Abstract Objective: The objective of this study was to calculate the direct costs of postoperative atrial fibrillation (POAF) in a high-complexity cardiovascular hospital. Methods: We performed a cost analysis with a pairwise-matched design. Twenty-two patients with POAF and 22 patients without this complication were included. Pair-matching was performed (1:1) based on the following criteria: identical type of surgery, similar EuroSCORE II values, and absence of any other postoperative complication. Results: The total hospital cost was significantly higher in the POAF group than in the non-POAF group (US$ 10,880 [± 2,688] vs. US$ 8,856 [± 1,782], respectively, for each patient; P=0.005). This difference was attributable to postoperative costs (US$ 3,103 [± 1,552] vs. US$ 1,238 [± 429]; P=0.0001) for patients with or without POAF, respectively. The median postoperative lengths of stay were 9 (range 5-17) and 5 (3-9) days for patients with and without POAF (P=0.032), respectively. Preoperatively, no differences were found in the EuroSCORE II values (median 1.7 vs. 1.6, respectively; P=0.91) or direct costs (US$ 1,127 vs. US$ 1,063, respectively; P=0.56) between POAF and non-POAF groups. Conclusion: POAF generates a high economic burden in the overall costs of cardiac surgery, and our results reveal the differential contribution of each of the evaluated factors. This information, which was previously unavailable in this setting, is essential for the development of more effective prevention strategies.

Resumen Objetivo Evaluar la concordancia interobservador en la identificación y grado de las Lesiones Por Presión -LPP- entre: i) enfermeros expertos utilizando fotografías digitales y, ii) entre estos expertos y los registros de enfermería en la historia clínica electrónica. Métodos Estudio observacional, que incluyó 225 registros fotográficos (184 pacientes, 97 con lesión por presión y 128 registros sin lesión) seleccionados al azar del total de fotografías registradas en el ensayo clínico PENFUP. Tres evaluadores expertos valoraron las mismas fotografías de forma encubierta. Se evaluaron las notas de enfermería de los pacientes incluidos relacionadas con la descripción de LPP. Se calculó el índice Kappa y la proporción de acuerdo con el compuesto para cada evaluación. Resultados Se observó una concordancia buena entre los evaluadores expertos de registros fotográficos sobre la presencia de LPP y entre buena y moderada para el grado de LPP (I-II). Así mismo, al evaluar la concordancia entre los registros de enfermería de LPP y la valoración fotográfica de los tres evaluadores expertos de las mismas áreas, se observó una concordancia buena para determinar la presencia de LPP moderada para la concordancia de los grados de LPP. Conclusión Los registros fotográficos son una herramienta que permite el reconocimiento de los tipos de heridas al igual que la visualización de las diferentes capas de piel lesionadas. Se resalta la importancia de la evaluación y validación por expertos ya que nos permite identificar problemas existentes que pueden llevar a la subvaloración o sobrevaloración de las LPP cuando los realiza un solo cuidador.

Abstract Objective This work sought to assess the inter-observer agreement among expert nurses by using digital photographs and between these experts and the nursing registries in the electronic clinical record in the identification and degree of PL. Methods This was an observational study, including 225 photographic records (184 patients, 97 with pressure lesion and 128 registries without lesion) randomly selected from the total of photographs registered in the PENFUP clinical trial (without lesion). Three expert evaluators assessed said photographs in masked manner. The notes from nursing of patients included related with the description of PL were evaluated. The Kappa index was calculated along with the composite agreement ratio for each evaluation. Results Good agreement was observed among expert evaluators of photographic records on the presence of PL and between good-moderate for the degree of PL (I-II). Likewise, upon evaluating the agreement between the nursing registries of PL and the photographic assessment of the three expert evaluators of the same areas, good agreement was observed to determine the presence of PL and moderate agreement for the degrees of PL. Conclusion Photographic records are a tool that permits recognizing the types of wounds, as well as the visualization of the different layers of skin injured. The study highlights the importance of assessment and validation by experts, given that it permits identifying existing problems that can lead to the underestimation or overestimation of PL when conducted by a single caregiver.

Resumo Objetivo Avaliar a concordância inter-observador na identificação e grau das Lesões Por Pressão -LPP- entre: i) enfermeiros especialistas utilizando fotografias digitais e, ii) entre estes especialistas e os registros de enfermagem na história clínica eletrônica. Métodos Estudo observacional, que incluiu 225 registros fotográficos (184 pacientes, 97 com lesão por pressão e 128 registros sem lesão) selecionados por azar do total de fotografias registradas no ensaio clínico PENFUP. Três avaliadores especialistas avaliaram as mesmas fotografias de forma encoberta. Se avaliaram as notas de enfermagem dos pacientes incluídos relacionadas com a descrição da LPP. Se calculou o índice Kappa e a proporção de acordo composto para cada avaliação. Resultados Se observou uma boa concordância entre os avaliadores especialistas de registros fotográficos sobre a presença de LPP e entre boa e moderada para o grau de LPP (I-II). Assim mesmo, ao avaliar a concordância entre os registros de enfermagem de LPP e a valorização fotográfica dos três avaliadores especialistas das mesmas áreas, se observou uma boa concordância para determinar a presença de LPP e moderada para a concordância dos graus de LPP. Conclusão Os registros fotográficos são uma ferramenta que permite o reconhecimento dos tipos de feridas ao igual que a visualização das diferentes capas de pele lesionadas. Se recalca a importância da avaliação e validação por especialistas já que nos permite identificar problemas existentes que podem levar à subvalorização ou sobrevalorização das LPP quando os realiza um único cuidador.

Introduction: This article compiles practices promoting fruits and vegetables consumption launched by eight members of AIAM5 - Global Alliance for Promoting Fruits and Vegetables Consumption "5 a day", with the aim of identifying best practices in the approaching strategies, programs and activities to encourage fruits and vegetables consumption. Material and Methods: A questionnaire designed to categorize and identify strengths, weaknesses, opportunities, cost-effectiveness, feasibility and practices with the greatest potential to adapt to national health promoting policies, was used. Questionnaires from eight countries from AIAM5 were evaluated: Mexico, Chile, Costa Rica, Venezuela, Colombia, Bolivia, Nicaragua and Spain. Results: One of the greatest strengths of the organizations of AIAM5 is the prestige and the professional, technical and academic knowledge that back up their activities. One evident weakness of their strategies is the lack of measuring practices of the impact of the implemented activities, and the evaluation of their cost-effectiveness. It was also observed that some of the entities that carry out the programs "5 a day" are conceived as social enterprises with diverse types of partners and allies. Conclusions: It is recommended that AIAM5 members should make an effort to measure the impact of their activities and interventions by setting quantifiable goals, and using indicators to assess the degree of achievement of the activities carried out. It is also recommended to exploit the niche of opportunities provided by the Corporate Social Responsibility to help them achieve their objectives of promoting fruits and vegetables consumption.

Introducción: Este artículo recopila las prácticas de promoción del consumo de frutas y verduras por parte de ocho miembros de AIAM5 - Alianza Global de Promoción al Consumo de Frutas y Hortalizas "5 al día", con el objetivo de identificar buenas prácticas en el planteamiento de estrategias, programas y actividades para la promoción del consumo de frutas y hortalizas. Material y Métodos: Se empleó un cuestionario diseñado para categorizar e identificar fortalezas, debilidades, oportunidades, costo-efectividad, viabilidad, así como las prácticas de mayor potencial para adaptarse a políticas de promoción de salud nacionales. Se evaluaron cuestionarios procedentes de ocho países de la AIAM5: México, Chile, Costa Rica, Venezuela, Colombia, Bolivia, Nicaragua y España. Resultados: Una de las grandes fortalezas de las entidades que conforman AIAM5 es el prestigio y conocimiento académico, profesional y técnico que respalda sus actividades. Se evidenció la debilidad de sus estrategias por la falta de medición del impacto de sus actividades y evaluación de costo-efectividad. También se evidenció que algunas entidades que lideran programas "5 al día" son concebidas como empresas sociales con diversidad de tipos de socios y aliados. Conclusiones: Se recomienda que los miembros de AIAM5 hagan un esfuerzo para medir el impacto de las actividades e intervenciones que realicen, estableciendo objetivos cuantificables mediante indicadores que permitan evaluar el grado de alcance de las acciones llevadas a cabo. Así mismo, es recomendable que exploten el nicho de oportunidades que ofrece la Responsabilidad Social Corporativa, para alcanzar sus objetivos de promoción del consumo de frutas y verduras.