Systematic review and comparative analysis of pediatric nutrition screening tools validated in Europe and Canada / Revisión sistemática y análisis comparativo de las herramientas de tamizaje nutricional en pediatría validadas en Europa y Canadá

Abstract Introduction: Nutritional screening is a useful tool for determining the risk of hospital malnutrition; therefore, reviewing the guidelines on its use in the pediatric population is of great importance. Objective: To provide recommendations on the use of nutrition screening tools validated in Canada and Europe in the Colombian pediatric population. Materials and method: A systematic review was conducted using the PRISMA methodology. The quality of the evidence found in the review was assessed using the U.S. Preventive Services Task Force (USPSTF) tool, which was established by the Canadian Task Force on the Periodic Health Examination for assessing preventive actions. Results: Fifteen studies were included in the review as they met the inclusion criteria. In addition, 7 nutrition screening tools were identified (PYMS, iPYMS, PeDiSMART, PNR, STAMP, PMST and STRONGkids). According to guidelines of the European Society for Clinical Nutrition and Metabolism, the PYMS, iPYMS and STRONGkids tools simultaneously assess prognostic variables such as current nutritional status, stability, expected improvement or worsening of the condition, and the influence of the disease process in nutritional deterioration. Regarding concurrent validity, data analysis shows that PYMS, iPYMS and PMST have sensitivities >85%, and that PYMS has a specificity >85%. In terms of reproducibility, PEDISMART, STRONGkids, STAMP and PYMS have an acceptable interobserver agreement (k>0.41). Conclusion: Based on the evidence found, which was analyzed in terms of prognostic variables, concurrent validity and reproducibility, the use of the PYMS tool in the clinical practice is suggested. In contrast, hospitals must assess the applicability of the STAMP and iPYMS tools.

Resumen Introducción. El tamizaje nutricional es una herramienta efectiva que permite establecer el riesgo de desnutrición hospitalaria, por consiguiente es importante revisar las directrices respecto a su uso en pediatría. Objetivo. Ofrecer recomendaciones sobre el uso de las herramientas de tamizaje nutricional validadas en Canadá y Europa en población colombiana. Materiales y métodos. Se realizó una revisión sistemática siguiendo la metodología PRISMA. Para la evaluación de la calidad de la evidencia se utilizó la herramienta U.S Preventive Services Task Force, formulada para medir acciones preventivas por la Canadian Task Force on the Periodic Health Examination. Resultados. Se incluyeron 15 estudios que cumplían los criterios de selección y se identificaron 7 herramientas (PYMS, iPYMS, PeDiSMART, PNR, STAMP, PMST y STRONGkids). Según los lineamientos de la Sociedad Europea de Nutrición Clínica y Metabolismo, la PYMS, la iPYMS y la STRONGkids evalúan simultáneamente variables pronósticas como estado nutricional actual, estabilidad, progresión esperada e influencia de la enfermedad. En cuanto a validez concurrente, el análisis de datos muestra que la PYMS, la iPYMS y la PMST tienen sensibilidades >85% y que la PYMS tiene especificidad >85%. Respecto a reproducibilidad, la PEDISMART, la STRONGkids, la STAMP y la PYMS tienen una concordancia inter-observadores aceptable (k>0.41). Conclusión. Según la evidencia analizada en términos de variables pronósticas, validez concurrente y reproducibilidad, se sugiere el empleo en la práctica clínica de la herramienta PYMS, mientras que para el uso de la STAMP y la iPYMS las instituciones deben evaluar su aplicabilidad.

Empatia de médicos avaliada por meio da Jefferson Scale of Empathy (JSE) - Physician como marcador do cuidado centrado no paciente / Physician empathy evaluated by the Jefferson Scale of Empathy (JSE) - Physician as a marker of patient-centered care

A empatia é considerada um pilar do cuidado centrado na pessoa, de qualidade e seguro, que permite a consolidação de parcerias e melhores desfechos. O objetivo deste estudo foi a adaptação transcultural da Jefferson Scale of Empathy ­ Physician - JSE (versão para médicos) para a língua portuguesa e o contexto brasileiro. É o instrumento mais pesquisado e utilizado no mundo, com validações em outras culturas, no qual a empatia é um atributo predominantemente cognitivo e divide-se em três dimensões: assumir perspectivas diferentes; cuidado com compaixão e vivenciar o lugar do paciente (calçar os sapatos do paciente). Foram realizadas as etapas de equivalências conceitual, semântica (tradução, retradução, equivalência entre retraduções e o instrumento, revisão pelo grupo de especialistas), pré-teste (20 entrevistados), operacional e de mensuração - Análise Fatorial Exploratória (AFE) e Confirmatória (AFC) e, consequentemente, a funcional. A JSE foi aplicada de outubro de 2017 a março de 2018 no Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), hospital com longo caminho voltado à qualidade. Responderam 101 médicos, 75% do sexo masculino, com idades entre 24 a 66 anos (média: 39,3). Os valores dos escores variaram de 75 a 140, com média de 117,8 (Desvio padrão - DP:13,5); escores médios dos itens variaram de 6,7 (DP:0,77) a 4,3 (DP:1,82). A estimativa de confiabilidade da escala (Alpha de Cronbach) foi 0,794 (também foram satisfatórios os Alfa de Cronbach padronizado, Alpha ordinal, Theta de Armor e Theta ordinal). Para validade do construto, foi realizada AFE com três dimensões, com rotação ortogonal varimax, oito itens carregaram na primeira dimensão; quatro na segunda e três na terceira. Três itens (1, 8 e 19) apresentaram cargas fatoriais com valores próximos (<0,2) nos fatores 2 e 3, e o item 2 carregou nos fatores 1 e 3. Três fatores com eigenvalues ≥ 1,5 foram extraídos com ACP, que explicam 41,4% da variância total. A análise de Kaiser-Meyer-Olkin apresentou um índice de 0,67, o teste de esfericidade de Bartlett mostrou um valor igual a 1027,04 (p < 0,01), o teste Steiger igual a 1879,70 (p < 0,01) e o teste de Jennrich igual a 276,70 (p < 0,01), que indicam a adequação dos dados para a análise fatorial. As subescalas cuidado com compaixão e assumir perspectivas estavam fortemente correlacionadas (r: 0,627), bem como as escalas vivenciar o lugar do paciente e cuidado com compaixão (r: 0,494). Na análise fatorial confirmatória, o modelo com 20 variáveis dependentes e 3 variáveis latentes apresentou bons índices de ajuste: RMSEA = 0,050 (IC 90%: 0,023-0,070), CFI = 0,952, TLI = 0,945 e SRMR = 0,071. Em nenhum dos estudos que validaram a escala, com variações metodológicas, a mesma se comportou exatamente como no trabalho original. O peso do fator cultural entre os diversos povos ainda não está bem esclarecido. Este é o primeiro estudo brasileiro de validação da JSE (médicos), possui diversas limitações, com clara correlação com o construto. São necessários mais estudos com a mesma, para permitir sua utilização de forma sistemática no nosso meio e elaborar planos de melhorias em prol do cuidado centrado na pessoa

Empathy is considered a pillar of quality, safe, person-centered care, allowing partnerships, leading to better outcomes. The objective of this study was the cross - cultural adaptation of the Jefferson Scale of Empathy - Physician - JSE (version for physicians) to the Portuguese language and the Brazilian context. It is the most researched and used instrument in the world, with validations in other cultures, in which empathy is a predominantly cognitive attribute and is divided into three dimensions: assume different perspectives; care with compassion and experience the patient's place (put on the patient's shoes). The pre-test (20 interviewed), operational and measuring equivalents - Exploratory Factor Analysis (AFE) and Confirmatory (Analysis, Retranslation, Equivalence between retranslations and the instrument, review by the group of experts) were performed. AFC) and, consequently, functional. The JSE was applied from October 2017 to March 2018 at the National Institute of Traumatology and Orthopedics Jamil Haddad (INTO), a hospital with a long road to quality. A total of 101 doctors were male (75%) aged 24 to 66 years (mean: 39.3). The values of the scores ranged from 75 to 140, with a mean of 117.8 (Standard deviation - SD: 13.5); mean scores of items ranged from 6.7 (SD: 0.77) to 4.3 (SD: 1.82). The reliability estimate of the scale (Cronbach's Alpha) was 0.794 (the standard Cronbach's alpha, Alpha ordinal, Armor's Theta and Theta ordinal were also satisfactory). For the validity of the construct, three-dimensional AFE was performed, with orthogonal varimax rotation, eight items loaded in the first dimension; four in the second and three in the third. Three items (1, 8 and 19) presented factorial loads with close values (<0.2) in factors 2 and 3, and item 2 loaded on factors 1 and 3. Three factors with eigenvalues ≥ 1.5 were extracted with ACP , which explain 41.4% of the total variance. The Kaiser-Meyer-Olkin analysis presented an index of 0.67, the Bartlett sphericity test showed a value equal to 1027.04 (p <0.01), the Steiger test equal to 1879.70 (p <0) , 01), and the Jennrich test was 276.70 (p <0.01), which indicates the adequacy of the data for the factorial analysis. The compassionate and compassionate subscales were strongly correlated (r: 0.627), as well as the scales experiencing the patient's place and compassionate care (r: .494). In the confirmatory factor analysis, the model with 20 dependent variables and 3 latent variables had good adjustment indexes: RMSEA = 0.050 (IC 90%: 0.023-0.070), CFI = 0.952, TLI = 0.945 and SRMR = 0.071. In none of the studies that validated the scale, with methodological variations, it behaved exactly as in the original work. The weight of the cultural factor among the various peoples is still not clear. This is the first Brazilian validation study of JSE (physicians), and it has several limitations, but a clear correlation with the construct. Further studies are needed to enable it to be used systematically in our setting and to develop improvement plans for person-centered care

Historia del Hospital Universitario "Manuel Ascunce Domenech" / History of the University Hospital "Manuel Ascunce Domenech"

Fundamento: la historia del hospital Manuel Ascunce Domenech comenzó en 1946. Objetivo: Resaltar la importancia que tuvieron los trabajadores y decisores en la evolución histórica de la institución. Método: Es una investigación histórica basada en la investigación documental, se utiliza el submétodo cronológico para establecer el orden de los hechos que se describen. Se hicieron entrevistas a personalidades que laboran en el hospital desde o cercano a su fundación el 14 de enero de 1962 y se revisaron algunos artículos históricos publicados. Resultados: Fueron necesarios 16 años desde que el gobierno de turno en el 1946 procediera a la segregación y compraventa de una parcela de terreno para la construcción del Hospital hasta su inauguración. Solo con el triunfo de la revolución y la voluntad política se pudo terminar la obra. Conclusiones: El Hospital ha cumplido una importante función asistencial, docente, gerencial e investigativa.

Fundamental: the history of “Manuel Ascunce Domenech” hospital began in 1946.Objective: To highlight the importance that the workers and decision makers had in the historical evolution of the institution. Method: It is a historical research based on the documental research. The chronological sub method is used with the purpose to establish the order of the facts that are described here. Interviews to personalities that work in the hospital from or near the date of foundation on January 14, 1962 were made and some published historical articles were revised. Results: a period of 16 years was necessary since 1946 when the government of that moment proceeded to segregation, sale and purchase of a land parcel for the construction of the Hospital until its inauguration. The building work was possible to conclude just with the victory of the revolution and its political will. Conclusions: The Hospital has completed a staunch assistance, educational, managerial and investigative function.