Síntesis de evidencia para intervenciones en COVID-19: informes de actualización de la Comisión Nacional de Evaluación de Tecnologías de Salud de Argentina / Evidence synthesis for COVID-19 interventions: update reports from Argentina's National Commission for Health Technology Assessment / Síntese de evidências para intervenções em COVID-19: relatórios de atualização da Comissão Nacional de Avaliação de Tecnologias em Saúde da Argentina

RESUMEN Este informe tiene por objetivo exponer el trabajo realizado sobre el diseño, la publicación y el impacto de las actualizaciones para intervenciones en COVID-19 basadas en la evidencia, para brindar síntesis de evidencia actualizadas a partir de revisiones sistemáticas vivas sobre intervenciones terapéuticas para dar soporte en la toma de decisiones. Para ello, se generó un grupo específico de trabajo en el ámbito de la Comisión Nacional de Evaluación de Tecnologías de Salud (CONETEC) en el Ministerio de Salud de Argentina en colaboración con la Organización Panamericana de la Salud (OPS). Se diseñó una metodología para elaborar y publicar documentos de evaluación orientados a dar apoyo en la toma de decisiones. Estos informes de actualización se respaldaron en la exploración de tres dominios: los efectos en la salud, la factibilidad de la implementación y las recomendaciones basadas en evidencia. Las conclusiones se adaptaron en un esquema semaforizado según el balance entre los beneficios y los aspectos negativos para los distintos escenarios clínicos, a fin de mejorar su interpretación y aplicación. Durante el año 2021 se publicaron 16 informes de síntesis de evidencia (13 originales y 3 actualizaciones completas) que recibieron un destacado número consultas desde la página web de CONETEC y la Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA). Así se hizo visible la necesidad de disponer de resúmenes de evidencia robustos, actualizados y confiables con adaptación al contexto de aplicación en el sistema sanitario del país. El desafío se presenta, además, en la actualización constante de la información, la diseminación apropiada y el sostenimiento en la rigurosidad en el desarrollo de los informes.

ABSTRACT This report presents the work done on the design, publication, and impact of updates on evidence-based COVID-19 interventions, in order to support decision-making with updated evidence syntheses based on living systematic reviews of therapeutic interventions. To this end, a specific working group was created within the National Commission for Health Technology Assessment (CONETEC) of the Ministry of Health of Argentina, in collaboration with the Pan American Health Organization (PAHO). A methodology was designed to develop and publish assessment documents aimed at supporting decision-making. These update reports were based on the exploration of three areas: health effects, feasibility of implementation, and evidence-based recommendations. A color-coded system was used to present the conclusions according to the balance between their positive and negative effects in different clinical scenarios, in order to improve their interpretation and implementation. In 2021, 16 evidence synthesis reports were published (13 original reports and three full updates). These were downloaded many times from the CONETEC website and the Regional Database of Health Technology Assessment Reports of the Americas (BRISA), highlighting the need for robust, up-to-date, reliable evidence summaries adapted for implementation in the country's health system. Other challenges include constant updating of information, appropriate dissemination, and sustained rigorous preparation of the reports.

RESUMO Este relatório tem como objetivo apresentar o trabalho realizado sobre o delineamento, publicação e impacto das atualizações para intervenções em COVID-19 baseadas em evidências, que visam fornecer sínteses de evidências atualizadas provenientes de revisões sistemáticas vivas sobre intervenções terapêuticas para apoiar a tomada de decisões. Para isso, foi criado um grupo de trabalho específico no âmbito da Comissão Nacional de Avaliação de Tecnologias de Saúde (CONETEC, na sigla em espanhol), do Ministério da Saúde da Argentina, em parceria com a Organização Pan-Americana da Saúde (OPAS). Foi desenhada uma metodologia para a elaboração e publicação de documentos de avaliação destinados a apoiar a tomada de decisões. Esses relatórios de atualização se basearam na exploração de três domínios: efeitos na saúde, viabilidade da implementação e recomendações baseadas em evidências. As conclusões foram adaptadas a uma escala semafórica de acordo com o equilíbrio entre os benefícios e os aspectos negativos para os diferentes cenários clínicos, de forma a melhorar a sua interpretação e aplicação. Durante o ano de 2021, foram publicados 16 relatórios de síntese de evidências (13 originais e 3 atualizações completas), que receberam um número significativo de consultas no site da CONETEC e da Base Regional de Informes de Avaliação de Tecnologias em Saúde das Américas (BRISA). Assim, tornou-se visível a necessidade de contar com resumos de evidências robustos, atualizados e confiáveis adaptados ao contexto de aplicação no sistema de saúde do país. A atualização constante das informações, sua divulgação adequada e a manutenção do rigor na elaboração dos relatórios também apresentam desafios.

Reporte de los primeros 50 pacientes con COVID-19 en ventilación mecánica hospitalizados en la Unidad de Cuidados Intensivos del Complejo Asistencial Dr. Sótero del Río

Background: Since March, Chile experienced an exponential increase in SARS-CoV2 cases, which led to an almost full occupancy of the intensive care units (ICU). Aim: To characterize patients with SARS-CoV2 disease who required hospitalization in the ICU and invasive mechanical ventilation (IMV) in our hospital. Material and Methods: A prospective observational study was performed, which included the first 50 patients, aged 54 ± 13 years (58% men), with SARS-CoV2 disease, with ICU and IMV requirements between March 23 and June 2, 2020. Demographics, comorbidities, symptoms, laboratory and imaging, therapies performed and IMV characteristics were registered. The most relevant outcomes observed were lethality, number of days in the ICU and connection to an IMV. Results: Ninety percent of patients were overweight or obese, 46% had hypertension and many had diabetes mellitus. They had elevated inflammatory parameters and typical patterns of COVID-19 in computed tomography. Most of the patients got protective lung ventilation with a high rate of use of neuromuscular blockade (NMB) and prone position. Antibiotics, hydroxychloroquine, and lopinavir/ritonavir were administered according to the protocol of the institution. Lethality was 16% (8 cases) at the end of this study. Conclusions: The information obtained in this study provides characteristics and early outcomes of hospitalized patients with confirmed COVID-19 and IMV, admitted to the ICU of our center.

Experiencia de educación continua en línea en gastroenterología para médicos no especialistas / Experience of continuing online education in gastroenterology for non specialist medical doctors

Background: Continuing education is essential for health professions and online courses can be a good way for professional development. Aim: To describe the experience with online courses for continuing education in hepatology and gastroenterology and to analyze their educational impact. Material and Methods: A three years' experience in courses on liver diseases and digestive tract is described. Their curricular design, methodology, and the educational impact was analyzed using the four levels of the Kirkpatrick's model. Results: On average, there were 321 students per course (2015-2017). 94% were Chilean and 6% from abroad (20 countries). In the educational impact analysis, in level 1 "reaction": 93% said that the course fulfilled their expectations and 92% would recommend it. In level 2 "learning": 42% approved the courses. Level 3 "behavior" was not evaluated and level 4 "organizational change" highlighted that the traditional face-to-face continuing education model of Chilean Gastroenterology Society (SChG) changed to full distance model in these three courses, with 1284 students from South America, Asia and Europe, in a 3-years-period. Additionally, these programs were included in the Medical Society of Santiago (SMS) continuing education agenda. Conclusions: The alliance between the SMS and the SChG generated on line courses that meet the educational needs of physicians and medical students, with excellent results and student perception.

Portafolio en pregrado de Medicina: impacto educacional a 10 años de su implementación / Educational impact after 10 years of implementation of a portfolio for undergraduate medical students

Background: A portfolio is a compilation of academic work that demonstrates student's knowledge, reflection and critical thinking. Aim: To describe the development and implementation of an undergraduate portfolio in the School of Medicine at the Pontificia Universidad Católica de Chile, its temporal evolution and its educational impact after 10 years of experience. Material and Methods: The development and implementation of a portfolio for 4th-year undergraduate medical student was analyzed. Its design, teaching and learning methodologies, results and perceptions of students and teachers were assessed. The educational impact was measured using Kirkpatrick's levels. Results: A total of 1,320 students participated between 2007 and 2017, supported by six teachers and 190 assistant-students. The portfolio included clinical cases, narrative medicine, palliative care and evidence-based medicine (EBM). The overall student's perception was positive, highlighting the development of critical analysis, clinical reasoning and professionalism. The delivery of feedback and learning assessment, allowed students to obtain excellent grades. There were only two cases of plagiarism reported. Fifteen EBM articles and two books with 52 narrative medicine essays were published. The greatest organizational impact of this teaching innovation, was that it evolved to become an established and continuous assessment instrument in 10 consecutive years. Conclusions: This portfolio is a project with a high educational impact, with a favorable perception by students and tutors, excellent results related to grades, stimulating both scientific writing and reflective practice.

Adaptación y validez de la Escala de Personalidad Tipo D (DS-14) en una muestra mexicana / Adaptation and validity of the Type D Personality Scale (DS-14) in a Mexican sample

El objetivo del presente trabajo consistió en explorar las propiedades psicométricas de una adaptación al castellano del Cuestionario de Personalidad Tipo D (DS-14) en una muestra mexicana (n = 702). Se evaluó la escala mediante un enfoque no paramétrico basado en el escalamiento Mokken y se aplicó el análisis factorial confirmatorio por el método de estimación de mínimos cuadrados ponderados con media y varianza ajustada (WLSMV), consistencia interna con coeficiente omega (ω), invarianza de medición por género, y validez convergente con medidas de salud mental (MBI = burnout, GHQ = depresión, trastornos de sueño, disfunción social y síntomas somáticos), parcializando los efectos de estresores laborales (JCQ = demandas y control laboral). Los resultados evidenciaron correlaciones parciales de bajas a moderadas de los ítems DS-14 con los puntajes de salud mental, así como índices de confiabilidad aceptables (ω = .62 - .86). Se halló invarianza de medición entre hombres y mujeres, y la estructura bifactorial original mostró índices de ajuste satisfactorios (CFI = .97, RMSEA = .04, SRMR = .05). Adicionalmente, se vislumbró la viabilidad de una estructura unidimensional, en particular para una versión de 9 ítems (CFI = .99, RMSEA = .04, SRMR = .04), la cual necesita estudios adicionales de replicabilidad. Se concluye que la escala DS-14 produce puntajes válidos y confiables, y se discuten estos hallazgos y sus implicaciones para la investigación futura.

The goal of this study was to explore the psychometric properties of a Spanish version of the Type D Personality Scale (DS-14) in a sample of Mexican participants (n = 702). The scale was evaluated through a non-parametric approach based on Mokken scaling. Moreover, confirmatory factor analyses were performed using the weighted least squares mean and variance (WLSMV) method, internal consistency estimation with omega coefficient (ω), measurement invariance by gender, and convergent validity with mental health measures (MBI = burnout, GHQ = depression, sleep disorders, social dysfunction, and somatic symptoms), and controlling job stressors (JCQ = job demands and job control). The results showed low to moderate partial correlations in DS-14 items concerning the mental health scores, and acceptable reliability rates (ω = .62 - .86). Measurement invariance between men and women was found, and the original two-factor structure showed satisfactory adjustment indices (CFI = .97, RMSEA = .04, SRMR = .05). Furthermore, the viability of a one-dimensional structure, which needs future replicability studies, was glimpsed particularly in the 9-item version (CFI = .99, RMSEA = .04, SRMR = .04). It is concluded that the DS-14 scale generates valid and reliable scores, and these findings and implications are discussed for further research.

Percepción de estudiantes de pregrado de Medicina de talleres de simulación de procedimientos médico-quirúrgicos / Undergraduate student's perception of clinical simulation workshops: assessment of an instrument

Background: Simulation is a useful training tool for undergraduate medical students. A valid instrument is needed to assess students' perception of simulation workshops. Aim: To adapt and validate an instrument to assess the undergraduate medical student's perception of simulation workshops of clinical procedures. Material and Methods: Delphi Methodology was used to adapt the instrument. Exploratory and confirmatory analyses were performed to determine the construct validity and Cronbach's Alpha (0 to 1) for internal consistency of the instrument. Results: A Delphi panel of 10 experts adapted a seven-item questionnaire (Likert scale 1-5; ranging from 7 to 35) and four open-questions. After 3-delphi-rounds, the instrument was administered to 210 students in six simulation training programs (Paracentesis, Cardiopulmonary Resuscitation, Airway management, Sutures, Thoracentesis and Nursing Procedures). The instrument was considered unidimensional in the factorial analysis. The overall median (Q1-Q3) score was 34 ranging from 32 to 35 and the Cronbach Alpha coefficient was 0.72, indicating a good reliability. Conclusions: The perception questionnaire is a useful and reliable instrument to assess students' perceptions of clinical simulations.

Diseño e implementación de un modelo de enseñanza en ambiente simulado de paracentesis abdomina / Design and implementation of an environment teaching model simulated abdominal paracentesis

Resumen: El aprendizaje de los estudiantes de Medicina de Pregrado en ambiente simulado constituye una alternativa en la obtención de competencias técnicas y no técnicas. Objetivo: Desarrollar un fantoma e implementar un taller modular de entrenamiento de paracentesis abdominal en ambiente simulado para estudiantes de Medicina. Métodos: Se diseñaron y desarrollaron modelos para la realización de paracentesis abdominal en la Escuela de Diseño de la Pontificia Universidad Católica de Chile (PUC) y se implementó un taller para alumnos de 4to año de Medicina de la PUC, utilizando un enfoque constructivista, sesiones de entrenamiento simulado con debriefing basadas en el modelo plus-delta y evaluación pre y post-procedimiento siguiendo los principios de evaluación para el aprendizaje. Resultados: Se desarrollaron 3 prototipos hasta llegar a un modelo definitivo de alta fidelidad basado en la percepción de 20 expertos. 237 alumnos asistieron a un taller de paracentesis abdominal en el Centro de Cirugía Experimental y Simulación Universidad Católica (UC). Este consistió en una actividad práctica grupal (7-8 alumnos por sesión) que incluyó: una evaluación pre-sesión, un vídeo instruccional, una demostración en tiempo real en el fantoma por parte de un docente, la realización guiada del procedimiento por parte de los alumnos, debriefing y cierre de la sesión. Conclusiones: Un modelo de enseñanza en ambiente simulado es posible de ser diseñado e implementado exitosamente en un centro educacional para estudiantes de Medicina de Pregrado. Este taller de paracentesis permite entrenar a los alumnos en la realización de paracentesis abdominal en un ambiente seguro para los alumnos y pacientes y puede ser implementado a bajo costo en otros centros o instituciones. (AU)

Abstract: Simulated environments are an option in the learning process of undergraduate medical students in order to obtain technical and non-technical. Aim: To develop a mannequin for abdominal paracentesis and the implementation of a training workshop to perform abdominal paracentesis in a simulated environment for undergraduate medical students. Methods: The prototypes were designed and developed to perform abdominal paracentesis at the School of Design at the Pontificia Universidad Católica de Chile (PUC) and a workshop was implemented in a course with 4-year medical students at the PUC, using a constructivist approach and simulated training sessions and providing debriefing (based on plus-delta model) and pre-post training assessment following the principles of Assessment for Learning. Results: Three prototypes were developed until the final high-fidelity-mannequin was achieved. The abdominal paracentesis workshop was attended by 237 students at the Universidad Católica (UC) Experimental Surgery and Simulation Center. This was a hands-on group activity (7-8 students per session) including pre-session assessment, instructional video-tape, real-time demonstration of abdominal paracentesis procedure by the clinical teacher, followed by abdominal paracentesis performed by the students, debriefing and closing session. Conclusions: A teaching model in a simulated environment is feasible to be successfully designed and implemented in an educational center for undergraduate medical students. This workshop allows students training process to perform abdominal paracentesis in a safe environment for students and patients and it can be implemented in other centers or institutions with low cost.(AU)

Análisis de las propiedades psicométricas del cuestionario: rasgo inteligencia emocional versión corta en estudiantes mexicanos / Analysis of the psychometric properties of the questionnaire: trait emotional intelligence short form in Mexican students"

Introducción: La inteligencia emocional ha demostrado tener relaciones con el desempeño académico y el laboral, sin embargo, las propiedades psicométricas de escalas utilizadas para su medición han sido escasamente analizadas en culturas latinoamericanas, como es el caso del Cuestionario Rasgo Inteligencia Emocional Versión Corta (TEIQue- SF por sus siglas en inglés). Objetivo: Analizar la confiabilidad de sus factores y facetas, examinar su estructura factorial y determinar su validez concurrente. Metodología: Estudio observacional analítico realizado con base en una muestra guiada por participantes compuesta de estudiantes de una universidad mexicana (N=155). La confiabilidad se determinó con alfa de Cronbach y coeficiente omega, la estructura factorial y su validez mediante análisis factoriales exploratorios y confirmatorios, y la validez concurrente teniendo como criterio las escalas afecto positivo y afecto negativo del PANAS. Resultados: Se obtuvieron en general índices de confiabilidad reducidos para los factores de la escala original (alfa de Cronbach entre .32 a .82; coeficiente omega entre .16 a .83), y su estructura original no pudo comprobarse en el análisis factorial confirmatorio (X2=768.47, gl=390 y p=.0000, CFI=.65, RMSEA=.008, 90% IC=.071-.087). Los análisis factoriales exploratorios tampoco sustentaron la validez de constructo, al obtenerse una estructura en que se mezclaron entre sí los ítems de distintos factores y facetas. La validez concurrente tanto de la escala original como de la obtenida con los nuevos factores pareció insuficiente al obtener algunas correlaciones significativas débiles tanto con el afecto negativo como con el afecto positivo (r entre -.04 y .21). Conclusiones: La escala no mostró adecuadas propiedades psicométricas en la muestra participante, y son necesarios más estudios que sustenten estos hallazgos, recalcando que es importante publicar resultados negativos en estos casos.

Introduction: Emotional intelligence has been shown to have relationships with academic performance and work, however, the psychometric properties of scales used for measurement have been poorly analyzed in Latin American cultures, such as Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF for its acronym in English). Objectives: To analyze the reliability of its factors and facets, examine its factorial structure and determine concurrent validity. Methodology: Analytical observational study based on a sample guided by participants composed of students from a Mexican university (N = 155). Reliability was determined with Cronbach's alpha and omega coefficient, the factor structure and validity through exploratory and confirmatory factor analyzes, and concurrent validity having criterion positive affect and negative affect scales PANAS. Results: Were obtained generally reduced reliability indices for the factors of the original scale (Cronbach's alpha between .32 to 8.2; omega coefficient between .16 to .83), and its original structure could not be verified in the confirmatory factor analysis (X2=768.47, df=390 and p=.0000, CFI=.65, RMSEA=.008, 90% CI=.071-.087). Exploratory factor analyzes also did not sustain construct validity, by obtaining a structure in which mixed together items of different factors and facets. The concurrent validity of both the original scale and obtained with the new factors seemed weak to get some significant correlations with both negative affect as positive affect (r between -.04 and .21). Conclusions: The scale did not show adequate psychometric properties in the participant sample, and more studies are needed to substantiate these findings, stressing that it is important to publish negative results in these cases.

Hiperinfección por Strongyloides stercoralis en un paciente con infección por virus HTVL-1 / Hiper-infection by Strongyloides stercoralis in a patient with HTLV-1 infection

Strongyloides stercolarisen un nemátodo endémico en países de clima tropical y subtropical, la infección suele manifestarse por síntomas predominantemente digestivos, en los casos de hiperinfestación produce una strongiloidiasis diseminada con sobreinfecciones bacterianas sistémicas que provocan una disfunción multiorgánica. Los factores de riesgo más importantes para que una infección en principio intestinal adquiera características de gravedad son la inmunosupresión así como la infección por HTVL-1. Presentamos un caso de síndrome de hiperinfección por S. stercolaris en un paciente con HTLV-1.

Strongyloides stercolarisis an endemic nematode in tropical and subtropical climates. Infection is predominantly manifested by gastrointestinal symptoms, and in cases of hyper-infestation causes a disseminated strongyloidiasis with a systemic bacterial over infection causing multiple organ dysfunctions with fatal outcome. The most important risk factors for intestinal infection to acquire gravity features include immunosuppression and HTVL-1 infection. The case presented corresponds to S. stercoralis hyperinfection syndrome in a patient with HTVL-1 infection.