchers and practitioners, especially in industrially-developing countries. In this paper, we present how an ergonomic intervention was carried out in an area of a Colombian meat processing plant using the Ergonomics Checkpoints tool. Of 65 checkpoints verified, 24 required improvement action and 17 of them were a priority. The main problems were related to materials storage and handling, hand tools, machine safety, workstation design, and work organization. Organizational and engineering proposals were made. The engineering proposals were modeled in 3 D to increase understanding of and acceptance by the company's workers. We hope that the lessons learned and reflections derived from this case study serve as a reference for conducting ergonomic interventions in similar contexts.

Procedimiento para el análisis y la prevención de errores de medicación usando el enfoque de la ergonomía

Los errores de medicación representan un problema de salud pública que afecta la seguridad del paciente y la calidad de los servicios de salud a escala global. En este artículo se presenta un procedimiento para el análisis y la prevención de los errores de medicación desde la perspectiva de la ergonomía, ejemplificándose su aplicación mediante un caso de estudio ilustrativo de administración de un medicamento inyectable. Como parte del procedimiento expuesto, se incluyeron los reconocidos métodos Hierarchical Task Analysis (HTA) para el análisis de la tarea y Systematic Human Error Reduction and Prediction Approach (SHERPA) para la identificación de los modos de error. Para la valoración de riegos se empleó la matriz de riesgos propuesta en la norma ISO 45001. El procedimiento propuesto quedó conformado por cuatro etapas: 1) selección de la tarea objeto de estudio, 2) análisis detallado de la tarea, 3) predicción de la posibilidad de error y 4) desarrollo de estrategias para la reducción del error. Se espera que la utilización sistemática de este procedimiento contribuya en la mejora de la calidad de los servicios de salud, disminuyendo los errores humanos y los posibles eventos adversos.

Medication errors represent a public health problem that affects patient safety and the quality of healthcare services globally. This article presents a procedure for the analysis and prevention of medication errors from the perspective of ergonomics, exemplifying its application through a case study. The well-known Hierarchical Task Analysis (HTA) and the Systematic Human Error Reduction and Prediction Approach (SHERPA) methods are included. The risk assessment was based on the risk matrix proposed in the ISO 45001 standard. The proposed procedure is structured in four stages: 1) selection of the task to be analysed, 2) detailed analysis of the task, 3) prediction of the possibility of error, 4) error reduction strategies. The use of the procedure is exemplified through a case study of the administration of an injectable drug. The systematic use of this procedure is expected to contribute to the improvement of the quality of health services by reducing human errors and possible adverse events.

Os erros de medicação representam um problema de saúde pública que afeta a segurança do paciente e a qualidade dos serviços de saúde em escala global. Este artigo apresenta um procedimento para a análise e prevenção de erros de medicação do ponto de vista ergonômico, exemplificado por um estudo de caso. Foram incluídos os métodos reconhecidos de Análise Hierárquica de Tarefas (HTA) para análise de tarefas e a Abordagem Sistemática de Redução e Previsão de Erros Humanos (SHERPA) para identificação de modos de erro. A avaliação do risco baseou-se na matriz de risco proposta na norma ISO 45001. O procedimento proposto é composto de quatro etapas: 1) seleção da tarefa em estudo, 2) análise detalhada da tarefa, 3) previsão da possibilidade de erro, 4) estratégias de redução de erros. A aplicação do procedimento é ilustrada por um estudo de caso de administração de um medicamento injetável. Espera-se que o uso sistemático deste procedimento contribua para a melhoria da qualidade dos serviços de saúde, reduzindo erros humanos e possíveis eventos adversos.

Surgimiento y evolución de la ergonomía como disciplina: reflexiones sobre la escuela de los factores humanos y la escuela de la ergonomía de la actividad / Emergence and evolution of ergonomics as a discipline: reflections on the school of human factors and the school of ergonomics of the activity / Surgimento e evolução da ergonomia como disciplina: reflexões sobre a escola dos fatores humanos e a escola de ergonomia da atividade

Resumen La ergonomía es considerada, en la actualidad, una disciplina científica consolidada, que se expande continuamente a nivel global. Este escenario actual es el resultado de diferentes visiones que han permeado la evolución de la ergonomía. En este artículo se hace un recorrido histórico de la ergonomía como disciplina, tomando en cuenta la escuela de los factores humanos y la escuela de la ergonomía de la actividad. Se presentan los orígenes de estas escuelas, sus paradigmas subyacentes y se realiza una comparación entre ellas. Las reflexiones presentadas en el artículo en torno a la ergonomía parten de la idea que, desde las diferencias y la diversidad, se erige el desarrollo. Los autores de este artículo son partidarios de abordar la ergonomía como una única disciplina, reconociendo la convergencia y la complementariedad entre las dos escuelas. Más allá de las diferencias existentes, la práctica de la ergonomía debe enfocarse en el diseño de los sistemas de trabajo, tomando como eje central al ser humano. Se espera que estas reflexiones permitan a los profesionales de la ergonomía y de otras diciplinas afines ganar mayor comprensión de cómo abordar la actividad humana para transformarla positivamente.

Abstract Ergonomics is now considered a consolidated scientific discipline that is continually expanding globally. This current scenario is the result of different visions that have permeated the evolution of ergonomics. This article presents a historical overview of ergonomics as a discipline considering human factors and the activity-oriented ergonomics schools. The origins of these two schools of thought on ergonomics and their underlying paradigms are presented, and a comparison between them is made. The reflections presented in the article on ergonomics are based on the idea that progress is built on differences and diversity. The authors of this article support the idea of approaching ergonomics as a single discipline, recognizing the convergence and complementarity between the two schools. Beyond the existing differences, ergonomics' practice should be focused on the design of human-centered work systems. It is hoped that the reflections made in this article will enable professionals in ergonomics and other related disciplines to understand how to approach human at work to transform working conditions positively.

Resumo A ergonomia é considerada, na atualidade, uma disciplina científica consolidada, que se expande continuamente a nível global. Este cenário atual es el resultado de diferentes visões que han permeado la evolución de la ergonomía. Neste artigo se tem uma recorrido histórico da ergonomia como disciplina, tomando na cuenta a escola dos fatores humanos e a escola da ergonomia da atividade. Se presentan los orígenes de estas escuelas, sus paradigmas subyacentes y se una realiza comparación entre ellas. Las reflexiones presentadas en el artículo en torno a la ergonomía parten de la idea that, from las diferencias y la diversidad, se erige el desarrollo. Los autores de este artículo son partidarios de abordar la ergonomía como una única disciplina, reconociendo la convergencia y la complementariedad entre las dos escuelas. Más allá de las diferencias existentes, la práctica de la ergonomía debe enfocarse en el diseño de los sistemas de trabajo, tomando como eje central al ser humano. Se espera que estas reflexiones permitan a los profesionales de la ergonomía y de otras diciplinas afines ganar mayor comprensión de cómo abordar la actividad humana para transformarla positivamente.

Efectos del trabajo de pie en trabajadores del sector sanitario / Effects of Standing Work among Health Care Workers

Introducción: En el sector sanitario es común la ejecución de actividades de pie; sin embargo, es un tema poco atendido, a pesar de los efectos negativos que se pueden generar en la salud de los trabajadores. Objetivo: Analizar la variación de dolor musculoesqueléticos en las extremidades inferiores y espalda baja, y la variación de volumen en las piernas presentados en trabajadores sanitarios que realizan sus actividades de pie durante una jornada laboral. Materiales y métodos: Estudio transversal donde se registró la percepción de dolor musculoesquelético de los segmentos corporales: espalda baja y el lado derecho e izquierdo de: muslo-cadera, rodilla, pierna y tobillo-pie y se midió la circunferencia para calcular su volumen de las piernas con la cinta métrica Gulick II a 21 trabajadores del sector sanitario. Los registros y mediciones se realizaron durante la primera y la última hora de una jornada laboral de 8 horas. Resultados: En todos los segmentos corporales la percepción de dolor musculoesquelético y el volumen en ambas piernas aumentó al final de la jornada laboral respecto al inicio. Los segmentos corporales muslo-cadera izquierda, tobillo-pie derecho y el volumen en ambas piernas aumentaron significativamente. Discusión: Los resultados obtenidos son similares a estudios con diseños experimentales, con la diferencia que nuestro estudio se desarrolló en condiciones reales sin control de variables. Conclusiones: Este estudio muestra cómo actividades del sector sanitario ejecutadas durante tiempos prolongados de pie pueden ocasionar en los trabajadores dolor musculoesqueléticos en las extremidades inferiores y la espalda baja, así como un aumento en el volumen de las piernas.

Introduction: In the health care sector, the execution of standing activities is common; however, it is an issue that receives little attention, despite the negative effects that can be generated in the health of workers. Objective: To analyze the variation of musculoskeletal pain in the lower extremities and lower back, and the variation of volume in the legs in health care workers who perform their activities while standing during a working day. Materials and methods: A cross-sectional study in which the perception of musculoskeletal pain was recorded in the following body segments: lower back and right and left side of the thigh-hip, knee, leg and ankle-foot, and the circumference was measured to calculate the volume of the legs with the Gulick II tape measure in 21 health care sector workers. Recordings and measurements were taken during the first and last hour of an 8-hour workday. Results: In all body segments the perception of musculoskeletal pain and the volume in both legs increased at the end of the working day compared to the beginning. The body segments left thigh-hip, right ankle-foot and the volume in both legs increased significantly. Discussion: The results obtained are similar to studies with experimental designs, with the difference that our study was developed under real conditions without variables control. Conclusions: This study shows how activities in the health care sector executed during prolonged standing times can cause musculoskeletal pain in the lower extremities and lower back in workers, as well as an increase in the legs volume.

Introdução: No setor de saúde, a execução de atividades em pé é comum; entretanto, é uma questão que recebe pouca atenção, apesar dos efeitos negativos que podem gerar sobre a saúde dos trabalhadores. Objetivo: Analisar a variação da dor musculoesquelética nos membros inferiores e lombar, e a variação do volume das pernas nos profissionais de saúde que realizam suas atividades em pé durante uma jornada de trabalho. Materiais e métodos: Estudo transversal no qual foi registrada a percepção da dor musculoesquelética nos segmentos do corpo: região lombar e lado direito e esquerdo da coxa-quadril, joelho, perna e tornozelo-pé, e a circunferência foi medida para calcular o volume das pernas com a fita métrica Gulick II em 21 trabalhadores do setor de saúde. Os registros e medições foram feitos durante a primeira e última hora de um dia de trabalho de 8 horas. Resultados: Em todos os segmentos do corpo, a percepção da dor musculoesquelética e o volume em ambas as pernas aumentou no final do dia de trabalho em comparação com o início. Os segmentos do corpo coxa-quadril esquerdo, tornozelo-pé direito e o volume em ambas as pernas aumentaram significativamente. Discussão: Os resultados obtidos são semelhantes aos estudos com desenhos experimentais, com a diferença de que nosso estudo foi realizado em condições reais sem controle de variáveis. Conclusões: Este estudo mostra como as atividades no setor de saúde realizadas durante períodos prolongados de permanência em pé podem causar dores musculoesqueléticas nos membros inferiores e a região lombar, bem como um aumento no volume das pernas.

Guía de Práctica Clínica de estenosis hipertrófica del píloro / Clinical Practice Guidelines in Hypertrophic Pyloric Stenosis

La estenosis hipertrófica del píloro es una enfermedad que se presenta fundamentalmente en lactantes, ocurre por un estrechamiento del canal pilórico debido a la hipertrofia gradual de la capa muscular de su esfínter, lo que origina un síndrome pilórico. El objetivo de esta publicación es presentar una actualización sobre el tema. La etiología de la enfermedad es desconocida, la tendencia actual es que se trata de una enfermedad que no es congénita y se sugiere un origen multifactorial, donde influyen factores genéticos y ambientales. Su síntoma fundamental son los vómitos no biliosos y el diagnostico se complementa con el ultrasonido abdominal. El tratamiento de elección es quirúrgico y sus resultados generalmente satisfactorios. La aprobación de esta guía por los servicios de cirugía pediátrica del país la convierten en un útil instrumento asistencial y docente(AU)

Hypertrophic Pyloric Stenosis is a disease that occurs mainly in infants, caused by a narrowing of the pyloric channel due to the gradual hypertrophy of the muscle layer of the sphincter, which originates a pyloric syndrome. The aim of this publication is to present an update on the topic. The etiology of the disease is unknown, the current trend is that it is a disease that is not congenital and a multifactorial origin is suggested, where genetic and environmental factors influence. Its main symptom is non-bilious vomiting and diagnosis is supplemented with abdominal ultrasound. The treatment of choice is the surgical one and its results are generally satisfactory. The approval of this guidelines by the country's pediatric surgery services makes it a useful care and teaching tool(AU)

Apendicitis aguda en el niño: guía de práctica clínica / Acute appendicitis in children. Clinical Pratice Guide

En las últimas décadas se ha prestado mayor atención a los resultados de la actividad quirúrgica debido al peso económico que esta actividad genera en los servicios de salud, el avance ocurrido en la mejora de los cuidados perioperatorios y la creciente ocupación institucional por la calidad de la asistencia y la satisfacción de la población. A este propósito han contribuido el desarrollo y aplicación de guías de práctica clínica. Estas guías reducen la variación en los cuidados del paciente quirúrgico y aumentan su eficiencia, lo que permite que los pacientes se beneficien de iniciativas institucionales encaminadas a mejorar la calidad de la asistencia sanitaria. La apendicitis aguda es sin dudas la enfermedad que tipifica la atención quirúrgica de urgencia en la mayoría de los centros dedicados a la atención sanitaria de niños y adolescentes. Su frecuencia, variación en las características clínicas en los diferentes grupos de edad y los crecientes reportes sobre la posibilidad de tratarse por métodos no quirúrgicos, hizo necesaria una revisión del tema. En el IV Simposio Nacional de Cirugía Pediátrica (Varadero, Matanzas, 1- 3 de julio de 2019), fue presentada, discutida y aprobada una Guía de Práctica Clínica de Apendicitis Aguda en el niño. Compartir la guía a través de su publicación, permitiría a servicios de cirugía pediátrica emplearla como referencia, aplicarla en sus propias instituciones y beneficiar a un gran número de pacientes(AU)

In the last decades, it has been paied attention to the results of the surgical activity due to the economic weight this activity yields in the health services, the advances in the improvement of perioperative cares and the growing institutional occupation due to the quality in the care and the population´s satisfaction. The development and implementation of clinical practice guides have contributed to that purpose. These guides reduce the variation in the cares of surgical patients and increase their efficiency, which allows patients to be benefited by institutional initiatives aimed to improve health care´s quality. Acute appendicitis is, with no doubts, the disease that characterizes emergencie´s surgical care in most of the facilities devoted to children and adolescents´health care. Its frequency, the variation of clinical characteristics in the different age groups and the increasing reports on the possibility of being treated by non-surgical approaches makes necessary a review on the topic. At the IV National Symposium on Pediatric Surgery (Varadero, Matanzas, 2019 July 1-3), a Clinical Practice Guide for Acute Appendicitis was presented, discussed and approved. Sharing the guideline through publication would allow similar services to use it as a reference for applying the model in their own institutions, benefiting a greater number of patients(AU)

A method for non-experts in assessing exposure to risk factors for work-related musculoskeletal disorders--ERIN.

A practical method for non-experts in assessing exposure to risk factors for work-related musculoskeletal disorders (WMSDs) is presented. Evaluación del Riesgo Individual (Individual Risk Assessment) (ERIN) is based on available ergonomic tools, epidemiological evidence and the joint IEA-WHO project for developing WMSDs risk management in developing countries. ERIN focuses primarily on the interaction of some physical workplace factors but also includes the workers' assessment. A scoring system has been proposed to indicate the level of intervention required to reduce the risk of injury. A worksheet has also been designed for increasing the usability of the method. Preliminary tests show that it is easy and quick to use, but further work is needed to establish its reliability and validity. The use of ERIN can contribute to the prevention of WMSDs in Cuba and other developing countries.

The discipline of ergonomics in Cuba within the occupational health framework: background and trends.

The concept of ergonomics was introduced in Cuba at the beginning of the 1970s. More than 40 years later, the prevailing approach to workers' health is still generally reactive rather than proactive, despite the commitment of the government to the subject. A factor influencing this issue is, generally, lack of recognition of the benefits of establishing ergonomic principles within most occupational activities. Recent progress to move occupational health practice toward a more preventive approach has been conducted, frequently with international support. The introduction of a set of Cuban standards proposing the necessity of ergonomic evaluations is an example of this progress. The main challenge for Cuban ergonomists is to transfer knowledge to occupational health practitioners in order to be in concordance with basic standards and regulations regarding ergonomics. The article offers a short description of the history of ergonomics and an overview of ergonomics practice in Cuba.

Preventing work-related musculoskeletal disorders in Cuba, an industrially developing country.

OBJECTIVES: This paper briefly describes the history of ergonomics in Cuba and also presents some ergonomic interventions carried out in major economic sectors, focused on reducing musculoskeletal risk factors. METHODS: Five studies concerning musculoskeletal risk factors were reviewed comparing the results of various ergonomic tools. Cuban legislation related to occupational health as well as statistics available on musculoskeletal disorders were examined. RESULTS: The reviewed studies were carried out using such universally recognized assessment tools as RULA, Strain Index, OWAS and NIOSH equations as well as human movement analysis software. The interventions presented are examples of a proactive approach to the improvement of workers' health. Musculoskeletal disorders are responsible for the second highest rate of total permanent disability in the Cuban work force. CONCLUSIONS: The prevailing approach to workers' health in terms of musculoskeletal disorders is basically reactive rather than proactive despite the commitment of the Cuban Government to the subject and a set of rules established to accomplish this goal. Simple tools for conducting a systematic evaluation of working conditions are needed in our context.

Apendicitis aguda en el lactante / Acute Appendicitis in Infants. A Case Report

La apendicitis aguda es más frecuente en niños de edad escolar, pero rara en menores de un año. Mientras menor es el paciente, la enfermedad cursa más rápido y el riesgo de complicaciones es mayor. Se presenta el caso de un lactante de 9 meses de edad, ingresado en el hospital pediátrico por presentar fiebre y diarreas. Después de varios exámenes fue operado. Se encontró peritonitis por apendicitis aguda gangrenada. Ya en la unidad de cuidados intensivos, sufrió choque séptico y fracaso agudo multiorgánico, falleciendo 24 horas después. La biopsia confirmó el diagnóstico de apendicitis aguda gangrenosa. La apendicitis aguda es una enfermedad que deben considerar los médicos encargados de la atención a lactantes con fiebre, diarreas e irritabilidad atribuida a dolor abdominal. De este modo se puede realizar un reconocimiento precoz de la enfermedad y ejecutar un tratamiento quirúrgico oportuno.

Acute appendicitis is more common in school-age children, but it rarely occurs in infants. The younger the patient, the fastest the course of the disease. In addition, there are greater risks of complications. A case of a nine-month-old infant, admitted to the pediatric hospital with fever and diarrhea, is presented. After several tests, he underwent surgery. Peritonitis caused by acute gangrenous appendicitis was diagnosed. While the patient was in the intensive care unit, he suffered a septic shock and acute multiple organ failure. As a result, he died 24 hours later. The biopsy confirmed the diagnosis of acute gangrenous appendicitis. Acute appendicitis is a disease that must be considered by doctors who treat infants with fever, diarrhea and abdominal pain related to irritability. Thus, an early diagnosis of the disease as well as the implementation of an appropriate surgical treatment can be performed.

Apendicitis aguda en el lactante / Acute appendicitis in infants: a case report

La apendicitis aguda es más frecuente en niños de edad escolar, pero rara en menores de un año. Mientras menor es el paciente, la enfermedad cursa más rápido y el riesgo de complicaciones es mayor. Se presenta el caso de un lactante de 9 meses de edad, ingresado en el hospital pediátrico por presentar fiebre y diarreas. Después de varios exámenes fue operado. Se encontró peritonitis por apendicitis aguda gangrenada. Ya en la unidad de cuidados intensivos, sufrió choque séptico y fracaso agudo multiorgánico, falleciendo 24 horas después. La biopsia confirmó el diagnóstico de apendicitis aguda gangrenosa. La apendicitis aguda es una enfermedad que deben considerar los médicos encargados de la atención a lactantes con fiebre, diarreas e irritabilidad atribuida a dolor abdominal. De este modo se puede realizar un reconocimiento precoz de la enfermedad y ejecutar un tratamiento quirúrgico oportuno(AU)

Acute appendicitis is more common in school-age children, but it rarely occurs in infants. The younger the patient, the fastest the course of the disease. In addition, there are greater risks of complications. A case of a nine-month-old infant, admitted to the pediatric hospital with fever and diarrhea, is presented. After several tests, he underwent surgery. Peritonitis caused by acute gangrenous appendicitis was diagnosed. While the patient was in the intensive care unit, he suffered a septic shock and acute multiple organ failure. As a result, he died 24 hours later. The biopsy confirmed the diagnosis of acute gangrenous appendicitis. Acute appendicitis is a disease that must be considered by doctors who treat infants with fever, diarrhea and abdominal pain related to irritability. Thus, an early diagnosis of the disease as well as the implementation of an appropriate surgical treatment can be performed(AU)

Relación médico paciente y consentimiento informado en cirugía pediátrica: teoría y realidad en la práctica local / Doctor-patient interaction and informed consent in pediatric surgery: theory and reality in the regional practice

El consentimiento informado constituye un elemento esencial de la relación médico paciente actualmente. Con el objetivo de revisar los fundamentos y bases legales de su procedimiento y su vinculación con la cirugía pediátrica en el entorno local, se realizó una revisión bibliográfica de artículos publicados sobre el tema, disponibles en revistas biomédicas nacionales e internacionales. Se concluye que el reconocimiento de la autonomía del paciente y el proceso de consentimiento informado han provocado un cambio en la relación médico paciente, del cual no puede sustraerse la práctica de la cirugía pediátrica en el entorno particular cubano contemporáneo. Además de la profundización en el estudio de los principios bioéticos y su aplicación por parte de los que prestarán los servicios sanitarios, se hace necesaria la búsqueda de respuestas útiles a los problemas bioéticos que en esos servicios afectan la propia relación y de herramientas legales que respalden el procedimiento(AU)

Informed consent is a core element in the doctor-patient interaction. With the objective of reviewing the essentials and legal basis of its procedure and relation with pediatric surgery in the regional context we developed a bibliographic review of national andinternational biomedical publications. It is widely accepted that the recognition of patient´s autonomy and the informed consent process have led to a change inthe doctor-patients interaction, which is closely linked to the pediatric surgical practice in the particular Cubanmodern environment. In addition to the study of bioethical principles and their enforcement by those who are to provide medical services, it is also necessary to look for useful answers to bioethical questions affecting the legal tools that support the procedure(AU)