Dr. Bruno Librado Bello Gutiérrez: excelente profesor universitario / Dr. Bello Liberated Bruno Gutiérrez: excellent university professor

Se enaltecen los aspectos y servicios científicos más importantes de la vida del prestigioso doctor y su valiosa preparación como profesor, investigador, salubrista e higienista, así también como paradigma militar en situaciones excepcionales y desastres. Resulta importante destacar la personalidad, su prestigio como escritor, superación personal, dedicación, conocimientos y lograda contribución en la formación de estudiantes de Medicina, personal de enfermería, trabajadores de la salud y médicos de la Brigada Henry Reeve. El Dr. Bruno es un modelo docente que contribuye a la formación médica revolucionaria de hoy(AU)

The aspects and more important scientific services in this prestigious doctor´s life; his valuable development as professor, investigator, health worker and hygienist, also considered as a military paradigm in exceptional situations and disasters are emphasized in this semblance. His personality, prestige as a writer, personal growth, dedication, knowledge, and achieved contribution to the formation of medical students, nurses, health workers, and the International Brigade of Doctors Specialized in Disaster Situations and Serious Epidemics Henry Reeve are also highlighted. Dr. Bruno is an educational model that contributes to the current revolutionary medical training(AU)

A theoretical framework for ethical decision-making during public health emergencies / Un marco teórico para la toma de decisiones éticas durante emergencias de salud pública / Um referencial teórico para tomada de decisão ética durante emergências de saúde pública

Abstract: The new theoretical ethical framework is a general frame or tool for ethical agents, developed to guide ethical reasoning during public health emergency preparedness and response. The TEF is based on the assumption that no existing ethical discourse in medical ethics alone is sufficient to address ethical issues of a PHE. The solutions suggested by existing approaches are limited in practicability and effectiveness, because they cannot address root problems and interplay among ethical problems. The reason for this insufficiency rests on the argument that ethical problems of PHEs have causal and reciprocal relationships, and any ethical decision-making framework should provide a wide enough perspective to consider relevant ethical norms and theories to suggest practical, implementable, coherent solutions compatible with the communal values and cultural norms. The TEF we suggest for PHEs embraces a holistic and integrated ethical perspective that enables us to comprehend that ethical problems that arise in various settings caused by PHE phenomena are in relationship with each other instead of addressing them as a standalone problem. The TEF provides decision-makers to achieve a coherent web of considered judgements compatible with ethical values and principles in various settings. This type of conceptualization offers a wide perspective to see causal and relational relationships among problems and produce outcomes that would not be possible by eclectic approaches.

Resumen: El nuevo Marco Ético Teórico (MET) es una estructura general o herramienta para eticistas, desarrollada para guiar el razonamiento ético durante la preparación y respuesta a emergencias de salud pública (ESP). Supone que no existe un discurso ético en la ética médica que por sí solo sea suficiente para abordar temas éticos de ESP. Las soluciones sugeridas de aproximaciones existentes son limitadas en la práctica y en la efectividad, debido a que no pueden abordar problemas de raíz sin considerar las interacciones entre los problemas éticos. Esta insuficiencia es porque los problemas éticos de ESP tiene relaciones causales y recíprocas, y cualquier estructura de toma de decisiones éticas debería proporcionar una perspectiva suficientemente amplia como para considerar normas éticas y teorías relevantes, y sugerir soluciones prácticas que sean coherentes y compatibles con valores comunes y normas culturales. El MET que sugerimos para ESP abarca una perspectiva ética integral e integrada, que posibilita la comprensión de que los problemas éticos que surgen en varías situaciones causadas por fenómenos ESP se hallan en relación entre ellos, en vez de abordarlos como un problema aislado. El MET proporciona a los que toman decisiones el lograr una red coherente de juicios compatibles con los valores y principios éticos en varias situaciones. Este tipo de conceptualización ofrece una amplia perspectiva para ver relaciones causales y relacionales entre problemas y producir resultados que no serían posibles mediante aproximaciones eclécticas.

Resumo: O novo referencial ético teórico (NT: TEF, sigla em inglês) é um referencial geral ou instrumento para agentes éticos, desenvolvido para guiar o raciocínio ético durante o preparo e resposta a emergências de saúde pública (NT: PHE, sigla em inglês). O TEF é baseado na suposição de que nenhum discurso ético existente em ética médica sozinho é suficiente para abordar aspectos éticos de uma PHE. As soluções sugeridas pelas abordagens existentes são limitadas em praticabilidade e efetividade, porque elas não podem abordar problemas fundamentais e inter-relacionar problemas éticos. A razão para essa insuficiência repousa no argumento de que problemas éticos de PHEs têm relações causais e recíprocas, e qualquer referencial para tomada de decisão ética deve propiciar uma perspectiva ampla o suficiente para considerar normas e teorias éticas relevantes para sugerir soluções práticas, implementáveis e coerentes, compatíveis com valores comunitários e normas culturais. A TEF que sugerimos para PHEs abarca uma perspectiva ética holística e integrada que nos permite compreender que os problemas éticos que surgem em diversos ambientes causados pelo fenômeno da PHE estão em relação entre si, ao invés de abordá-los como um problema isolado. O TFE propicia a tomadores de decisões alcançar uma rede de julgamentos considerados compatíveis com valores e princípios éticos em ambientes diversos. Esse tipo de conceitualização oferece uma perspectiva ampla para observar relações causais e relacionais entre problemas e produzir desfechos que não seriam possíveis por abordagens ecléticas.

Experiências e condutas do profissional de saúde diante do óbito neonatal: revisão integrativa / Experiencias y conductas de los profesionales de la salud ante la muerte neonatal: revisión integradora / Experiences and behaviors of healthcare professionals in the face of neonatal death: an integrative review

RESUMO Objetivo: identificar as experiências e a condutas do profissional de saúde diante do óbito neonatal disponíveis na literatura. Método: estudo bibliográfico descritivo, do tipo revisão integrativa, com delimitação temporal de 2009 a 2020, realizado nas bases de dados LILACS, BDENF, MEDLINE, Scopus, Web of Science, CINAHL e biblioteca virtual SciELO, por duas pesquisadoras de forma independente em junho de 2021. Foram selecionados 511 artigos, mas somente 21 compuseram o corpus final do estudo após a aplicação dos critérios de inclusão/exclusão. Resultados: os estudos evidenciaram que as experiências dos profissionais diante do óbito são permeadas por sentimentos ambivalentes que influenciam na escolha de suas estratégias de enfrentamento. Dentre as condutas adotadas pelos profissionais, a comunicação clara e sensível, o acolhimento ao luto dos familiares, o respeito à decisão dos pais em relação aos cuidados com o recém-nascido e a entrega de lembranças foram consideradas atitudes positivas para a superação do óbito neonatal. Considerações finais: os resultados mostram o despreparo dos profissionais para lidar com o processo de morte do recém-nascido e a necessidade de haver estratégias de educação permanente voltada ao óbito neonatal.

RESUMEN Objetivo: identificar las experiencias y conductas de los profesionales de la salud ante la muerte neonatal disponibles en la bibliografía. Método: estudio bibliográfico descriptivo, tipo revisión integradora, con delimitación temporal de 2009 a 2020, realizado en las bases de datos LILACS, BDENF, MEDLINE, Scopus, Web of Science, CINAHL y la biblioteca virtual SciELO, por dos investigadoras de forma independiente en junio de 2021. Se seleccionaron 511 artículos, pero sólo 21 constituyeron el corpus final del estudio tras aplicar los criterios de inclusión/exclusión. Resultados: los estudios evidencian que las experiencias de los profesionales en el ámbito laboral están impregnadas de sentimientos ambivalentes que influyen en la elección de sus estrategias de enfrentamiento. Entre las conductas adoptadas por los profesionales, se destacan: la comunicación clara y sensible; atención al duelo de los familiares; el respeto a la decisión de los países en relación a los cuidados con el recién nacido; y la entrega de las memorias, fueron consideradas actitudes positivas para la superación del fallecimiento neonatal. Consideraciones finales: los resultados muestran la falta de preparación de los profesionales para afrontar el proceso de muerte del recién nacido y la necesidad de estrategias de formación continua centradas en la muerte neonatal.

ABSTRACT Objective: to identify the experiences and behaviors of healthcare professionals in the face of neonatal death Available from the literature. Method: descriptive bibliographical study, of the integrative review type, with temporal delimitation from 2009 to 2020, carried out in the LILACS, BDENF, MEDLINE, Scopus, Web of Science, CINAHL and SciELO virtual library databases, by two researchers independently in June de 2021. A total of 511 articles were selected, but only 21 made up the final corpus of the study after applying the inclusion/exclusion criteria. Results: the studies showed that the experiences of professionals in the face of death are permeated by ambivalent feelings that influence the choice of their coping strategies. Among the behaviors adopted by the professionals, clear and sensitive communication, welcoming the grieving of family members, respect for the parents' decision regarding the care of the newborn and the delivery of memories were considered positive attitudes for overcoming neonatal death. Final considerations: the results show the unpreparedness of healthcare professionals to deal with the newborn's death process and the need for permanent education strategies focused on neonatal death.

Evaluating the level of disaster preparedness of Tunisian University Hospitals using the Hospital Safety Index: a nationwide cross-sectional study

Background: Mid-way through the 'Sendai Framework for Disaster Risk Reduction 2015-2030', many nations are spending time, money and effort to enhance their level of preparedness facing disasters, on the other hand communities, countries and even continents are being left behind. Objectives: This study was conducted aiming at evaluating the level of disaster preparedness and response of Tunisian University Hospitals. Methods: This is a cross-sectional nationwide study conducted in Tunisia, from November 2020 to April 2021. Including 9 Tunisian University Hospitals and using the Hospital Safety Index. The data were analysed using the 'Module and safety index calculator'. Results: This study showed that 7 out of the 9 University Hospitals were assigned the 'B' category of safety with overall safety indexes that ranges between 0.37 and 0.62. Also, 4 out of 9 University Hospitals had safety scores less than 0.20 regarding their emergency and disaster management. Conclusions: This is the first study to evaluate disaster preparedness and response of university hospitals in Tunisia and in north Africa. It showed that the lack of knowledge, resources and willingness, are the most important issues that needs to be addressed in order to enhance the preparedness of Tunisian hospitals

A rapid assessment of health system preparedness and response to the COVID-19 pandemic in Guinea

Epidemic-prone diseases have high adverse impacts and pose important threats to global health security. This study aimed to assess levels of health facility preparedness and response to the COVID-19 pandemic in Guinea. This was a cross-sectional study in public and private health facilities/services across 13 Guinean health districts. Managers and healthcare workers (HCWs) from departments in each facility/service were interviewed. Descriptive statistics and comparisons were presented using Pearson's Chi-Squared Test or Fischer exact test. Totally, 197 managers and 1020 HCWs participated in the study. Guidance documents and dedicated spaces for management/isolation of suspected COVID-19 cases were available only in 29% and 26% of facilities, respectively. Capacities to collect (9%) and safely transport (14%) samples were low. Intensive care units (5%), dedicated patient beds (3%), oxygenators (2%), and respirators (0.6%) were almost lacking. While 36% of facilities/services had received infection prevention and control supplies, only 20% had supplies sufficient for 30 days. Moreover, only 9% of HCWs had received formal training on COVID-19. The main sources of information for HCWs were the media (90%) and the internet (58%). Only 30% of HCWs had received personal protective equipment, more in the public sector (p<0.001) and in Conakry (p=0.022). This study showed low levels of preparedness of health facilities/services in Guinea and highlighted a lack of confidence among HCWs who felt unsafe at their workplace. Better governance to improve and maintain the capacity of the Guinean health system to respond to current and future epidemics is needed.

Análisis causal integrado en la radiosinoviortesis y el tratamiento mielosupresor de la policitemia vera / Integrated causal analysis in radiosynoviorthesis and the myelosupressor treatment of polycythemia vera

Introducción: Con la matriz de riesgo se identifican las medidas de control relevantes. El análisis de modos y efectos de fallo posterga definir la efectividad de las medidas correctivas. El uso de uno solo de estos métodos limita el alcance al evaluar los riesgos y la toma de decisiones. Objetivos: Determinar la contribución individual de las causas básicas de fallo en el riesgo radiológico de la radiosinoviortesis y el tratamiento mielosupresor de la policitemia vera, a partir del modelo de la matriz y los reportes. Métodos: Se adaptó el análisis de la gestión de la calidad en radioterapia a las prácticas en estudio y la selección individual de las causas básicas más contribuyentes al riesgo radiológico. La base internacional de incidentes aportó las causas que completaron el listado de las derivadas de la aplicación del principio de Pareto. Resultados: Los subprocesos más contribuyentes al riesgo fueron, por orden de importancia, la administración del radiofármaco, su preparación y la prescripción clínica. Para estos se identificaron las etapas, modos de fallo y sus causas más importantes. Existieron causas que contribuyeron a varios modos de fallo. El incumplimiento de procedimientos, protocolos o prácticas, la falta de entrenamiento del personal y la fatiga del personal son las causas de los riesgos identificados. Conclusiones: Se caracterizó la efectividad de las medidas correctivas de las causas más contribuyentes, las que se adicionan a las derivadas de la matriz, en el plan de mejora en la radiosinoviortesis y el tratamiento mielosupresor de la policitemia vera en Cuba(AU)

Introduction: The risk matrix identifies the relevant control measures. Failure modes and effects analysis postpones defining the effectiveness of corrective measures. Using just one of these methods limits the scope when assessing risks and making decisions. Objectives: To determine the individual contribution of the basic causes of failure in the radiological risk of radiosynoviorthesis and the myelosupressor treatment of polycythemia vera, based on the matrix model and the reports. Methods: The analysis of quality management in radiotherapy was adapted to the practices under study and the individual selection of the basic causes most contributing to radiological risk. The international incident base provided the causes that completed the list of those derived from the application of the Pareto principle. Results: The sub-processes that contributed the most to risk were, in order of importance, the administration of the radiopharmaceutical, its preparation and the clinical prescription. For these, the most important, stages, failure modes and their causes were identified. There were causes that contributed to various failure modes. Non-compliance with procedures, protocols or practices, lack of staff training and staff fatigue are the causes of the identified risks. Conclusions: The effectiveness of the corrective measures of the most contributing causes, which are added to those derived from the matrix, was characterized in the improvement plan in radiosynoviorthesis and myelosupressor treatment of polycythemia vera in Cuba(AU)

El reto de la Educación 4. 0 a nivel universitario de cara a la emergencia por COVID-19 / The challenge of Education 4. 0 at the university level in the face of the COVID-19 emergency

El cierre de universidades, generado por la pandemia de la COVID-19, ha llevado a los países del mundo entero a enfrentar el desafío de la educación remota de emergencia. En latinoamérica, las acciones implementadas para prevenir la propagación del virus obligaron a los ministerios de Educación de la región al cierre de los centros educativos, dejando en marzo de 2020 más de 165 millones de estudiantes sin educación presencial. A partir de las realidades expuestas, una educación 4.0 que promueve al aprendizaje no sólo de habilidades y conocimientos. Bajo el modelo pedagógico aula inversa presencial y a distancia, se evaluo el aprendizaje autodirigido global y por dominios, sobre sobre las enfermedades infectocontagiosas y precauciones de aislamiento en la atención hospitalaria, en los estudiantes universitarios de enfermería, se valoran por los dominios de la Escala de Preparación para el Aprendizaje Autodirigido. De 144, estudiantes la edad fue de 21,73± 1,27 años, para ambos grupos AIP y AID, de los cuales, el 61,81% (n=89) son del sexo femenino, la EPAD para AIP fue de 3,64 ± 0,84 y para AIP de 3,89± 0,93 y un el alfa de Cronbach de 0,89. El nivel de aprendizaje autodirigido de los estudiantes en un aula invertida en ambas modalidades fue similar, se explica porque de la enseñanza interactiva, sincrónica y orientada a la resolución de problemas, y desarrollar las habilidades blandas son capacidades comunicativas, de trabajo en equipo, adaptabilidad, empatía, proactividad, autocrítica y flexibilidad frente a situaciones cambiantes(AU)

The closure of universities, generated by the COVID-19 pandemic, has led countries around the world to face the challenge of emergency remote education. In Latin America, the actions implemented to prevent the spread of the virus forced the Ministries of Education in the region to close educational centers, leaving in March 2020 more than 165 million students without face-to-face education. Based on the exposed realities, a 4.0 education that promotes learning not only of skills and knowledge. Under the face-to-face and distance learning inverse classroom pedagogical model, global and domain self-directed learning was evaluated on infectious and contagious diseases and isolation precautions in hospital care, in ursing university students, the domains of the Scale were evaluated. Preparation for Self-Directed Learning. Of 144 students, the age was 21.73± 1.27 years, for both AIP and AID groups, of which 61.81% (n=89) were female, the EPAD for AIP was 3 0.64 ± 0.84 and for AIP 3.89 ± 0.93 and Cronbach's alpha of 0.89. The level of self-directed learning of the students in a flipped classroom in both modalities was similar, it is explained because of the interactive, synchronous and problem-solving oriented teaching, and the development of soft skills are communicative abilities, teamwork, adaptability, empathy, proactivity, self-criticism and flexibility in the face of changing situations(AU)

Estrategias de preparación en unidades de neonatología durante la pandemia de COVID-19: Encuesta en maternidades de la Argentina / Preparedness strategies in neonatology units during the COVID-19 pandemic: A survey conducted at maternity centers in Argentina

Introducción. El objetivo de este estudio fue analizar recursos disponibles, guías utilizadas y preparación para la atención de neonatos en maternidades de Argentina durante la pandemia de COVID-19.Método. Estudio transversal mediante una encuesta enviada a equipos médicos y de enfermería. En mayo de 2020, se contactaron instituciones de más de 500 nacimientos anuales en la Argentina, el 58 % del sector público.Resultados. Respondieron 104/147 instituciones (el 71 %). Todas contaban con guías para la atención durante la pandemia, y un 93 % refirió haber recibido capacitación para su uso. No autorizaban la presencia de acompañante en el parto el 26 % de instituciones privadas y el 60 % de las públicas (p < 0,01). El 87 % recomendaba ligadura oportuna del cordón, el 62 % promovía internación conjunta en neonatos asintomáticos, un 70 % recomendaba la puesta al pecho con medidas de protección, y el 23 %, leche materna mediante biberón. El 94 % restringía el ingreso de familiares a Neonatología.Las dificultades incluyeron imposibilidad de contar con habitaciones individuales para neonatos sintomáticos y potencial limitación del personal de salud y equipos de protección personal.Conclusiones. Todas las instituciones conocen las guías nacionales para enfrentar la pandemia. La mayoría cuenta con recursos para respetar las medidas de protección recomendadas. Existe incertidumbre sobre si, ante un aumento significativo en el número de casos, serán suficientes los elementos de protección personal, el personal y el espacio físico disponible en los distintos centros

Introduction. The objective of this study was to analyze available resources, guidelines in use, and preparedness to care for newborn infants at maternity centers in Argentina during the COVID-19 pandemic.Method. Cross-sectional study based on a survey administered to medical and nursing staff. In May 2020, Argentine facilities with more than 500 annual births were contacted; 58 % of these were from the public sector.Results. In total, 104/147 facilities answered (71 %). All had guidelines for care during the pandemic, and 93 % indicated they had been trained on how to use them. A companion was not allowed during childbirth in 26 % of private facilities and in 60 % of public ones (p < 0.01). Deferred cord clamping was recommended in 87 %; rooming-in with asymptomatic newborns was promoted in 62 %; breastfeeding using protective measures was recommended in 70 %; and breast milk using a bottle, in 23 %. In 94 %, family visiting in the Neonatology Unit was restricted.Difficulties included the unavailability of individual rooms for symptomatic newborn infants and a potential shortage of health care staff and personal protective equipment.Conclusions. All facilities are aware of the national guidelines to fight the pandemic. Most have the resources to comply with the recommended protective measures. There is uncertainty as to whether personal protective equipment, staff, and physical space available at the different facilities would be enough if cases increased significantly

La educación antisísmica con estudiantes de medicina a través de un proyecto comunitario / Anti-seismic education of medical students through a community project

La prevención ante los desastres acaecidos por sismos constituye una problemática en determinadas regiones vulnerables en Cuba, y una prioridad en la formación de estudiantes de medicina. En este trabajo, las opiniones de los autores se fundamentan en la influencia que tiene un proyecto comunitario, para actuar ante situaciones sísmicas, en la preparación de los estudiantes de medicina, pues favorece una mayor calidad profesional y contribuye a enriquecer su labor preventiva con la población. Como parte del proceso, participaron 46 estudiantes de cuarto año de la Facultad de medicina No. 1, de Santiago de Cuba, en el período comprendido entre septiembre de 2016 a febrero de 2018(AU)

Prevention of earthquake disasters is a problem in certain vulnerable regions of Cuba, and a priority in the training of medical students. In this work, the authors' opinions are based on the influence that a community project has, to act in seismic situations, in the preparation of medical students, since it favours a higher professional quality and contributes to enriching their preventive work with population. As part of the process, 46 fourth-year students from the Faculty of Medicine No. 1, Santiago de Cuba, participated in the period from September 2016 to February 2018(AU)

Propuesta para obtener consistencias líquidas para la evaluación de la disfagia / Proposal to obtain liquid consistencies for dysphagia assessment

La iniciativa internacional para la estandarización de la dieta de disfagia (IDDSI) clasifica la viscosidad de los líquidos por niveles y determina metodologías específicas para evaluar cada consistencia. Con todo, la iniciativa no determina las medidas específicas de espesante requeridas para obtener cada nivel de viscosidad y sugiere hacer adaptaciones de acuerdo con las condiciones particulares de aplicación. Este estudio desarrolló una propuesta para la preparación de viscosidades mediante pruebas experimentales en las que se controló rigurosamente la cantidad de espesante y agua haciendo uso de instrumentos de mezclado de fácil acceso en entornos clínicos (vasos plásticos, jarra de agua, baja lenguas para integrar los elementos y cronómetro para considerar el tiempo de fraguado). Posterior a ello, cada nivel de viscosidad obtenido fue evaluado con el test de flujo propuesto por las IDDSI. Como resultado, este estudio especifica las cantidades necesarias de agua y espesante para conseguir viscosidad en bebidas de 0-4. Los hallazgos presentados, tienen en cuenta factores influyentes como la ubicación geográfica, temperatura y altitud. Se espera que esta propuesta incida en las dinámicas de evaluación de la deglución en el área clínica colombiana de forma que esta sea más precisa y eficaz. Finalmente, es pertinente realizar futuras investigaciones que determinen medidas específicas de espesante para lograr cambios en la viscosidad de líquidos diferentes al agua e igualmente necesario, replicar esta propuesta con otros espesantes de más fácil acceso para los usuarios y que tengan en cuenta otros aspectos como la palatabilidad

The International Dysphagia Diet Standardisation Initiative (IDDSI) classifies the viscosity of liquids by levels and determines specific methods to evaluate each consistency. However, the initiative does not determine the specific measures of thickener required to obtain each level of viscosity and suggests making adaptations according to the particular conditions of application. This study developed a proposal for the preparation of viscosities through experimental tests in which the amount of thickener and water was rigorously controlled using mixing instruments that were easily accessible in clinical settings (plastic cups, pitcher of water, tongue depressors to integrate the elements and timer to consider setting time). After that, each level of viscosity obtained was evaluated with the flow test proposed by the IDDSI. As a result, this study specifies the required amounts of water and thickener to achieve drinks viscosities 0-4. The findings presented take into account influencing factors such as geographic location, temperature and altitude. It is expected that this proposal will affect the dynamics of swallowing assessment in the Colombian clinical area so that it is more precise and effective. Finally, it is pertinent to carry out future investigations that determine specific measures of thickener to achieve changes in the viscosity of liquids other than water and it is equally necessary to replicate this proposal with other thickeners that are easier for users to access and that take into account other aspects such as palatability.

Ações implementadas no preparo e administração de heparina endovenosa: relato de evento adverso / Acciones implementadas en la preparación y administración de heparina endovenosa: relato de evento adverso / Actions implemented in the preparation and endovenous administration of heparin: adverse event report

RESUMO Objetivo: relatar evento adverso no preparo e administração de heparina endovenosa e ações implementadas pela equipe de saúde. Métodos: trata-se de relato de experiência sobre as ações implementadas após análise de evento adverso no preparo e administração de heparina em paciente internado em um Hospital Universitário do Sul do Brasil. Os dados foram coletados nos registros do prontuário do paciente, atas de reuniões das equipes envolvida se do plano de ação das medidas instituídas após evento ocorrido em novembro de 2017. A análise dos resultados foi realizada de forma descritiva e o projeto aprovado por Comitê de Ética em Pesquisa. Resultados: as ações realizadas incluíram a revisão de rotinas e protocolos relacionados ao cálculo de dose, preparo e administração da heparina endovenosa. Houve a inclusão como medicamento de alta vigilância e realização da dupla checagem. Também foram divulgadas orientações e alertas em nível institucional para todos os membros da equipe de enfermagem. Conclusão: a experiência contribuiu para evidenciar a necessidade de monitorar incidentes e seus impactos, encontrar estratégias para reduzi-los por meio de revisões nos processos e implementação de ações na prática assistencial visando maior segurança no preparo e administração de heparina endovenosa.

RESUMEN Objetivo: relatar evento adverso en la preparación y administración de heparina endovenosa y acciones implementadas por el equipo de salud. Métodos: se trata de un relato de experiencia sobre las acciones implementadas tras el análisis de evento adverso en la preparación y administración de heparina en paciente ingresado en un Hospital Universitario del Sur de Brasil. Los datos fueron recolectados en los registros médicos del paciente, actas de reuniones de los equipos involucrados y del plan de acción de las medidas instituidas tras el evento ocurrido en noviembre de 2017. El análisis de los resultados fue realizado de forma descriptiva y el proyecto aprobado por Comité de Ética en Investigación. Resultados: las acciones realizadas incluyeron la revisión de rutinas y los protocolos relacionados al cálculo de dosis, preparación y administración de heparina endovenosa. Hubo la inclusión como medicamento de alta vigilancia sanitaria y la realización del doble chequeo. También fueron divulgadas orientaciones y alertas a nivel institucional para todos los miembros del equipo de enfermería. Conclusión: la experiencia contribuye para evidenciar la necesidad de monitorear incidentes y sus impactos, encontrar estrategias para reducirlos por medio de revisiones en los procesos y la implementación de acciones en la práctica asistencial con el objetivo de una mayor seguridad en la preparación y administración de heparina endovenosa.

ABSTRACT Objective: to report an adverse event in the preparation and endovenous administration of heparin and actions implemented by the health team. Methods: this is an experience report on the actions implemented after analyzing an adverse event in the preparation and administration of heparin in a patient admitted to a University Hospital in southern Brazil. Data were collected from the patient's medical records, minutes of meetings of the teams involved, and the action plan of the measures instituted after an event that occurred in November 2017. Results were analyzed in a descriptive manner and the project was approved by the Research Ethics Committee. Results: the actions carried out included the review of routines and protocols related to the calculation of dose, preparation, and endovenous administration of heparin. There was inclusion as a high-alert medication and double checking. Institutional-level guidelines and alerts were also released to all members of the nursing team. Conclusion: the experience contributed to highlight the need to monitor incidents and their impacts, find strategies to reduce them through process reviews and implementation of actions in care practice aiming at greater safety in the preparation and endovenous administration of heparin.

Overview of preparedness and response to COVID-19 in Ghana

The Coronavirus disease 2019 (COVID-19) outbreak in Ghana is part of an ongoing pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The first two cases of COVID-19 were confirmed in Ghana on 12th March 2020. COVID-19 was consequently declared a Public Health Emergency of National Concern, triggering several response actions, including enhanced surveillance, case detection, case management and contact tracing, closure of borders, suspension of international flights, ban on social gatherings and closure of schools. Preparedness and response plans were activated for implementation at the national, regional, district and community levels. Ghana's Strategic approaches were to limit and stop the importation of cases; detect and contain cases early; expand infrastructure, logistics and capacity to provide quality healthcare for the sick; minimise disruption to social and economic life and increase the domestic capacity of all sectors to deal with existing and future shocks. The health sector strategic frame focused on testing, treatment, and tracking. As of 31st December 2020, a total of 535,168 cases, including 335 deaths (CFR: 0.61%), have been confirmed with 53,928 recoveries and 905 active cases. All the regions have reported cases, with Greater Accra reporting the highest number. The response actions in Ghana have seen highlevel political commitment, appropriate and timely decisions, and a careful balance of public health interventions with economic and socio-cultural dynamics. Efforts are ongoing to intensify non-pharmaceutical interventions, sustain the gains made so far and introduce COVID-19 vaccines to reduce the public health burden of the disease in Ghana

Organização da Atenção Primária à Saúde no Paraná no enfrentamento da pandemia Covid-19 / Organization of Primary Health Care in Paraná in the pandemic Covid- 19

A Covid-19 tem representado a maior crise sanitária, econômica e social do novo milênio, caracterizando um desafio global aos sistemas de saúde. O objetivo deste estudo foi descrever as ações e atividades para a organização da atenção primária à saúde no Paraná em resposta à pandemia de Covid-19, segundo o Plano de Contingência Estadual. Trata-se de um estudo descritivo, qualitativo, do tipo relato de experiência. A resposta coordenada do Estado do Paraná frente à Covid-19 partiu do Plano de Resposta a Emergências em Saúde Pública. Fundamentado nesse plano, a Secretaria da Saúde ativou o Comitê de Operações de Emergência em Saúde Pública, publicando posteriormente o Plano de Contingência - Novo Coronavírus, composto por três níveis de resposta. Diante desse risco, configurado na doença Covid-19, a elaboração e atualização do plano de contingência foram fundamentais na organização das ações de intervenção na realidade e geração de respostas apropriadas a essa pandemia. (AU)

Covid-19 has been the biggest health, economic and social crisis in the new millennium, representing a global challenge to health systems. This paper describes actions and activities towards the health primary care in Paraná in response to Covid-19 pandemic, according to the State Contingency Plan. It is a case study, descriptive, qualitative, method. The coordinated answer of Paraná state against Covid-19 started with the Public Health Contingency Plan and, based on it, the Health State Secretariat set in motion a specific Emergency Operations Committee, and afterwards published the Preparedness Plan - New Coronavirus with three levels of response. Given this risk, configured in Covid-19 disease, the elaboration and updating of the contingency plan were fundamental in the organization of intervention actions in reality and generation of appropriate responses to this pandemic. (AU)

No inferioridad entre dos agentes de bajo volumen (picosulfato de sodio/citrato de magnesio frente al sulfato de sodio/potasio/magnesio) en la preparación del colon para procedimientos diagnósticos: estudio observacional / Non-inferiority between two low-volume agents (sodium picosulfate/magnesium citrate vs. sodium sulfate/potassium/magnesium) to prepare the bowel for diagnostic procedures: an observational study

Resumen Introducción: el cáncer colorrectal es un problema de salud pública; sin embargo, la detección temprana reduce su morbimortalidad. La colonoscopia es el procedimiento de elección para detectar lesiones premalignas y el éxito depende de una limpieza adecuada. El objetivo es evaluar el desempeño de dos preparaciones de bajo volumen empleados en un hospital de alto nivel. Materiales y métodos: estudio prospectivo en adultos que asistieran a colonoscopia en la Fundación Santa Fe de Bogotá, Colombia. Las preparaciones se evaluaron con la escala de Boston, con puntaje ≥ 6 puntos para una limpieza adecuada. Se realizó un análisis de regresión logística para establecer la efectividad de los medicamentos con un cálculo de no inferioridad del 3 %-5 %. Resultados: 598 pacientes fueron evaluados. El 49 % (293) fue expuesto al picosulfato de sodio/citrato de magnesio y el 51 % (305) fue expuesto al sulfato de sodio/potasio/magnesio. Con un promedio de Boston de 6,98 ± 1,86 (78 % con puntaje de Boston ≥ 6) y 7,39 ± 1,83 (83 %), respectivamente (p = 0,649). Según el análisis de la presencia y frecuencia de síntomas no deseados, el picosulfato fue mejor tolerado (p < 0,001). Conclusiones: los estudios de preparación intestinal en pacientes de un escenario real son muy escasos. Los medicamentos de bajo volumen obtuvieron una efectividad global y por segmento de colon similar, confirmando la no-inferioridad; el picosulfato de sodio/citrato de magnesio fue mejor tolerado. Un estudio de costo-efectividad podría definir esto según las necesidades de la población de estudio.

Abstract Introduction: Colorectal cancer is a public health problem; however, early detection reduces morbidity and mortality. Colonoscopy is the procedure of choice for detecting precancerous lesions, and success depends on proper bowel cleansing. Objective: To evaluate the performance of two low-volume agents used in a high-level hospital. Materials and methods: Prospective study in adults who underwent colonoscopy at the Fundación Santa Fe in Bogotá, Colombia. Preparations were evaluated using the Boston Bowel Preparation Scale. A score ≥6 points indicated adequate preparation. A logistic regression analysis was carried out to establish the effectiveness of the medicines with a non-inferiority ratio of 3-5%. Results: 598 patients were evaluated. 49% (293) received sodium picosulfate/magnesium citrate and 51% (305) received sodium sulfate/potassium/magnesium, with an average Boston score of 6.98±1.86 (78% Boston ≥6) and 7.39±1.83 (83%), respectively (p=0.649). According to the analysis of the presence and frequency of unwanted symptoms, picosulfate was better tolerated (p < 0.001). Conclusions: Bowel preparation studies in patients from a real-life scenario are scarce. Low-volume agents had similar overall and segmental effectiveness in the colon, confirming non-inferiority; sodium picosulfate/magnesium citrate was better tolerated. A cost-effectiveness study could establish the best option according to the needs of the study population.

Consumo familiar de alimentos andinos, en las ciudades de La Paz y El Alto, gestión 2019 / Family consumption of andean foods, in the city of La Paz and El Alto, term 2019

OBJETIVO: determinar las características del consumo familiar de alimentos andinos, en la ciudad de La Paz y El Alto, gestión 2019. MATERIALES Y MÉTODO: es un estudio descriptivo de serie de casos en 285 familias de diferentes zonas de la ciudad de La Paz y El Alto. Se aplicó una encuesta de consumo familiar de alimentos andinos como la Quinua, Cañahua, Amaranto y Tarwi, se identificó las características de la frecuencia de consumo, la forma de preparación, lugar de compra y las posibles razones de no consumirlos. RESULTADOS: el 51.9% de la población compra los alimentos andinos en los mercados y el 31.2% lo compra en las ferias. El 37% de los encuestados consumen Quinua, el 23% consumen Cañahua, el 22% consumen Tarwi, y el 17% consumen Amaranto. La frecuencia de consumo oscila entre 1 a 2 veces a la semana, y la consumen más en el desayuno 41% y en el almuerzo, y la razón más frecuente (36%) de no consumo es por el costo elevado. CONCLUSIONES: entre los alimentos andinos más consumidos está la Quinua seguida de la Cañahua, Tarwi, y el Amaranto. La frecuencia de consumo oscila entre 1 a 2 veces a la semana, y la consumen más en el desayuno y en el almuerzo, la razón de no consumo es argumentado por el costo elevado.

OBJECTIVE: to determine the characteristics of family consumption of Andean foods, in the city of La Paz and El Alto, term 2019. MATERIALS AND METHOD: it is a descriptive case series study in 285 families from different areas of the city of La Paz and El Alto. A survey of family consumption of Andean foods was applied, such as Quinoa, Cañahua, Amaranth and Tarwi, the characteristics of the frequency of consumption, the form of preparation, place of purchase and the possible reasons in the case of non-consumption were identified. RESULTS: 51.9% of the population buys Andean food in the markets and 31.2% buys it at fairs. 37% of respondents consume Quinoa, 23% consume Cañahua, 22% consume Tarwi, and 17% consume Amaranth. The frequency of consumption ranges from 1 to 2 times a week, and they consume it more at breakfast 41% and at lunch, and the reason for not consuming 36% is argued for the high cost. CONCLUSIONS: among the most consumed Andean foods is Quinoa followed by Cañahua, Tarwi, and Amaranth. The frequency of consumption ranges from 1 to 2 times a week, and it is consumed more at breakfast and lunch, the reason for non-consumption is argued for the high cost.

Plan de preparación y respuesta ante posible segunda ola pandémica por COVID-19 en el Perú: Documento técnico / Preparedness and response plan for a possible second pandemic wave due to COVID-19 in Peru: Technical document

El documento contiene propósitos, resultados y objetivos, así como las actividades que prioritariamente se deben realizar, a fin de reducir los daños a la salud y/o complicaciones.

Pandemia COVID-19: Reflexiones sobre su impacto para la preparación en el control de enfermedades infecciosas en Colombia: [Editorial] / Pandemic COVID-19: A reflection on the impact for preparedness on the control of infectious diseases in Colombia: [Editorial]

La Organización Mundial de la Salud finalmente declaró al brote por el coronavirus SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) como una pandemia el 11 de marzo de 2020 . Al momento de escribir este editorial (Abril 4 de 2020) el mundo sobrepasó el millón de infectados y el número de muertes registraba cerca de 70 mil, con múltiples países sufriendo más de mil muertes diarias . Las características propias de este coronavirus, a pesar de ser similar a otros, como el SARS y el MERS, hace que existan interrogantes sobre su impacto en países de regiones y condiciones socioeconómicas y culturales diferentes.

The World Health Organization finally declared the SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) outbreak a pandemic on March 11, 2020 . At the time of writing this editorial (April 4, 2020) the world surpassed one million infected and the number of deaths was close to 70,000, with multiple countries suffering more than one thousand deaths per day. The specific characteristics of this coronavirus, despite being similar to others, such as SARS and MERS, raise questions about its impact in countries of different regions and socioeconomic and cultural conditions.

Retos de la implementación del aprendizaje basado en equipos en los programas de medicina / The challenges of implementing team-based learning to the medical major programs

Introducción: El aprendizaje basado en equipos es una estrategia de enseñanza y de aprendizaje centrada en el alumno, en la cual el profesor tiene un rol facilitador. Este constituye un método pedagógico de aprendizaje activo que mejora la motivación hacia el aprendizaje y lleva a los alumnos a aplicar sus conocimientos para resolver problemas y combinar la teoría con la práctica. Los avances en educación médica a nivel mundial han llevado a las escuelas de medicina a optar por este tipo de estrategias. Objetivo: Identificar los retos de la implementación del aprendizaje basado en equipos en los programas de medicina. Resultados: Mediante la aplicación del aprendizaje basado en equipos en los programas de medicina, se identificaron los factores de sobrecarga laboral y de estudio con incidencia en los participantes en la estrategia, la necesidad de garantizar entrenamiento previo a los actores del proceso, la importancia de la realización de una adecuada distribución de los grupos de trabajo, y los recursos adicionales que deben garantizarse. Conclusiones: Para obtener beneficios pedagógicos de forma plena, la implementación del aprendizaje basado en equipos debe ser sistemática, lo que requiere procesos de formación y preparación, tanto de los estudiantes como de los profesores. Como cualquier cambio, demandará convicción, tiempo y ajustes a lo largo del proceso(AU)

Introduction: Team-based learning is a student-centered teaching and learning strategy, in which the teacher has the role of a facilitator. It constitutes an active learning pedagogical method that improves motivation towards learning and leads students to apply their knowledge to solve problems and combine theory with practice. Advances in medical education worldwide have led medical schools to opt for such strategies. Objective: To identify the challenges of implementing team-based learning in the medical major programs. Results: Through the application of team-based learning to the medical major programs, such factors as work and study overloads were identified as having an impact on the strategy participants, together with the need to guarantee prior training to the process stakeholders, the importance of adequate distribution of the working groups, and the additional resources that must be guaranteed. Conclusions: In order to obtain full pedagogical benefits, the implementation of team-based learning must be systematic, a process requiring training and preparation processes for both students and teachers. Like any change, it will demand conviction, time and adjustments throughout the process(AU)

La internacionalización del conocimiento / Internationalization of Knowledge

El tema de la internacionalización del conocimiento no es nuevo; sin embargo, resulta uno de los más complejos y estratégicos que debe enfrentar la educación superior. A partir de los métodos tradicionales, el intercambio académico en estos momentos tiene un enfoque más abarcador, apoyado en el uso de las nuevas tecnologías de la información y las comunicaciones. En este sentido, el presente artículo tiene el objetivo de analizar las realidades, los desafíos, las oportunidades y las amenazas que la internacionalización del conocimiento impone a la universidad en general. A partir del concepto de internacionalización tradicional, se enfocan los aspectos relacionados con la educación superior y su importancia para generar oportunidades y ampliar los horizontes de producción, almacenamiento y transmisión de conocimientos en esta época, caracterizada por la globalización, como una tarea urgente en un mundo de desigualdades crecientes y grandes crisis sociales y económicas, para vencer barreras culturales, políticas y geográficas. La internacionalización del conocimiento en la época actual constituye un tema relevante, que impone nuevos retos y requiere de una adecuada cultura de internacionalización en el seno de las universidades, así como de la preparación adecuada de los factores involucrados directa o indirectamente en su aplicación(AU)

The issue of internationalization of knowledge is not new. However, it is one of the most complex and strategic ones that higher education must face. Based on traditional methods, academic exchange now has a more comprehensive approach, supported by the use of new information and communications technologies. In this respect, this article aims to analyze the realities, challenges, opportunities and threats that the internationalization of knowledge imposes on the university in general. Based on the concept of traditional internationalization, focus is placed on aspects related to higher education and its importance to generate opportunities and expand the horizons of production, storage and transmission of knowledge at this time, characterized by globalization, and as an urgent task in a world of growing inequalities and major social and economic crises, to overcome cultural, political and geographical barriers. Internationalization of knowledge in the current era is a relevant issue, which imposes new challenges and requires an adequate culture of internationalization within universities, as well as the adequate preparation of the actors directly or indirectly involved in its application(AU)

COVID radiology preparedness in Nigeria: How ready are we?

The novel human coronavirus (COVID-19) began in Wuhan China as an interstitial pneumonia of unidentifiable origin in December 2019 and thereafter spread its tentacles all over the world.There is a need for radiology departments in both government and private facilities to be prepared to meet this crisis. Their efforts should be geared not only toward diagnosis, but also to preventing patient-to-patient, staff-to-patient, and staff-to-staff transmission of infection by utilizing social distancing measures and personal protective equipment (PPE).Aim: To evaluate the preparedness of radiologic departments of government hospitals and private centers, by assessing the outlay of the facility and likelihood to attend to COVID patients, type of equipment in the centers, and plans in place for protection of staff and the public.Materials and Methods: The radiology departments of government and private facilities in each geopolitical zone of the country were randomly selected to discuss radiology preparedness in Nigeria using preset guidelines which were sent to radiologists at the facilities. Written informed consent was obtained from the radiologists at the participating centers. Ethical approval was also obtained from the Lagos University Teaching Hospital Health Research Ethics Committee.Results: A total of twelve centers were included in the study, comprising eight government and four private centers. All had plans in place to attend to COVID patients; majority were in the process of developing standard operating procedures (SOPs). Majority of the government facilities lacked mobile equipment and adequate PPEs, with only one computed tomography machine and no holding area in some of the facilities for symptomatic patients unlike the private facilities. They, however, had infection control teams in place.Conclusion: Private radiological centers appear better prepared and more equipped to cope with the crisis than government hospitals. Adequate PPEs, mobile equipment, and isolation rooms need to be provided for the government facilities. Radiology information systems should be installed for remote viewing. Training and retraining on COVID management and decontamination should be conducted periodically. SOPs should be drafted universally and modified for each facility