Cross-cultural adaptation of the Cambridge Pulmonary Hypertension Outcome Review for use in patients with pulmonary hypertension in Colombia / Adaptación transcultural de la escala Cambridge Pulmonary Hypertension Outcome Review en pacientes con hipertensión pulmonar en Colombia

ABSTRACT Objective: To conduct a cross-cultural adaptation of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) as an instrument to evaluate the perception of symptoms, functional limitation, and health-related quality of life (HRQoL) in subjects diagnosed with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) in Colombia. Methods: The adaptation process involved 3 phases: translation, cognitive debriefing interviews, and a validation survey. To evaluate the psychometric properties, we recruited individuals ≥ 18 years of age who had been diagnosed with PAH or CTEPH to take part in the latter two stages of the adaptation process. All individuals were being followed on an outpatient basis by the pulmonary hypertension programs at Hospital Universitario San Ignacio, Fundación Clínica Shaio,and Clínicos IPS, all located in the city of Bogotá, Colombia. Results: A Spanish-language version of the CAMPHOR was developed for use in Colombia. The internal consistency was excellent for the symptoms, functioning, and quality of life scales (Cronbach's alpha coefficients of 0.92, 0.87, and 0.93, respectively). Test-retest reliability was above 0.70. The evaluation of the convergent validity and known group validity of the CAMPHOR scales confirmed that there were moderate and strong correlations with the related constructs of the Medical Outcomes Study 36-item Short-Form Health Survey, version 2, as well as showing their capacity to discriminate disease severity. Conclusions: The Spanish-language version of the CAMPHOR developed for use in Colombia was the result of a translation and cultural adaptation process that allows us to consider it equivalent to the original version, having shown good psychometric properties in the study sample. Therefore, its use to assess the impact of interventions on the HRQoL of patients with PAH or CTEPH is recommended, in research and clinical practice.

RESUMEN Objetivo: Realizar la adaptación transcultural del cuestionario Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) como instrumento para evaluar la percepción de síntomas, la limitación funcional y la calidad de vida relacionada con la salud (CVRS) en una población colombiana de sujetos con diagnóstico de hipertensión arterial pulmonar (HAP) e hipertensión pulmonar tromboembólica crónica (HPTEC). Métodos: Estudio de validación de pruebas de determinación de precisión y propiedades psicométricas desarrollado en 3 fases: traducción con adaptación cultural mediante panel bilingüe, aplicación inicial y general para la evaluación de características psicométricas en una cohorte de pacientes > 18 años, con diagnóstico de HAP e HPTEC, en seguimiento por consulta externa de programas de hipertensión pulmonar del Hospital Universitario San Ignacio, Fundación Clínica Shaio y Clínicos IPS. Resultados: Se obtuvo una versión en castellano de la escala CAMPHOR. La consistencia interna observada para los dominios de síntomas, actividades y calidad de vida (valores del coeficiente alfa de Cronbach de 0,92, 0,87 y 0,93 respectivamente) fue adecuada. La confiabilidad prueba-reprueba estuvo por encima de 0,70 y la evaluación de la validez convergente y de grupos conocidos de las subescalas confirmó las correlaciones moderadas y fuertes con constructos relacionados del SF36v2, así como la capacidad discriminatoria según la severidad de la enfermedad. Conclusiones: La versión en castellano de la escala CAMPHOR presentó un proceso de traducción lingüística y adaptación cultural que permite considerarla equivalente a la versión original, demostrando adecuadas propiedades psicométricas en la muestra estudiada. Por ello se recomienda su utilización tanto en la investigación como en la práctica clínica, con el fin de evaluar el impacto de las intervenciones en la CVRS.

Lesión renal aguda adquirida en el hospital: factores de riesgo y desenlaces clínicos / Non-critical care hospital-acquired acute kidney injury: analysis of 101 cases

Background: Non-critical care Hospital-Acquired Acute Kidney Injury (Non-ICU HA-AKI) is a preventable common complication. Aim: To analyze its risk factors and outcomes in a general hospital ward. Material and Methods: A retrospective paired case-control 1:2 study was carried out from April to December 2014. Non-ICU HA-AKI was defined as those patients who experienced a 1.5-fold, or 0.3 mg/dl rise in serum creatinine after 24 hours of hospitalization. Controls were randomly selected, paired by date of hospital admission and specialty causing the admission. We analyzed short-term outcomes and risk factors. Results: We included 101cases aged 65 ± 16 years (55% women). Mean length of stay at the time of diagnosis of AKI was 7.9 ± 8.9 days. Hospital length of stay was longer in patients with AKI (p < 0.01), The risk for intensive care unit (ICU) admission and mortality were also higher (odds ratio [OR], 2.43 [95% confidence intervals (CI), 1.24 to 4.75)p < 0.01 and OR, 26.2 [95% CI, 8.8 to 104, P < 0.01). In a multivariate analysis, sepsis (OR, 3.64 [95% CI, 1.30 to 10.16] p = 0.013), dehydration (OR, 14.4 [95% CI, 4.49 to 46.19), baseline glomerular filtration (OR, 0.96 [95% CI, 0.94-0.98), contrast medium exposure (OR, 4.33 [95% CI, 1.60 to 11.66), recent exposure to Nonsteroidal Anti-inflammatory Drugs (OR 3.23 [95% CI, 1.22 to 8.52 (p = 0.02)] and Charlson comorbidity index (OR, 1.23 [95% CI, 1.05 to 1.43 (p < 0.01) were independent risk factors for Non-ICU HA-AKI. Conclusions: Non-ICU HA-AKI is associated with a longer hospital stay and higher risk of ICU admission and mortality. Most risk factors are potentially preventable.