Colombia Medica最新文献

Journals have experienced a significant rise in submissions of systematic reviews and other types of reviews that often fall short of acceptable quality standards. These shortcomings typically stem from insufficient rigor in their methodology, reporting, or critical appraisal. As a result, these submissions are frequently rejected raising concerns about the standards authors are following when preparing such work. This growing trend of low-quality reviews not only places a burden on editorial teams but also poses a risk to the scientific community by potentially disseminating flawed or unreliable conclusions. Ensuring that articles maintain high standards is crucial for preserving the integrity of the scientific literature and facilitating evidence-based decision-making. In an effort to address this problem, this viewpoint editorial aims to offer concepts and recommendations on available tools for future authors to improve the quality of their reviews, as well as to guide readers and potential journal reviewers on how to critically interpret these articles.

Objective: To establish the construct validity, internal consistency, and difficulty and discrimination of the items in the Maslach Burnout Inventory- Human Services Survey, with modified response options, for measuring burnout in healthcare workers in Colombia.

Methods: A descriptive study of validation of measurement instruments was conducted. With the support of a panel of experts, the response options were modified, and the new version was administered to 377 healthcare workers. Internal consistency was evaluated, and confirmatory factor analysis was conducted to assess the structural construct validity. The structural Equation Modeling model was calculated using the diagonally weighted least squares estimation method. Finally, item discrimination and difficulty thresholds of the response options were calculated using the generalized partial credit model of Item Response Theory.

Results: The emotional exhaustion and personal accomplishment subscales showed good internal consistency (α= 0.87 and 0.77), while the depersonalization subscale was low (0.45). The confirmatory factor analysis indicated an acceptable but not ideal fit (NFI and RFI <0.95; RMSEA >0.06). Inadequate functioning of the response options and measurement bias were identified.

Conclusions: The previously validated version of the Maslach Burnout Inventory- Human Services Survey and the adapted version in this study have limitations in Colombian healthcare workers, especially in the depersonalization subscale. A thorough revision is suggested to appropriately measure burnout in healthcare personnel in our context.

Objective: To identify the levels of loneliness and the factors associated with the prevalence of loneliness in caregivers of patients with dementia.

Methods: An observational cross-sectional study was conducted, including unpaid caregivers of patients with dementia who were receiving home care in Bogotá, Colombia. The prevalence of loneliness was estimated using the UCLA Loneliness Scale. Participants were also assessed regarding their satisfaction with providing care and whether they felt they received the necessary emotional support from family and friends. The association between loneliness and the patient's clinical variables, as well as the sociodemographic characteristics of the caregiver, was evaluated by calculating the odds ratio (OR) between the groups.

Results: A total of 52 caregivers of patients with dementia were included. Severe loneliness was present in 5.77% of caregivers, while 26.92% experienced moderate loneliness. All caregivers reported feeling satisfied with providing care to their relatives, and 71% felt that their family or friends provided the emotional support they required. Loneliness was more common among caregivers of patients with total functional dependence (OR: 4.061, p= 0.0278). Conversely, the perception of receiving emotional support from family and friends was identified as a potential protective factor against loneliness (OR: 0.184, p= 0.0104).

Conclusions: The prevalence of loneliness in this study is lower than that reported in previous studies. All caregivers reported satisfaction in providing care; most perceived adequate emotional support from family and friends. These factors could be contributing to the lower prevalence of loneliness observed.

Advanced Nursing Practice (ANP) is a key strategy for achieving universal health coverage as it focuses on the individual. Additionally, it is evidence-based, which improves health outcomes. This strategy contributes to achieving "Health for All," an initiative led by the United Nations within the Sustainable Development Goals, by reducing costs and expanding care in underserved areas. Since its inception in the United States, ANP has taken on roles in diagnosis, prescription, and treatment coordination, becoming established in primary care and other clinical settings. In this century, ANP has strengthened quaternary prevention by protecting individuals from overmedicalization through ethical and personalized care, enhancing the quality of life, and optimizing health system efficiency. This paper will focus on the role of ANP in achieving "One Health," promoted by the World Health Organization, and on how it will contribute to improving coverage and transforming the health system according to the population's needs while maintaining a preventive and holistic.

Case description: A 49-year-old male patient, a rural worker, presented with a two-day history of fever. Initial treatment for suspected community-acquired pneumonia was followed by the development of confusion and signs of meningeal irritation. Western Equine Encephalitis Virus infection was confirmed. The patient required prolonged intensive care due to central hypoventilation syndrome, a complication not previously described for this condition.

Clinical findings: The patient exhibited hypercapnia-related encephalopathy, with MRI revealing pontine lesions. Respiratory drive testing confirmed central hypoventilation. Peripheral muscular strength was preserved, ruling out muscular or peripheral neurological involvement. Persistent metabolic alkalosis secondary to failed ventilator weaning attempts was noted.

Treatment and outcome: Treatment included mechanical ventilation, nocturnal invasive ventilation, and acetazolamide to address post-hypercapnic metabolic alkalosis. Gradual improvement led to successful decannulation after 46 days. At the 30-day follow-up, the patient reported full independence and returned to work, maintaining stable respiratory function and acid-base balance.

Clinical relevance: This case highlights central hypoventilation syndrome as a rare but significant complication of Western Equine Encephalitis Virus infection. The administration of acetazolamide proved effective in managing metabolic alkalosis, supporting its potential role in similar cases. Further investigation is needed to better understand this complication and to establish evidence-based management strategies.

Damage control surgery in obstetrics is a technique aimed at managing catastrophic obstetric hemorrhage when conventional methods have failed. Its main objective is to control the bleeding and stabilize the patient, allowing for the correction of metabolic alterations and coagulopathies. This intervention is carried out in stages: it begins with an abbreviated laparotomy, followed by abdominal tamponade and culminates with transfer to the intensive care unit for subsequent stabilization. The proper application of this approach has been shown to improve survival rates in cases of massive hemorrhage, and the article provides a detailed review of the techniques, indications, complications and outcomes associated with this procedure.

Background: Guidelines in medicine are essential tools to provide quality and standardised medical care. We analysed the quality of aesthetic medicine guidelines.

Methods: A systematic review with a prospective registration protocol (https://osf.io/8pdyv) of databases (MEDLINE, EMBASE, Web of Science, Scopus, CDSR), web pages of scientific societies and grey literature was done from inception to February 2023 and without language restrictions. Quality was evaluated using AGREE II (% of the maximum score), RIGHT (% of the total 35 items) and a shared decision making (SDM) quality assessment tool (31 items score) individually and in duplicate, respectively.

Results: Six (86%) guidelines were classified as not recommended; one (14%) was recommended with modifications, and all were classified as poorly reported (7/7; 100%). The median overall quality was 27% (IQR: 26-43) and 26% (IQR 15-36) for AGREE II and RIGHT, respectively. No document used these tools for its development. SDM appeared superfluity in almost all of the guidelines explored.

Conclusions: Aesthetic medicine and surgical guidelines had low quality and must be improved. There is a wide range of improvement, especially in applicability, reporting of evidence, recommendations, conflict of interest, quality control and SDM. These guidelines require a rigorous methodology based on systematic reviews to ensure quality evidence-based recommendations.

Case description: Four cases of patients aged 41, 33, 43 and 68 years who presented periapical lesions and needed periodontal surgery for pre-prosthetic purposes.

Clinical findings: The first case presented an intra-radicular retainer that was difficult to remove and likely to generate a root fracture. In addition, asymmetry of the gingival zenith was observed. The second case presented a complete crown at 16 with mesial marginal mismatch and subgingival margins distally. The third case presented a vestibular fistula with inflammation at the cervical level. The fourth case presented a vestibular fistula in the upper right lateral incisor. All patients showed apical lesions.

Treatment and outcome: The first three cases received coronal lengthening and apical surgery in the same surgical procedure. In the fourth case, apical surgery was performed, and placement of implants 13 and 15 with a pontic of 14. During the clinical control and radiographs performed after the surgical procedures, bone filling of the lesion was found.

Clinical relevance: Considering the results obtained, performing the periodontal and endodontic surgery procedures in a single surgical act is suggested. This reduces costs, travel, number of appointments, medication intake and post-surgical complications.