High Complexity University Hospital Research Articles

P.503: The importance of a Brazilian specialized transplant center in a high-complexity university hospital: An 11 years overview of the outcomes.

P.503: The importance of a Brazilian specialized transplant center in a high-complexity university hospital: An 11 years overview of the outcomes.

Patient Blood Management Program Implementation: Comprehensive Recommendations and Practical Strategies.

Blood transfusion is one of the most common medical practices worldwide. However, current scientific literature has shown that the immunomodulatory effects of blood transfusion are associated with an increased likelihood of infection, prolonged hospitalization, and morbimortality. Also, it means high costs for healthcare systems. In this context, acknowledging that blood transfusions are essentially heterologous cell transplantations, the use of therapeutic options has gained strength and is collectively known as the patient blood management (PBM) program. PBM is an approach based on three main pillars: (1) treating anemias and coagulopathies in an optimized manner, especially in the preoperative period; (2) optimizing perioperative hemostasis and the use of blood recovery systems to avoid the loss of the patient's blood; (3) anemia tolerance, with improved oxygen delivery and reduced oxygen demand, particularly in the postoperative period. Current scientific evidence supports the effectiveness of PBM by reducing the need for blood transfusions, decreasing associated complications, and promoting more efficient and safer blood management. Thus, PBM not only improves clinical outcomes for patients but also contributes to the economic sustainability of healthcare systems. The aim of this review was to summarize PBM strategies in a comprehensive, evidence-based approach through a systematic and structured model for PBM implementation in tertiary hospitals. The recommendations proposed herein are from researchers and experts of a high-complexity university hospital in the network of the Sistema Único de Saúde, presenting itself as a strategy that can be followed as a guideline for PBM implementation in other settings.

Characteristics of the pediatric population with gender incongruence attending specialized care in Cali, Colombia: an observational, descriptive and retrospective study

BackgroundGender incongruence can often manifest itself from early childhood [Olson KR, Gülgöz S. Child Dev Perspect. 2018;12:93–7. https://doi.org/10.1111/cdep.12268] with a significant psychological impact, altering social and school dynamics without the appropriate care.[Tordoff DM, et al. JAMA Netw Open. 2022;5(2): e220978. https://doi.org/10.1001/jamanetworkopen.2022.0978] Early identification and gender–affirming care are essential to reduce adverse mental health outcomes, such as depression and self-harm [Tordoff DM, et al. JAMA Netw Open. 2022;5(2): e220978. https://doi.org/10.1001/jamanetworkopen.2022.0978]..This study aims to analyze characteristics and to estimate relative frequencies of gender incongruence in a population of children and adolescents receiving gender-affirming care at a high-complexity university hospital located in the third largest city in Colombia.MethodsThis was a retrospective descriptive study of patients under 18 with gender incongruence that received gender-affirming care between January 2018 and June 2022 at Fundacion Valle del Lili in Cali, Colombia. Sociodemographic and clinical characteristics of 43 patients were assessed, as well as the relative frequencies of gender incongruence. Data analysis was performed with the statistical package STATA®. To determine significant differences between the characteristics of the patients who participated in the study, the Mann‒Whitney U test was performed for numerical variables with non-parametric distribution, while either Pearson's Chi-2 test or Fisher's exact test was performed for categorical variables.ResultsFor every ten individuals assigned female at birth, who manifested gender incongruence, there were eight assigned male at birth. The median age of onset of gender incongruence was ten years (IQR: 5–13 years), and the median time elapsed between the reported onset of gender incongruence and the first consultation with a multidisciplinary gender-affirming team was three years (IQR: 1–10 years).The frequency of transgender identity was notable in participants with ages between 15 and 17 years. Depressive symptoms, anxiety, and psychotropic drug use were significantly higher in individuals assigned female at birth. Among 25 individuals assigned female at birth who participated in this study, 60% self-recognized as transgender men.18 individuals assigned male at birth, 67% self-recognized as transgender women. The most frequent treatment was a referral to mental health services (46.51%).ConclusionBased on the cohort of our study, we can conclude that patients consult for gender-affirming treatment 3 years after the onset of gender incongruence. Anxiety and depression were higher in individuals assigned female at birth. Additionally, they presented at a later stage of sexual maturation, reducing the possibility of using puberty blockers.

Sedación paliativa percepción del personal médico e implicaciones en la práctica clínica en un hospital de alta complejidad

Introduction: palliative care is geared to symptoms control and quality of life improvement among patients with advanced, progressive, or non-curative diseases. It plays a fundamental role on refractory symptoms and lack of teaching on this matter, at all medical training levels, leads to unawareness and misunderstanding or fear to administer it. Materials and methods: a descriptive, cross-sectional study conducted to define knowledge, and personal and professional perception of palliative sedation (PS), using a survey applied to 201 participants selected from last year medical students, general practitioners, residents, and different specialists at a high complexity university hospital in Cali, Colombia in 2021. Results: 57.2% were men, 3.98% worked mostly in operating rooms, 25.4% in the outpatient clinic, 57.2% in the hospitalization ward and 13.4% in the emergency room. Regarding training in palliative care 19.9% considered they had not received any training, 67.7% little and 12.4% a lot, 16.4% did not know the definition of terminal illness and 25.4% did not know the definition of PS. 90 % would not distinguish between the purpose of palliative sedation and euthanasia, although 94.5% recognized that preventing patient suffering was important and that sedation was a therapeutic option. Discussion and conclusions: palliative sedation is an important intervention in patients with refractory symptoms. Knowledge gaps limiting its clinical administration show the need of strengthening education on PS, at all levels of medical training.

Capillary Refill Time and Serum Lactate as Predictors of Mortality and Postoperative Extracorporeal Membrane Oxygenation Requirement in Congenital Heart Surgery.

Multiple tissue perfusion markers are described to guide therapy in critically ill pediatric patients undergoing congenital heart surgery. Given the advantages of capillary refill time, our goal is to determine its predictive capacity for mortality and postoperative extracorporeal oxygenation requirements in congenital heart surgery and compare it to serum lactate. We conducted a prospective cohort observational study in a single high-complexity university hospital. Serum lactate and capillary refill time were measured at five predetermined time points: preoperative, immediate postoperative, 6, 12, and 24 h after the surgery. Prolonged immediate postoperative, 6 h, and 12 h capillary refill time measurements turned out to be independent risk factors for both outcomes. The capillary refill time area under the curve ranged between 0.70 and 0.80, while the serum lactate resulted between 0.79 and 0.92 for both outcomes. Both tissue perfusion markers resulted in mortality and extracorporeal oxygenation requirement predictors. Given the advantages of capillary refill time over serum lactate, a monitoring strategy including these two perfusion markers should be considered for congenital heart surgeries.

Performance of Brazilian Pediatric Risk of Severity Model for Illness (Brprism) Compared to Pediatric Index of Mortality and Pediatric Risk of Mortality 2

Introduction: The best prognosis score with which to evaluate high-risk patients upon admission into pediatric intensive care is not well established in resource-limited settings. The objective of study was to formulate a risk-of-illness severity model for pediatric mortality to be applied upon PICU admission in resource-limited settings. Methods: Our study was designed to develop an illness severity index and a prognostic model for critically ill children. A prospective, observational multicenter pilot study, performed between February 1995 and October 1999, evaluated the variables, methodology and statistical techniques for the development of a model. A single-center prospective cohort study, performed between November 1999 and October 2004, collected information from consecutive admissions into the Pediatric Intensive Care Unit (PICU) at a high-complexity university, teaching, and reference hospital in São Paulo, Brazil. Results: In the pilot study, 1,459 patients (a PICU mortality rate of 16%) were included, and in the second study, 1,033 patients (a PICU mortality rate of 13.9% and a hospital mortality rate of 6.9% after PICU discharge) were included. We used multivariable regression to determine two probabilistic models; the first addressed survival and the overall probability of death (hospital plus PICU deaths), and the second was conditional (i.e., PICU death). An illness severity index stratified these probabilities into three risk strata: low-, medium- and high-risk patients. In the final step, the new death probabilities were estimated using a Bayesian adjustment. Conclusions: The model estimates three probabilities (survival, death in the PICU and death in the hospital after PICU discharge) stratified into three risk categories. To the best of our knowledge, this is the first study using a Bayesian adjustment to determine a prognosis and illness severity, and it should enable us to make therapeutic adjustments and provide appropriate counseling for high-risk patients in resource-limited settings.

Bleeding hepatocellular adenoma: historical series and outcomes.

hepatocellular adenoma - AHC - is a rare benign neoplasm of the liver more prevalent in women at reproductive age and its main complication is hemorrhage. In the literature, case series addressing this complication are limited. between 2010 and 2022, 12 cases of bleeding AHC were attended in a high-complexity university hospital in southern Brazil, whose medical records were retrospectively evaluated. all patients were female, with a mean age of 32 years and a BMI of 33kg/m2. The use of oral contraceptives was identified in half of the sample and also half of the patients had a single lesion. The mean diameter of the largest lesion was 9.60cm and the largest lesion was responsible for bleeding in all cases. The presence of hemoperitoneum was documented in 33% of the patients and their age was significantly higher than the patients who did not have hemoperitoneum - 38 vs 30 years, respectively. Surgical resection of the bleeding lesion was performed in 50% of the patients and the median number of days between bleeding and resection was 27 days. In only one case, embolization was used. The relation between ingrowth of the lesions and the time, in months, was not obtained in this study. it is concluded that the bleeding AHC of the present series shows epidemiological agreement with the literature and may suggest that older patients trend to have hemoperitoneum more frequently, a fact that should be investigated in further studies.

Safe and effective re-use policy for high-efficiency filtering facepiece respirators (FFRS): Experience of one hospital during the Covid-19 pandemic in 2020.

The high transmissibility rate of the Severe Acute Respiratory Syndrome Coronavirus 2 facilitated an exponential growth in the number of infections, posing a tremendous threat to healthcare systems across the world. The use of Non-oil 95% efficiency (N95) respirators demonstrated to reduce the risk of virus transmission. The escalated demand in N95 respirators during 2020 generated a massive shortage worldwide which resulted in serious implications, one being an increase in healthcare providers' costs. In response, various optimization strategies were implemented. This study aimed to assess the implementation of a safe and effective re-use policy for high-efficiency filtering facepiece respirators (FFRs) in a high-complexity university hospital in 2020. Associated costs were estimated through a descriptive accounting analysis of resources saved. Acceptability, appropriateness, and feasibility rates were 80.5%, 78.8%, and 83.6%, respectively. With an implementation cost of approximately 10,000 USD, there was a 56.1% reduction in FFRs consumption, compared with a non-policy scenario, with savings exceeding 500,000 USD in 2020. In a pandemic scenario where it is vital to spare resources, a FFRs rational use policy demonstrated to be a highly cost-efficient alternative in order to save resources without increasing contagion risk among healthcare workers.

MO115: Cardiorenal Units as Management Strategy to Improve Outcomes in Cardiorenal Syndrome

Abstract BACKGROUND AND AIMS Cardiorenal syndrome (CRS), defined as the spectrum of disorders that acutely or chronically affect both heart and kidney function, is often a challenging condition with paucity of evidence-based therapy. The increasing burden of this entity has prompted the creation of cardiorenal units (CRU) as integrating programs intended to provide a combined multidisciplinary approach to maximize all chances for organ and patient recovery. Here we describe the early results of the creation of one CRU in a high complexity university hospital. METHOD This observational study included all patients diagnosed with CRS, who have been seen in the cardiorenal day care unit, formed by specific trained nephrologist, cardiologist and nurses. Assessment of cardiorenal function and volume status was performed by conventional cardiac ultrasound plus V-Scan, GFR estimation by CKD EPI, NT-proBNP determination and bioelectrical impedance when indicated. RESULTS Cardiorenal Unit of Puerta de Hierro University Hospital was created in January 2021. A total of 68 patients have been evaluated with a mean follow-up of 4 months (SD 3.2). Most frequent cardiologic diagnoses were 63.9% heart fellow with reduced function (HFrF) and 37.1% heart failure with preserved ejection fraction (HFpEF) and the presence on pulmonary hypertension or tricuspid regurgitation were 29.4% and 50.9%. 51.6% patients showed diuretic resistance. Most frequent renal diagnosis were pure CRS 36.9%, and 27.7% and 24.6% CRS associated to diabetic kidney disease or nephroangioesclerosis, respectively. Mean FGe rate when patients were initially evaluated was 31.5 mL/min/1.73 m2 (SD 11.0) with demonstration of albuminuria in 48.5% of patients. The integrated cardiorenal management of these patients included initiation or adjustment of specific cardio-nephroprotective drugs [SGLT2 inhibitors (46.8%), ARNi (25.8%), aldosterone receptor antagonists (4.8%)] or diuretic regime adjustment including iv administration (54.8%). Peritoneal dialysis was indicated in three patients and haemodialysis in one patient. Approximately 13.2% patients suffer new episodes of heart failure that needed hospitalization or unexpected medical attention at the day-care clinic. One patient died during follow-up (1.5%). CONCLUSION We conclude that this coordinated cardionephro approach of CRS was useful to optimize drug therapy aimed to mid-long term goals of cardionephro protection and to implement advanced therapies for fluid management in patients with diuretic resistance.

Evaluation of Indicators of a Vascular Access Device Program led by Nursing Professionals in a High-complexity University Hospital in Colombia.

Objective.This work sought to evaluate result indicators of the specialized vascular access program led by nursing during the period between 01 January 2018 and 31 December 2019 at Fundación Cardioinfantil -Instituto de Cardiología (Colombia).Methods.This was a retrospective descriptive study based on medical records of 1,210 patients who received insertion of vascular access devices by the specialized group of nurses. Result indicators are described.Results.Of all the patients who received insertion of a vascular access catheter, 53.1% were women, with mean age of 34.2 years, admitted to critical care services with cardiovascular problems and sepsis (90.2%). Placement of the peripherally inserted central catheter, midline and arterial was echo-guided between 91% and 100%, with a success rate on the first puncture of 66%. The average duration time of the peripherally inserted central catheter was 25.3 days, that of the midline catheter was 8 days, with a reach of 57% until the end of the treatment. The rate observed per catheter-days of overall phlebitis was 2.03, for positive blood culture of the central peripheral insertion device was 1.9 and thrombosis of 0.50; and arterial line thrombosis was 11.7.Conclusion.The Vascular Access Device Program led by nursing reported rational use of these elements with structured therapeutic purposes according with the complexity of the patients admitted to hospitalization. Improvement plans must be implemented to increase efficacy in post-admission insertion times, reduce infection rate and thrombosis through effective follow-up and control mechanisms.

P0158 / #274: COMPARISON ON PERFORMANCE OF THE PEDIATRIC INDEX OF MORTALITY (PIM) -2 AND PIM-3 SCORES IN THE PEDIATRIC CARE UNIT OF A HIGH COMPLEXITY INSTITUTION

Aims & Objectives: To determine the performance of each of the available Pediatric Index of Mortality (PIM) scores, by assessing the capability for discrimination and calibration in patients admitted to a pediatric intensive care unit in the city of Bogotá. Methods: We designed a retrospective, observational cohort study, which included all patients aged between a month and 17 years and 364 days, admitted to the Pediatric Intensive Care Unit of a high complexity university hospital between April 1, 2016 and December 31, 2018. We analyzed the standardized mortality ratio, discrimination, calibration and net reclassification index (NRI) for each model. Results: A total of 722 patients were included, the mortality rate was 3.74 % and for PIM3 the ratio between expected and observed mortality was 0.66 (p = 0.01) for PIM2 and 1.00 (p = 0.99) for PIM3. The Hosmer-Lemeshow test suggests inadequate calibration for PIM2 (HL= 13.18 p = 0.11), but adequate calibration for PIM3 (HL = 28.08 p < 0.01). The area under the diagnostic performance curve for PIM2 was 0.87 (95% CI 0.80; 0.94), and 0.89 (95% CI 0.82; 0.95) for PIM3. The net reclassification index was -27.1 %. PIM 3 classified survivors better than PIM2, but inadequately classified non-survivors. Conclusions: Although both models show adequate discrimination ability, PIM3 shows a better correlation between predicted risk score and observed mortality. Thus, it may be a useful tool for measuring the internal processes of intensive care units in Colombia and for making comparisons between groups of similar characteristics.

Comparison of Performance of the Pediatric Index of Mortality (PIM)-2 and PIM-3 Scores in the Pediatric Intensive Care Unit of a High Complexity Institution.

ObjectiveTo determine the performance of each of the available pediatric index of mortality (PIM) scores, by assessing the capability for discrimination and calibration in patients admitted to a pediatric intensive care unit in Bogotá.Design and settingWe designed a retrospective, observational cohort study, which included all patients aged between a month and 17 years and 364 days, admitted to the pediatric intensive care unit of a high complexity university hospital between April 1, 2016 and December 31, 2018. We analyzed the standardized mortality ratio, discrimination, calibration, and net reclassification index (NRI) for each model.ResultsA total of 722 patients were included, the mortality rate was 3.74%, and for PIM-3, the ratio between expected and observed mortality was 0.66 [confidence interval (CI) 0.40–1.05] for PIM-2 and 1.00 (CI 0.59–1.68) for PIM-3. The Hosmer–Lemeshow (HL) test suggests inadequate calibration for PIM-2 (HL = 13.18, p = 0.11) and adequate calibration for PIM-3 (HL = 28.08, p < 0.01). The area under the diagnostic performance curves for PIM-2 and PIM-3 were 0.87 (95% CI 0.80–0.94) and 0.89 (95% CI 0.82–0.95), respectively. The NRI was −27.1%. PIM-3 classified survivors better than PIM-2, but inadequately classified nonsurvivors.ConclusionAlthough both models show adequate discrimination ability, PIM-3 shows a better correlation between predicted risk score and observed mortality. Thus, it may be a useful tool for measuring the internal processes of intensive care units in Colombia and for making comparisons between groups of similar characteristics.How to cite this articleQuiñónez-López D, Patino-Hernandez D, Zuluaga CA, García ÁA, Muñoz-Velandia OM. Comparison of Performance of the Pediatric Index of Mortality (PIM)-2 and PIM-3 Scores in the Pediatric Intensive Care Unit of a High Complexity Institution. Indian J Crit Care Med 2020;24(11):1095–1102.

Risk Factors Related to New-Onset Diabetes after Renal Transplantation in Patients of a High Complexity University Hospital in Colombia, 20 Years of Experience.

Introduction New-onset diabetes after transplantation (NODAT) is associated with immunosuppression. Its complications can negatively influence patients' quality of life, which is why it is important to study the associated risk factors and expand the possible therapies in this particular group of patients. Materials and methods. Case-control study nested in a retrospective cohort. It included patients who received kidney transplantation at the high complexity University Hospital Fundación Valle del Lili in Cali, Colombia, between 1995 and 2014. Two controls were assigned for each case, depending on the type of donor and the date of the surgery. Information was collected from clinical records and the institutional TRENAL registry. We carried out a descriptive analysis of the selected variables and identified the risk factors with conditional logistic regression. Results 122 cases were identified to which 224 controls were assigned. The median age was 44 years (IQR: 34–55), and 54% were men. Having >50 years of age at the time of transplantation (OR: 3.18, 95% CI: 1.6−6.3, p = 0.001), body mass index >30 kg/m2 (OR: 3.6, 95% CI: 1.3−9.7, p = 0.010) and being afro-descendant (OR: 2.74, 95% CI: 1.1−6.5, p = 0.023) were identified as risk factors for the development of NODAT. Pretransplant fasting plasma glucose >100 mg/dl (OR: 2.9, 95% CI: 1.4−6.4, p = 0.005) and serum triglycerides >200 mg/dl (OR: 2.5, 95% CI: 1.4−4.4, p = 0.002) were also reported as independent risk factors.Conclusion We ratify some risk factors for the development of this important disease, which include certain modifiable characteristics. Interventions aimed at changes in lifestyle could be established in a timely manner before transplant surgery.

The impact of COVID-19 on the plastic surgery activity ina high-complexity university hospital in Brazil: the importance of reconstructive plastic surgery during the pandemic.

BackgroundThe Hospital das Clínicas - University of Sao Paulo Medical School (HCFMUSP) is the largest university hospital complex in Brazil. HCFMUSP has been converted into a reference center for coronavirus disease 2019. The Division of Plastic Surgery postponed non-essential surgeries and outpatient consultations, accomplishing new guidelines (ANG) of national and international organizations. Even with these challenges arising from the pandemic, alternatives were considered to maintain institutional characteristics. This study aims to analyze this new scenario and the impact on patients’ assistance and Plastic Surgery residents training.MethodsTotal number of surgeries, type of procedures, and outpatient consultations in 2020, before (pre-ANG) and after (post-ANG) ANG, were compared with the same period in 2019 (2019-pre and 2020-post).ResultsA marked reduction in the total number of surgeries and outpatient consultations was observed in the post-ANG period. In the post-ANG period, 267 operations were performed (26.7 ± 20.3/week), while in the 2019-post period, 1036 surgeries were performed (103.6 ± 9.7/week) (p = 0.0002). Similarly, 1571 consultations were conducted in the post-ANG period (157.1 ± 93.6/week), while in the 2019-post period, 3907 were performed (390.7 ± 43.1/week) (p = 0.0003). However, in the post-ANG period, an increase in the proportion of reconstructive compared with aesthetic surgery was observed. The maintenance of highly complex procedures such as microsurgical transplants was also identified.ConclusionsThe predominant profile of reconstructive surgeries at the Division of Plastic Surgery allowed the continuity of procedures at all technical complexity levels, patient care maintenance, and Plastic Surgery residents training.Level of evidence: not ratable

Glycemic Control and Hypoglycemia in Patients Treated with Insulin Pump Therapy: An Observational Study.

Introduction Diabetes mellitus (DM) is a highly prevalent disease worldwide. It has been associated with an important morbimortality due to its complications and sometimes as a result of adverse events related to treatment. Insulin pump therapy (IPT) is one of the options used to control this disease and reduces one of the most frequent complication associated with treatment: hypoglycemia, which has also a great impact on life quality and clinical status of patients. Materials and Methods A descriptive and retrospective study was performed including patients treated and followed by the department of endocrinology from a high-complexity university hospital in Cali, Colombia, between 2012 and 2017. Patients were on IPT and continuous glucose monitoring (CGM): MiniMed Paradigm® Veo™ Insulin Pump (Medtronic®) and MiniMed 640G Insulin Pump-Enlite™ Sensor (Medtronic®). Presentation of hypoglycemia and variables associated with its development were evaluated. Results 51 patients were included. The main indication for IPT initiation was the report of hypoglycemic episodes and inappropriate metabolic control. Initiation of IPT was related with a decrease in glycosylated hemoglobin (HbA1c) and also a decrease in severe hypoglycemic events and hospitalization due to hypoglycemia. The risk factors linked with clinically significant hypoglycemia were male gender, and standard deviation of glucose measures calculated by CGM. A diminished glomerular filtration rate (GFR) (<60 mL/min/1.73 m2) was correlated with higher risk of severe hypoglycemia. Conclusion IPT with CGM is a useful strategy in the management of patients with DM; it is associated with a reduction of adverse hypoglycemic events and hospitalizations due to hypoglycemia.

Predicting the occurrence of surgical site infections using text mining and machine learning.

In this study we propose the use of text mining and machine learning methods to predict and detect Surgical Site Infections (SSIs) using textual descriptions of surgeries and post-operative patients’ records, mined from the database of a high complexity University hospital. SSIs are among the most common adverse events experienced by hospitalized patients; preventing such events is fundamental to ensure patients’ safety. Knowledge on SSI occurrence rates may also be useful in preventing future episodes. We analyzed 15,479 surgery descriptions and post-operative records testing different preprocessing strategies and the following machine learning algorithms: Linear SVC, Logistic Regression, Multinomial Naive Bayes, Nearest Centroid, Random Forest, Stochastic Gradient Descent, and Support Vector Classification (SVC). For prediction purposes, the best result was obtained using the Stochastic Gradient Descent method (79.7% ROC-AUC); for detection, Logistic Regression yielded the best performance (80.6% ROC-AUC).

Olimpíada de qualidade e segurança em hospital universitário público sentinela

Introduction: The quality of health care aims to ensure safe and free from unnecessary harm care to the customer. Objective: Describe the experience of the Risk Management sector at the quality and safety awareness event in a sentinel public university hospital. Method: This is a descriptive experience report study that used the active methodology called Gamification to promote patient quality and safety. The event was held in April 2018, in a high-complexity university hospital located in northern Parana, inserted in the SentinelHospitals Network of the National Health Surveillance Agency. Results: Approximately 325 people were involved among health professionals, administrative technicians, teachers, residents, academics and external community who participated in the various proposed activities. Nine challenges were made for the dissemination of knowledge on the subject. Concurrent with the activities, the judging committee met to assess the challenges and score points, displayed on the scoreboard posted in the hospital hall. The award of the winning team was a lunch at a renowned restaurant, and for the others, certificates and medals. Conclusion: The use of games and dynamics is a pedagogical tool that provides learning and collaborates in the dissemination of the theme of quality and safety, as well as provides interaction between employees. At the end of the event, the participants’ satisfaction survey was applied, being rated between excellent and good by 90% of respondents.

The effect of training and experience on mass casualty incident triage performance: Evidence from emergency personnel in a high complexity university hospital.

This was a cross-sectional prospective study that analyzed the performance of 94 emergency department staff on the triage classifications of 50 trauma patients, before and after a short training in MCI triage, while taking into account their academic background and work experience. The participants were assigned initially to one of two groups: low experience if they had less than 5 years of practice, and high experience if they had more than 5 years of practice. In the low experience group, the initial accuracy was 45.76 percent, over triage 45.84 percent, and subtriage 8.38 percent. In the high experience group, the initial accuracy was 53.80 percent, over triage 37.66 percent, and sub triage 8.57 percent. In the low experience group, the post intervention accuracy was 63.57 percent, over triage 21.15 percent, and subtriage 15.30 percentage. In the high experience group, the postintervention accuracy was 67.66 percentage, over triage 15.19 percentage, and subtriage 17.14 percentage. Upon completion of this study, it can be concluded that MCI triage training significantly improved the performance of all those involved in the workshop and that experience plays an important role in MCI triage performance.

Effect of a Surgical Site Infection Surveilance Program in a High Complexity University Hospital in Colombia

Fajardo, Roosevelt R. MD, MBA, FACS; Vanegas Morales, Blanca Stella MSc; Mususu, William Cruz MD; Gordillo, Heidy Trujillo Author Information

Factors associated with cesarean sections in a high complexity university hospital in southern Brazil.

Objective To identify the factors associated with cesarean sections in a high complexity university hospital in southern Brazil. Methods Cross-sectional study carried out at the Obstetric Hospital Unit of the Hospital de Clínicas de Porto Alegre. Data were gathered from questionnaires carried out with 361 puerperal women and maternal and neonatal records, from February to April 2013. For the analysis, Prevalence Ratio through Univariate Poisson Regression was used. Results The prevalence of cesarean sections was 31%. The category of hospitalization, cervix dilation and its characteristics, fetal presentation, and uterine dynamics, at the time of admission, were statistically related to cesarean sections; not having a previous cesarean section and night shift (from midnight to 6AM) were protective factors. Conclusions The prevalence of cesarean sections is above the rate recommended by the World Health Organization, but it is similar to rates found in other university hospitals, thus pointing out the need for the proposition of actions aimed at improving this indicator.