Instituto de Efectividad Clínica y Sanitaria

Introduction. Patient information transfers between professionals on different shifts are a particularly sensitive area for errors and omissions. Our objective was to evaluate the impact of implementing a structured handover (I-PASS) on data omission in patient information transfers between pediatric residents. Population and methods. The study was conducted in a public hospital in the province of Salta, Argentina, from November 14, 2020, to December 14, 2020 (pre-intervention) and from March 15, 2021, to April 15, 2021 (post-intervention). The design was quasi-experimental, before-and-after, uncontrolled. Pre- and post-intervention shift handovers were evaluated. The intervention included training resident physicians in a structured handover using the mnemonic rule I-PASS, teamwork training, and digitized written handover. The quality of the handover was evaluated through direct observation. Results. There were 233 pre-intervention and 245 post-intervention evaluations. The pre- and postintervention comparison showed a significant improvement in most key handover data. Distractions were reduced from 40.8% to 24.1% (p = 0.001); communication of severity increased from 36.8% to 63.2% (p =0.001). Conclusion. The introduction of the I-PASS program reduced the omission of sensitive data and interruptions, without prolonging handover duration.

Introducción La insuficiencia cardíaca (IC) es un problema de salud de creciente importancia, especialmente entre los pacientes añosos. Sobre la base de la función sistólica del ventrículo izquierdo (FSVI), existen dos tipos de insuficiencia cardíaca (IC con FSVI deteriorada e IC con FSVI conservada) que se caracterizan por tener diferencias fisiopatológicas y clínicas. Nuestra hipótesis es que esto podría devenir en una diferente utilización de los recursos de la salud. Pese a su importancia, no existen en la Argentina registros que comparen los costos hospitalarios de estas dos formas de IC en pacientes añosos, población en la que predomina la IC con FSVI conservada (fracción de eyección ≥ 50%). ObjetivoAnalizar los costos hospitalarios de estas dos formas de IC en pacientes añosos. Material y métodosSe analizaron datos de 133 pacientes añosos internados por IC. La muestra se dividió según la FSVI; se compararon las características previas y durante la hospitalización y los costos totales desde la perspectiva del financiador. ResultadosLa IC con FSVI conservada fue más frecuente (55,6%) y con predominio femenino. No se observaron grandes diferencias entre ambos grupos, excepto para el uso de espironolactona y la cantidad de medicaciones recibidas, que fue más frecuente en el grupo con FSVI deteriorada. Esta última presentó un costo total mayor (27% más respecto de la otra variante), mayor tiempo de internación y un costo de medicamentos más elevado. ConclusionesSi bien el número de pacientes es reducido, el presente trabajo brinda una aproximación acerca de la importancia del análisis de costos de ambas formas de IC en sujetos añosos en la Argentina, lo cual constituye el paso inicial para la proyección de los gastos en salud.

Small (<5 mm) intracranial aneurysms present a therapeutic challenge due to their low annual rupture risk and uncertainties regarding procedure-related morbidity. Evidence from Latin America remains limited. We conducted a retrospective multicenter observational study including 1,519 patients treated between 2017 and 2023 in eight referral centers across five Latin American countries. Demographic, clinical, morphological, and treatment-related variables were analyzed. Logistic regression was used to identify independent predictors of treatment-related complications. The overall complication rate was 6%. Surgical treatment showed higher crude complication rates (11%) compared with endovascular therapy (6%), largely reflecting a greater proportion of ruptured aneurysms. Independent predictors of treatment-related complications were a history of aneurysmal subarachnoid hemorrhage (odds ratio [OR] = 5.03), intraparenchymal hematoma before treatment (OR = 3.56), and ruptured aneurysm status (OR = 2.13). Complications were associated with higher mortality (31% vs. 7%; P < 0.001) and worse 1-year outcomes (Modified Rankin Scale 3-6: 41% vs. 12%; P < 0.001). In this first regional multicenter series, treatment of small intracranial aneurysms in Latin America demonstrated low complication rates and favorable safety profiles for both surgical and endovascular techniques. The predictors identified may support clinical decision-making and improve prognostic assessment.

BackgroundIn Argentina, diabetes is a growing public health concern, with a prevalence of 14% in 2024 and projections reaching 15.4% by 2050. In this context, a Diabetes Prevention and Care Program was implemented in low-income areas across 3 provinces. A key component of the program was a WhatsApp (WhatsApp LLC)-based intervention aimed at promoting self-care, encouraging healthy behaviors, and supporting follow-up among people with diabetes, those at risk, and pregnant women.ObjectiveThis study aimed to describe the implementation and process evaluation of a WhatsApp-based intervention within Argentina’s public health system, using the Carroll Implementation Fidelity Framework, focusing on challenges encountered, implementation strategies used, and lessons learned across the 3 target populations.MethodsThe intervention was implemented in 40 primary care centers. The population included adults residing in the catchment areas of the selected primary care centers. Participants included adults with type 2 diabetes, people at moderate or high risk based on the Finnish Diabetes Risk Score, and pregnant women. A set of 192 educational and reminder messages was developed and validated through expert input and community feedback. Messages were tailored to each target population and delivered through WhatsApp via Twilio (Twilio Inc) Business API (application programming interface). We assessed implementation fidelity focusing on adherence to the intervention, participant responsiveness, quality of delivery, and contextual barriers.ResultsA total of 11,029 participants were enrolled in this study, of whom 9983 (90.5%) had a valid mobile phone number registered in the system. Among these, 32.8% (3276/9983) had a diagnosis of type 2 diabetes, 53.3% (5320/9983) were identified as being at moderate or high risk based on the Finnish Diabetes Risk Score questionnaire, and 13.9% (1387/9983) were pregnant women. Overall, 67.3% (n=5749) opted in to receive messages, with the highest acceptance among those with diabetes (n=2169, 74.3%) and the lowest among at-risk people (n=2935, 62.1%). Message adherence was high: 88.7% (n=5004) of participants received at least the minimum number of educational messages expected, and the mean proportion of messages read per participant was 82.2% (SD 29.8). The dropout rate was low (6.1%) but higher among pregnant participants (14.6%). Message delivery issues mostly included problems with WhatsApp on the mobile phones of participants. Technical challenges, including server overload, were addressed during implementation.ConclusionsThe WhatsApp-based intervention was feasible and well-received in public primary care settings in Argentina, particularly among people with diabetes. The experience illustrates how a WhatsApp-based intervention can be leveraged to strengthen service delivery in low-resource contexts, while also highlighting the need for further work on integration with electronic health records, tailoring of content to population needs, and strategies to enhance digital inclusion for underserved populations.

BackgroundDespite mitral valve replacement through a transseptal approach requires technical expertise, it allows a better exposure of the mitral leaflets and subvalvular apparatus, especially when left atrium is small, during reoperations or in combination with tricuspid valve interventions. ObjectivesTo evaluate the technical difficulties and complications associated with the transseptal approach for mitral valve replacement. Material and MethodsBetween 2006 and 2009 we included 62 consecutive patients undergoing isolated mitral valve replacement or associated with myocardial revascularization through a transseptal approach extended to the left atrium roof. Technical difficulties, morbidity and mortality related to the procedure were evaluated. ResultsThe procedure did not show technical difficulties and the mitral valve was properly exposed in all cases. Postoperative conduction abnormalities rate was 9.7% and 4.8% of patients required a permanent pacemaker. In patients with preoperative atrial fibrillation (n=18), 83.3% were in sinus or junctional rhythm after the procedure. Conclusions The extended transseptal approach provided a better exposure of the mitral valve compared to conventional approach; yet technical expertise is required. The operative times and the incidence of mortality and complications were similar to those of the conventional technique, except for a probable greater incidence of junctional rhythm and AV block. Patients with previous atrial fibrillation may have the benefit of sinus rhythm restoration.

Unwanted family planning often refers to fertility desires as a proxy for contraceptive desire and lacks alignment with the tenets of person‐centered care. We construct a person‐centered measure of unwanted family planning by asking women whether they wanted to use a method, examine its alignment with the fertility‐derived measure, and describe the characteristics of women with unwanted family planning and reasons women state for not wanting to use a method. We conducted a cross‐sectional study of women aged 15–49 in Argentina, Ghana, and India. Data were collected on stated desire to use contraception and basic sociodemographic characteristics. Fertility desire was collected using the standard Demographic and Health Survey questionnaire. In total, 4794 women were included in our study. Among women using a method, 2.5 percent (n = 53) of women had unwanted family planning, with 4.2 percent in Ghana, 2.2 percent in Argentina, and 2.0 percent in India. Most unwanted family planning (85.2 percent, n = 23) occurred among women who did not want a child within the next nine months. Sexual infrequency was the most common reason behind a lack of desire to use a method. Our results highlight the substantial differences found between classifying women's contraceptive needs from a person‐centered versus a fertility‐derived approach.

The 7th Global Ministerial Summit on Patient Safety, convened in Manila in April 2025, advanced global efforts to reduce harm in healthcare under the theme ‘Weaving Strengths for the Future of Patient Safety’. Drawing on the metaphor of textile weaving, the Summit emphasised that safeguarding patients is a collaborative endeavour, requiring integrated action across sectors and systems. The Mandaluyong Declaration reaffirmed commitments to the WHO Global Patient Safety Action Plan (2021–2030) and made four pledges: strengthening global collaboration, advancing leadership and governance, integrating patient safety into disaster preparedness and climate resilience, and building people-centred safety systems. The mission of the International Society for Quality in Health Care (ISQua), a key presence at the Summit, is aligned with these aims, contributing through its White Paper on patient safety, its Green Paper on climate-resilient health systems, and its Person-Centred Care White Paper. The Summit marked a shift from commitment to implementation, recognising the importance of climate change, digital transformation, and equity as integral to safe care. Patient safety now stands as both a global health and environmental priority. ISQua will continue supporting this work through advocacy, standards development, and partnerships, helping to weave patient safety into the daily practice of healthcare worldwide.

Background: Catheter ablation (CA) has been shown to be effective in patients with recurrent ventricular tachycardia (VT); however, its role in patients with electrical storm (ES) has not been studied in randomized trials.Objective: The aim of this study was to analyze ES cases treated with CA.Methods: This was a retrospective analysis of patients treated with CA for ES due to sustained monomorphic VT (SMVT). Procedure success was defined as lack of inducible VT at the end of ablation, partial success as the induction of non-clinical VT, and failure as inducible clinical VT.Results: Sixteen procedures were performed in 14 patients: 10 successful, 3 partially successful, and 3 failures. All patients were free from ventricular arrhythmia immediately after ablation. Ten patients (71.4%) were free from VT and 86.7% free from ES [8 (3–30)-month follow-up]. Five patients (35.7%) died from causes unrelated to arrhythmia.Conclusions: Catheter ablation is associated with acute suppression of VT in all patients with ES due to SMVT and with a recurrence-free outcome in most of them.

Restriction measures during the COVID-19 pandemic may have reduced opportunities to engage in physical activity. This study explored the changes in self-reported physical activity level (PAL), risk factors, and estimated cardiorespiratory fitness (eCRF) among south American adults by comparing data reflecting the pre-pandemic period to data collected during the survey. We conducted a cross-sectional online survey between July 2021 through March 2022 using validated questionnaires (e.g., GPAQ and WHO-STEPS) on a convenience sample of 1,934 adults (68.7% women) from Argentina (n = 484), Brazil (n = 405), Chile (n = 279), Colombia (n = 343) and Uruguay (n = 423). We compared self-reported PAL, risk factors, and eCRF before the pandemic period and at the time of the survey (mean 842days from the first reported case in each country). Data were presented as medians (interquartile range [IQR]) or means (95% confidence interval [CI]) for continuous variables and percentages for categorical ones. Paired data analyses were conducted using paired t-tests, Wilcoxon Signed Rank test, and McNamar's tests, as applicable. We observed a decrease in PAL at work (median, 0 METs/min/week and interquartile range, [0-240] vs. 0 METs/min/week [0-30]; p = 0.032) and active transportation domains (0 METs/min/week [0-693] vs. 0 METs/min/week [0-594]; p = 0.008). In addition, the median sedentary time on weekdays increased by 60min/day (360 [240-540] vs 420 [240-600]; p < 0.001). We also observed an increase in the proportion of participants with hypertension (12.9 vs. 16.5%), diabetes (6.8 vs. 9.8%), dyslipidemia (18.9 to 24%), depression symptoms (14.4 to 15.4%) and obesity (15.4 to 18.2%) compared with pre-pandemic levels (all p-values < 0.05). The eCRF was significantly lower at the survey time compared with pre-pandemic levels (mean difference, -1.17mL/min/kg (or 3.34%): 95% CI, -1.03 to -1.30) even after adjusting for age (-0.50mL/min/kg (or 1.45%): 95% CI -0.37 to -0.64). Across five countries in South America, social restriction policies to control the COVID-19 pandemic may have reduced physical activity and estimated cardiorespiratory fitness with no recovery until the survey time.