Institute Efectividad Clinica y Sanitaria

Buenos Aires, Argentina

Institute Efectividad Clinica y Sanitaria

Buenos Aires, Argentina

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PubMed | Institute Efectividad Clinica y Sanitaria, Institute For Health Care Improvement Open School Para Latinoamerica Address Avenida Doctor Emilio Ravignani 2024 and Institute for Health Care Improvement Open School para Latinoamerica
Type: Journal Article | Journal: Medwave | Year: 2017

Patient safety aims to achieve healthcare free of damage. The World Health Organization indicates that this objective is achieved through communication, analysis, and prevention of adverse events in patients. Organizational culture has been identified as one of the main factors for interventions aimed to reduce medical errors; and an essential component of safety culture is the attitude of health professionals towards medical error. Attitudes can be improved through appropriate education in biomedical careers but its inclusion in Argentina is scarce. The Attitudes Questionnaire for Patient Safety, measures knowledge, beliefs, and attitudes about patient safety and could be a useful tool in our country.To validate the modified attitudes for patient safety questionnaire to measure knowledges, beliefs, and attitudes of medical students at CEMIC University Institute. To describe the level of knowledges, beliefs, and attitudes in patient safety of medical students at CEMIC University Institute in 2012, 2015 and 2016.Design: descriptive study. Scope: Exploratory. Setting: the CEMIC University Institute in Buenos Aires, Argentina. Population: medical students of 4th and 5th year. Sampling: a sample size of 100 participants was estimated to derive meaningful estimates as per a Cronbachs alpha> 0.60.The reliability of the instrument (internal consistency) by Cronbachs alpha showed an overall correlation of 0.695. Suitable Cronbachs alpha values were obtained in all categories, except in two: importance of patient safety in the curriculum and the inevitability of error. The responses on knowledge, attitudes and perceptions about patient safety in the three cohorts showed that 57% of students believe they understand concepts about patient safety, 53% consider their training prepares them to understand the cause of medical errors, only 59% believe that human error is inevitable and 98% believe that real professionals do not make mistakes. Lastly, 64% believe that this knowledge is only acquired from clinical experience.This study shows that the APSQ-III modified survey is valid and could be used in Argentina and the region to measure the impact of incorporating patient safety topics in the medical curriculum.


Miller S.,University of California at San Francisco | Bergel E.F.,Institute Efectividad Clinica y Sanitaria | El Ayadi A.M.,University of California at San Francisco | Gibbons L.,Institute Efectividad Clinica y Sanitaria | And 7 more authors.
PLoS ONE | Year: 2013

Background:Obstetric hemorrhage is the leading cause of maternal mortality. Using a cluster randomized design, we investigated whether application of the Non-pneumatic Anti-Shock Garment (NASG) before transport to referral hospitals (RHs) from primary health care centers (PHCs) decreased adverse outcomes among women with hypovolemic shock. We hypothesized the NASG group would have a 50% reduction in adverse outcomes.Methods and Findings:We randomly assigned 38 PHCs in Zambia and Zimbabwe to standard obstetric hemorrhage/shock protocols or the same protocols plus NASG prior to transport. All women received the NASG at the RH. The primary outcomes were maternal mortality; severe, end-organ failure maternal morbidity; and a composite mortality/morbidity outcome, which we labeled extreme adverse outcome (EAO). We also examined whether the NASG contributed to negative side effects and secondary outcomes. The sample size for statistical power was not reached; of a planned 2400 women, 880 were enrolled, 405 in the intervention group. The intervention was associated with a non-significant 46% reduced odds of mortality (OR 0.54, 95% CI 0.14-2.05, p = 0.37) and 54% reduction in composite EAO (OR 0.46, 95% CI 0.13-1.62, p = 0.22). Women with NASGs recovered from shock significantly faster (HR 1.25, 95% CI 1.02-1.52, p = 0.03). No differences were observed in secondary outcomes or negative effects. The main limitation was small sample size.Conclusions:Despite a lack of statistical significance, the 54% reduced odds of EAO and the significantly faster shock recovery suggest there might be treatment benefits from earlier application of the NASG for women experiencing delays obtaining definitive treatment for hypovolemic shock. As there are no other tools for shock management outside of referral facilities, and no safety issues found, consideration of NASGs as a temporizing measure during delays may be warranted. A pragmatic study with rigorous evaluation is suggested for further research.Trial Registration:ClinicalTrials.gov NCT00488462. © 2013 Miller et al.


Dell'Arciprete A.,Institute Efectividad Clinica y Sanitaria | Braunstein J.,CONICET | Touris C.,Instituto Nacional Of Parasitologia Dr Mario Fatalachaben | Dinardi G.,National University of Tres de Febrero | And 4 more authors.
International Journal for Equity in Health | Year: 2014

Introduction. Ninety percent of the aboriginal communities of Argentina are located in areas of endemic vectorial transmission of Chagas disease. Control activities in these communities have not been effective. The goal of this research was to explore the role played by beliefs, habits, and practices of Pilaga and Wichi indigenous communities in their interaction with the local health system in the province of Formosa. This article contributes to the understanding of the cultural barriers that affect the communication process between indigenous peoples and their health care providers. Methods. Twenty-nine open ended interviews were carried out with members of four indigenous communities (Pilaga and Wichi) located in central Formosa. These interviews were used to describe and compare these communities' approach to health and disease as they pertain to Chagas as well as their perceptions of Western medicine and its incarnation in local health practice. Results: Five key findings are presented: 1) members of these communities tend to see disease as caused by other people or by the person's violation of taboos instead of as a biological process; 2) while the Pilaga are more inclined to accept Western medicine, the Wichi often favour the indigenous approach to health care over the Western approach; 3) members of these communities do not associate the vector with the transmission of the disease and they have little awareness of the need for vector control activities; 4) indigenous individuals who undergo diagnostic tests and accept treatment often do so without full information and knowledge; 5) the clinical encounter is rife with conflict between the expectations of health care providers and those of members of these communities. Conclusion: Our analysis suggests that there is a need to consider the role of the cultural patterning of health and disease when developing interventions to prevent and control Chagas disease among indigenous communities in Northern Argentina. This is especially important when communicating with these communities about prevention and control. These research findings might also be of value to national and provincial agencies in charge of decreasing the rates of Chagas disease among indigenous populations. © 2014 Dell'Arciprete et al.; licensee BioMed Central Ltd.


Defago M.D.,Institute Efectividad Clinica y Sanitaria | Defago M.D.,National University of Cordoba | Gu D.,Peking Union Medical College | Hixson J.E.,University of Houston | And 7 more authors.
American Journal of Hypertension | Year: 2013

Background We examined the association between 14 endothelial system genes and salt-sensitivity of blood pressure (BP). Methods After a 3-day baseline examination, during which time the usual diet was consumed, 1,906 Chinese participants received a 7-day low-sodium diet (51.3 mmol of sodium/day) followed by a 7-day high-sodium diet (307.8 mmol of sodium/day). BP measurements were obtained at baseline and at the end of each intervention using a random-zero sphygmomanometer. Results The DDAH1 rs11161637 variant was associated with reduced BP salt sensitivity, conferring attenuated systolic BP (SBP) and mean arterial pressure (MAP) decreases from baseline to the low-sodium intervention (both P = 2×10-4). Examination of genotype-sex interactions revealed that this relation was driven by the strong associations observed in men (P for interactions = 1.10×10-4 and 0.008, respectively). When switching from the low-to high-sodium intervention, increases in diastolic BP (DBP) and MAP were attenuated by the COL18A1 rs2838944 minor A allele (P = 1.41×10-4 and 1.55×10-4, respectively). Conversely, the VWF rs2239153 C variant was associated with increased salt sensitivity, conferring larger DBP and MAP reductions during low-sodium intervention (P = 1.22×10-4 and 4.44×10-5, respectively). Ten variants from 3 independent SELE loci displayed significant genotype-sex interactions on DBP and MAP responses to low-sodium (P for interaction = 1.56×10-3 to 1.00×10-4). Among men, minor alleles of 4 correlated markers attenuated BP responses to low-sodium intake, whereas minor alleles of another 4 correlated markers increased BP responses. No associations were observed in women for these variants. Further, qualitative interactions were shown for 2 correlated SELE markers. Conclusions These data support a role for the endothelial system genes in salt sensitivity. © 2013 American Journal of Hypertension, Ltd 2013. All rights reserved.


Linhares A.C.,Instituto Evandro Chagas | Stupka J.A.,Laboratorio Of Gastroenteritis Virales | Ciapponi A.,Institute Efectividad Clinica y Sanitaria | Bardach A.E.,Institute Efectividad Clinica y Sanitaria | And 8 more authors.
Reviews in Medical Virology | Year: 2011

The efficacy of licensed rotavirus vaccines has only been shown against certain rotavirus group A (RV-A) types. It is critical to understand the burden of rotavirus gastroenteritis (RVGE) and its prevalent types to assess the potential impact of these vaccines in Latin America and the Caribbean (LA&C). We performed a systematic review and meta-analyses of all the available evidence reported from 1990 to 2009 on the burden of rotavirus disease and strains circulating in LA&C. Eligible studies-185 country-level reports, 174951 faecal samples-were selected from MEDLINE, Cochrane Library, EMBASE, LILACS, regional Ministries of Health, PAHO, regional proceedings, doctoral theses, reference lists of included studies and consulting experts. Arc-sine transformations and DerSimonian-Laird random-effects model were used for meta-analyses. The proportion of gastroenteritis cases due to rotavirus was 24.3% (95%CI 22.3-26.4) and the incidence of RVGE was 170 per 1000 children-years (95%CI 130-210). We estimated a global annual mortality for 22 countries of 88.2 (95%CI 79.3-97.1) deaths per 100000 under 5 years (47000 deaths).The most common G type detected was G1 (34.2%), followed by G9 (14.6%), and G2 (14.4%). The most common P types detected were P[8] (56.2%), P[4] (22.1%) and P[1] 5.4%, and the most prevalent P-G type associations were P[8]G1 17.9%, P[4]G2 9.1% and P[8]G9 8.8%. In the last 10 years, G9 circulation increased remarkably and G5 almost disappeared. More recently, G12 appeared and P[4]G2 re-emerged. To our knowledge, this is the first meta-analysis of rotavirus infection and burden of disease in LA&C. © 2011 John Wiley & Sons, Ltd.


Defago M.D.,Institute Efectividad Clinica y Sanitaria | Defago M.D.,National University of Cordoba | Elorriaga N.,Institute Efectividad Clinica y Sanitaria | Irazola V.E.,Institute Efectividad Clinica y Sanitaria | Rubinstein A.L.,Institute Efectividad Clinica y Sanitaria
Journal of Clinical Hypertension | Year: 2014

The purpose of this study was to conduct a systematic review on the association of food patterns (FPs) and endothelial biomarkers. An electronic literature search from 1990 to 2012 was conducted and reference lists and experts were consulted. Studies without dietary intervention and without language restrictions were considered. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were employed. Methodological quality was assessed by Strengthening the Reporting of Observational Studies in Epidemiology guidelines. A total of 546 references were identified, of which 8 were finally included. Several FPs were identified. Healthy FPs (abundant in fruits and vegetables) had a beneficial impact on endothelial function as estimated by circulating levels of biomarkers such as C-reactive protein, soluble intercellular adhesion molecule 1, soluble vascular adhesion molecule 1, and E-selectin molecules. Westernized patterns (higher intakes of processed meats, sweets, fried foods, and refined grains) were positively associated with inflammation molecules and atherogenic promoters. The study of FPs in relation to endothelial function contributes to the development of dietary recommendations for improved cardiovascular health and therefore a better lifestyle. © 2014 Wiley Periodicals, Inc.


Gamboa-Leon R.,Tulane University | Gonzalez-Ramirez C.,Autonomous University of Yucatán | Padilla-Raygoza N.,Campus Celaya Salvatierra | Sosa-Estani S.,Institute Efectividad Clinica y Sanitaria | And 3 more authors.
Journal of Parasitology | Year: 2011

We sought to determine the serological test that could be used for Trypanosoma cruzi seroprevalence studies in Mexico, where lineage I predominates. In a previous study among pregnant women and their newborns in the states of Yucatan and Guanajuato, we reported a 0.8-0.9% of prevalence for T. cruzi-specific antibodies by Stat-Pak and Wiener ELISA. We have expanded this study here by performing an additional non-commercial ELISA and confirming the seropositives with Western blot, using whole antigens of a local parasite strain. We found a seroprevalence of 0.6% (3/500) in Merida and 0.4% in Guanajuato (2/488). The 5 seropositive umbilical cord samples reacted to both non-commercial ELISA and Western blot tests, and only 1 of the maternal samples was not reactive to non-commercial ELISA. A follow-up of the newborns at 10 mo was performed in Yucatan to determine the presence of T. cruzi antibodies in children as evidence of congenital infection. None of the children was seropositive. One newborn from an infected mother died at 2 wk of age of cardiac arrest, but T. cruzi infection was not confirmed. The T. cruzi seroprevalence data obtained with both commercial tests (Stat-Pak and ELISA Wiener) are similar to those from non-commercial tests using a local Mexican strain of T. cruzi. © American Society of Parasitologists 2011.


Ciapponi A.,Institute for Clinical Effectiveness and Health Policy | Alison L.,Institute Efectividad Clinica y Sanitaria | Agustina M.,Institute for Clinical Effectiveness and Health Policy | Demian G.,Institute for Clinical Effectiveness and Health Policy | And 2 more authors.
COPD: Journal of Chronic Obstructive Pulmonary Disease | Year: 2014

Background: In the developing world, COPD continues to be an under studied, diagnosed and treated disorder. In the present study, we analyzed the prevalence, mortality and resource utilization of COPD in Latin America and the Caribbean (LAC) in order to guide future research and public policies. Methods: A systematic review and meta-analysis was performed following MOOSE and PRISMA guidance. We searched CENTRAL, MEDLINE, EMBASE, LILACS, countries' Ministries of Health, proceedings, and doctoral theses from January 1990 to October 2012. We included studies with a validated definition of COPD that assessed the incidence, prevalence, use of health care resources or costs since 1985. Using EROS, a web-based software, pairs of reviewers independently selected, performed quality assessment (using a STROBE-based checklist) and extracted the study data. Discrepancies were resolved by consensus. Arcsine transformations and random-effects model were used for proportion meta-analyses. Results: 26 articles met entry criteria. The pooled COPD prevalence defined by GOLD criteria (11 cities, 6 countries) was 13.4% (95%CI, 10.1-17.1). Most patients suffer mild or moderate COPD and were undertreated according to international guidelines. The prevalence increased by age and was 1.75 times higher in men than women. 35 of every 1,000 hospitalizations were due to COPD, most of high economic cost, and the COPD in-hospital mortality ranged from 6.7% to 29.5%. Conclusions: COPD burden in LAC is high, especially for men and older persons; however few persons had severe disease. COPD patients often received inappropriate treatment and had high exacerbation and hospitalization rates leading to high economic costs. © 2014 Informa Healthcare USA, Inc.


Vaccaro C.A.,Hospital Italiano Of Buenos Aires | Rossi G.L.,Hospital Italiano Of Buenos Aires | Quintana G.O.,Hospital Italiano Of Buenos Aires | Soriano E.R.,Hospital Italiano of Buenos Aires | And 2 more authors.
Diseases of the Colon and Rectum | Year: 2014

BACKGROUND: The advantages associated with the laparoscopic approach are lost when conversion is required. Available predictive models have failed to show external validation. Body surface area is a recently described risk factor not included in these models. OBJECTIVE: The aim of this study was to develop a clinical rule including body surface area for predicting conversion in patients undergoing elective laparoscopic colorectal surgery. DESIGN: This was a prospective cohort study. SETTING: This study was conducted at a single large tertiary care institution. PATIENTS: Nine hundred sixteen patients (mean age, 63.9; range, 14-91 years; 53.2% female) who underwent surgery between January 2004 and August 2011 were identified from a prospective database. MAIN OUTCOME MEASURES: Conversion rate was analyzed related to age, sex, obesity, disease location (colon vs rectum), type of disease (neoplastic vs nonneoplastic), history of previous surgery, and body surface area. A predictive model for conversion was developed with the use of logistic regression to identify independently associated variables, and a simple clinical prediction rule was derived. Internal validation of the model was performed by using bootstrapping. RESULTS: The conversion rate was 9.9% (91/916). Rectal disease, large patient size, and male sex were independently associated with higher odds of conversion (OR, 2.28 95%CI, 1.47-3.46]), 1.88 [1.1-3.44], and 1.87 [1.04-3.24]). The prediction rule identified 3 risk groups: low risk (women and nonlarge males), average risk (large males with colon disease), and high risk (large males with rectal disease). Conversion rates among these groups were 5.7%, 11.3%, and 27.8% (p < 0.001). Compared with the low-risk group, ORs for average- And high-risk groups were 2.17 (1.30-3.62, p = 0.004) and 6.38 (3.57-11.4, p < 0.0001). LIMITATIONS: The study was limited by the lack of external validation. CONCLUSION: This predictive model, including body surface area, stratifies patients with different conversion risks and may help to inform patients, to select cases in the early learning curve, and to evaluate the standard of care. However, this prediction rule needs to be externally validated in other samples (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A137). © The ASCRS 2014.


This article reflects on barriers to research in family medicine, particularly in Latin American countries. These difficulties are not only related to the lack of family physicians as clinical researchers, but also to their progressive relegation from research on specific diseases or conditions by specialists whose domain is an organ system or disease. In addition, family physicians in Latin America are also loaded with the difficulties imposed by the growing north-south divide between developed and developing countries given that, as compared with developed countries, few studies are conducted in Latin America. While research in Family Medicine is not a lost cause, it requires strong commitment from all academic, political, and social stakeholders dedicated to family medicine as a structural axis of healthcare services in Latin America, to offer primary care research the boost it needs. © 2012 Universidad del Valle, Facultad de Salud.

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