ABSTRACT Objective: To determine the performance of groups of pediatric residents from a Buenos Aires hospital, in terms of correct recognition and communication of a medical error (ME), in a high-fidelity simulation scenario. To describe the reactions and communication attempts following the ME and the self-perception by the trainees before and after a debriefing. Methods: Quasi-experimental uncontrolled study conducted in a simulation center. First- and third-year pediatric residents participated. We designed a simulation case in which an ME occurred and the patient deteriorated. During the simulation, participants had to provide information on communicating the ME to the patient’s father. We assessed communication performance and, additionally, participants completed a self-perception survey about ME management before and after a debriefing. Results: Eleven groups of residents participated. Ten (90.9%) identified the ME correctly, but only 27.3% (n=3) of them reported that a ME had occurred. None of the groups told the father they were going to give him important news concerning his son’s health. All 18 residents who actively participated in this communication completed the self-perception survey, with an average score before and after debriefing of 5.00 and 5.05 (out of 10) (p=0.88). Conclusions: We observed a high number of groups that recognized the presence of a ME, but the communication action was substantially low. Communication skills were insufficient and residents’ self-perception of error management was regular and not modified by the debriefing.

RESUMO Objetivo: Determinar o desempenho de grupos de residentes pediátricos de um hospital de Buenos Aires, em termos de reconhecimento e comunicação correta de um erro médico (EM),em cenário de simulação. Descrever as reações e tentativas de comunicação após o EM e a autopercepção pelos estagiários antes e depois de um questionário. Métodos: Estudo quase experimental não controlado realizado em centro de simulação. Participaram residentes pediátricos do primeiro e terceiro anos. Concebeu-se um caso de simulação em que ocorreu um EM com deterioração de um paciente. Durante a simulação, os participantes tiveram que fornecer informações relacionadas à comunicação do EM ao pai do paciente. Avaliou-se o desempenho da comunicação e, adicionalmente, os participantes completaram um inquérito de autopercepção sobre a gestão da EM, antes e depois de um questionário. Resultados: Onze grupos de residentes participaram. Dez (90,9%) identificaram corretamente o EM, mas apenas 27,3% (n=3) deles comunicaram que havia ocorrido o EM. Nenhum dos grupos disse ao pai que iria dar notícias importantes sobre a saúde do seu filho. Todos os 18 residentes que participaram ativamente da comunicação completaram o questionário de autopercepção com uma pontuação média antes e depois do questionário de 5,00 e 5,05 (máximo: 10 pontos) (p=0,88). Conclusões: Observamos elevado número de grupos que reconheceram a presença de um EM, mas a ação de comunicação foi rara. A capacidade de comunicação foi insuficiente e a autopercepção da gestão de erros por parte dos residentes foi regular, não sendo modificada pelo debriefing.

ABSTRACT In recent years the planet has suffered great effects on the environment. Nature has been damaged causing environmental damage, with manifestations such as the indiscriminate felling of forests, contamination of estuaries, streams and rivers, and the indiscriminate spillage of chemical waste harmful to the environment. However, quantifying the environmental impact of the different indicators represents a problem little addressed by science. The present research proposes a solution to the problem raised from the development of a method to quantify environmental damage and its impact on good living. The method bases its operation through a multi-criteria approach with the use of experts. As a result, an environmental assessment is obtained from the proposed method that allows quantifying the behavior of the indicators over time.

RESUMEN En los últimos años el planeta ha sufrido grandes afectaciones en el medio ambiente. La naturaleza ha sido dañada provocando perjuicios ambientales, con manifestaciones como la tala indiscriminada de bosques, contaminación de esteros, riachuelos y ríos, y el derrame indiscriminado de desechos químicos nocivos para el medio ambiente. Sin embargo, cuantificar la incidencia ambiental de los diferentes indicadores representa un problema poco abordado por la ciencia. La presente investigación propone una solución a la problemática planteada a partir del desarrollo de un método para cuantificar el daño ambiental y su afectación al buen vivir. El método basa su funcionamiento mediante un enfoque multicriterio con el empleo de expertos. Se obtiene como resultado una valoración ambiental a partir del método propuesto que permite cuantificar el comportamiento de los indicadores en el tiempo.

Background: Optical diagnostic involves predicting polyp histopathology from its endoscopic characteristics. It is only recommended for diminutive polyps (≤ 5 mm) and for predictions made with high confidence. Objectives: To evaluate the accuracy of optical imaging in clinical practice and to assess if optical diagnosis is useful for predicting future colonoscopy surveillance intervals without waiting for histopathological analysis. Methods: consecutive > 18 years patients were enrolled in this prospective study. Colonoscopies were performed by five expert endoscopists who previously participated in an ex-vivo training. Colonoscopes CF-H180AL and CF-Q180AL were used together with Exera II (Olympus Medical System, Tokyo, Japan) processors. Each polyp was characterized in real time using white light and Narrow Band Imaging. Accuracy of optical diagnosis (S, E, NPV, PPV) and correlation between surveillance interval based on optical diagnosis and histopathological analysis were calculated. Results: 311 colon polyps < 10 mm (216 diminutive) in 195 patients were analyzed. Accuracy of optical diagnostics for predictions made with high confidence: Diminutive polyps (sensitivity 0.59, specificity 0.92, NPV 0.48); polyps < 10 mm (sensitivity 0.73, specificity 0.88, NPV 0.50). An optical diagnosis based surveillance recommendation was given to 90 patients. Concordance with histopathology based recommendation was 92.2% according to the European guideline and 93.3% according to the ESGE guideline. Conclusions: Optical diagnostics can be used to predict future surveillance intervals immediately after colonoscopy. However, in this study, based on clinical practice, the accuracy of optical imaging is below the recommended standards.

Antecedentes: el diagnostico óptico consiste en predecir la histopatología de un pólipo a partir de sus características endoscópicas. Sólo es recomendable para pólipos diminutos (≤ 5 mm) y para predicciones realizadas con alta confianza. Objetivos: evaluar la precisión del diagnóstico óptico en la práctica clínica habitual y valorar si es posible recomendar un intervalo de seguimiento basado en diagnóstico óptico sin esperar el análisis histopatológico. Métodos: estudio prospectivo con pacientes consecutivos > 18 años. Las colonoscopias fueron realizadas por 5 endoscopistas expertos que realizaron previamente un entrenamiento ex-vivo. Se emplearon colonoscopios CF-H180AL y CF-Q180AL y procesadores Exera II (Olympus Medical System, Tokyo, Japan). Se evaluó cada pólipo en tiempo real con luz blanca y narrow band imaging. Se calculó la precisión del diagnóstico óptico (sensibilidad, especificidad, VPN, VPP), así como la concordancia entre la recomendación de seguimiento basada en diagnóstico óptico y en diagnóstico histopatológico. Resultados: se analizaron 311 pólipos de colon < 10 mm (216 diminutos) en 195 pacientes. Precisión del diagnóstico óptico para las predicciones realizadas con alta confianza: pólipos diminutos (sensibilidad 0,59, especificidad 0,92, VPN 0,48); pólipos < 10 mm (sensibilidad 0,73, especificidad 0,88, VPN 0,50). Pudo darse una recomendación de seguimiento basada en diagnóstico óptico a 90 pacientes, coincidiendo con la recomendación tras histopatología según la guía europea en 92,2% y según la guía ESGE en 93,3%. Conclusiones: el diagnóstico óptico permite dar una recomendación de seguimiento tras la colonoscopia. Sin embargo, en este estudio basado en práctica clínica, la precisión del diagnóstico óptico está por debajo de los estándares recomendados.

Avian antibodies (IgY) display some advantages in relation to the mammalian IgG antibodies due to its easy procedure for generation and purification and besides for its lower production cost. The objective of this work was to analyze the feasibility of binding IgY antibodies to polystyrene particles and to evaluate its performance in latex-agglutination tests in slide. For this purpose, the detection of hepatitis B surface antigen (HBsAg) was used as a model. Leghorn hens were immunized with the active pharmaceutical ingredient (MPA) used in the manufacturing of the Cuban recombinant vaccine Heberbiovac HB . The obtained antibodies were purified and used in the preparation of the latex particles (0.8 µm) for the detection of the HBsAg by agglutination. The performance of the test was evaluated with 50 serum samples against similar commercial reagent. The results obtained were satisfactory and demonstrated the feasibility of binding such avian antibodies to latex particles. These results open a perspective to the use of this type of assay for the rapid diagnostic of many diseases.

Los anticuerpos aviares (IgY) presentan algunas ventajas con relación a los anticuerpos IgG de mamíferos, debido a su fácil obtención y purificación y su bajo costo de producción. El objetivo de este trabajo fue estudiar la factibilidad de acoplar anticuerpos IgY a partículas de poliestireno y evaluar su desempeño en ensayos de látex-aglutinación en lámina. Para este propósito se utilizó como modelo la detección del antígeno de superficie de la hepatitis B (HBsAg). Gallinas Leghorn se inmunizaron con el ingrediente farmacéutico activo que se utiliza en la elaboración de la vacuna recombinante cubana Heberbiovac-HB. Los anticuerpos obtenidos se purificaron y emplearon en la preparación de reactivos de látex-aglutinación (0,8 µm) para la detección del HBsAg, los cuales se evaluaron con 50 muestras de suero frente a un reactivo comercial similar. Los resultados se evaluaron de satisfactorios. Se demostró la factibilidad de acoplar anticuerpos aviares a partículas de látex y se abre una perspectiva al empleo de este tipo de ensayo para el diagnóstico rápido de diversas enfermedades.