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Background  Traumatic brain injury (TBI) is a global public health problem. In Colombia, it is estimated that 70% of deaths from violence and 90% of deaths from road traffic accidents are TBI related. In the year 2014, the Ministry of Health of Colombia funded the development of a clinical practice guideline (CPG) for the diagnosis and treatment of adult patients with severe TBI. A critical barrier to the widespread implementation was identified-that is, the lack of a specific protocol that spans various levels of resources and complexity across the four treatment phases. The objective of this article is to present the process and recommendations for the management of patients with TBI in various resource environments, across the treatment phases of prehospital care, emergency department (ED), surgery, and intensive care unit. Methods  Using the Delphi methodology, a consensus of 20 experts in emergency medicine, neurosurgery, prehospital care, and intensive care nationwide developed recommendations based on 13 questions for the management of patients with TBI in Colombia. Discussion  It is estimated that 80% of the global population live in developing economies where access to resources required for optimum treatment is limited. There is limitation for applications of CPGs recommendations in areas where there is low availability or absence of resources for integral care. Development of mixed methods consensus, including evidence review and expertise points of good clinical practices can fill gaps in application of CPGs. BOOTStraP (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol) is intended to be a practical handbook for care providers to use to treat TBI patients with whatever resources are available. Results  Stratification of recommendations for interventions according to the availability of the resources on different stages of integral care is a proposed method for filling gaps in actual evidence, to organize a better strategy for interventions in different real-life scenarios. We develop 10 algorithms of management for building TBI protocols based on expert consensus to articulate treatment options in prehospital care, EDs, neurological surgery, and intensive care, independent of the level of availability of resources for care., Competing Interests: NoteAuthors’ ContributionsConflict of Interest No human subjects were involved in this work. Andrés M. Rubiano, MD, PhD(c): Principal investigator, senior author. David S. Vera, MD, José N. Carreño, MD, Oscar Gutiérrez, MD, Jorge Mejía, MD, MSc, Juan D. Ciro, MD, Ninel D. Barrios, MD, Alvaro R. Soto, MD, Paola A. Tejada, MD, MSC, PhD, Maria C. Zerpa, MD, Alejandro Gómez, TAPH, MD, Norberto Navarrete, MD, MSc, Oscar Echeverry, TAPH, Mauricio Umaña, MD, Claudia M. Restrepo, MD, José L. Castillo, MD, Oscar A. Sanabria, MD, Maria P. Bravo, MD, Claudia M. Gómez, MD, Daniel A. Godoy, MD, German D. Orjuela, TAPH, Augusto A. Arias, MD, Raul A. Echeverri, MD, Jorge Paraños, MD: Coinvestigators, coauthors. Jorge H. Montenegro, MD, Nancy Ann Carney, PhD, and Angelica Clavijo MD: Coninvestigators, coauthors also. None declared.

Introduction. Patient safety is an important topic. The purpose of this study is to evaluate the perceived versus observed patient safety measures (PSM) in critically ill patients in a teaching hospital in Latin America. Materials and Methods. The level of perceived patient safety was evaluated with the patient safety hospital survey. Three months later, a qualitative study was conducted, including video recording of procedures, graded according to adherence to PSM. Levels of adherence were scored during patient mobilization (PM), placement of central catheters (PCC), other invasive procedures (OIP), infection control (IC), and endotracheal intubation (ETI). Results. The perceived adherence of PSM in the prestudy survey was considered fair by 89.1% of the ICU staff. After the survey, 829 ICU procedures were video-recorded. Mean observed adherence for fair patient safety measures was 20.8%. Perceived adherence was higher than the real patient safety protocol measures observed in the videos. Conclusion. Perception of PSM was higher than observed in the management of critically ill patients in a teaching hospital in southern Colombia.

Introduction: Dengue is the fastest spreading disease in the world and a permanent threat to global public health. It is a viral illness for which approximately 2.5 million people are at high risk of infection. Given the severity of the disease at national and global levels, new predictive methodologies need to be generated to facilitate decision-making in public health. , Objective: To characterize cases of dengue reported from 2009 to 2013 in Valle del Cauca department, Colombia, and to establish a methodology to develop endemic channels that can be applied to this event. , Materials and Methods: This was a retrospective descriptive study. Notification forms were used as a secondary database to characterize dengue cases from 2009 to 2013. Two endemic channels were developed, one using running means and the other through exponential smoothing. , Results: Dengue in the department of Valle del Cauca showed a positive tendency, indicating that the number of cases had increased in the last five years. An important variation was observed that could be explained by a three-year cycle beginning in the first epidemiological period of the year. , Conclusion: The development of the dengue endemic channel for Valle del Cauca illustrates the importance of applying these monitoring methodologies to events of public health interest. As can be seen from the results, there were some years in which the number of cases was very low and others in which the epidemic reached very high levels.

Objectives: To quantify the prevalence of suicidal ideation in a population of university students, to characterize groups in connection with ideation and suicidal behavior, and to determine the variables associated with suicidal ideation and suicide attempts., Methods: Observational, analytic and cross-sectional study of a probabilistic sample of the population studied. An instrument for measuring suicide risk and associated variables was applied to this sample., Results: The prevalence of the current suicidal ideation was 3.6%, and 18% in the last year. Both suicidal ideation and history of suicide attempts were higher among female students. Rape history, being alone more than eight hours a day, and female gender were the factors more strongly related to suicidal ideation. A relationship suicidal ideation and awareness of the suicide of others was not found in this sample., Conclusion: A history of rape, remaining alone for more than eight hours during the day, and being a woman should alert the clinician about the possibility of suicidal ideation. It is recommended to explore and assess suicidal ideation in all people with these factors.