[Prevalence, risk of progression and quality of life assessment in adolescents undergoing school screening for adolescent idopathic scoliosis]. / Prevalencia, riesgo de progresión y calidad de vida en estudiantes tamizados para escoliosis idiopática adolescente.

OBJECTIVE: To determine the prevalence of adolescent idiopathic scoliosis (AIS), progression risk, and quality of life in students aged from 10 to 18 years. PATIENTS AND METHOD: Cross-sectional descriptive study in students 10 - 18 years old from 5 communes in Santiago, Chile, between 2015-2016. Adam's Test was performed and the angle trunk rotation (ATR) at the thoracic, thoracolumbar, and lumbar levels were measured with a scoliometer. If ATR was ≥ 6°, anteroposterior and lateral radiological images of the spine were taken, and Cobb angle was measured. Scoliosis was confirmed if the Cobb angle was ≥ 10° plus vertebral rotation. Progression factor was calculated with Lonstein and Carlson formula. Quality of life was assessed through spinal deformities questionnaires and the trunk appearance perception scale. RESULTS: 1200 students were evaluated, 54.9% were female, and 8.17% had ATR ≥ 6°. We found mild scoliosis in 2.91%, moderate in 0.75% and severe in 0.17%. Total prevalence was 3.83% (CI 95%: 2.74 - 4.92). 82.61% of the cases had a late diagnosis, after their growth spurt. Of the patients with scoliosis, 21.74% had a progression risk ≥ 50%. Quality of life had a positive correlation with scoliosis severity, not statistically significant. CONCLUSIONS: Prevalence of AIS was 3.83%. Most patients were diagnosed after their growth spurt with high progression risk. Quality of life showed a weak positive correlation with scoliosis severity.

Estimación de la eficiencia del uso de pabellones electivos en el sistema de salud público chileno entre 2018 y 2021. / Efficiency estimation on the use of elective surgical theaters in the Chilean public health system from 2018 to 2021.

Objective: The efficient use of wards intended for elective surgeries is essential to resolve cases on the surgical waiting list. This study aims to estimate the efficiency of ward use in the Chilean public health system between 2018 and 2021. Methods: The design was an ecological study. Section A.21 of the database constructed by the monthly statistical summaries that each public health network facility reported to the Ministry of Health between 2018 and 2021 was analyzed. Data from subsections A, E and F were extracted: ward staffing, total elective surgeries by specialty, number and causes of suspension of elective surgeries. Then, the surgical performance during working hours and the percentage of hourly occupancy for a working day was estimated. Additionally, an analysis was made by region with data from 2021. Results: The percentage of elective wards in use ranged from 81.1% to 94.1%, while those enabled for those staffing ranged from 70.5% to 90.4% during 2018 and 2021. The total number of surgeries was highest in 2019 (n = 416 339), but for 2018, 2020, and 2021 it ranged from 259 000 to 297 000. Suspensions varied between 10.8% (2019) and 6.9% (2021), with the leading cause being patient-related. When analyzing the number of cases canceled monthly by facility, we saw that the leading cause was trade union-related. The maximum throughput of a ward intended for elective surgery was reached in 2019 and was 2.5 surgeries; in 2018, 2020 and 2021, the throughput borders on two surgeries per ward enabled for elective surgery. The percentage of ward time occupied during working hours by contract day varies between 80.7% (2018) and 56.8% (2020). Conclusions: All the parameters found and estimated in this study show that there is an inefficient utilization of operating rooms in Chilean public healthcare facilities.

Objetivo: El uso eficiente de pabellones destinados a cirugías electivas es fundamental para resolver patologías en lista de espera quirúrgica. El objetivo general de este estudio es estimar la eficiencia del uso de pabellones en el sistema de salud público de Chile entre los años 2018 y 2021. Métodos: El diseño fue un estudio ecológico. Se analizó la Sección A.21 de la base de datos construida por los resúmenes estadísticos mensuales que cada establecimiento de la red de salud pública reportó al Ministerio de Salud de Chile entre 2018 y 2021. Se extrajeron los datos de la subsección A, E y F: dotación de pabellones, total de cirugías electivas por especialidad, número y causas de suspensión de cirugías electivas. Luego se estimó el rendimiento quirúrgico en horario hábil y el porcentaje de ocupación horaria respecto de una jornada laboral. Adicionalmente, se hizo un análisis por región con datos de 2021. Resultados: El porcentaje de pabellones electivos respecto de los en dotación varió entre 81,1 y 94,1%; mientras que los habilitados respecto de los en dotación varió entre 70,5 y 90,4% durante 2018 y 2021. El número total de cirugías fue más alto en 2019 (n = 416 339), pero en 2018, 2020 y 2021 variaron entre 259 y 297 mil cirugías. Las suspensiones varían entre 10,8 (2019) y 6,9%w(2021), siendo la principal causa de suspensión atribuida al "paciente". Al analizar la cantidad de pacientes suspendidos mensualmente por institución, se observa que la principal causa es "gremial". El rendimiento máximo de un pabellón destinado a cirugía electiva se alcanzó en 2019 y fue de 2,5 cirugías; mientras que en 2018, 2020 y 2021 el rendimiento bordea las dos cirugías por pabellón habilitado para cirugía electiva. El porcentaje de tiempo de pabellón ocupado en horario hábil respecto a una jornada de contrato varía entre 80,7 (2018) y 56,8% (2020). Conclusiones: Todos los parámetros encontrados y estimados en este estudio muestran que el uso de pabellones en el sistema público de Chile es ineficiente.

Estimación de la eficiencia del uso de pabellones electivos en el sistema de salud público chileno entre 2018 y 2021 / Efficiency estimation on the use of elective surgical theaters in the Chilean public health system from 2018 to 2021

Objective The efficient use of wards intended for elective surgeries is essential to resolve cases on the surgical waiting list. This study aims to estimate the efficiency of ward use in the Chilean public health system between 2018 and 2021. Methods The design was an ecological study. Section A.21 of the database constructed by the monthly statistical summaries that each public health network facility reported to the Ministry of Health between 2018 and 2021 was analyzed. Data from subsections A, E and F were extracted: ward staffing, total elective surgeries by specialty, number and causes of suspension of elective surgeries. Then, the surgical performance during working hours and the percentage of hourly occupancy for a working day was estimated. Additionally, an analysis was made by region with data from 2021. Results The percentage of elective wards in use ranged from 81.1% to 94.1%, while those enabled for those staffing ranged from 70.5% to 90.4% during 2018 and 2021. The total number of surgeries was highest in 2019 (n = 416 339), but for 2018, 2020, and 2021 it ranged from 259 000 to 297 000. Suspensions varied between 10.8% (2019) and 6.9% (2021), with the leading cause being patient-related. When analyzing the number of cases canceled monthly by facility, we saw that the leading cause was trade union-related. The maximum throughput of a ward intended for elective surgery was reached in 2019 and was 2.5 surgeries; in 2018, 2020 and 2021, the throughput borders on two surgeries per ward enabled for elective surgery. The percentage of ward time occupied during working hours by contract day varies between 80.7% (2018) and 56.8% (2020). Conclusions All the parameters found and estimated in this study show that there is an inefficient utilization of operating rooms in Chilean public healthcare facilities.

Objetivo El uso eficiente de pabellones destinados a cirugías electivas es fundamental para resolver patologías en lista de espera quirúrgica. El objetivo general de este estudio es estimar la eficiencia del uso de pabellones en el sistema de salud público de Chile entre los años 2018 y 2021. Métodos El diseño fue un estudio ecológico. Se analizó la Sección A.21 de la base de datos construida por los resúmenes estadísticos mensuales que cada establecimiento de la red de salud pública reportó al Ministerio de Salud de Chile entre 2018 y 2021. Se extrajeron los datos de la subsección A, E y F: dotación de pabellones, total de cirugías electivas por especialidad, número y causas de suspensión de cirugías electivas. Luego se estimó el rendimiento quirúrgico en horario hábil y el porcentaje de ocupación horaria respecto de una jornada laboral. Adicionalmente, se hizo un análisis por región con datos de 2021. Resultados El porcentaje de pabellones electivos respecto de los en dotación varió entre 81,1 y 94,1%; mientras que los habilitados respecto de los en dotación varió entre 70,5 y 90,4% durante 2018 y 2021. El número total de cirugías fue más alto en 2019 (n = 416 339), pero en 2018, 2020 y 2021 variaron entre 259 y 297 mil cirugías. Las suspensiones varían entre 10,8 (2019) y 6,9%w(2021), siendo la principal causa de suspensión atribuida al "paciente". Al analizar la cantidad de pacientes suspendidos mensualmente por institución, se observa que la principal causa es "gremial". El rendimiento máximo de un pabellón destinado a cirugía electiva se alcanzó en 2019 y fue de 2,5 cirugías; mientras que en 2018, 2020 y 2021 el rendimiento bordea las dos cirugías por pabellón habilitado para cirugía electiva. El porcentaje de tiempo de pabellón ocupado en horario hábil respecto a una jornada de contrato varía entre 80,7 (2018) y 56,8% (2020). Conclusiones Todos los parámetros encontrados y estimados en este estudio muestran que el uso de pabellones en el sistema público de Chile es ineficiente.

Radiografía al acceso en artroplastia de rodilla entre los beneficiarios del Fondo Nacional de Salud entre 2004 y 2021 / Access to knee arthroplasty among National Health Fund beneficiaries in Chile between 2004 and 2021

Introducción La artrosis de rodilla es una patología que afecta la calidad de vida, siendo la artroplastía de rodilla un tratamiento costo-efectivo para la etapa severa de esta enfermedad. El acceso a artroplastia de rodilla es un indicador de salud de la Organización de Cooperación y Desarrollo Económico. Los objetivos de este estudio son determinar la incidencia de artroplastia de rodilla entre 2004 y 2021 en los beneficiarios del Fondo Nacional de Salud en Chile, la proporción que se operaron en el sistema privado y estimar el gasto del bolsillo del paciente para operarse. Método Estudio transversal. Se utilizó la base de datos del Departamento de Estadística e Información de Salud. Se pesquisaron pacientes que egresaron de un centro de salud chileno que fueron intervenidos por artroplastia rodilla entre 2004 y 2021. Se analizó la proporción de pacientes por tramo del Fondo Nacional de Salud y si se realizó su cirugía en establecimiento de la red pública o privada. Resultados De las 31 526 intervenciones de artroplastia de rodilla, 21 248 (67,38%) fueron realizadas en pacientes del Fondo Nacional de Salud y 16 238 en instituciones públicas (51,49%). Los pacientes de dicho fondo presentan un alza sistemática en el volumen de artroplastías de rodilla hasta 2019, pero disminuyeron en 2020 y 2021 un 68% y un 51%. Del total de pacientes del sistema público operados de artroplastia de rodilla, 856 (9%) pertenecían al tramo A1, al tramo B 12 806 (60%), al tramo C 2044 (10%) y al tramo D 4421 (21%). Se estimó que el gasto incurrido por estos pacientes varía entre el 24,4 y 27,2%. Las proporciones históricas de acceso en instituciones privadas a esta cirugía son en el tramo A 7%, tramo B 13%, tramo C 24% y tramo D 52%. Conclusión El 50% de las cirugías de artroplastía de rodilla se realizan en instituciones públicas y dos tercios se realizan en pacientes del Fondo Nacional de Salud. El 46% de los tramos C y D se operaron en el sistema privado. La pandemia ha aumentado la brecha de acceso, lo que ha provocado un alza significativa en la proporción de pacientes del Fondo Nacional de Salud de los tramos B, C y D que han migrado al sistema privado para acceder a esta cirugía.

Introduction Knee osteoarthritis affects the quality of life, with knee arthroplasty being a cost-effective treatment for the severe stage of this disease. Access to knee arthroplasty is a health indicator of the Organisation for Economic Co-operation and Development. The objectives of this study are to determine the incidence of knee arthroplasty between 2004 and 2021 in beneficiaries of the National Health Fund in Chile, the proportion of patients who underwent surgery in the private system, and to estimate the patient's out-of-pocket expenditure for surgery. Methods Cross-sectional study. We used the Department of Statistics and Health Information database. Patients discharged from a Chilean health center who underwent knee arthroplasty surgery between 2004 and 2021 were investigated. We analyzed the proportion of patients by their National Health Fund category and whether their surgery was performed in public or private network facilities. Results Of the 31 526 knee arthroplasty procedures, 21 248 (67.38%) were performed on National Health Fund patients and 16 238 in public institutions (51.49%). Patients from the National Health Fund showed a systematic increase in knee arthroplasty volume until 2019 but decreased in 2020 and 2021 by 68% and 51%. Of the total number of patients in the public system operated on for knee arthroplasty, 856 (9%) belonged to group A1, 12 806 (60%) to group B, 2044 (10%) to group C, and 4421 (21%) to group D. The expenditure incurred by these patients was estimated to vary between 24.4% and 27.2%. The historical proportions of access to this surgery in private institutions are 7% in group A, 13% in group B, 24% in group C, and 52% in group D. Conclusion Fifty percent of knee arthroplasty surgeries are performed in public institutions, and two-thirds are performed on patients of the National Health Fund. Forty-six percent of the C and D groups were operated in the private system. The pandemic has increased the access gap, leading to a substantial increase in the proportion of patients from the National Health Fund of the B, C, and D groups who have migrated to the private system to access this surgery.

Access to knee arthroplasty among National Health Fund beneficiaries in Chile between 2004 and 2021. / Radiografía al acceso en artroplastia de rodilla entre los beneficiarios del Fondo Nacional de Salud entre 2004 y 2021.

Introduction: Knee osteoarthritis affects the quality of life, with knee arthroplasty being a cost-effective treatment for the severe stage of this disease. Access to knee arthroplasty is a health indicator of the Organisation for Economic Co-operation and Development. The objectives of this study are to determine the incidence of knee arthroplasty between 2004 and 2021 in beneficiaries of the National Health Fund in Chile, the proportion of patients who underwent surgery in the private system, and to estimate the patient's out-of-pocket expenditure for surgery. Methods: Cross-sectional study. We used the Department of Statistics and Health Information database. Patients discharged from a Chilean health center who underwent knee arthroplasty surgery between 2004 and 2021 were investigated. We analyzed the proportion of patients by their National Health Fund category and whether their surgery was performed in public or private network facilities. Results: Of the 31 526 knee arthroplasty procedures, 21 248 (67.38%) were performed on National Health Fund patients and 16 238 in public institutions (51.49%). Patients from the National Health Fund showed a systematic increase in knee arthroplasty volume until 2019 but decreased in 2020 and 2021 by 68% and 51%. Of the total number of patients in the public system operated on for knee arthroplasty, 856 (9%) belonged to group A1, 12 806 (60%) to group B, 2044 (10%) to group C, and 4421 (21%) to group D. The expenditure incurred by these patients was estimated to vary between 24.4% and 27.2%. The historical proportions of access to this surgery in private institutions are 7% in group A, 13% in group B, 24% in group C, and 52% in group D. Conclusion: Fifty percent of knee arthroplasty surgeries are performed in public institutions, and two-thirds are performed on patients of the National Health Fund. Forty-six percent of the C and D groups were operated in the private system. The pandemic has increased the access gap, leading to a substantial increase in the proportion of patients from the National Health Fund of the B, C, and D groups who have migrated to the private system to access this surgery.

Introducción: La artrosis de rodilla es una patología que afecta la calidad de vida, siendo la artroplastía de rodilla un tratamiento costo-efectivo para la etapa severa de esta enfermedad. El acceso a artroplastia de rodilla es un indicador de salud de la Organización de Cooperación y Desarrollo Económico. Los objetivos de este estudio son determinar la incidencia de artroplastia de rodilla entre 2004 y 2021 en los beneficiarios del Fondo Nacional de Salud en Chile, la proporción que se operaron en el sistema privado y estimar el gasto del bolsillo del paciente para operarse. Método: Estudio transversal. Se utilizó la base de datos del Departamento de Estadística e Información de Salud. Se pesquisaron pacientes que egresaron de un centro de salud chileno que fueron intervenidos por artroplastia rodilla entre 2004 y 2021. Se analizó la proporción de pacientes por tramo del Fondo Nacional de Salud y si se realizó su cirugía en establecimiento de la red pública o privada. Resultados: De las 31 526 intervenciones de artroplastia de rodilla, 21 248 (67,38%) fueron realizadas en pacientes del Fondo Nacional de Salud y 16 238 en instituciones públicas (51,49%). Los pacientes de dicho fondo presentan un alza sistemática en el volumen de artroplastías de rodilla hasta 2019, pero disminuyeron en 2020 y 2021 un 68% y un 51%. Del total de pacientes del sistema público operados de artroplastia de rodilla, 856 (9%) pertenecían al tramo A1, al tramo B 12 806 (60%), al tramo C 2044 (10%) y al tramo D 4421 (21%). Se estimó que el gasto incurrido por estos pacientes varía entre el 24,4 y 27,2%. Las proporciones históricas de acceso en instituciones privadas a esta cirugía son en el tramo A 7%, tramo B 13%, tramo C 24% y tramo D 52%. Conclusión: El 50% de las cirugías de artroplastía de rodilla se realizan en instituciones públicas y dos tercios se realizan en pacientes del Fondo Nacional de Salud. El 46% de los tramos C y D se operaron en el sistema privado. La pandemia ha aumentado la brecha de acceso, lo que ha provocado un alza significativa en la proporción de pacientes del Fondo Nacional de Salud de los tramos B, C y D que han migrado al sistema privado para acceder a esta cirugía.

Inter-observer reliability of trained physiotherapists on the Functional Status Score for the Intensive Care Unit Chilean-Spanish version.

Purpose: Evaluate inter-observer reliability of trained physiotherapists administering the Chilean-Spanish version of the Functional Status Score for the Intensive Care Unit (FSS-ICU).Methods: Six adult patients in a medical-surgical ICU were assessed and video-recorded by 1 of 2 expert physiotherapists. Twelve physiotherapists were then trained using recommended Spanish-language FSS-ICU materials. The 12 physiotherapists independently scored the FSS-ICU for the 6 video-recorded patients. Intraclass Correlation Coefficient (ICC) was used to evaluate the inter-observer reliability, and modified Bland-Altman plots evaluated agreement between the physiotherapists and experts.Results: This study was performed between May and August 2018. The FSS-ICU total score had a median score of 18 (range: 6 to 34) for the 6 patients. The ICC of the total score was 0.96 (95% CI, 0.92 to 1.00), and for each of the 5 individual FSS-ICU tasks, the ICC ranged between 0.87 and 0.92. The modified Bland-Altman plot revealed a mean difference of 0.6 (95% limits of agreement: -3.3 to 4.5).Conclusions: Twelve trained physiotherapists had excellent inter-observer reliability when administering the Chilean-Spanish FSS-ICU using videos of six critically ill patients, and had excellent agreement with an expert, revealing differences within the established minimal important difference. These findings provide new data supporting clinimetric properties of the Chilean-Spanish FSS-ICU.

Herramientas de evaluación de actividades de la vida diaria instrumentales en población adulta: revisión sistemática / Tools for the evaluation of daily life activities instrumental in adults: systematic review

Introducción: La transición al modelo biopsicosocial implica que las herramientas de evaluación se adapten a esta nueva visión de la salud. Las herramientas usadas en Chile para medir la funcionalidad en las actividades de la vida diaria instrumentales (AVDI) son las mismas desde los años 50, por lo que se requiere hacer una revisión de la literatura a fin de conocer nuevas metodologías de evaluación en la materia. Objetivo: Identificar las herramientas de evaluación en AVDI, qué ítems son considerados, metodología de puntuación (rangos, puntajes, categorización de resultados), tiempo y contexto de aplicación, creadores de las herramientas y propiedades psicométricas de los mismos. Diseño: Revisión sistemática. Fuentes de datos: PubMed, BIREME y Epistemonikos. Se realizaron tres búsquedas: dos el 2018 (marzo y septiembre) y una el 2020 (diciembre). Selección de estudios: Estudios observacionales (estudios de cohorte y estudios de corte transversal) y revisiones sistemáticas que contemplaron la valoración de AVDI en mayores de 18 años, en inglés o español, publicados desde 1998 y de libre acceso. Extracción de datos: Se realizó lectura de títulos y resúmenes como primer filtro, y posteriormente el texto completo. Una vez seleccionados los estudios que cumplen con los criterios de inclusión, se les aplicó la pauta "Strengthening The Reporting of Observational studies in Epidemiology (STROBE)" y la pauta "Critical Appraisal Skills Programme Spanish (CASPe)" para evaluar la calidad metodológica. Se estableció, a través de un consenso de las investigadoras, que cada estudio seleccionado debía cumplir con al menos 13 de los 22 ítems de la pauta STROBE. Resultados: De los 27.606 artículos encontrados, 15 cumplieron con los criterios de inclusión y el punto de corte establecido de la pauta. Sólo un artículo era en idioma español y 14 en inglés; y fueron publicados principalmente en EE.UU. y España. De los 20 instrumentos encontrados en los artículos seleccionados, el 60% corresponde a la "Escala Lawton y Brody", el 10% a la de "The Performance Assessment of Self-Care Skills (PASS)" y el porcentaje restante otras herramientas. Conclusiones: A nivel internacional se han creado nuevas herramientas de evaluación de AVDI en respuesta a necesidades locales, dificultando la posibilidad de ser generalizadas a otros contextos sin contar previamente con un proceso de validación transcultural y estadística que resguarde la confiabilidad de su aplicación y data. La "Escala de Lawton y Brody", pese a las limitaciones ni sesgos, sigue siendo un patrón de oro a nivel internacional.

Background: The transition to the biopsychosocial model implies that the assessment tools are adapted to this new vision of health. In Chile, the evaluations to measure functionality on Instrumental Activities of Daily Living (IADL), have been the same since the 1950s, so a review of the literature is required to know new evaluation tools in the matter. Aim: To identify the evaluation tools that exist to assess the functionality in AVDI, what items are considered, scoring methodology (rank, score, categorization of results), time and in which contexts they are applied, assessment creators and psychometric properties. Design: Systematic review. Data sources: PubMed, BIREME and Epistemonikos. Three searches were carried out: two in 2018 (March and September) and one in 2020 (December). Study selection: Observational studies (cohort studies and cross-sectional studies) and Systematic Reviews that contemplated the assessment of IADL in people over 18 years of age, in English or Spanish, published since 1998 and open access. Data extraction: Titles and abstracts were read as a first filter, followed by the full text. Once the studies that met the inclusion criteria had been selected, the "Strengthening The Reporting of Observational studies in Epidemiology (STROBE)" and "Critical Appraisal Skills Programme Spanish (CASPe)" guideline was applied to assess methodological quality. It was established, through a consensus of the researchers, that each selected study had to comply with at least 13 of the 22 items of STROBE guideline. Results: Of the 27.606 articles found, 15 met the inclusion criteria and the established cut-off point of the guideline. One article was written in Spanish and 14 in English, which were carried out mainly in the United States and Spain (3 out of 15 respectively). Of the 20 instruments found in the selected articles, 60% correspond to "Lawton & Brody Scale", 10% to "The Performance Assessment of Self-Care Skills (PASS)" and the remaining percentage other tools. Conclusions: At an international level, new IADL assessment tools have been created in response to local needs, making it difficult to generalize to other contexts without previously having a cross-cultural and statistical validation process that safeguards the reliability of its application and data. The "Lawton s Brody Scale", despite its limitations and biases, remains an international gold standard.

Adolescent Lifestyle Profile-Revised 2: validity and reliability among adolescents in Chile

Abstract Objective: The aims of this study were twofold. First, to provide evidence of the validity and reliability of the Adolescent Lifestyle Profile-Revised 2 (ALP-R2) among adolescents in Chile; and second, to examine the relationship between the health-promoting behaviors measured by this scale and several demographic variables. Methods: Cross-sectional survey. Students attending grades 9 through 12 from schools representing low-, middle-, and high-income families were included. All schools were in the city of San Felipe, Chile. Students completed the ALP-R2, a fourty-four-item scale aiming to assess health-promoting behaviors. To evaluate validity and reliability, confirmatory factor analysis and omega coefficient calculation were conducted, respectively. Results: The sample size was 572 students (82.5% of the eligible population). More males (56.6%) than females (43.4%) participated in the study, and the mean age was 16.4 (SD, 1.3) years. The ALP-R2 had adequate adjustment indicators in the confirmatory factor analysis, which means that the data supports the original theoretical model (seven subscales). The highest internal consistency was obtained for the total scale (Ω = 0.87); and (among the subscales), physical activity (Ω = 0.85) and spiritual health (Ω = 0.78) had the highest reliability. Conclusions: The ALP-R2 appears to be a valid and reliable instrument to assess health-promoting behaviors among adolescents attending secondary schools.

[Reduction of reconciliation errors in chronic pediatric patients through an educational strategy]. / Reducción de errores de conciliación en pacientes crónicos pediátricos mediante una estrategia educativa.

BACKGROUND: Medication reconciliation errors, also known as unintentional discrepancies, are frequent during admission, especially in chronic patients, and have an impact on safety. Educational interventions can be a reduction strategy. MATERIAL AND METHODS: Quasi-experimental study, before-after design. Participants were chronic patients admitted into hospitalization services. Medication reconciliation was conducted at admission. The intervention consisted of a training to each prescribing physician with study contents and printed educational material. To study the association between intervention and change of frequency of unintentional discrepancies was made a logistic regression model, adjusting for selected variables. RESULTS: A sample of 54 patients was studied in each stage. In the first stage it was observed that 42.6% of patients had at least one unintentional discrepancy. After intervention the proportion of patients with at least one unintentional discrepancy decreased to 24.1% (p = 0.041). In both stages, omission was the main category of unintentional discrepancy. The significant reduction after the intervention is maintained by controlling for variables such as emergency admission and pre-admission service. CONCLUSIONS: Incidence of unintentional discrepancies in admission is high in chronic hospitalized patients and can be reduced through an educative strategy.

Adolescent Lifestyle Profile-Revised 2: validity and reliability among adolescents in Chile.

OBJECTIVE: The aims of this study were twofold. First, to provide evidence of the validity and reliability of the Adolescent Lifestyle Profile-Revised 2 (ALP-R2) among adolescents in Chile; and second, to examine the relationship between the health-promoting behaviors measured by this scale and several demographic variables. METHODS: Cross-sectional survey. Students attending grades 9 through 12 from schools representing low-, middle-, and high-income families were included. All schools were in the city of San Felipe, Chile. Students completed the ALP-R2, a fourty-four-item scale aiming to assess health-promoting behaviors. To evaluate validity and reliability, confirmatory factor analysis and omega coefficient calculation were conducted, respectively. RESULTS: The sample size was 572 students (82.5% of the eligible population). More males (56.6%) than females (43.4%) participated in the study, and the mean age was 16.4 (SD, 1.3) years. The ALP-R2 had adequate adjustment indicators in the confirmatory factor analysis, which means that the data supports the original theoretical model (seven subscales). The highest internal consistency was obtained for the total scale (Ω=0.87); and (among the subscales), physical activity (Ω=0.85) and spiritual health (Ω=0.78) had the highest reliability. CONCLUSIONS: The ALP-R2 appears to be a valid and reliable instrument to assess health-promoting behaviors among adolescents attending secondary schools.

Riesgo de infección en pacientes con enfermedades inmunológicas y oncológicas tratados con biológicos: revisión panorámica

Biological medications are effective for the treatment of cancer and inflammatory diseases. The aim of this review is to summarize the available evidence in systematic reviews or meta-analyses about the risk of infection in patients with cancer, arthritis, psoriasis and inflammatory bowel disease who use biological medications. We included systematic reviews or meta-analyses of controlled clinical trials and case/control studies that analyze infections during and after treatment with FDA-approved biological medications for the treatment of cancer, arthritis, inflammatory bowel disease and psoriasis, both in adults and children. The following databases were consulted: PubMed, Epistemonikos, Crochrane reviews, JIB, and Prospero. A quality guideline (AMSTAR) was applied to the selected studies. We included 26 studies. The risk of infections in patients with solid organ cancer is consistent in the literature. In psoriasis there is a risk of non-serious infections. In arthritis and other inflammatory diseases there is a risk of serious infections. In inflammatory bowel disease there is a risk for opportunistic infections. In conclusion, in patients with cancer and inflammatory diseases use biological medications entails a risk of infection. The evidence is different depending on the underlying disease of each patient.

Caracterización de incontinencia urinaria en mujeres premenopáusicas con cáncer de mama en tratamiento con tamoxifeno por cinco años en el Instituto Nacional del Cáncer / Characterization of urinary incontinence in pre-menopausal women with breast cancer treated with tamoxifen for 5 years at the National Cancer Institute

INTRODUCCIÓN El cáncer de mama es el tipo de cáncer que se diagnostica con mayor frecuencia en mujeres y la segunda causa más común de muerte por cáncer en este género. Dentro de las indicaciones de tratamiento, se encuentran: cirugía, radioterapia, quimioterapia y terapia endocrina. Esta última se basa en el uso de tamoxifeno, cuyo uso de forma prolongada puede producir efectos secundarios como sequedad vaginal, ardor, irritación, picazón, disuria, incontinencia urinaria, entre otros OBJETIVO Caracterizar la incontinencia urinaria en mujeres premenopáusicas con cáncer de mama en tratamiento con tamoxifeno por 5 años en el Instituto Nacional del Cáncer MATERIAL Y MÉTODO Estudio descriptivo de corte transversal. Se incluyeron mujeres diagnosticadas con cáncer de mama inscritas y tratadas en el Instituto Nacional del Cáncer. Se aplicó cuestionario ICIQ ­SF a la población de estudio con el fin de caracterizar la presencia de incontinencia urinaria. Además, se calculó la proporción entre mujeres con incontinencia urinaria y nuliparidad/mujeres con incontinencia urinaria y paridad RESULTADOS Se evaluaron 15 pacientes. 93,33% presentaron incontinencia urinaria. El promedio de edad de mujeres con incontinencia urinaria fue de 51,21 (± 4,74) años. La razón de mujeres con nuliparidad/con paridad fue de 4:15 CONCLUSIÓN 99,33% de las pacientes presentaron incontinencia urinaria. Los resultados entregados en este estudio deben ser considerados como un elemento que contribuya a detectar la magnitud del problema en la población inscrita y tratada en el Instituto Nacional del Cáncer.

BACKGROUND Breast cancer is the type of cancer diagnosed most frequently in women, and the second most common cause of death from cancer in this gender. Within the indications of treatment, they are: surgery, radiotherapy, chemotherapy and endocrine therapy. The last is based on the use of tamoxifen, whose prolonged use can produce side effects such as vaginal dryness, burning, irritation, itching, dysuria, urinary incontinence, among others OBJECTIVE To characterize urinary incontinence in pre-menopausal women with breast cancer treated with tamoxifen for 5 years at the Instituto Nacional del Cáncer MATERIAL AND METHOD Descriptive cross-sectional study. We included women diagnosed with breast cancer enrolled and treated at the Instituto Nacional del Cáncer. The ICIQ -SF questionnaire was applied to the study population to characterize the presence of urinary incontinence. In addition, the proportion between women with urinary incontinence and nulliparity / women with urinary incontinence and parity was calculated RESULTS 93,33% presented urinary incontinence. The average age of women with urinary incontinence was 51,21 (± 4,74) years. The ratio of women with nulliparity / with parity was 4:15 CONCLUSION 99,33% of the patients presented urinary incontinence. The results delivered in this study should be considered as one element that helps to detect the magnitude of this problem in the population registered and treated in the Instituto Nacional del Cáncer. Keywords:

[Risk of infections associated with the use of biological medications; a review]. / Riesgo de infección en pacientes con enfermedades inmunológicas y oncológicas tratados con biológicos: revisión panorámica.

Biological medications are effective for the treatment of cancer and inflammatory diseases. The aim of this review is to summarize the available evidence in systematic reviews or meta-analyses about the risk of infection in patients with cancer, arthritis, psoriasis and inflammatory bowel disease who use biological medications. We included systematic reviews or meta-analyses of controlled clinical trials and case/control studies that analyze infections during and after treatment with FDA-approved biological medications for the treatment of cancer, arthritis, inflammatory bowel disease and psoriasis, both in adults and children. The following databases were consulted: PubMed, Epistemonikos, Crochrane reviews, JIB, and Prospero. A quality guideline (AMSTAR) was applied to the selected studies. We included 26 studies. The risk of infections in patients with solid organ cancer is consistent in the literature. In psoriasis there is a risk of non-serious infections. In arthritis and other inflammatory diseases there is a risk of serious infections. In inflammatory bowel disease there is a risk for opportunistic infections. In conclusion, in patients with cancer and inflammatory diseases use biological medications entails a risk of infection. The evidence is different depending on the underlying disease of each patient.

[Predictive model preparation for surgical wound infection in adult patients undergoing total hip arthroplasty in high complexity hospital for years 2012 and 2014]. / Confección de un modelo predictor para infección de herida operatoria en pacientes adultos intervenidos de artroplastía total de cadera en un hospital de alta complejidad, años 2012 y 2014.

INTRODUCTION: Operative wound infections of patients undergoing total hip arthroplasty have an incidence from 2% to 5%, generating impact on hospital stay, resource use, prolonged antibiotic therapy, including temporary or definitive sequelae. OBJECTIVE: To generate a predictive model for surgical wound infection in patients undergoing total hip arthroplasty between 2012 and 2014 at the High Complexity Hospital. MATERIAL AND METHOD: Cohort of patients with total hip arthroplasty. A description of the epidemiological variables was made and a predictive model was generated by means of logistic regression. RESULTS: 441 patients were analyzed. The predictive model obtained included the variables: days of post-operative stay (OR 1.11 IC95% [1.03 - 1.20]), transfusion of at least one unit of red blood cells (OR 3.13 IC95% [1.17 - 10.86]), diagnosis of previous depression to surgery (OR 5.75 IC95% [1.32 - 25.32], non-compliance with antibioprophylaxis administration time (OR 5.46 IC95% [1.68 - 17.78], P < 0.001) and pseudo R2 = 0.2293. Score point of 13 points with sensitivity 44.4%, specificity of 91.6%, LR (+) 5.29, LR (-) 0.61, 1 to 6 points "low risk", 7 to 12 points "medium risk", 13 to 18 points "high risk", from 19 points as "maximum risk". CONCLUSION: the model presents a good predictive capacity of operative wound infection and adequately represents the cohort under study.

Confección de un modelo predictor para infección de herida operatoria en pacientes adultos intervenidos de artroplastía total de cadera en un hospital de alta complejidad, años 2012 y 2014 / Predictive model preparation for surgical wound infection in adult patients undergoing total hip arthroplasty in high complexity hospital for years 2012 and 2014

Resumen Introducción: Las infecciones de herida operatoria de pacientes intervenidos de artroplastía total de cadera, presentan una incidencia desde 2 a 5%, generando impacto en la estadía hospitalaria, uso de recursos, antibioterapia prolongada y secuelas temporales o definitivas. Objetivo: Generar un modelo predictivo para la infección de herida operatoria en pacientes intervenidos de artroplastía total de cadera, entre los años 2012 y 2014, en un hospital de alta complejidad. Material y Método: Cohorte de pacientes con artroplastía total de cadera. Se efectuó la descripción de las variables epidemiológicas y se generó un modelo predictivo por regresión logística. Resultados: Se analizaron 441 pacientes. El modelo predictivo obtenido incluyó las variables: días de estadía post operatoria (OR 1,11 IC95% [1,03-1,20]), transfusión de al menos una unidad de glóbulos rojos (OR 3,13 IC95% [1,17-10,86]), diagnóstico de depresión previo a la cirugía (OR 5,75 IC95% [1,32-25,32], incumplimiento del tiempo de administración de la antibioprofilaxis (OR 5,46 IC95% [1,68-17,78]; p < 0,001) y pseudo R2 = 0,2293. Punto de corte de "score" de 13 puntos con sensibilidad 44,4%, especificidad de 91,6%, LR (+) 5,29, LR (-) 0,61, considerando además la siguiente clasificación: 1 a 6 puntos "bajo riesgo", 7 a 12 puntos "mediano riesgo", 13 a 18 puntos "alto riesgo", desde 19 puntos como "máximo riesgo". Conclusión: El modelo presenta una buena capacidad de predicción de infección de herida operatoria y representa adecuadamente a la cohorte en estudio.

Introduction: Operative wound infections of patients undergoing total hip arthroplasty have an incidence from 2% to 5%, generating impact on hospital stay, resource use, prolonged antibiotic therapy, including temporary or definitive sequelae. Objective: To generate a predictive model for surgical wound infection in patients undergoing total hip arthroplasty between 2012 and 2014 at the High Complexity Hospital. Material and Method: Cohort of patients with total hip arthroplasty. A description of the epidemiological variables was made and a predictive model was generated by means of logistic regression. Results: 441 patients were analyzed. The predictive model obtained included the variables: days of post-operative stay (OR 1.11 IC95% [1.03 - 1.20]), transfusion of at least one unit of red blood cells (OR 3.13 IC95% [1.17 - 10.86]), diagnosis of previous depression to surgery (OR 5.75 IC95% [1.32 - 25.32], non-compliance with antibioprophylaxis administration time (OR 5.46 IC95% [1.68 - 17.78], P < 0.001) and pseudo R2 = 0.2293. Score point of 13 points with sensitivity 44.4%, specificity of 91.6%, LR (+) 5.29, LR (-) 0.61, 1 to 6 points "low risk", 7 to 12 points "medium risk", 13 to 18 points "high risk", from 19 points as "maximum risk". Conclusion: the model presents a good predictive capacity of operative wound infection and adequately represents the cohort under study.

[Impact of the ERA and GES health programs on mortality from community-acquired pneumonia in persons aged ≥65 years in ChileImpacto do programa de saúde ERA e do GES na mortalidade por pneumonia adquirida na comunidade em indivíduos com idade acima de 65 anos no Chile]. / Impacto de los programas de salud ERA y GES en la mortalidad por neumonía adquirida en la comunidad en personas de 65 años o más en Chile.

OBJECTIVE: Evaluate the impact of the Adult Respiratory Diseases (ERA) Program and the General System of Explicit Health Guarantees (GES) on mortality from community-acquired pneumonia (CAP) in persons aged ≥65 years in Chile. METHODS: In this ecological study, annual and quarterly mortality rates from CAP were calculated in persons aged 65 to 79 years and ≥80 years from 1990 to 2014. Information was gathered from the databases of Chile's Department of Health Statistics and Information and its National Statistics Institute. The ERA Program (implemented in 2001) and the inclusion of CAP in the GES (starting in 2005) were evaluated as interventions. Data were analyzed using the interrupted time-series method, following the Prais-Winsten model, with a 5% significance level. RESULTS: The analysis showed that after the ERA Program began, significant reductions in CAP mortality were observed in the two age groups studied, whereas after CAP was added to the GES program, no statistically significant changes were found in those rates. CONCLUSIONS: Implementation of the ERA Program helped to reduce CAP mortality in persons aged ≥65 years in Chile, whereas inclusion of CAP in the GES program did not.

OBJETIVO: Avaliar o efeito do Programa Enfermidades Respiratorias del Adulto (doenças respiratórias do adulto, ERA) e do Régimen General de Garantías Explícitas en Salud (regime geral de garantias explícitas em Saúde, GES) na mortalidade por pneumonia adquirida na comunidade (PAC) em indivíduos acima de 65 anos no Chile. MÉTODOS: Estudo ecológico em que foram calculadas as taxas anuais e trimestrais de mortalidade por PAC em indivíduos de 65 a 79 anos e acima de 80 anos no período entre 1990 e 2014. Os dados foram obtidos dos bancos de dados do Departamento de Estatística e Informação em Saúde e do Instituto Nacional de Estatística do Chile. As intervenções avaliadas foram o Programa ERA (implantado em 2001) e a inclusão da PAC no GES (a partir de 2005). Os dados foram analisados com o método de séries temporais interrompidas segundo o modelo de Prais-Winsten. O nível de significância foi de 5%. RESULTADOS: A análise demonstrou que, após a implantação do Programa ERA, houve uma redução significativa na taxa de mortalidade por PAC nas duas faixas etárias consideradas. Por outro lado, a inclusão da PAC no GES não teve efeito estatisticamente significativo na taxa de mortalidade. CONCLUSÕES: A implantação do Programa ERA contribuiu para reduzir a taxa de mortalidade por PAC em indivíduos acima de 65 anos no Chile, porém o mesmo não ocorreu com a inclusão da PAC no GES.

Impacto de los programas de salud ERA y GES en la mortalidad por neumonía adquirida en la comunidad en personas de 65 años o más en Chile

[RESUMEN]. Objetivo. Evaluar el impacto del Programa de Enfermedades Respiratorias del Adulto (ERA) y el Régimen General de Garantías Explícitas en Salud (GES) en la mortalidad por neumonía adquirida en la comunidad (NAC) en personas de 65 años o más en Chile. Métodos. En este estudio ecológico se calcularon las tasas anuales y trimestrales de mortalidad por NAC en personas de 65 a 79 años y de 80 años o más entre 1990 y 2014. Las fuentes de información fueron las bases de datos del Departamento de Estadística e Información de Salud y del Instituto Nacional de Estadística de Chile. Como intervenciones se evaluó el Programa ERA (puesto en marcha en el 2001) y la inclusión de la NAC en el GES (a partir del 2005). Los datos se analizaron mediante el método de series de tiempo interrumpidas, según el modelo de Prais-Winsten. Se consideró un nivel de significación del 5%. Resultados. El análisis mostró que después del inicio del programa ERA se observaron disminuciones significativas de la tasa de mortalidad por NAC en los dos grupos de edad estudiados, mientras que a partir de la incorporación de la NAC al programa GES no se encontraron cambios estadísticamente significativos en esas tasas. Conclusiones. La implementación del programa ERA contribuyó a reducir las tasas de mortalidad por NAC en personas de 65 años o más en Chile, no así la incorporación de la NAC al GES.

[ABSTRACT]. Objective. Evaluate the impact of the Adult Respiratory Diseases (ERA) Program and the General System of Explicit Health Guarantees (GES) on mortality from community-acquired pneumonia (CAP) in persons aged ≥65 years in Chile. Methods. In this ecological study, annual and quarterly mortality rates from CAP were calculated in persons aged 65 to 79 years and ≥80 years from 1990 to 2014. Information was gathered from the databases of Chile’s Department of Health Statistics and Information and its National Statistics Institute. The ERA Program (implemented in 2001) and the inclusion of CAP in the GES (starting in 2005) were evaluated as interventions. Data were analyzed using the interrupted time-series method, following the Prais-Winsten model, with a 5% significance level. Results. The analysis showed that after the ERA Program began, significant reductions in CAP mortality were observed in the two age groups studied, whereas after CAP was added to the GES program, no statistically significant changes were found in those rates. Conclusions. Implementation of the ERA Program helped to reduce CAP mortality in persons aged ≥65 years in Chile, whereas inclusion of CAP in the GES program did not.

[RESUMO]. Objetivo. Avaliar o efeito do Programa Enfermidades Respiratorias del Adulto (doenças respiratórias do adulto, ERA) e do Régimen General de Garantías Explícitas en Salud (regime geral de garantias explícitas em Saúde, GES) na mortalidade por pneumonia adquirida na comunidade (PAC) em indivíduos acima de 65 anos no Chile. Métodos. Estudo ecológico em que foram calculadas as taxas anuais e trimestrais de mortalidade por PAC em indivíduos de 65 a 79 anos e acima de 80 anos no período entre 1990 e 2014. Os dados foram obtidos dos bancos de dados do Departamento de Estatística e Informação em Saúde e do Instituto Nacional de Estatística do Chile. As intervenções avaliadas foram o Programa ERA (implantado em 2001) e a inclusão da PAC no GES (a partir de 2005). Os dados foram analisados com o método de séries temporais interrompidas segundo o modelo de Prais-Winsten. O nível de significância foi de 5%. Resultados. A análise demonstrou que, após a implantação do Programa ERA, houve uma redução significativa na taxa de mortalidade por PAC nas duas faixas etárias consideradas. Por outro lado, a inclusão da PAC no GES não teve efeito estatisticamente significativo na taxa de mortalidade. Conclusões. A implantação do Programa ERA contribuiu para reduzir a taxa de mortalidade por PAC em indivíduos acima de 65 anos no Chile, porém o mesmo não ocorreu com a inclusão da PAC no GES.

[Head and neck cancer: validation of the QLQ-H&N35 quality of life questionnaire]. / Cáncer de cabeza y cuello: validación de cuestionario QLQ-H&N35.

BACKGROUND: Head and neck cancer affects esthetic and anatomical parameters, causing pain and functional impotence, affecting vital functions such as eating and breathing, hampering the quality of life of patients. EORTCQLQ-C30 questionnaire with its supplementary module QLQ-H & N35 evaluates the quality of life of these patients. AIM: To statistically validate the QLQ-H & N35 questionnaire in patients with head and neck cancer. MATERIAL AND METHODS: In a cross-sectional study, we studied patients with head and neck cancer who attended a rehabilitation unit. Reliability was measured using Cronbach's α and validity was determined by the diagnostic efficiency of the QLQ-H & N35 scale as compared with the SF-36 quality of life survey. A Receiver Operational Characteristic (ROC) curve was generated. RESULTS: The Cronbach's α global internal consistency of the questionnaire was > 0.70 and its discrimination capacity was 74.2%, which are considered acceptable. CONCLUSIONS: These results confirm the statistical validity of the QLQ-H & N35 questionnaire, specifically for patients with head and neck cancer in Chile.

Cáncer de cabeza y cuello: validación de cuestionario QLQ-H& N35 / Head and neck cancer: validation of the QLQ-H& N35 quality of life questionnaire

Background: Head and neck cancer affects esthetic and anatomical parameters, causing pain and functional impotence, affecting vital functions such as eating and breathing, hampering the quality of life of patients. EORTCQLQ-C30 questionnaire with its supplementary module QLQ-H & N35 evaluates the quality of life of these patients. Aim: To statistically validate the QLQ-H & N35 questionnaire in patients with head and neck cancer. Material and Methods: In a cross-sectional study, we studied patients with head and neck cancer who attended a rehabilitation unit. Reliability was measured using Cronbach's α and validity was determined by the diagnostic efficiency of the QLQ-H & N35 scale as compared with the SF-36 quality of life survey. A Receiver Operational Characteristic (ROC) curve was generated. Results: The Cronbach's α global internal consistency of the questionnaire was > 0.70 and its discrimination capacity was 74.2%, which are considered acceptable. Conclusions: These results confirm the statistical validity of the QLQ-H & N35 questionnaire, specifically for patients with head and neck cancer in Chile.

Anestesia general con máscara laríngea para radioterapia infantil: técnica y complicaciones / General anesthesia with laryngeal mask airway management for radiotherapy in children: anesthetic technique and complications

Objetivo: El objetivo de este estudio es describir la técnica de anestesia general con máscara laríngea y la presencia de complicaciones anestésica en niños sometidos a radioterapia entre el 2014 y el 2016 en el Instituto Nacional del Cáncer. Secundariamente, se describirán las características demográficas y clínicas de la población estudiada. Material y Método: Estudio descriptivo, retrospectivo. Se extrajeron datos clínicos y demográficos de radioterapia bajo anestesia general realizados entre 2014 y el 2016 en niños menores de 15 años. Los datos recopilados fueron: edad, sexo, número de radioterapias con anestesia general, diagnóstico, tipo de anestesia, dispositivo de la vía aérea utilizado, complicaciones (náuseas, vómitos, laringoespasmo, aspiración broncopulmonar). El análisis estadístico fue descriptivo. Resultados: Se registraron 1.285 radioterapias en 65 niños. Todas con anestesia general. Del total de sesiones, en 85 (7%) fue necesario instalar una vía venosa periférica o el paciente contaba con una. Con respecto a los dispositivos de vía aérea, en 1.139 (94%) se utilizó máscara laríngea, en 64 (5%) presentaba traqueostomía y en 8 (0,66%) fue necesario la intubación orotraqueal. Dentro de las complicaciones encontramos náuseas y/o vómitos en 71 sesiones, correspondientes al 5,53%. Espasmo laríngeo ocurrió en 9 (0,7%) de las sesiones. Conclusiones: La anestesia general con máscara laríngea es una técnica útil y con pocas complicaciones para el manejo de niños que requieren radioterapia, donde parece no ser indispensable contar con una vía venosa periférica o central de rutina.

Objective: Describe the use of general anesthesia with laryngeal mask airway management, and the presence of complications in children who require anesthesia for radiotherapy. The demographic and clinical characteristics of the children studied will also be described. Material and Methods: This is a descriptive, retrospective study. Clinical and demographic data were obtained from radiotherapy procedures with general anesthesia in children under 15 years of age completed between 2014 and 2016. The data collected included: sex, age, number of radiotherapies with general anesthesia, diagnosis, type of anesthesia, airway management device, complications (nausea and vomiting, laryngospasm and bronchopulmonary aspiration). The data were analyzed through descriptive statistics. Results: 1,285 radiotherapies where analyzed in 65 children. All patients received general anesthesia. Of the total sessions, only in 85 (7%). Was required to install a peripheral intravenous line or the patient had one. In 1,139 (94%) of the cases, the preferred airway management device was laryngeal mask, 64 (5%) presented with tracheostomy, and in 8 (0.66%) patients it was necessary to use an orotracheal tube. Nausea and vomiting occurred in 71 cases (5.53%), and laryngospasm in only 9 (0.7%) patients. Conclusion: General anesthesia with laryngeal mask airway management is a useful technique associated with low complications when caring for children requiring anesthesia for radiotherapy. Also, in this context, it seems unnecessary to routine install a peripheral intravenous line.