Papers by Hernando Gaitán
BMJ Quality & Safety, Aug 1, 2013
Background There is a need to develop strategies for guideline development. It is essential to le... more Background There is a need to develop strategies for guideline development. It is essential to learn educational needs of health professionals who work at PHC level. Evidence based guidelines should be applied for these health professionals taking into account their context. Objectives To identify skills and resources of primary health professionals in a distance learning course (UNASUS from UFC-SPA -Federal University of Health Science of Porto Alegre). Methods A quasi-experiment study had been carried out and the inclusion criteria were dentists, nurses and family physicians that provide PHC. Data had been collected in the beginning of the distant course, as a baseline and one year after the enrollment. This course enables specialisation for primary health care. A web-based questionnaire was applied to these subjects. The sample size was 251 eligible subjects. The mean age of the responders was 35.2±8.27DP (range: 25-68), from 48 different towns from South Brazil. The majority (88.8%) were women and 67.3% had nurse degree. 94% of the subjects reported that the distance course was a good strategy to change their practice. Interactive activities resembling their daily routine had a higher impact. Discussion The results have shown that distance learning is effective to enhance primary health care professional's behaviour, especially when simulating real cases. The present research has identified that it is essential to improve access to evidencebased clinical practice guidelines and resources across Brazil, and to increase skill capacity in using evidence to inform clinical decision-making.
Revista Colombiana de Obstetricia y Ginecología, Jan 9, 2004
Post-partum infection is one of the main causes of maternal morbidity-mortality in developing cou... more Post-partum infection is one of the main causes of maternal morbidity-mortality in developing countries. Identifying factors predisposing to infection will allow intervention for preventing them or (if they cannot be prevented) using other means for reducing their impact. Toxaemia seems to increase the risk of infection developing due to alterations in cell and humoral immunity. The present work's object is to evaluate whether patients having preeclampsia have a greater risk of presenting post-partum infection. Materials and Methods. A matched case control study was carried out. Pairing by day of birth was done. Inclusion criteria: women giving birth in the Instituto Materno Infantil aged between 15 and 45. Exclusion criteria: clinical patients having infection on being admitted, immunosuppression, second stage of delivery greater than two hours, antibiotic-therapy one week before birth, postpartum eclampsia. Sample size: 95% level of confidence, 80% power, 1:1 ratio, 8% frequency of controls' exposure, estimated OR 2. It was determined that 369 patients would be required per group. The two groups were compared by using t student test paired or Wilcoxon signed ranks test (according to normality in continuous variables) and McNemar's test for percentages. Bivariable analysis was done on stratifying by birth route. Crude and adjusted OR were estimated for controlling confounders using conditional logistical regression. Results. The risk of infection was increased in mild preeclampsia (OR 8.28, 95%CI 2.04-33.5) and severe preeclampsia (OR 9.42, 95%CI 2.10-41.3). The risk of infection was also increased in adolescents (OR 3.87, 95%CI 1.75 -8.54) and who underwent caesarean section (OR 8.17, 95%CI 2.71 -24.62). Conclusions. Using prophylactic antibiotics must be evaluated in vaginal birth and alternatives should be evaluated in terms of duration and currently considered first-choice antibiotic schemes for prophylaxis in caesarean section in patients suffering from preeclampsia.
Cochrane Database of Systematic Reviews, Jul 22, 2013
Analysis 1.4. Comparison 1 Enema versus no enema, Outcome 4 Neonatal Infection (any infectious ou... more Analysis 1.4. Comparison 1 Enema versus no enema, Outcome 4 Neonatal Infection (any infectious outcome, during the first month of life
BMJ Quality & Safety, Aug 1, 2013
The recent IOM standards were developed by as best practice with little guidance for potential in... more The recent IOM standards were developed by as best practice with little guidance for potential interpretation or resource requirements. The CMSS Principles are intended to be a step towards practical guidelines standards and this research the first feedback step as to measuring that practicality.
The Cochrane library, Jan 29, 2020
Rapid point of care test for detecting urogenital Chlamydia trachomatis infection in nonpregnant ... more Rapid point of care test for detecting urogenital Chlamydia trachomatis infection in nonpregnant women and men at reproductive age.
Revista colombiana de obstetricia y ginecologia, Sep 29, 1995
RESUMEN: Con el fin de comparar la eficacia y seguridad de dos regímenes terapéuticos (clindamici... more RESUMEN: Con el fin de comparar la eficacia y seguridad de dos regímenes terapéuticos (clindamicina-gentamicina y pefloxacinametronidazol) en el tratamiento de la endometritis post-cesárea, se incluyeron 71 pacientes que fueron sometidas a parto abdominal de urgencia en el Instituto Materno Infantil del r de septiembre de 1993 al31 de agosto de 1994 y que presentaron endometritis post-cesárea diagnosticada por la presencia de tres de nueve criterios utilizados en el Servicio de Sépticas. Se asignaron de manera aleatoria a uno de los dos grupos de tratamiento: gentamicina-clindamicina o metronidazol-pefloxacina. Se estudió la eficacia terapéutica mediante la comparación del tiempo de desaparición de la fiebre, la evolución clínica, los fracasos terapéuticos y las complicaciones. También se evaluó la seguridad de los dos regímenes. Se aplicó la prueba t de student y Chi cuadrado para significación estadística (a=0.05). RESULTADOS: La seguridad se determinó en 68 pacientes que asistieron al control el día 5 de tratamiento y la eficacia en 63 pacientes que asistieron al control del día 7. Los cultivos de endometrio mostraron gérmenes anaerobios en el48 % de las pacientes y se aislaron en promedio 1.9 gérmenes por paciente. No hubo diferencias entre los dos grupos de tratamiento en cuanto a desaparición de la fiebre (p=0.82), tasa de mejoría (p=0.49), complicaciones (p=0.44), seguridad (p=0.94). La sensibilidad antibiótica de los gérmenes aerobios fue alta para los antibióticos utilizados y no se encontró b lactamasa en los cuatro casos en los que se aisló N. gonorroheae. CONCLUSIONES: La asociación clindamicina-gentamicina fue tan eficaz como la asociación pefloxacina-metronidazol en el tratamiento de la endometritis post-cesárea por lo que ésta última asociación se podría tener como una alternativa terapéutica.
Objective Examining the power (ability) of classical epidemiological estimators to rate inequalit... more Objective Examining the power (ability) of classical epidemiological estimators to rate inequality in health in univariate and composite ways. Methods Ecological study. Ratio, excess risk, attributable risk (AR) and relative difference were the estimators used for showing disparities; all of them were weighted by population size. Kappa concordance coefficient was used between weighted estimators and weighted Gini coefficients for each health outcome used. Cumulative variance at first factor in principal component analysis was used for determining the estimators' suitability for use in a composite index. 24 high-income OECD (Organisation for Economical Cooperation and Development) countries' data for 1998-2002 were included. Such data was obtained from OECD health data for 2004 (3 rd edition). Data concerning child mortality and gross domestic product (GDP) was obtained from World Development Indicators for 2005 on CD-ROM.The main outcomes compared amongst countries were: maternal mortality, child mortality, infant mortality, low birthweight, life-expectancy, measles' immunisation and DTP immunisation. Results Ratio and AR ranked maternal mortality as being the condition having the most disparity; risk excess ranked vaccination programmes and relative difference ranked low birth-weight as being the worst conditions. There was concordance in the ranking of inequities amongst ratio, AR and Gini coefficients (p<0.05). Cumulative variance in the first factor was higher for ratio and AR when they were used for constructing a composite index. Conclusions Ratio and AR were better than risk excess and relative difference for measuring disparities in health and constructing composite inequity in health indexes.
Proyecto académico sin fines de lucro, desarrollado bajo la iniciativa de acceso abierto
Revista de salud publica, Jul 1, 2005
Objective To compare the costs and effectiveness of early laparoscopy with those of conventional ... more Objective To compare the costs and effectiveness of early laparoscopy with those of conventional diagnostic methods based on clinical and paraclinical observation and diagnostic images for ascertaining the cause of non-specific acute low abdominal pain (NSALAP) in females of reproductive age from the third-party payers' (TPP) point of view. Methods Population: 110 reproductive aged females suffering from NSALAP. Place: Instituto Materno Infantil, perinatal and maternal attention referral hospital in Bogotá, Colombia. Research design: cost-effectiveness study of a controlled clinical trial carried out in 1998 and 1999. Outcomes to be measured: effectiveness, direct medical costs (in Colombian pesos and their equivalent in US dollars (USD-December 2004) from length of hospital stay, diagnostic procedures carried out, medical visits and managing complications. Analysis: Cost-effectiveness incremental ratio, analysing sensitivity in five different scenarios. Results Early diagnostic laparoscopy was more cost-effective in 4 out of the 5 possible scenarios. Savings varying from $21.875 to $69.834 (USD 9.42 and USD 30.1) were made per unit of increased effectiveness. Conclusion Early diagnostic laparoscopy was cost-effective in 4 out of 5 scenarios dealing with managing NSALAP in reproductive aged females.
Resumen es: Introduccion: los fitoestrogenos son sustancias encontradas en gran variedad de plant... more Resumen es: Introduccion: los fitoestrogenos son sustancias encontradas en gran variedad de plantas. Recientemente, han sido propuestos para el manejo de las alterac...
Sexually transmitted infections, 2015
To determine the diagnostic accuracy of tests developed for use at the point of care for Chlamydi... more To determine the diagnostic accuracy of tests developed for use at the point of care for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and syphilis in women having symptoms of lower urinary tract infection. Cross-sectional study involving sexually active 14-49-year-old women with lower urinary tract infection symptoms consulting during 2010 at a private health clinic and at two public hospitals in Bogotá, Colombia. Pregnant women, those with a previous hysterectomy or those who received antibiotics during the previous 7 days were excluded. Sequential sampling was used; sample size: 1500 women. The ACON NG and CT duo test combo and the ACON individual test plates for NG and separately for CT were used. The QuickVue Chlamydia rapid test (RT) was also used. All of them were compared with nucleic acid amplification methods. The SD Bioline 3.0 and ACON test for syphilis were evaluated and compared with serological tests. Sensitivity and specificity were estimated. CT RTs had a s...
Revista Colombiana de Obstetricia y Ginecología, 2014
Investigaciones en Seguridad Social y Salud
IntroducciónEl tiempo de estancia hospitalaria es un indicador de la eficiencia en la utilización... more IntroducciónEl tiempo de estancia hospitalaria es un indicador de la eficiencia en la utilización de los recuros y últimamente se ha utilizado como una estrategia de contención en los hospitales de Santafé de Bogotá. Existe la duda de si pertenecerá la red de la Secretaría Distrital de Salud (SDS) conlleva a diferencias en el tiempo de hospitalización con relación a los hospitales no adscritos con los cuales hay contratación externa de servicios, o de si existen diferencias dependiendo del organismo fuente de pago de los costos de hospitalización.Materiales y metodologíaEste estudio, ensamblado sobre una cohorte histórica, compara la estancia hospitalaria dependiendo de la adscripción y de la fuente de pago de los cotos de hospitalización, en 2,084 historias de pacientes atendidos entre enero y junio de 1998, en Santa Fe de Bogotá, en segundo y en tercer nivel de atención, controlando por otros factores que se asocian al tiempo de estancia hospitalaria. Se utilizó un análisis univar...
Revista Colombiana de Obstetricia y Ginecología, 2004
Hace ya cinco años al llegar a la dirección de la Revista, nos trazamos el objetivo de lograr que... more Hace ya cinco años al llegar a la dirección de la Revista, nos trazamos el objetivo de lograr que ésta fuera incluida en las bases de datos electrónicas más importantes a nivel internacional y nacional.En este sentido se dieron los pasos necesarios con el propósito de cumplir con los requisitos de las bases más importantes. Se ha cumplido con los requisitos de las bases Scielo Colombia - Bireme OPS y Publindex de Colciencias.En relación al proyecto a Scielo - Bireme OPS se encuentran digitados 24 números en el ambiente Scielo. La segunda publicación con mas números digitados es la Revista Colombiana de Cardiología. Falta que por lo menos que cuatro revistas colombianas tengan al menos seis números digitados para quedar incluidos en la página principal del proyecto Scielo (http://www.scielo.org/index.php?lang=en). Por ahora se puede acceder a la revista desde la página http://www.col.ops-oms.org/iah/ y desde la página principal de la Biblioteca Virtual de la Salud - Bireme http://www...
Revista Colombiana de Obstetricia y Ginecología, 1994
Con el objeto de investigar la sensibilidad de los hallazgos clínicos en el diagnóstico de la EPI... more Con el objeto de investigar la sensibilidad de los hallazgos clínicos en el diagnóstico de la EPI, se analizaron 76 pacientes que ingresaron al Servicio de Sépticas del IMI de Bogotá durante el período comprendido entre ello de noviembre de 1990 y el 31 de diciembre de 1991, quienes fueron sometidas a un procedimiento quirúrgico (laparoscopia [48 pacientes], laparotomía [17 pacientes] y ambos procedimientos [11 pacientes]) para establecer el diagnóstico de certeza de la enfermedad.En 66 de estas 76 pacientes (86.8 %) se estableció el diagnóstico de EPI. Los diagnósticos de las otras 10 pacientes fueron: embarazo ectópico en tres; apendicitis en tres; pelvis normal en dos y quiste del ligamento ancho y perforación uterina con pelviperitonitis en una paciente cada uno.En el 86% de los casos con sospecha clínica de EPI, ésta fue confirmada. Se encontró un 11 % de falsos positivos con otra patología y un 2.8% con pelvis normal. En este grupo de pacientes analizando el diagnóstico clínic...
Revista Colombiana de Obstetricia y Ginecología, 2010
Nos congrega la conmemoración de los 60 años de la Revista Colombiana de Obstetricia y Ginecologí... more Nos congrega la conmemoración de los 60 años de la Revista Colombiana de Obstetricia y Ginecología (RCOG), la revista médica más antigua del país. Se completan seis décadas de circulación ininterrumpida, motivo de orgullo para la Federación Colombiana de Sociedades de Obstetricia y Ginecología. Debemos hacer un reconocimiento a la labor desplegada desde la dirección de la Revista por quienes me han antecedido: los doctores Rafael Ramírez, Hernando Amaya, Arturo Marroquín, Ramón Francisco Sánchez, Rodulfo Camero, Carlos Roberto Silva, Héctor Enrique Bernal, Gonzalo Echeverri, Guillermo López, Miguel Ángel Fernández, Jorge Villareal, Jesús Alberto Gómez, Enrique Archila, Francisco Pardo, Álvaro Velasco, Alberto Reyes, Hernando Navas, Germán Palomares, Jorge Medina, Gabriel Acuña, Arturo Rodríguez, Miguel Pulido, Rubén Darío Guzmán, Luis Armando Muñoz, Luis Eduardo Santamaría, Fernando Cardona, Juan Mendoza, Germán Uriza, William Onatra, Ariel Iván Ruiz, Gilberto Martínez, Jairo de la ...
Epidemiology, Monitoring and Evaluation, 2017
The use of alcohol and drugs was high in both groups, and cocaine and crack were the most commonl... more The use of alcohol and drugs was high in both groups, and cocaine and crack were the most commonly reported drugs. All transvestites and 80% of MtFs referred syphilis treatment. About 36% of transvestites and 22.7% of MtFs were HIV+ (p=0.099). They had already performed treatment for tuberculosis, 25.9% of transvestites and 9.1% of MtFs (p=0.096). HIV-AIDS-tuberculosis co-infection was observed in 17.2% of transvestites and 6.1% of MtFs. Conclusion The results indicate that the living and health conditions of this population are marked by their vulnerability to HIV-AIDS and co-infection with tuberculosis. The invisibility of this group in official health data compromises the control of these diseases in this population. Also, the dichotomies observed between transvestites and MtFs should be considered in the planning of preventive actions and future studies.
The Cochrane Database of Systematic Reviews, 1999
The use of enemas during labour usually reflects the preference of the attending healthcare provi... more The use of enemas during labour usually reflects the preference of the attending healthcare provider. However, enemas may cause discomfort for women and increase the costs of delivery. To assess the effects of enemas applied during the first stage of labour on infection rates in mothers and newborns, duration of labour, perineal wound dehiscence in the mother, perineal pain and faecal soiling. We searched the Cochrane Pregnancy and Childbirth Group&#39;s Trials Register (March 2007), PubMed (1966 to December 2006), the Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2006, Issue 4), clinical trials registers (December 2006) and reference lists of articles. Randomized controlled trials (RCTs) in which an enema was administered during the first stage of labour and which included assessment of possible neonatal or puerperal morbidity or mortality. Two review authors assessed studies for inclusion independently. Three RCTs (1765 women) met the inclusion criteria. Meta-analysis revealed no significant differences for infection rates in puerperal women (2 RCTs; 594 women; relative risk (RR) 0.66, 95% CI 0.42 to 1.04) or newborn children (1 RCT; 370 newborns; RR 1.12, 95% CI 0.76 to 1.67) after one month of follow up. No significant differences were found in the incidence of lower or upper respiratory tract infections. One trial described labour to be significantly shorter with enema versus no enema (1 RCT, 1027 women; 409.4 minutes versus 459.8 minutes; weighted mean difference (WMD) -50,40 CI 95% -75.68 to -25.12; P &lt; 0.001), but another, adjusted for parity, did not confirm this (median 515 minutes with enemas versus 585 minutes without enemas, P = 0.24). Two trials found no significant differences in neonatal umbilical infection (2 RCTs; 592 newborns; RR 3.16 95% CI 0.50 to 19.82). The one trial that researched women&#39;s views found no significant differences in satisfaction between groups. The evidence provided by the three included RCTs shows that enemas do not have a significant effect on infection rates such as perineal wound infection or other neonatal infections and women&#39;s satisfaction. This evidence does not support the routine use of enemas during labour; therefore, such practice should be discouraged.
… de Obstetricia y …, 2005
RESUMEN Introducción: en Colombia la mayoría de los partos son institucionales; sin embargo, la m... more RESUMEN Introducción: en Colombia la mayoría de los partos son institucionales; sin embargo, la morbimortalidad materna y perinatal es alta. Los resultados de la atención materna están determinados en parte por la adecuada atención de las complicaciones. ...
BJOG: An International Journal of Obstetrics & Gynaecology, 2006
Objective The aim of this study was to assess long‐term effects for women following the use of m... more Objective The aim of this study was to assess long‐term effects for women following the use of magnesium sulphate for pre‐eclampsia.Design Assessment at 2–3 years after delivery for women recruited to the Magpie Trial (recruitment in 1998–2001, ISRCTN 86938761), which compared magnesium sulphate with placebo for pre‐eclampsia.Setting Follow up after discharge from hospital at 125 centres in 19 countries across five continents.Population A total of 7927 women were randomised at the follow‐up centres. Of these women, 2544 were not included for logistic reasons and 601 excluded (109 at a centre where <20% of women were contacted, 466 discharged without a surviving child and 26 opted out). Therefore, 4782 women were selected for follow‐up, of whom 3375 (71%) were traced.Methods Questionnaire assessment was administered largely by post or in a dedicated clinic. Interview assessment of selected women was performed.Main outcome measures Death or serious morbidity potentially relat...
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Papers by Hernando Gaitán