The scales to measure functional mobility in critically ill patients were developed and validated in English, there is a need for these tools in Spanish speaking countries.  To perform translation, cultural adaptation and inter-rater reliability of the Spanish versions of the Perme Intensive Care Unit Mobility Score and IMS tools in ICU patients. Translation and validation study between November 2016 and July 2017, following the COSMIN Protocol's recommendations. Two couples of physiotherapists with the role of observer/rater applied both scales in 150 patients upon admission and discharge of a medical-surgical ICU from a private hospital in Colombia. The sample size was defined taking into account the lowest proportion of reported agreement (68.57%), a Kappa index of 0.2784 or higher to ensure that the calculated n was adequate, and a confidence level of 95%  Translation and cultural adaptation were performed, the final version of both scales in Spanish was approved by the authors. The sample was 150 patients, 52% were men, the average age was 58 ± 17 years, invasive mechanical ventilation was present in 63 (42%) of the cases. Inter-rater reliability of the ICU Mobility Scale was between 0.97 and 1.00, and for the Perme Intensive Care Unit the Mobility Score it was between 0.99 and 1 in the two moments of the measurements.  Both scales were translated and culturally adapted and presented excellent inter-rater reliability in the two pairs of raters (rater/observer). Translation and cultural adaptation studies have been carried out in Portuguese and German over the last two years ,Both the IMS and the ,,Given the increasing use of Early Mobilization (EM) in ICU patients The use of an instrument that already exists in another country's a language and culture, must go through a cultural adaptation and validation process before being implemented in order to verify if the new version is reproducible and reliable Having instruments to measure patient mobility will improve the early identification of deficiencies, allow for earlier intervention, and the provision of services that reduce the impact of hospitalization on the patient's functional independence and quality of life. The aim of the study was to carry out the translation and cultural adaptation, and to measure inter-rater reliability of the Spanish version of the Perme Score and the IMS.We conducted a translation and validation study following the COSMIN checklist's criteria  The "Perme Intensive Care Unit Mobility Score" (Perme Score), has good inter-rater reliability (ICC: 0.98801) (13), and was translated and validated into Portuguese in ICU patients (inter-rater reliability (κ: >0.9 e: >0.9 for most of the domains). It contains 15 items grouped into 7 categories: mental state, potential barriers to mobility, functional strength, bed mobility, transfers, walking and resistance. The score varies from 0 to 32; uses a maximum range of 2 to 4 points for each of the 15 items included. A high total score indicates few barriers to mobility and minimal assistance required for mobility activities The ICU Mobility Scale (IMS) is a tool with a good inter-rater reliability of 0.83 (95% CI: 0.76-0.90), has scores ranging from 0 to 10 according to the mobility activities, and allows scoring mobility of the patient from the moment in which he is bed-ridden until he independently walks without a walker and without the help of another person. In the IMS, higher scores are associated with greater mobility This procedures were carried out between November and December 2016. In this phase, eight physiotherapists with experience in critical patients participated in addition to the certified translators. The certified translators (certified by the Ministry of Foreign Affairs of Colombia), were bilingual and native Spanish speakers, one of the translators (T1) had experience in translations in the medical field and the other translator (T2) had no translation experience in this field area. Each of them independently translated each scale into Spanish (T1 and T2). The translated versions were analyzed comparing item by item with the original scales in English by a physiotherapist with experience in critical patient care, bilingual and native Spanish speaker, arriving at a conciliated version.This conciliated version was presented to a group of experts of 8 physiotherapists with a minimum experience of two years in critical care and intermediate English proficiency, who received the two formats of both scales translated into Spanish and the original format in English two weeks before the meeting for analysis and reflection. Questions and specific suggestions for change were sent to the main researcher and were analyzed and reviewed in a plenary, generating a corrected version in Spanish that was easy to understand for all participants. The corrected version of the scales in Spanish was translated (RT1 and RT2) back into English by two certified translators fluent in English and Spanish. These translators did not have contact with the original version of the scale in English nor did they know the initial translation process. The re-translation (Spanish to English) and the original English version of both scales were compared, and no significant differences were identified between them that would affect the meaning of the items. This re-translation was sent to the authors of each scale, to ensure that the Spanish version really reflected the content of the original version. There was match between the translators during the drafting of the T1 and T2 versions. Based on the analysis of the notes issued at the expert meeting, recommendations arose related to practical aspects for the application of the two scales in Spanish (T1-T2):For the Perme Score.Could the graphic form of the domain items of the potential barriers in item 5 be modified? In practical terms, the statements are more visible if they are vertical.Could the instructions have more specific definitions to merge the assistance percentage during transfers?In the Gait item, could we convert distance units from feet to meters? In Colombia and a large part of Spanish-speaking countries, the unit of measurement commonly used for distance is meters.The two versions of each scale retranslated to the English language were obtained. The divergences found between the original versions in English and the versions re-translated from Spanish were resolved by discussing with the research team, and the final version of both scales was obtained in Spanish. The original authors of both scales approved the final version in Spanish.This process was carried out between February and June 2017. The final version of both scales was used to determine their inter-rater reliability. Initially 4 physiotherapists were trained in the application of both scales and a pilot test was carried out with a convenience sample with 30 patients. The approximate time for the application of the IMS was less than two minutes, and less than five minutes for the Perme Score.et alThe inter-rater reliability study was conducted in an adult 14-bed ICU in a hospital of the third level of complexity. The sample size was calculated using the advance estimate of Perme The sample size was calculated using the following formula: Resulting in a sample size of 108 patients. Taking into account possible drop outs and that the selection process was performed by incomplete balanced blocks, a sample of 150 patients was considered convenient.A 12-hour training was conducted for the 4 physiotherapists who were in charge of the data collection; each professional evaluated each patient and recorded the duration, execution, comments and questions generated during the process. Patients who were assessed in this pilot test had characteristics similar to those of the sample.To evaluate the inter-rater reliability of both scales, these were applied to 150 patients. Patients were over 18 years of age, with independent mobility before admission to the ICU (Barthel score above 90), reported by the closest relatives or by the patient , we excluded patients with hearing loss, patients who were transferred from other units without clinical data, patients with re-admission to the ICU, patients with unstable fractures or injuries that prevented EM or who did not speak Spanish. All family members and patients, if the clinical condition allowed, signed informed consent prior to their participation in the study. The application of the scales was carried out at two different times (24 hours upon admission/discharge from the ICU).Two pairs of trained raters were formed who independently applied the two scales at the same time for the same patient. Rater "A", specialist physiotherapist (over 5 years of experience) evaluated the patient, the rater "B", physiotherapist without specialization (with over 5 years of experience) observed the entire process. Both raters registered their results (in scoring forms) after completing the application of the two scales and before performing physiotherapy. The scoring forms of the two scales were completed separately, without communication between the raters. Rater "B" was responsible for recording the other variables of the study , time of stay in ICU, type of weaning, place of discharge). The two scales and the raters were randomized per incomplete balanced blocks using sealed envelopes. The main researcher and the ICU work team were masked. The institution's standardized EM checklist was used before the application of the scales, related to the indications, with hemodynamic, psychic and motor stability. Once the information recorded in the collection formats was verified, it was entered into a database designed in Excel 2013. The SPSS 22 program was used for the statistical analysis.For the description of the patients' clinical characteristics, the central trend, mean and median measures were used, the standard deviation (SD) was used as a measure of dispersion, and absolute frequencies and percentages (%) were used according to the type and distribution of each variable.p: <0.05. The classification of Landis and Koch To assess the inter-rater reliability (observer/rater) for the scores of the IMS and Perme Score at both times, the intraclass correlation index (ICC) was used and 95% confidence intervals (95% CI) were determined with a level of significance of During the data collection period, 150 patients were included. The clinical characterization is described in In order to verify the inter-rater agreement (observer/rater), the intraclass correlation coefficient (ICC) was used with a confidence interval (CI) of 95%. Values close to one for the ICC were obtained in both scales and measurements in the two moments. This shows an excellent agreement between raters and observers for both scales.Considering that the analysis in general terms could mask reliability problems between the scores of each observer/rater pair, it was necessary to analyze each pair at the two moments of the measurements. When analyzing the results of the IMS in pairs it was observed that an excellent ICC was obtained for all roles (observer/rater) for the first measurement, obtaining values of one (1) in three of the four rater-observer combinations, while only one of the couples obtained an intraclass correlation of 0.941, which corresponds to a high correlation. Results similar to those of the first measurement were found in the second measurement of the IMS. The intraclass correlation index was 1 in three of the four combinations of couples, and 0.96 in one of the pairs .When analyzing the results of the Perme Score in pairs, it was found that an excellent ICC was obtained for the first measurement, with values of one (1) in two of the four rater-observer combinations, while two of the observer/rater combinations obtained an ICC of 0.999. Results similar to those of the first measurement were also found in the second measurement for the Perme Score. The ICC was excellent in three of the four combinations and 0.998 in one of the pairs .The present work represents the first report of translation, cultural adaptation and inter-rater reliability of the Perme Score and the IMS in Spanish. The authors consider that since currently there are not valid scales in Spanish to assess functional mobility in the ICU context, the results of this research may be appropriate for teams of Spanish-speaking health care professionals and institutions to guide early mobilization interventions in the critical patient. ,The recommendations of a protocol were followed in the Spanish translation and the cultural adaptation of the Perme Score and the IMS, and both scales are easy to apply in critical patients. Translations and cultural adaptations of both scales exist for several countries, which facilitates the comparison between the studies carried out et al.The sample size (n = 150) in this study is greater than that used in the validation of the original versions of both scales, Nawa ,,The age, sex and medical diagnoses of the present study's sample are very similar to the demographic variables of the samples used in the validation studies The sample was recruited in patients with different medical diagnoses and the severity was classified upon admission to the ICU with the APACHE II. et al.et al. The original validation studies of the Perme Score and the IMS also report the use of APACHE II. Hodgson et al.Parry et al.et al.et al,,In the reviewed publications, no studies were identified that assessed the inter-rater reliability in two pairs in the rater/observer role, in two different moments. Hodgson To identify the inter-rater reliability, the measurements were made by two pairs of raters made up of a physiotherapist without specialization (Ft.) with over 5 years of experience and a physiotherapist specializing in cardiopulmonary physiotherapy (Ft.E) with over 5 years of experience; each pair at two different times (24 hours upon admission to/discharge from the ICU), with a randomization of the order of the observer/rater role in each pair, made the measurements without knowing the scores obtained.These methods differ from the validation studies of the original scales; the authors consider that changing roles during assessments favored reducing biases related to commands, approach and orientations to patients, which are factors that may be different from one professional to another and influence the scores. They also assume that a greater number of raters who rotate the rater/observer role represent a situation closer to what happens in an ICU with different professionals assessing the patient at different times, which makes our results applicable.In this study we observed a high concordance and absence of significant differences between the observer/rater roles for the two scales in the two measurement moments. The authors of the research consider that this could be related to the training carried out, the appropriate learning and the clinical experience.For the authors, it is important to note that, unlike the original validation processes of both scales, making the measurements at two different times allowed discriminating between the environments of ICU admission and the successive changes in the mobility of patients in the ICU context. They also consider that the randomization in the observer/rater role avoided the bias that the assessment could be conditioned by the recall effect of the first.The study's methodological strengths are related to the randomization per incomplete balanced blocks to establish the rater/observer role, achieving a similar number of patients in each pair; with the heterogeneity in the patients' severity; with the strategies implemented to reduce the possibility of information and selection bias, and to control confusion factors, such as the masking of the main researcher and the measurements results and the quality control carried out to the information collection and analysis processes. The study's authors identified the following limitations: having been carried out in a single institution, not having taken into account other professionals of the ICU team  and the absence of other functional assessments such as muscle strength. However, these aspects do not affect the validity of the results, bearing in mind that this study did not evaluate the effects of EM interventions. ,Further research is recommended regarding the use of scales to evaluate early mobility protocols, and to analyze other clinimetric properties of both scales. Although the translation was done in Colombia, it is feasible to use it in other Spanish-speaking countries, since the translation and cultural adaptation process took into account that the final Spanish version was the reflection of the original version in English, and that it was easy to understand, avoiding the use of ambiguous terms or local idioms The process of translation, cultural adaptation and reliability of the Perme Score and the IMS was carried out with a rigorous methodology, and both scales are available in Spanish with an excellent inter-rater reliability at two different times (24 hours upon admission/discharge from the ICU). The use of both tools is recommended in the critical patient care context to guide and quantify EM interventions.  -Las actividades de movilización temprana en las unidades de cuidado intensivo (UCI) son una estrategia para mejorar la recuperación funcional durante y después de la enfermedad critica prolongada, disminuir la debilidad muscular adquirida en cuidado intensivo (DMA UCI), el delirio y también para disminuir la estancia hospitalaria ,Las medidas de resultado descritas en las investigaciones sobre la movilidad en el paciente crítico han sido la duración de días en UCI y en el hospital, la duración de la ventilación mecánica, la fuerza muscular, la funcionalidad y la mortalidad Status Score for the ICU (FSS-ICU), Chelsea Critical Care Physical Assessment Tool (CPAx), ICU Mobility Scale (IMS), Perme Intensive Care Unit Mobility Score (Perme Score), Surgical Intensive Care Unit Optimal Mobility Scale (SOMS), y fueron originalmente construidos en inglés -Un total de 26 instrumentos para medir la función de los pacientes críticos fue identificado en una revisión sistemática Perme Score han demostrado niveles adecuados de confiabilidad al aplicarse en diversas poblaciones de pacientes hospitalizados en UCI, en los últimos dos años se han llevado a cabo estudios de traducción y adaptación cultural al portugués y al alemán ,Tanto la IMS como el ,,Ante la creciente utilización de la movilización temprana (MT) de pacientes en la UCI  El uso de un instrumento que ya existe en un idioma y cultura de otro país, antes de ser implementado, debe pasar por un proceso de adaptación cultural y validación para verificar si la nueva versión es reproducible y confiable Disponer de instrumentos para medir la movilidad permitirá mejorar la identificación temprana de deficiencias, el inicio de la intervención y la provisión de servicios que reduzcan el impacto de la hospitalización en la independencia funcional y calidad de vida del paciente. El objetivo del estudio fue realizar la traducción, adaptación cultural y medir confiabilidad inter evaluador de la versión en español del Perme Score y de la IMS.Estudio de traducción y validación siguiendo los criterios de la lista de chequeo COSMIN  El “Perme Intensive Care Unit Mobility Score” (Perme Score), tiene buena confiabilidad entre evaluadores (ICC 0.98801) La ICU Mobility Scale (IMS), es una herramienta con buena confiabilidad inter evaluador de 0.83 (IC 95%: 0.76-0.90), tiene puntaciones que varían entre 0 y 10 de acuerdo a actividades de movilidad, y permite calificar la movilidad del paciente desde que está en cama hasta que de manera independiente camina sin caminador y sin ayuda de otra persona. En la IMS las puntuaciones mayores están asociadas a mayor movilidad Fue realizada en noviembre y diciembre del 2016. En esta fase participaron además de los traductores oficiales, ocho fisioterapeutas con experiencia en pacientes críticos.Los traductores oficiales (certificados por el Ministerio De Relaciones Exteriores De Colombia), eran bilingües y hablantes nativos de español, uno de los traductores (T1) tenía experiencia en traducciones en el área de salud y el traductor (T2) sin experiencia en traducciones en el área. Cada uno de ellos tradujo de manera independiente cada escala al idioma español (T1 y T2). Las versiones traducidas fueron analizadas comparando ítem por ítem con las escalas originales en inglés por un fisioterapeuta con experiencia en atención de pacientes críticos, bilingüe y hablante nativo de español, llegando a una versión conciliada.Esta versión conciliada fue presentada a un grupo de expertos de 8 fisioterapeutas con experiencia mínima de 2 años en atención de pacientes críticos y proficiencia intermedia en inglés, quienes dos semanas antes de realizarse la reunión, recibieron los 2 formatos de ambas escalas traducidas al español y el formato original en inglés para su análisis y reflexión. Las dudas y las propuestas específicas se enviaban al investigador principal y en plenaria se analizaron y revisaron generándose una versión corregida en idioma español que fuera de fácil comprensión. La versión corregida de las escalas en español fue traducida (RT1 y RT2) al inglés por dos traductores certificados con fluidez en los idiomas inglés y español. Estos traductores no tuvieron contacto con la versión original de la escala en inglés ni conocieron el proceso inicial de traducción. La retraducción (español a inglés) y la versión original en inglés de ambas escalas fueron comparadas y no se identificaron diferencias importantes entre ellas que afectaran el significado de los ítems. Esta retradución fue enviada a los autores de cada escala, para asegurar que la versión en español reflejara realmente el contenido de la versión original. Hubo concordancia entre los traductores durante la preparación de las versiones T1 y T2. A partir del análisis de las notas emitidas en la reunión de expertos surgieron recomendaciones relacionadas con aspectos prácticos para la aplicación de las dos escalas en idioma español (T1-T2):Para el Perme Score.¿Se podría modificar la forma gráfica de los ítems del dominio de las potenciales barreras ítem 5? En términos prácticos se hacen más visible los enunciados en forma vertical.Se podría tener en el instructivo definiciones más específicas para unificar el porcentaje de asistencia durante las trasferencias.?¿Se podrían cambiar en el ítem de Marcha, en la distancia los pies por metros? En Colombia y gran parte de países de habla hispana la unidad de medida empleada habitualmente para la distancia es metros.En las Se obtuvieron las dos versiones de cada escala retraducidas al idioma inglés. Las divergencias encontradas entre las versiones originales en idioma inglés y las versiones retraducidas desde el idioma español se resolvieron mediante discusión del equipo investigador, y se obtuvo la versión final de ambas escalas en idioma español. Los autores originales de ambas escalas aprobaron la versión final en idioma español.Este proceso fue realizado entre febrero y junio de 2017. La versión final de ambas escalas, fue utilizada para determinar la confiabilidad inter-evaluador. Inicialmente 4 fisioterapeutas fueron entrenados en la aplicación de ambas escalas y se realizó una prueba piloto con una muestra por conveniencia con 30 pacientes. El tiempo aproximado para la aplicación de la IMS fue menor de dos minutos y menos de cinco minutos para el Perme Score.El estudio de confiabilidad interevaluador se realizó en una UCI adulto de 14 camas en una clínica de tercer nivel de complejidad. El tamaño muestral se calculó utilizando la estimación adelantada de Perme et al,El tamaño de la muestra se calculó utilizando la siguiente fórmula: Dando como resultado un tamaño de muestra de 108 pacientes. Teniendo en cuenta las posibles pérdidas y que el proceso de selección fue realizado por bloques incompletos balanceados, se consideró conveniente una muestra de 150 pacientes.Se realizó un entrenamiento de 12 horas, para los 4 fisioterapeutas que estuvieron a cargo de la recolección de datos; cada profesional valoró a cada paciente y se registró la duración, ejecución, comentarios y preguntas generadas durante el proceso. Los pacientes que se valoraron en esta prueba piloto tuvieron características similares a los de la muestra.Para evaluar la confiabilidad inter evaluador de ambas escalas, éstas se aplicaron a 150 pacientes. Fueron incluidos pacientes con edad mayor de 18 años, con movilidad independiente antes de ingreso a UCI (Puntuación de Barthel por encima de 90), reportado por los familiares más próximos o por el propio paciente en función de la situación de salud del paciente 7 días al ingreso a UCI), y fueron excluidos pacientes con deficiencia auditiva, pacientes con transferencia de otras unidades sin datos clínicos, pacientes con re internación a UCI, pacientes con fracturas inestables o lesiones que impidieran la MT o que no hablaran español.Todos los familiares y los pacientes, si la condición clínica lo permitía, firmaron consentimiento informado previo a su participación en el estudio. La aplicación de las escalas se realizó en dos momentos diferentes .información después de terminar la aplicación de las dos escalas y antes de realizar la fisioterapia. Se conformaron dos parejas de evaluadores entrenados quienes independientemente aplicaron las dos escalas al mismo tiempo para el mismo paciente. El evaluador "A”, fisioterapeuta especialista (mayor de 5 años de experiencia) evaluaba el paciente, el evaluador "B", fisioterapeuta sin especialización (con más de 5 años de experiencia) observaba todo el proceso. Ambos evaluadores completaron el formato de recolección de la Los formatos de puntuación de las dos escalas fueron diligenciados separadamente, sin comunicación entre los evaluadores. El evaluador "B" fue el responsable de registrar las otras variables del estudio , tiempo de estancia en UCI, tipo de destete, lugar de egreso). Las dos escalas y los evaluadores fueron aleatorizados por bloques incompletos balanceados utilizando sobres cerrados. Se realizó enmascaramiento del investigador principal y del equipo de trabajo de UCI. Antes de la aplicación de las escalas se utilizó la lista de chequeo de MT estandarizada en la institución, relacionada con las indicaciones, con estabilidad hemodinámica, psíquica y motora. Una vez verificada la información consignada en los formatos de recolección, se digitó en una base de datos diseñada en el programa Excel versión 2013. Para el análisis estadístico fue utilizado el programa SPSS 22.Para la descripción de las características clínicas de los pacientes se utilizaron las medidas de tendencia central, media y mediana, como medida de dispersión la desviación estándar (DE), y se utilizaron frecuencias absolutas y porcentajes (%) de acuerdo al tipo y distribución de cada variable.p <0.05. Para la interpretación de los valores del ICC se tuvo en cuenta la clasificación de Landis y Koch Para evaluar la confiabilidad ínter evaluador  para las puntuaciones de la IMS y Perme Score en los dos momentos, se utilizó el índice de correlación intraclase (ICC) y se determinaron intervalos de confianza del 95% (IC 95%), con un nivel de significancia de Durante el periodo de recolección de datos, se incluyeron 150 pacientes. La La caracterización clínica se describe en la Para verificar la concordancia interevaluador  se usó el coeficiente de correlación intraclase (ICC) con un intervalo de confianza (IC) del 95%. En ambas escalas y mediciones en los dos momentos se obtuvieron valores cercanos a uno para el ICC. Lo que muestra una excelente concordancia entre evaluadores y observadores para ambas escalas.Considerando que el análisis en términos generales podía enmascarar problemas de confiabilidad entre las puntuaciones realizadas por cada pareja observador/ evaluador, fue necesario realizar el análisis de cada pareja en los dos momentos de las mediciones.Al analizar los resultados de la IMS por parejas se observó que para la primera medición se obtuvo un ICC excelente para todos roles , obteniéndose valores de uno (1) en tres de las cuatro combinaciones evaluador-observador, mientras que sólo una de las parejas obtuvo una correlación intraclase de 0.941, lo que corresponde a una alta correlación. Para la segunda medición de la IMS se encontraron resultados similares a los de la primera medición. El índice de correlación intraclase fue de 1 en tres de las cuatro combinaciones de parejas, y de 0,96 en una de las parejas .Al analizar los resultados del Perme Score por parejas se observó que para la primera medición se obtuvo un ICC excelente, obteniendo valores de uno (1) en dos de las cuatro combinaciones evaluador-observador, mientras que dos de las combinaciones observador/evaluador obtuvieron un ICC de 0.999. En el caso de la segunda medición para el Perme Score también se encontraron resultados similares a los de la primera medición. El ICC fue excelente en tres de las cuatro combinaciones y de 0.998 en una de las parejas .En la El presente trabajo representa el primer reporte de traducción, adaptación cultural y confiabilidad inter evaluador del Perme Score y de la IMS en idioma español, los autores consideran que teniendo en cuenta que a la fecha, en nuestro medio no hay escalas traducidas ni validadas para su uso en español que permitan evaluar la movilidad funcional en el contexto de la UCI, los resultados de esta investigación pueden ser apropiados por los equipos de profesionales e instituciones de lengua hispana para guiar intervenciones de movilización temprana en el paciente crítico. ,En la traducción para el idioma español y la adaptación cultural del Perme Score y de la IMS se siguieron las recomendaciones de un protocolo, ambas escalas son de fácil aplicación en pacientes críticos. Existen traducciones y adaptaciones culturales de ambas escalas para varios países lo que facilita la comparación entre los estudios realizados et al.et al.El tamaño de muestra (n= 150) en este estudio es mayor al utilizado en la validación de las versiones origínales de ambas escalas, Nawa ,,La edad, el sexo y los diagnósticos médicos de la muestra del presente estudio son muy similares a las variables demográficas de las muestras usadas en los estudios de validación La muestra se reclutó en pacientes con diferentes diagnósticos médicos y se clasificó la severidad o gravedad al ingreso a UCI con el APACHE II. et al.et al. Los estudios originales de validación del Perme Score y de la IMS también reportan el uso del APACHE II. Hodgson et al. Parry et al. et al,,En las publicaciones revisadas no se identificaron estudios que evaluaran la confiabilidad interevaluador en dos parejas en el rol de evaluador/observador, en dos momentos diferentes. Hodgson Para identificar la confiabilidad inter evaluador, las mediciones fueron realizadas por dos parejas de evaluadores conformadas por un fisioterapeuta sin especialización (Ft.) con más de 5 años de experiencia y por un fisioterapeuta especialista en fisioterapia cardiopulmonar (Ft.E) con más de 5 años de experiencia; cada pareja en dos momentos diferentes , con una aleatorización del orden del rol observador/evaluador en cada pareja, realizaron las mediciones desconociendo la puntuaciones obtenidas.Estos métodos difieren con los estudios de validación de las escalas originales; los autores consideran que cambiar de rol durante las evaluaciones favoreció a disminuir los sesgos relacionados con los comandos, abordaje y orientaciones a los pacientes, que son factores que pueden ser diferentes de un profesional a otro e influir en las puntuaciones. También asumen que un mayor número de evaluadores que rotan el rol evaluador/observador representa una situación más cercana a lo que ocurre en una UCI con diferentes profesionales valorando al paciente en diferentes momentos, lo que hace que nuestros resultados sean aplicables.En este estudio se observó una alta concordancia y ausencia de diferencias significativas entre los roles observador/ evaluador para las dos escalas en los dos momentos de medición. Los autores de la investigación consideran que lo anterior, pudo estar relacionado con el entrenamiento realizado, el aprendizaje adecuado y la experiencia clínica.Para los autores, es importante resaltar que, a diferencia de los procesos originales de validación de ambas escalas, realizar las mediciones en dos momentos diferentes, permitió discriminar entre los entornos de ingreso a UCI y los cambios sucesivos en la movilidad de los pacientes en el contexto de la UCI. También consideran que la aleatorización en el rol observador/ evaluador evitó el sesgo de que la evaluación pudiese estar condicionada por el efecto del recuerdo de la primera.Las fortalezas metodológicas del estudio están relacionadas con la aleatorización por bloques balanceados incompletos para establecer el rol de evaluador/observador lográndose garantizar un número similar de pacientes en cada pareja; con la heterogeneidad en la gravedad de los pacientes; con las estrategias implementadas para disminuir la posibilidad de sesgos de información y selección, y para controlar factores de confusión, tales como el enmascaramiento del investigador principal y de los resultados de las mediciones y el control de calidad realizado a los procesos de recolección y análisis de la información. Los autores del estudio consideran que entre las limitaciones se identifican: el haberse realizado en una sola institución, no haber tenido en cuenta otros profesionales del equipo de la UCI  y la ausencia de otras evaluaciones funcionales como fuerza muscular. Sin embargo, estos aspectos no afectan la validez de los resultados, teniendo en cuenta que este estudio no evalúo los efectos de las intervenciones de MT. ,Se recomienda la realización de futuras investigaciones con el uso de las escalas para evaluar la aplicación y validación de protocolos de movilidad temprana, también se reconoce la necesidad de analizar otras propiedades clinimétricas. Aunque la traducción fue realizada en Colombia, es factible el uso en otros países de habla hispana, puesto que, durante el proceso de traducción y adaptación cultural, se tuvo en cuenta que la versión ﬁnal en idioma español fuera el reﬂejo de la versión original en idioma inglés, y que fuera de fácil comprensión, evitándose el uso de términos ambiguos o modismos locales El proceso de traducción, adaptación cultural y confiabilidad del Perme Score y de la IMS fue realizado con una metodología rigurosa y se dispone de ambas escalas en idioma español, con excelente confiabilidad inter evaluador, en dos momentos diferentes . Se recomienda el uso de ambas herramientas en el contexto de la atención del paciente crítico para orientar y cuantificar las intervenciones de MT.


The authors wish to make the following erratum to this paper :The affiliation 5 of co-author Ewa Moczko should be corrected into:“Departamento de Química Ambiental, Facultad de Ciencias, Universidad Católica de la Santísima Concepción, Concepción 4090541, Chile”.The authors would like to apologize for any inconvenience caused to the readers by these changes.


Scientific Reports 10.1038/s41598-018-28061-1, published online 27 June 2018Correction to: The original version of this Article contained an error in Affiliation 4 which was incorrectly given as ‘Universidade de Santo Amaro, Botucatu, São Paulo, Brasil’The correct affiliation is listed below:Universidade de Santo Amaro, São Paulo, São Paulo, BrasilThis error has now been corrected in the HTML and PDF versions of the Article.


The term chronic venous disease (CVD) encompasses the many different signs and symptoms of venous disease. ,,clinical signs); E (etiologic classification); A (anatomic distribution) e P (pathophysiologic dysfunction),chronic venous disorders)Venous Clinical Severity Score (VCSS), revisado em 2010, é utilizado para acompanhar os sintomas e mensurar a gravidade da DVC e não inclui no escore telangiectasias e veias reticulares,,,,World Health Organization Instrument to Assess Quality of Life (WHOQOL) e 36-item Short-Form Health Survey (SF-36) são instrumentos genéricos para estudar a QV, enquanto o Chronic Venous Insufficiency Questionnaire (CIVIQ), o Venous Insufficiency Epidemiological and Economic Study/Quality of Life-Symptoms (VEINES/QoL-Sym), o Aberdeen Varicose Vein Questionnaire (AVVQ) e o Charing Cross Venous Ulceration Questionnaire (CXVUQ) são específicos para a QV na DVC,,,,,,,,,,,,,,A complexidade que envolve a doença venosa pode ser observada na multiplicidade de siglas e conceitos utilizados. O termo doença venosa crônica (DVC) abrange os diversos sinais e sintomas da doença venosa


Academic leagues are extracurricular student organizations that are supervised by professors on the faculty of a higher education institution and are dedicated to improving knowledge in certain areas. There has recently been a marked growth in the number of new leagues, giving undergraduate students access to additional information, lectures, internships, and conferences. Angiology and vascular surgery is one of the specialties that have such organizations.  To determine the academic profile of the angiology and vascular surgery academic leagues at medical schools in the state of São Paulo, Brazil, and investigate the academic performance of their members.  This is a cross-sectional, descriptive, and analytical study that recruited undergraduate medical students who had joined angiology and vascular surgery academic leagues in the state of São Paulo. On-line questionnaires were used to collect data on each league and the students took examinations to determine their performance.  Most leagues had an entrance exam for enrollment, with an obligatory introductory course. Monthly theoretical lectures were held by 42.9% of the leagues. Practical activities were provided by 85.7% of the leagues. The majority of the leagues (71.4%) were involved in scientific research. Paired-sample comparison of students’ performance in the exams revealed a significant increase in mean scores, from 61.1 to 72.6 (p < 0.05).  The angiology and vascular surgery academic leagues in the state of São Paulo all function in a similar manner, but the range of theoretical, practical and scientific activities they offer are not uniform. For the sample investigated, the academic leagues appear to be effective at teaching angiology and vascular surgery during undergraduate courses.  Medical science teaching has a history going back millennia and as developments emerge over time new discoveries and technologies have influenced medical education. Since the very earliest days of medical training, it was felt that there was a need for a consultant or tutor or even a group of people who shared the same interest in a research problem. Technical development, social responsibility, and humanitarian behavior were essential elements of medical education to train professionals capable of identifying and treating health problems in other human beings.  In the mid 1920s, groups with objectives and interests in common began to grow and exchange information, experiences, and activities (with a tutor as facilitator), enabling undergraduate students to develop their skills. The seed from which Brazil’s academic leagues would grow had been sown.  The academic leagues are student organizations supervised by a professor from a teaching institution that work to improve knowledge in specific areas through extracurricular activities. Factors that possibly motivate undergraduate students studying Medicine to participate in the academic leagues include: contact with medical practice, acquisition of experience, interaction with colleagues, identification with a group, professional qualification, and a need to overcome possible curricular deficiencies.  The first league established in Brazil was the League to Fight Syphilis (Liga de Combate à Sífilis), in 1920, at the Universidade de São Paulo Medical Faculty. , In general, the academic leagues offer undergraduates access to theoretical lectures, courses, symposia, scientific research, conferences and, in some cases, supervised medical care activities.  Over the years, associations of academic leagues have been formed, such as, for example, the Brazilian Society of Cardiology Leagues (Sociedade Brasileira de Ligas de Cardiologia), which has almost 80 member leagues and organizes symposia and conferences, illustrating the organizational level that such entities can attain.  The objective of this study was to trace the profiles of angiology and vascular surgery academic leagues at medical schools in the state of São Paulo, Brazil.  This is a cross-sectional, descriptive, analytical study conducted with 56 medical students who were members of angiology and vascular surgery academic leagues at medical schools in the state of São Paulo. This study was approved by the Research Ethics Committee at the Universidade de Mogi das Cruzes, under hearing number 2.216.240  on August 13, 2017.  An initial survey was conducted of medical schools in the state of São Paulo that have angiology and vascular surgery academic leagues. All of the students and presidents involved agreed to participate voluntarily and signed free and informed consent forms. ,-t test.  Teaching effectiveness was determined by application of two identical assessment exams, containing 20 multiple choice questions, randomized across the students, before (test I) and after (test II) the leagues’ 2017 academic year. These assessment tests covered the material that comprises the basic knowledge of the angiology and vascular surgery specialty , taken from two Brazilian references on the specialty (text books).  The profiles of the academic leagues were evaluated using an on-line questionnaire that was completed by the president of each league on the Google Forms®  The survey of medical schools in the state of São Paulo identified a total of 59. Just 10 of these have an angiology and vascular surgery league. Seven leagues agreed to participate voluntarily in the study: six in the greater São Paulo area (86%) and one in upstate São Paulo (14%). These leagues were founded between 2008 and 2017. The number of new members they enrolled in 2017 varied from six to 10 students.  The leagues have administrations organized as president, vice-president, treasurer, etc. The administrations of the leagues investigated have terms varying from 1 year to 1 and a half year. The oldest of these leagues, founded in 2008, has had six terms to date.  Enrollment of new members involves a written test of theory in 57.10% of the leagues.  All of the leagues organized obligatory introductory courses that were a prerequisite for enrollment, with the primary objectives of presenting the material that would be tested in enrollment exams and to ensure a standard minimum level of knowledge for new members. With relation to lectures, 42.9% of the student organizations offered monthly lectures, 42.9% offered fortnightly lectures, and one of them held lectures weekly. A majority of the leagues (85.7%) ran a proportion of these lectures in partnership with other specialty leagues.  In addition to theoretical activities, 85.7% of the leagues ran supervised internships as practical activities. The frequencies of practical internships are illustrated in  Scientific activities (academic research) were part of the majority of the leagues’ programs (71.4%). Six out of seven of the leagues provide incentives for scientific activity, while 100% of the leagues’ students participated. The number of presentations at academic conferences per league is illustrated in  A total of 56 students took the exams to test the leagues’ teaching effectiveness (tests I and II). A total of 34 students took test I and 34 students took test II. A total of 12 students took both tests.  In test I, the highest percentage of correct answers were for questions on vascular anatomy (76.4%). The lowest percentage was for the group of questions on natural history of the disease (59.8%), as illustrated in  In test II, the highest proportion of correct answers was for questions on natural history (85.2%), and the lowest was on the etiology and pathophysiology of vascular diseases (51.9%), as illustrated in  The basic objective of academic leagues is to help future doctors to accumulate knowledge; but, to date, they have been investigated little. ,, Practical activities can introduce students to the day-to-day reality of practicing the specialty, improving the patient-physician relationship, in addition to consolidating all of the knowledge taught within the university curriculum, by means of the introductory course and the lectures provided. This study found that the majority of leagues offer these activities, which is compatible with the literature. -, The objective of the processes for selection of new students is to screen for those with greatest interest in the specialty.  It was also observed that the introductory course, lectures, and other face-to-face theoretical activities are offered by all of the leagues, which is similar to data available in the literature. , With regard to scientific activities, all of the leagues stated that they take part in conferences, present and publish scientific research, which is stimulated by the institutions to which they are affiliated. Many studies have shown the positive impact of these activities, demonstrating that the students’ primary objective is to build an outstanding CV. ,,, The students performed well in both of the exams set (scores exceeding 60%). The paired analysis of what was learned over the course of an academic year revealed a statistically significant increase in overall mean scores, demonstrating that performance had improved. No other studies in the literature have assessed the knowledge of students who are members of academic leagues. Previous studies have reported that the knowledge, experience, and development of scientific reasoning acquired through academic league activities are useful in many medical specialties and in correlated areas,  The angiology and vascular surgery academic leagues in the state of São Paulo (Brazil) all function in a similar manner, but offer a varied range of theoretical, practical, and scientific activities. In the sample investigated, the academic leagues were effective for teaching angiology and vascular surgery to undergraduate students.   O ensino e a aprendizagem da ciência médica datam de milênios, e a evolução dos tempos, novas tecnologias e descobertas influenciaram esse processo. Desde os primórdios do ensino médico, sentiu-se a necessidade de haver um consultor/tutor ou até mesmo um grupo de pessoas que compartilhasse um mesmo interesse sobre um problema de pesquisa. O desenvolvimento técnico, a responsabilidade social e o comportamento humanitário deveriam fazer parte da educação médica para a formação de profissionais capazes de identificar e tratar problemas de saúde em outros seres humanos  Em meados da década de 1920, grupos com objetivos e interesses comuns começaram a crescer a partir de trocas de informações, experiências e atividades (com o auxílio de um tutor), possibilitando o desenvolvimento de habilidades durante a graduação. Assim, lançou-se a semente para o surgimento das ligas acadêmicas no Brasil  As ligas acadêmicas são organizações estudantis que contam com a supervisão de um docente vinculado à instituição de ensino e visam aprimorar o conhecimento em determinadas áreas, sendo esta uma atividade extracurricular. Entre os fatores motivacionais que levam os graduandos de Medicina a participarem das ligas acadêmicas podem estar: aproximação da prática médica, aquisição de experiência, interação com colegas, identificação com um grupo, qualificação profissional e tentativa de suprir possíveis insuficiências curriculares  A primeira liga criada no Brasil foi a Liga de Combate à Sífilis, em 1920, na Faculdade de Medicina da Universidade de São Paulo , Nas ligas acadêmicas, os graduandos têm, usualmente, acesso a aulas teóricas, cursos, simpósios, pesquisa científica, congressos e, eventualmente, atividades de assistência médica supervisionada  Ao longo dos anos foram surgindo também associações de ligas acadêmicas como a Sociedade Brasileira de Ligas de Cardiologia, que inclui quase 80 ligas e organiza simpósios e conferências, demonstrando o nível organizacional que essas entidades podem atingir  Este estudo tem como objetivo verificar o perfil e o ensino das ligas acadêmicas de angiologia e cirurgia vascular das faculdades de Medicina do estado de São Paulo.  Trata-se de um estudo transversal, descritivo e analítico com 56 alunos de Medicina membros de ligas de angiologia e cirurgia vascular das faculdades de Medicina do estado de São Paulo. Esta pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da Universidade de Mogi das Cruzes com parecer nº 2.216.240 (CAAE nº 69718117.6.0000.5497) em 13 de agosto de 2017.  Foi feito um levantamento inicial das escolas médicas do estado de São Paulo que contam com ligas acadêmicas de angiologia e cirurgia vascular. Todos os alunos e presidentes envolvidos aceitaram participar voluntariamente da pesquisa, assinando o termo de consentimento livre e esclarecido. ,-on-line pela plataforma ProProfs®  A determinação da efetividade no ensino foi realizada através de duas avaliações idênticas, com 20 questões de múltipla escolha, aleatorizadas entre os alunos, aplicadas antes (prova I) e após (prova II) o ano letivo das ligas em 2017. Essas avaliações contemplaram conteúdo de conhecimento básico da especialidade de angiologia e cirurgia vascular  com duas fontes (livros-texto) de referência nacional da especialidade on-line preenchido pelos presidentes das ligas pela plataforma Google Forms®  A avaliação do perfil das ligas acadêmicas foi feita através de questionário  O levantamento das faculdades de Medicina no estado de São Paulo resultou em um total de 59 escolas. Dessas, apenas 10 contavam com uma liga de angiologia e cirurgia vascular. Sete ligas participaram voluntariamente do estudo: seis da região da Grande São Paulo (86%) e uma do interior do estado (14%). A data de fundação dessas ligas variou entre 2008 e 2017. O número de novos membros ingressantes no ano de 2017 variou entre seis e 10 alunos.  As ligas dispunham de gestões, organizadas em presidente, vice-presidente, tesoureiro, etc. Entre as ligas pesquisadas, as gestões variaram entre um ano e um ano e meio de duração. A liga mais antiga, criada em 2008, já apresentou seis gestões até o momento.  O ingresso de novos membros ocorreu através de teste teórico escrito em 57,10% das ligas. A  Como pré-requisito ao ingresso nas ligas, 100% delas realizaram um curso introdutório, com as principais finalidades de apresentar os conteúdos para a prova de ingresso e nivelar o conhecimento dos novos membros. Entre as entidades estudantis, 42,9% relataram oferecer aulas para seus membros mensalmente, 42,9% quinzenalmente, e uma delas semanalmente. A maioria das ligas  ministraram parte dessas aulas em parceria com ligas de outras especialidades. A  Além das atividades teóricas, 85,7% das ligas realizaram estágios supervisionados como atividade prática. A frequência de realização dos estágios está demonstrada na  A atividade científica era uma realidade na maioria das ligas . Houve incentivo dessa atividade em seis das sete ligas pesquisadas. A participação dos alunos ocorreu em 100% das ligas. A quantidade de trabalhos apresentados em congressos pelas ligas é demonstrada na  Um total de 56 alunos responderam as avaliações para verificação da efetividade do ensino nas ligas (provas I e II). Responderam a prova I um total de 34 alunos, e outros 34 responderam a prova II. Um total de 12 alunos responderam ambas as provas.  Na prova I, houve um maior percentual de acertos de questões que envolveram o assunto anatomia vascular . O menor percentual foi verificado no grupo de questões referentes ao assunto história natural da doença , conforme mostra a  Na prova II, o maior índice de acertos foi sobre história natural , e o menor sobre etiofisiopatologia das doenças vasculares , conforme demonstrado na  As ligas acadêmicas possuem o objetivo básico de auxiliar na construção do conhecimento dos futuros médicos; porém, ainda hoje, têm sido pouco exploradas ,, Atividades práticas podem aproximar o aluno da realidade diária da especialidade, melhorando o relacionamento com o paciente, além de consolidar todo o conhecimento transmitido pelo currículo da faculdade, pelo curso introdutório e pelas aulas ministradas. Na presente pesquisa, foi evidenciado que a maioria das ligas dispõe dessas atividades, o que é compatível com a literatura -, O objetivo do processo seletivo dos novos membros é triar alunos com maior interesse pela especialidade  Verificou-se também que o curso introdutório, assim como aulas e outras atividades teóricas presenciais, estão presentes em todas as ligas avaliadas, dado semelhante ao encontrado na literatura , Quanto ao desenvolvimento de atividades científicas, todas as ligas relataram participar de congressos e desenvolver trabalhos científicos, sendo estes estimulados pelas instituições as quais estão vinculadas. Diversos estudos reafirmam o aspecto positivo dessas atividades, demonstrando que o objetivo principal do aluno é a construção de um currículo diferenciado ,,, Em ambas as avaliações realizadas, os alunos apresentaram bom desempenho (notas superiores a 60%). Na avaliação do aprendizado durante o período letivo, comparando-se dados pareados, constatou-se um aumento estatisticamente significante da média geral, determinando melhora comprovada no desempenho. Não há outros estudos na literatura que realizaram avaliações de conhecimento de alunos de ligas acadêmicas. Estudos prévios já relatavam que o conhecimento, a experiência e o desenvolvimento de raciocínio científico adquiridos nas atividades em uma liga acadêmica são úteis em diversas especialidades da medicina e áreas correlatas  As ligas acadêmicas de angiologia e cirurgia vascular do estado de São Paulo apresentam modos de funcionamento semelhantes e um perfil heterogêneo quanto a atividades teóricas, práticas e científicas. A partir da presente amostra, as ligas acadêmicas aparentam ser efetivas no ensino de angiologia e cirurgia vascular durante a graduação.


Most maternal that deaths occur in developing countries are considered unfair and can be avoided. In 2008, The WHO proposed a checklist for delivery care, in order to assess whether a simple, low-cost intervention had an impact on maternal and neonatal mortality in low-income countries. To translate, adapt and validate the content of the WHO Safe Childbirth Checklist (SCC) for its use in Colombia The translation of the list was carried out, adaptation was made to our context and validation of content through a panel of experts composed of 17 health workers with experience in maternal and neonatal care and safety. The reliability among the judges was calculated (Rwg) and according to the results, items were modified or added to each section of the list. Modifications were made to the wording of 28 items, none was eliminated, and 19 new items were added. The most important modifications were made to the management guidelines that accompany each item and the items included refer to risks inherent to our environment. The Colombian version of the SCC will be a useful tool to improve maternal and neonatal care and thereby will contribute to reducing maternal and neonatal morbidity and mortality in our country. These are lists of items to be checked during a complex activity, as a memory aid, to ensure the correct execution of a task. Integration of checklist programs into clinical practice has shown to reduce mortality and the incidence of complications in surgery and intensive care ,A strategy based on a checklist is well adapted to childbirth care if it considers several characteristics of the event, for example, that the main causes of maternal and perinatal mortality are well described; that most deaths occur within a short period of time (twenty-four hours after birth); that international guidelines for best practices exist but are not followed; and that some proven interventions are relatively inexpensive, cost-efficient, easy to implement, but may be difficult to remember and to implement in the appropriate sequence, which could be solved by using a checklist For this reason, in 2008 the WHO established a safety program based on the Safe Childbirth Checklist to determine whether a simple, low-cost intervention had an impact on maternal and neonatal mortality in low-income countries. The initially proposed checklist contains 29 items addressing the leading global causes of maternal death ; childbirth-related fetal death (inappropriate intrapartum care); and neonatal death . It also addresses childbirth care , and simultaneously controls all preventable direct and indirect causes of maternal mortality within the first 24 hours after birth until discharge from hospital.Pilot test results showed that the implementation of the childbirth checklist led to improved quality of care provided by health workers who attend institutional births Due to these results, in 2012, the WHO undertook an initiative that involved the collaboration of 29 countries and 34 research groups that mainly sought to evaluate the factors that facilitated or hindered the application and effective use of this instrument, leading to the design of an implementation guide and an updated checklist In order to use this instrument with a different population, its format should be modified to suit the context in which it will be used. Therefore, within the framework of the worldwide pilot study, the checklist had to be translated and adapted to our context. This study sought to translate, adapt and validate the content of the WHO Safe Childbirth Checklist for its use in Colombia.Validation study of instruments.A team of 17 experts in patient safety, obstetrics, maternal and neonatal safety and mortality were available for expert consensus: 6 anesthesiologists, 1 internist, 5 obstetrician-gynecologists, 4 nurses and 1 pediatrician neonatologist. Most of them had more than 10 years of experience, and only 2 had less than that (7 and 2 years); they were selected by expert referral. The list of expert judges can be seen in ,The indications of the American Psychological Association (A.P.A.) for the adaptation of measuring instruments were followed to adapt the instrument, which include: 1) making sure that there is equivalence between languages and cultural groups of interest, 2) deciding whether to adapt an existing instrument or prepare a new one, 3) selecting qualified professional translators, 4) performing direct or inverse translation, 5) reviewing the adapted version of the instrument and making the necessary corrections, among others The original instrument was translated by a qualified Colombian translator; this version was reviewed by the co-researchers of the project. The final adjustments to the translation were made in accordance with their suggestions and observations.The evaluation of the contents is usually performed by a panel of experts or expert judges, and is defined as "an informed opinion of people with experience in the subject, who are recognized by others as qualified experts, and who can provide information, evidence, judgments and assessments The group of judges received a format to assess the clarity and relevance of each item in the checklist, as well as their sufficiency to measure each phase of childbirth care proposed in the original instrument. The scores given to each behavior or section, in each of these categories, ranged from 1 to 4 on a Likert scale, according to the criteria shown in 𝑾𝑮: within-group interrater reliability) was calculated for each behavior. This is used to determine the level of agreement among evaluators when validating the items, and is estimated by:Reliability between judges  did not exceed a cut-off point of 0.8, the item or instrument had to be modified The Safe Childbirth Checklist (SCC) was developed by the WHO along with nurses, midwives, obstetricians, pediatricians, patient safety experts and patients from around the world as a strategy to help health workers improve their practices in maternal and newborn care. It focuses on the leading causes of maternal mortality worldwide , intrapartum-related stillbirths (inadequate care) and neonatal deaths . Each item on the list is a critical action and its omission can lead to serious outcomes.Pilot tests have shown that the SSC (version 1.0) has improved the practices of health workers Pause points occur during critical situations when complications can be avoided or adequately managed. They also occur at times when it is convenient to check the mother and the newborn. Thus, the Safe Birth Checklist is designed to be used at these four pause points during institutional births:On admission (8 items)Just before pushing or before cesarean section (5 items)Soon after birth within 1 hour (9 items)And, before discharge (7 items),This work complies with national and international recommendations for biomedical research In order to control possible bias among members of the consensus, a modified Delphi was applied, for which the experts gave their scores individually and blinded to the scores of the other experts first. Then each expert received a scoring device on the day of face-to-face consensus, so that each one gave again an individual score, blinded to the scores of the other experts.Once reliability among judges (Rwg) for each item and care phase was established, and taking into account the decision criteria, modifications were made to 28 items, in order to make them more suitable for use in our context. No items were removed, and 1 item remained the same; the results are presented in As Furthermore, 19 new items were added: 4 in the admission phase, 9 before delivery, 2 soon after birth and 4 in the discharge phase. The 4 items of the admission phase refer to allergy review, need for antihypertensive and syphilis treatment, while the supplies item was divided into two parts. The 9 items added to the section before birth are explained by the fact that the supplies item was considered as one, while it was separated in the new version; in addition questions about partogram and the need for antihypertensive treatment were added. In the section soon after birth, two items were added regarding the need for an antihypertensive medication for the mother and screening for congenital hypothyroidism and hemoclassification for the newborn. Finally, in the section before discharge, 4 items were added that refer to investigating if anemic syndrome is observed in the mother, if a postpartum control appointment was scheduled, if treatment for syphilis was given, and if catheters and foileys were used.The final version of the Safe Birth Check List for use in Colombia can be seen in ,The Safe Childbirth Checklist Thus, following the methodology described above, after the translation of the original document and after reviewing and adjusting the Spanish version of each question and its recommendations, consensus points were modified and added to each of the four items on the list. For the first section, admission, all items were modified, adding considerations to each question, and formulating four new ones. Thus, regarding partogram, the suggested times for monitoring signs were modified. The proposal to take blood pressure every 2 hours instead of every 4 hours was considered because every 4 hours is a very long period of time to assess the impact of possible measures that may be taken. Measuring temperature every 4 hours rather than every 2 hours is explained by the fact that fever during labor is considered infrequent and that this parameter is not variable as to look for alterations so frequently. Controlling maternal and fetal heart rate every 30 minutes is also necessary, as well as measuring uterine activity every hour, since these parameters present a rapid variation based on the change of clinical conditions and the interventions in the patient and the neonate.S. AgalactiaeRegarding the use of antibiotics for the mother, modifications were made to several items on the list. On admission, antibiotic therapy was added in patients confirmed as carriers of New questions were also added. One is related to the presence of allergies in the mother, because it is essential to know, from the very beginning of childbirth care, whether the patient may present an allergic reaction that manifests itself as an anaphylactic shock that could lead to death. The second refers to whether the mother requires treatment for syphilis, considering the high prevalence of this disease in our context and the possibility of transmission to the fetus, thus protecting the mother and preventing congenital syphilis. Treatment for syphilis with antitreponemal antibiotic therapy is categorical and determinant if the mother is diagnosed with syphilis S. Agalactiae was added to the section that refers to antibiotic therapy for the mother, and the need to initiate antibiotic therapy if there is a suspicion of infection of any site. The indication for antibiotic therapy was removed when prolonged rupture of membranes occurs (more than 18 hrs) since this consideration should be made on admission; it has no place in this section either if the patient was admitted to the institution during expulsion, because it should be answered at both moments of the checklist, both in the admission section (where this indication is referred) and in the just before childbirth or cesarean section.With respect to the second section, just before the expulsion or caesarean section, some questions were added. One refers to the initiation of antihypertensives and another to the evolution of the partogram, because answering these questions seeks to predict complications and the need for interventions at birth. Suspicion or infection by During the third section, after delivery or cesarean section (and up to one hour later), the mother is also asked whether she took magnesium sulphate during pregnancy, and the clinician is asked to consider the same indications as in the previous two sections. This part also refers to the use of antibiotic therapy, extending the indications of the original list by adding use of antibiotics for instrumental delivery, manual removal of the placenta, uterine revision, severe perineal tear and clinical suspicion of infection of any site. This section also includes the baby, considering indications of need of referral, antibiotic therapy and special monitoring, which were maintained. Modifications were made to the item antibiotic therapy, ruling out neonatal seizures at this stage as an indication for administering antibiotic therapy because this symptom, right at birth, is considered to be caused by clinical situations other than neonatal infection, such as hydroelectrolytic disorders, hypoglycemia and metabolic disorders. Antibiotic therapy for congenital syphilis and APGAR less than 7 (which predisposes to more infections in neonates) were added. A new question was added regarding screening for congenital hypothyroidism and blood sample collection for hemoclassification in the newborn, which should occur during labor, before expulsion, by collecting blood from the umbilical cord, to avoid unnecessary puncture in the baby and considering that the collection of the sample after one hour leads to false results Finally, the last section of the checklist, before discharging both the mother and the baby, situations in which antibiotics should be administered were also established. Antibiotic therapy should be given to every mother with temperature above or equal to 38°C and foul-smelling vaginal bleeding, which coincides with the original checklist; however, initiating antibiotic treatment when there are signs of infection in the surgical site, superficial and deep and a clinical suspicion of infection in any site was added. As for the baby, the same indications established in the original checklist were maintained, because, at this point, the probability that neonatal seizures are generated by infection is very high. Regarding maternal HIV infection, the need for follow-up due to infectious diseases was added for both the mother and the baby for long-term control. The moments in which the postpartum check-up appointment should be granted by the outpatient clinic were clarified, so an appointment at seven days is recommended if the delivery was low risk and at 48 hours if there were risk factors. Finally, questions of whether the mother and the baby received syphilis treatment, if the test was positive, and if probes and catheters were removed, were added; this seeks to avoid discharging the patient and her baby with possible infections or risk factors that may lead to an infection.The Colombian version of the Safe Childbirth Checklist is expected to become an instrument useful to support institutions and improve care for mothers and newborns, while supporting the fulfillment of the objectives of sustainable development in our country. In addition, we expect that its implementation is especially useful in remote areas, where many safe practices are not systematically followed. All of this is intending to contribute to reducing maternal and neonatal morbidity and mortality. ,,La reducción de la mortalidad materna es una prioridad en salud pública a nivel mundial, definida como una de las “metas para el desarrollo del milenio”, de las Naciones Unidas En Colombia, para el año 2014, el Ministerio de Salud y de la Protección Social estimó con cifras del DANE una RMM de 53.7 por 100,000 nacidos vivos, sin embargo, los indicadores por departamento muestran grandes inequidades en el país, siendo los departamentos con mayores índices de pobreza los que tienen a su vez las RMM materna más altas, superando incluso por tres o cuatro veces al indicador nacional -En años recientes se han adoptado con mayor frecuencia intervenciones basadas en listas de verificación, con el fin de ayudar en la gestión de tareas complejas o desatendidas en las que se corre el riesgo de cometer mayor número de errores. Estas consisten en una lista de elementos para ser comprobados durante una actividad compleja, como una ayuda de memoria, para asegurar la correcta ejecución de una tarea. La integración de los programas de las listas de verificación en la práctica clínica ha demostrado reducir la mortalidad y la incidencia de complicaciones en cirugía y cuidados intensivos ,Una estrategia basada en la lista de verificación se adapta bien a la atención del parto dadas varias características propias del evento, a saber: que las principales causas de mortalidad materna y perinatal están bien descritas; que la mayoría de muertes se producen dentro de una estrecha ventana de tiempo (veinticuatro horas después del nacimiento); que existen directrices internacionales para las mejores prácticas pero no se siguen; y algunas intervenciones probadas son relativamente económicas, costo-eficientes, fáciles de realizar, pero pueden ser difíciles de recordar y ejecutar en la secuencia apropiada, aspecto que podría solucionarse usan una lista de verificación The WHO Safe Childbirth Checklist), inicialmente propuesta, contiene 29 ítems que abordan las principales causas mundiales de muerte materna ; muerte fetal relacionada con el parto (atención intraparto inadecuada); y muerte neonatal . Además, aborda la atención del nacimiento , y controla simultáneamente todas las causas prevenibles, directas e indirectas de mortalidad materna, en las primeras 24 horas desde el nacimiento hasta el egreso hospitalario.Por esto, en el año 2008 la Organización Mundial de la Salud (OMS) estableció un programa de seguridad basado en la Lista de Verificación para Atención del Parto Seguro, con el objetivo de determinar si una intervención simple, de bajo costo, tenía impacto sobre la mortalidad materna y neonatal en los países de bajos ingresos. La lista , fueron seleccionados por referenciación de expertos. El listado de jueces expertos se puede ver en el ,En el proceso de adaptación del instrumento se siguieron las indicaciones hechas por la Asociación de Psicólogos Americana (A.P.A.) para la adaptación de instrumentos de medición, que incluyen: 1) asegurarse de que existe una equivalencia entre los idiomas y grupos culturales de interés, 2) decidir si se adapta un instrumento ya existente o se desarrolla uno nuevo, 3) seleccionar traductores profesionales cualificados, 4) realizar traducción directa o inversa, 5) revisar la versión adaptada del instrumento y realizar las correcciones necesarias, entre otros Se realizó la traducción del instrumento original con ayuda de un traductor cualificado nativo de Colombia, esta versión se revisó entre los co-investigadores del proyecto. De acuerdo con las sugerencias y observaciones realizadas en esta fase se hicieron los últimos ajustes a la traducción del mismo.Esta generalmente es evaluada a través de un panel o juicio de expertos, el cual está definido como “una opinión informada de personas con trayectoria en el tema, que son reconocidas por otros como expertos cualificados en éste, y que pueden dar información, evidencia, juicios y valoraciones” Al grupo de jueces se les entregó un formato para evaluar la claridad y relevancia de cada uno de los ítems que componían la lista de verificación y la suficiencia de estos para medir cada fase de la atención del parto propuestos en el instrumento original. Las puntuaciones dadas a cada comportamiento o apartado, en cada una de estas categorías, oscilaron en una escala Likert de 1 a 4, de acuerdo a los criterios que se muestran en la 𝑾𝑮: within-group interrater reliability) para cada comportamiento; la cual se usa para determinar el nivel de acuerdo entre evaluadores en la validación de ítems, y se calcula a partir de la fórmula:Se calculó la fiabilidad entre jueces  no supera un punto de corte de 0.8, se deben modificaciones al ítem o al instrumento wg menor a 0.8 en claridad indicaba la necesidad de modificar el ítem, un Rwg menor a 0.8 en relevancia abría la discusión sobre eliminar o no el ítem y un Rwg menor a 0.8 en suficiencia abría la discusión sobre los ítems que era necesario incluir en la versión para Colombia. Este proceso se realizó varias veces hasta que las modificaciones realizadas mostraron un acuerdo entre los jueces superior al punto de corte.De acuerdo con este cálculo, se decidió eliminar, modificar o no modificar cada ítem y añadir o no nuevos ítems a cada fase de la lista. El criterio que se acepta es que si el nivel de acuerdo (RLa lista de Verificación del Parto Seguro (LVPS) fue desarrollada por la OMS en un trabajo colaborativo con enfermeras, parteras, obstetras, pediatras, expertos en seguridad del paciente y pacientes de todo el mundo; como una estrategia para ayudar a los trabajadores de la salud a mejorar sus prácticas en la atención materna y del recién nacido. Se enfoca en las principales causas de mortalidad materna en el mundo , mortinatos relacionados con el intraparto (atención inadecuada) y muertes neonatales . Cada ítem de la lista es una acción crítica y su omisión puede conducir a situaciones graves.Las pruebas piloto han mostrado que la LVPS (versión 1.0), ha mejorado las prácticas de los trabajadores de la salud Los puntos de pausa suceden en aquellas situaciones críticas en las que se pueden evitar complicaciones o tratarse adecuadamente. También tienen lugar en aquellos momentos en los que es conveniente revisar a la madre y al recién nacido. De este modo, la Lista de Verificación del Parto Seguro está diseñada para utilizarse en estos cuatro puntos de pausa durante los partos institucionales:En el ingreso (8 ítems)Justo antes del trabajo de parto o antes de la cesárea (5 ítems)Después del nacimiento, dentro de la primera hora (9 ítems)Y, antes de dar de alta (7 ítems),La realización del presente trabajo se adecua a las recomendaciones para investigación biomédica nacionales e internacionales Para controlar posibles sesgos debidos a las influencias entre los miembros del consenso se decidió aplicar un Delphi modificado, en el cual en primera instancia los expertos dieron las puntuaciones de forma individual y cegada a los puntajes de los otros expertos, y en segunda instancia en la jornada de consenso presencial se usaron dispositivos de puntuación que fueron entregados a cada experto de modo que cada uno volvía a dar los puntajes que considerara de forma individual y cegada a los puntajes de los otros expertos.WG) para cada ítem y fase de atención, y teniendo en cuenta los criterios de decisión, se hicieron modificaciones a la redacción de 28 ítems, con el fin de hacerlos más acordes para el uso en nuestro contexto; no se eliminaron ítems, y se dejó 1 ítem tal como estaba, los resultados se presentan en la Una vez determinada la fiabilidad entre los jueces  puesto que esta consideración debe realizarse desde el ingreso, y si ingresara la paciente a la institución en expulsivo, tampoco tiene cabida en este apartado puesto que ante esta situación, deben ser llenados en este instante ambos momentos de la lista de chequeo, tanto el apartado correspondiente al ingreso (en donde esta indicación sí está referida) como el apartado justo antes del parto o la cesárea.En el segundo momento “justo antes del expulsivo o de la cesárea”, se adicionaron preguntas, una referente al inicio de antihipertensivos y otra referente a la evolución del partograma. Su diligenciamiento desde el ingreso, tiene como resolución la predicción de complicaciones y de la necesidad de intervenciones justo en el momento del nacimiento. Al apartado que se refiere a la antibioticoterapia para la madre, se adicionó la sospecha o infección por En el tercer momento, después del parto o la cesárea (y hasta una hora después), también se pregunta si la madre manejo su embarazo con sulfato de magnesio, y se le pide al clínico considerar las mismas indicaciones expuestas en los dos apartados anteriores. Allí también se hace referencia al uso de antibioticoterapia, ampliando las indicaciones de la lista original al agregar su uso ante el parto instrumentado, extracción manual de la placenta, revisión uterina, desgarro perineal severo y sospecha clínica de infección de cualquier localización. En este tercer momento aparecen las indicaciones referentes al bebé, y aquí, se mantienen las indicaciones de necesidad de remisión, antibioticoterapia y requerimiento de monitoreo especial haciendo modificaciones al ítem de antibioticoterapia, al descartar las convulsiones neonatales en esta etapa como indicación para administrar antibioticoterapia por considerar que este síntoma, justo al nacimiento, se debe a otras situaciones clínicas diferentes a infección neonatal, tales como trastornos hidroelectrolíticos, hipoglucemia y desordenes del metabolismo. Se adicionó la indicación de antibioticoterapia ante sífilis congénita y APGAR <7 (que predispone a mayores infecciones en el neonato). Se formuló una nueva pregunta que se refiere al tamizaje para hipotiroidismo congénito y la toma de una muestra de sangre para la hemoclasificación en el neonato, situación que debe realizarse en el mismo parto, antes del alumbramiento, con la obtención de sangre del cordón umbilical, para evitarle al bebé una punción innecesaria y que la toma de la muestra luego de una hora lleva a falsos resultados Referente al último momento de la lista de chequeo, antes de dar el alta tanto a la madre como al bebe, también se establecieron las situaciones en las cuales se debe pensar en antibióticos. Se propone iniciar antibioticoterapia a toda madre con temperatura superior o igual a 38 grados y sangrado vaginal fétido como en la guía original, pero se adicionó iniciar el tratamiento con antibióticos cuando hay signos de infección en el sitio quirúrgico, superficial y profundo y una sospecha clínica de infección en cualquier localización. En cuanto al bebé, se dejan las mismas indicaciones establecidas en la lista original; en este momento ante convulsiones neonatales, la probabilidad de que estas sean generadas por infección es suficientemente alta. En cuanto a la infección materna por VIH, se agregó la necesidad de un seguimiento por infectología tanto a la madre como al bebé para su control a largo plazo. Se aclararon los momentos en que se debe otorgar la cita de control postparto por la consulta externa, por lo que se recomienda una cita a los siete días si el parto fue de bajo riesgo y de 48 horas si hubo factores de riesgo. Por último, se agregó una verificación de si la madre y el bebé recibieron tratamiento para sífilis, si la prueba fue positiva y si se retiraron sondas y catéteres de haber sido utilizados. Esto para evitar que la paciente y su bebé egresen del hospital con posibles infecciones o con factores de riesgo que permitan desarrollar una infección.Se espera que la versión para Colombia de la Lista de Verificación del Parto Seguro sea una herramienta que ayude a las diferentes instituciones en salud a mejorar la atención a las maternas y neonatos. Apoyando con esta versión en el cumplimiento de los objetivos de desarrollo sostenible en nuestro país. Se espera que sea especialmente útil en las zonas distantes donde muchas de las prácticas seguras no se cumplen de forma sistemática. Con todo esto se espera que contribuya a disminuir la morbi-mortalidad materna y neonatal,


Superior mesenteric artery aneurysms are rare, accounting for less than 0.5% of all intra-abdominal aneurysms. They are mainly caused by atherosclerosis and septic emboli resulting from bacterial endocarditis. Although uncommon, these aneurysms are considered dangerous because of possible complications such as rupture with hemorrhage and intestinal ischemia. Since the consequences can be very serious, early diagnosis and treatment are essential to improve outcomes. Although there is no well-defined consensus, recommended treatments include open surgery, endovascular therapy, and watchful waiting with periodic examinations. In this article we report the case of an asymptomatic 58-year-old man with an incidental and unusual finding of two superior mesenteric artery aneurysms. Since anatomy was not favorable for an endovascular approach, open surgery was performed, using a dacron graft to successfully repair the artery.  In addition to the possibility of hemorrhagic shock in the event of rupture, SMA aneurysms can involve risk of ischemia of the intestine, which must be treated because of its lethal nature.  Modern imaging techniques have improved diagnosis and offer the possibility of safely monitoring the disease.  This case report describes a patient with two aneurysms of the SMA, for whom open surgical treatment was chosen because of the size of the aneurysm and anatomy that was not suitable for an endovascular approach.  The patient was a 58-year-old man, on treatment for hypertension, who was admitted to a vascular surgery service because of an incidental finding of two aneurysms of the SMA, identified during preoperative imaging exams preparatory to repair of an incisional hernia. The patient had no abdominal symptoms and on physical examination his abdomen was flaccid and painless and with a pulsating mobile mass in the epigastrium. Abdominal ultrasonography indicated a partially thrombosed saccular aneurysm in the retroperitoneal space, with no communication with the aorta. Multislice angiotomography revealed two aneurysms of the SMA, a proximal one measuring 5.9 × 5.2 × 5.0 cm and a distal one measuring 5.3 × 3.5 × 3.2 cm   and 2 .- Aneurysms of the SMA are the third most common type of visceral aneurysm, after aneurysms of the splenic artery and the hepatic artery. In almost all cases, including the case of the patient described here, the aneurysm is within the first 5 proximal cm of the SMA and does not involve the projection of the middle colic artery. ,- Infectious etiologies caused by septic embolism, provoking what are known as mycotic aneurysms, generally affect patients under the age of 50 who have a history of bacterial endocarditis and intravenous drug use. Other causes that merit mention are atherosclerosis (primarily in elderly patients), connective tissue diseases, rheumatoid arthritis, pancreatitis, trauma, Behçet’s disease, neurofibromatosis, and syphilis. ,, In contrast with other aneurysms of the visceral arteries, which in general are asymptomatic, more than 90% of aneurysms of the SMA are symptomatic, manifesting with nonspecific abdominal pains and mimicking gastrointestinal pathologies. ,,, Around half of all SMA aneurysms are diagnosed in the emergency department because of manifestations of spontaneous rupture, where hypovolemic shock, hemoperitoneum, or acute abdomen are the first manifestations. The mortality rate in these cases is 30 to 90%.  Aneurysms of the SMA have been diagnosed with increasing frequency over recent years, because of greater accessibility and precision of diagnostic imaging methods.  As in the case described here, diagnosis can be made with abdominal ultrasound, which is a rapid, accessible, and inexpensive tool.  Because of the rarity of SMA aneurysms, there is not yet a definitive consensus on their management, but the options described are watchful waiting, open surgery, and endovascular intervention.  In general, it is recommended that all patients with mycotic SMA aneurysm should undergo aneurysm repair of some type, as should patients with aneurysms larger than 25 mm. People who have aneurysm with sizes less than or equal to 25 mm can be managed with four-monthly imaging exams. ,,, Open surgery is a management option for patients with low surgical risk ratings and, primarily, for those who are hemodynamically unstable and need emergency repair. ,, As the techniques and devices used have improved, endovascular repair has become an effective and less invasive option for elective treatment of aneurysms of the SMA, particularly in high-risk patients for whom open surgery is contraindicated. , Currently, the literature reporting results of endovascular interventions in SMA aneurysms still lacks large reviews and is limited to very small cases series, so it is difficult to assess long-term results.  Therefore, even after more than 50 years of development of diagnosis and treatment, an SMA aneurysm remains a serious life-threatening condition. Satisfactory results are only achieved with timely diagnosis and treatment.  ,, Descritos primeiramente em 1951 por Koch, aneurismas de artéria mesentérica superior (AMS) são raros, representando 5,5 a 8% dos casos de aneurismas viscerais e menos de 0,5% de todos os aneurismas intra-abdominais  Além de choque hemorrágico em caso de ruptura, aneurismas de AMS podem colocar o intestino em risco de isquemia, demandando, pois, atenção devido à sua natureza letal  Técnicas de imagem modernas proporcionaram melhoria no diagnóstico e segurança no acompanhamento da doença  O presente relato de caso apresenta um paciente com aneurisma de AMS em duplicidade, no qual tratamento cirúrgico aberto foi o escolhido, devido ao tamanho do aneurisma e à anatomia desfavorável à abordagem endovascular. multislice evidenciou dois aneurismas de AMS, um proximal medindo 5,9 × 5,2 × 5,0 cm e outro distal medindo 5,3 × 3,5 × 3,2 cm , doenças do tecido conjuntivo, artrite reumatoide, pancreatite, trauma, doença de Behçet, neurofibromatose e sífilis ,, Ao contrário de outros aneurismas de artérias viscerais, em geral assintomáticos, mais de 90% dos aneurismas de AMS são sintomáticos, manifestando-se como dor abdominal não específica e mimetizando patologias gastrointestinais ,,, Cerca de metade dos aneurismas de AMS são diagnosticados no departamento de emergência devido à manifestação de ruptura espontânea, quando choque hipovolêmico, hemoperitônio ou abdome agudo são as primeiras manifestações. A taxa de mortalidade nesses casos é de 30% a 90%  Os aneurismas de AMS têm sido diagnosticados com frequência crescente nos últimos anos, devido à maior acessibilidade e acuidade dos métodos diagnósticos de imagem multislice – o exame padrão-ouro para essa situação. Para tal exame, avanços significativos nos softwares de imagem possibilitam a obtenção de figuras de alta resolução em três dimensões da aorta abdominal e de seus ramos, auxiliando o planejamento terapêutico  O diagnóstico, tal como no caso relatado, pode ser alcançado com ultrassom abdominal, uma ferramenta acessível, rápida e barata  Devido à raridade de aneurismas de AMS, ainda não há um consenso definitivo sobre o manejo dessa afecção, sendo descritas as opções de medida expectante, cirurgia aberta e intervenção endovascular  Em geral, recomenda-se que todos os pacientes com aneurisma micótico de AMS tenham de alguma forma o aneurisma reparado, assim como aqueles com aneurisma maior que 25 mm. Já os indivíduos com aneurisma menor ou igual a 25 mm podem ser submetidos a controle periódico com exames de imagem trianuais ,,, Cirurgia aberta é uma opção de manejo para pacientes de baixo risco cirúrgico e, principalmente, para aqueles hemodinamicamente instáveis que requerem reparo de emergência ,, Com o aprimoramento das técnicas e dos dispositivos utilizados, o reparo endovascular surge como opção efetiva e menos invasiva no tratamento eletivo de aneurisma de AMS, particularmente em pacientes de alto risco, em que cirurgia aberta não é indicada , Atualmente, a literatura que relata os resultados de intervenção endovascular em aneurisma de AMS ainda é carente de grandes revisões e limitada a séries de casos muito pequenas, sendo difícil avaliar os resultados a longo prazo  Logo, mesmo após mais de 50 anos de avanço no diagnóstico e tratamento, o aneurisma de AMS continua sendo uma condição séria que ameaça a vida. Os resultados satisfatórios só são alcançados através do diagnóstico e tratamento oportuno em tempo hábil