Established Exclusion Criteria Research Articles

32 Hypermobile Ehlers-Danlos Syndrome: Phenotypic Presentation, Comorbidity Risk, and Medical Service Utilization in the United States

OBJECTIVES/GOALS: Hypermobile Ehlers-Danlos syndrome (hEDS) is a heritable connective tissue disorder with no known genetic etiology. Its complex phenotypic presentation with multi-system involvement delays proper diagnosis and treatment, especially for females. This study examines the risk for common hEDS comorbidities and medical service utilization. METHODS/STUDY POPULATION: Electronic health records from over 150 million patients across 92 American healthcare servers were queried using the TriNetX database to determine phenotypic presentation of hEDS and risk of receiving comorbid diagnoses. Contingency tables were created with hEDS as the condition and postural orthostatic tachycardia syndrome (POTS) or gastroparesis as the grouping variables. Advanced analytics were conducted to compare outcomes of two cohorts: (1) patients diagnosed with hEDS and both POTS and gastroparesis, and (2) patients with a sole diagnosis of hEDS. After propensity score matching, differences in medical service utilization and mental health diagnoses were assessed between these two cohorts. All analyses restricted age (12-70 years) and employed established exclusion criteria (e.g., diabetes). RESULTS/ANTICIPATED RESULTS: TriNetX national health records (N = 1,968) reveal that hEDS predominantly affects females (87%) and is diagnosed at a mean of 35 years of age. People diagnosed with hEDS have a high prevalence of comorbid nervous system (81%), mental health (76%), and digestive system (69%) disorders. They are 29.7 times more likely to be diagnosed with POTS [95% CI: 27.1, 32.6] and 66.3 times more likely to be diagnosed with gastroparesis [95% CI: 56.5, 77.9], compared to people without hEDS. After propensity score matching for sex, race, and ethnicity, people diagnosed with hEDS and both POTS and gastroparesis have significantly greater service utilization (72.2% vs. 56.7%; z = 2.18, p < .05) but not a greater incidence of mental health disorders (34.4% vs. 24.4%; z = 1.47, p = .14) than people diagnosed with hEDS alone. DISCUSSION/SIGNIFICANCE: This study reveals the phenotypic presentation of hEDS and the elevated risk of co-occurring POTS and/or gastroparesis diagnosis. hEDS and its comorbidities are associated with more frequent medical encounters but not with a greater incidence of mental illness. Findings have implications for both clinical practice guidelines and further research.

Is Ancient Medical Treatment an Option for Curating Osteosarcoma Combined with Chemotherapy? A Basic Analysis of Clinic Pharmacy.

As a malignant tumor, osteosarcoma (OS) ranks first place among adolescent cancers and is susceptible to developing resistance to chemotherapeutic agents. Differently, Traditional Chinese medicine (TCM) has multiple pharmacodynamic targets and complex biological components, which can inhibit tumor survival and drug resistance and gradually play an important role in the treatment of sarcoma. This study is to systematically evaluate the safety and efficacy of TCM combined with chemotherapy performed in the clinical treatment of OS. Based on multiple mainstream databases, eleven articles on the relationship between natural products and chemotherapy involving 656 patients were selected from all the literature published as of June 2022. Revman 5.4 software was used for a comprehensive search analysis, supplemented by established exclusion criteria, the Jadad scale, and the evaluation methods provided by Cochrane. The efficiency of TCM combined with chemotherapy was significantly increased compared with chemical drugs alone [OR=2.56, 95% CI (1.36,4.79), Z=2.92, P=0.003]. Meanwhile, the adverse reactions such as nausea and vomiting, hepatotoxicity, and hematological changes caused by chemical drugs were alleviated correspondingly. This study indicates that the mode of TCM combined with chemotherapy sheds light on the clinical treatment of OS, which is much better than the one-way mode.

Behavioral Health Integrated Support Network (BHISN).

This article reviews process and performance of an innovative effort leveraging virtual health to manage unmet demand for behavioral health and substance use disorder services across a large military region. This effort began in June 2022 and included nearly all of the Defense Health Agency Region-Europe's military behavioral health and substance abuse clinics participating. The two goals of improving access to behavioral health and substance use services for active duty service members and improving utilization of the military clinics were employed. Operational and remote locations with known care gaps could access services as well. Connecting services to the point of need is an established strength of virtual health delivery systems of care. A team consisting of clinical leaders and Virtual Medical Center-Europe staff developed a centralized screening process and simple business rules. When a clinic was unable to meet its access-to-care standard of 28 days, the patient requesting or referral from a remote location, was offered a virtual video option with a provider from another clinic with availability. Centralized screening was created and staffed by three technicians. The Behavioral Health Integrated Support Network (BHISN) screening clinic assessed appropriateness of virtual care using established exclusion criteria. Once screened, the patient was scheduled for an appointment with one of the 31 therapists in 14 participating clinics in a 3- to 5-day window. The military health system's video connect platform was used. Between June 2022 and November 2023, 131 patients who were unable to find routine care in their home clinic were screened, scheduled, and completed a virtual visit with one of the 31 participating therapists from 14 behavioral health and substance use clinics. Seventy-eight (59%) participants were active duty empaneled to military treatment facilities in Europe and 53 (39%) were active duty enrolled in Tricare Prime Remote and deployed to remote locations with limited care. Forty-four percent of patients were recommended for continued virtual therapy or counseling kept their first follow-up demonstrating good follow-up care using a virtual option. The overall no-show rate was low at 7%. Care and consultation were successfully delivered using video visits to location in 18 countries in three geographic Europe, the Middle East and, Africa. The Virtual Medical Center-Europe, Army Europe Behavioral Health, and Substance Use leadership work collaboratively to plan and optimize program performance. For BHISN to function as intended requires key dedicated support staff, such as mental health and social services assistants to screen and coordinate virtual care. Scheduling can be performed by a central cell requiring clinics to relinquish some local control in the interest of meeting patient demand in large and diverse area that covers three continents. BHISN shows promising initial success by providing a process of managing demand and connecting requests for behavioral health and substance use care leveraging capacity from all clinics using a virtual video service in a diverse operating environment.

Ozempic (Semaglutide) for the treatment of obesity: advantages and disadvantages from an integrative analysis

Objective: To analyze the advantages and disadvantages of Ozempic for the treatment of obesity. Methods: Through an integrative analysis, it was possible to highlight different investigations in scientific articles. The article established inclusion criteria, such as keywords, publication language and being on one of the preselected platforms (Scielo, PubMed and RDU) and also established exclusion criteria, such as incomplete research, was the subject investigated and without methods and explicit methods. Results: The Ozempic (semaglutide) has good results in helping to lose weight in obese patients. Despite being developed for the treatment of patients with type 2 diabetes mellitus, the results for obesity were positive. Among the main results is weight loss, which is directly conditioned to the dosage of medication, as well as a better energy intake and a lower preference for fatty foods in the patients' choice. All these factors were considered advantages. Among the disadvantages of using the drug is the fact that it is new in the market, which limits scientific research. According to the authors, some researchers have already established a causal relationship between the use of semaglutide and thyroid cancer in rodents; this factor has not been proven in humans and is considered a disadvantage. Final considerations: The use of Ozempic presents interesting results for weight loss, however, although the long-term side effects of the use of this drug are not known, a factor that may pose a risk to patients who are using Ozempic for it. treatment of obesity.

Conceptualizing learning health systems: A mapping review.

Health systems worldwide face the challenge of increasing population health with high-quality care and reducing health care expenditure growth. In pursuit for a solution, regional cross-sectoral partnerships aim to reorganize and integrate services across public health, health care and social care. Although the complexity of regional partnerships demands an incremental strategy, it is yet not known how learning works within these partnerships. To understand learning in regional cross-sectoral partnerships for health, this study aims to map the concept Learning Health System (LHS). This mapping review used a qualitative text analysis approach. A literature search was conducted in Embase and was limited to English-language papers published in the period 2015-2020. Title-abstract screening was performed using established exclusion criteria. During full-text screening, we combined deductive and inductive coding. The concept LHS was disentangled into aims, design elements, and process of learning. Data extraction and analysis were performed in MAX QDA 2020. In total, 155 articles were included. All articles used the LHS definition of the Institute of Medicine. The interpretation of the concept LHS varied widely. The description of LHS contained 25 highly connected aims. In addition, we identified nine design elements. Most elements were described similarly, only the interpretation of stakeholders, data infrastructure and data varied. Furthermore, we identified three types of learning: learning as 1) interaction between clinical practice and research; 2) a circular process of converting routine care data to knowledge, knowledge to performance; and performance to data; and 3) recurrent interaction between stakeholders to identify opportunities for change, to reveal underlying values, and to evaluate processes. Typology 3 was underrepresented, and the three types of learning rarely occurred simultaneously. To understand learning within regional cross-sectoral partnerships for health, we suggest to specify LHS-aim(s), operationalize design elements, and choose deliberately appropriate learning type(s).

The Use of Screening Algorithm to Defer Blood Donors with Subclinical Malaria.

Plasmodium falciparum infection in blood donors is common in malaria endemic countries, including Ghana. To date, there are no established exclusion criteria to defer a donor carrying malaria parasites. Therefore, based on significant independent variables identified in this study, donor malaria screening algorithm was developed to be used by blood banks to screen blood donors for subclinical malaria. Each significant variable was weighted one (1) point and its alternative response was weighted negative one (−1) point. Accumulation of the points determines the risk level of the donor. These weighted points were used to categorize infected donors as having negligible (<2 points), tolerable (3-4 points), undesirable (5–8 points), or intolerable (>9 points) risk. Based on accumulated weight of ≥5 points, the algorithm was 94.7% (54/57) sensitive but 82% (298/364) specific. With this level of specificity, 18% of the blood donors without malaria would have been deferred. Therefore, it is imperative that all donors with accumulated risk ≥5 be screened for malaria using either malaria rapid test kit or microscopy.

Prevalence of Bovine Tuberculosis in Yaks Between 1982 and 2020 in Mainland China: A Systematic Review and Meta-Analysis.

Bovine tuberculosis (bTB) is a major chronic bacterial disease in cattle and is the major economic and animal welfare issue in the world. Although the economic costs and public health safety risks associated with the disease are considerable, the overall epidemiology of the Chinese yak (Bos grunniens) bTB is unclear. To fully reveal the basic prevalence of yak bTB in different regions of China, we searched five databases including PubMed, Science Direct, CNKI (China National Knowledge Infrastructure), Wanfang and Chongqing VIP. Based on the incidence and prevalence of yak tuberculosis in China from 1982 to 2020, a meta-analysis of yak bTB in China was established for the first time. By formulating the search formula, 97 studies were searched in five databases. According to the established exclusion criteria and excluded comments and repeated and irrelevance research, we finally selected 19 cross-sectional studies, which showed the prevalence of bTB in Chinese yaks. Random-effect meta-regression model analysis showed that the estimated prevalence of 122,729 yaks in China was 1.0 (95% confidence interval [CI]: 0.0-1.0). The regional prevalence varies greatly, northwest China prevalence rate 0. 39% (95% CI: 0.2-0. 64) and southwest China prevalence rate 2.59% (95% CI: 1.94-3.34); in terms of province level, the prevalence was highest in Tibet 2.59% (95% CI: 1.94-3.34), followed by Xinjiang 2.36% (95% CI: 0.86-4.58), and Shanxi has the lowest 0.00% (95% CI: 0.00-0.98). This systematic review and meta-analysis identified the estimated prevalence of bTB in Chinese yaks and estimated the underlying factors associated with bTB, including geographic location, sampling year, age, and TB detection method. Provide evidence to plan corresponding disease control strategies for policymakers and to assess future economic risks accurately.

Síndrome de Guillain-Barré associada a infecções virais

A Síndrome de Guillain-Barré tem diversas consequências negativas de acordo com a gravidade de seus sintomas. A perda da independência funcional é um dos fatores que mais interferem na qualidade de vida, tornando-a deletéria; além disso, cabe destacar que se trata de uma doença multifatorial. Com isso, a presente pesquisa objetivou analisar as relações entre a Síndrome de Guillain-Barré e as infecções virais. Trata-se de uma revisão integrativa da literatura, de caráter exploratório, com abordagem qualitativa, realizada nos meses de Abril a Junho de 2020. Para a realização desse estudo, foram consultadas as bases de dados: Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Eletronic Library Online (SCIELO). Utilizou-se os Descritores em Ciências da Saúde (DeCS) de forma associada: Sindrome de Guillain Barré; COVID-19; Neurológia; Infecções por Vírus. Assim, foram considerados inicialmente 704 estudos com a temática proposta; dentre estes, foram excluídos 622 estudos, de acordo com os critérios de exclusão estabelecidos. Após a aplicação dos critérios de inclusão, restaram 9 estudos. Os estudos incluídos foram tabelados e foram feitas revisões críticas e corroborativas entre cada um deles. Conclui-se que há um aumento nos casos de Guillain-Barré durante os surtos virais, com um aumento na incidência e no número de casos/mês. No geral, observa-se que entre as principais causas de Síndrome de Guillain-Barré estão os processos infecciosos.

Cardiovascular magnetic resonance imaging in patients with cardiac implantable electronic devices: best practice and real-world experience.

Cardiovascular magnetic resonance (CMR) imaging has long been a contraindication for patients with a cardiac implantable electronic device (CIED). Recent studies support the feasibility and safety for non-thoracic magnetic resonance imaging, but data for CMR are sparse. The aim of the current study was to determine the safety in patients with magnetic resonance (MR)-conditional or non-MR-conditional CIED and to develop a best practice approach. All patients with a CIED undergoing CMR imaging (1.5 T) between April 2014 and April 2017 were included in the study. Devices were programmed according to the standardized protocol directly before and after the CMR examination. Follow-up interrogation was performed 6 months after CMR examination. Results were compared with a large, reference cohort of CIED patients not undergoing any MR examination. A total of 200 consecutive patients with a CIED (non-MR-conditional, n = 103) were included in the study. Directly after CMR imaging, one device failure (0.5%, battery status = end of service) was noted necessitating premature generator replacement. In three patients (2%) of pacemaker/implantable cardioverter-defibrillator (ICD) carriers a sustained ventricular tachycardia (VT) occurred during CMR imaging. Ten ICD showed a decrease in battery capacity immediately after CMR. Overall, the reference cohort showed comparable changes of CIED function during follow-up. With adherence to a standardized protocol and established exclusion criteria CMR imaging could safely be performed in patients with a CIED. The potential risks of device malfunction necessitate the presence of a device trained individual during the entire CMR examination. If there is a history of VT storm the attendance of an experienced cardiologist, should be mandatory.

The Flipped Classroom: A Critical Appraisal.

IntroductionThe objective of this study was to review and critically appraise the medical education literature pertaining to a flipped-classroom (FC) education model, and to highlight influential papers that inform our current understanding of the role of the FC in medical education.MethodsA search of the English-language literature querying Education Resources Information Center (ERIC), PsychINFO, PubMed, and Scopus identified 296 papers related to the FC using either quantitative, qualitative, or review methods. Two reviewers independently screened each category of publications using previously established exclusion criteria. Eight reviewers then independently scored the remaining 54 publications using either a qualitative, quantitative, or review-paper scoring system. Each scoring system consisted of nine criteria and used parallel metrics that have been previously used in critical appraisals of education research.ResultsA total of 54 papers (33 quantitative, four qualitative, and 17 review) on FC met a priori criteria for inclusion and were critically appraised and reviewed. The top 10 highest scoring articles (five quantitative studies, two qualitative studies, and three review papers) are summarized in this article.ConclusionThis installment of the Council of Emergency Medicine Residency Directors (CORD) Academy Critical Appraisal series highlights 10 papers that describe the current state of literature on the flipped classroom, including an analysis of the benefits and drawbacks of an FC approach, practical implications for emergency medicine educators, and next steps for future research.

Three-factor prothrombin complex concentrates for refractory bleeding after cardiovascular surgery within an algorithmic approach to haemostasis.

Prothrombin complex concentrates (PCC) are increasingly administered off-label in the United States to treat bleeding in cardiovascular surgical patients and carry the potential risk for acquired thromboembolic side-effects after surgery. Therefore, we hypothesized that the use of low-dose 3-factor (3F) PCC (20-30IU/kg), as part of a transfusion algorithm, reduces bleeding without increasing postoperative thrombotic/thromboembolic complications. After IRB approval, we retrospectively analysed 114 consecutive, complex cardiovascular surgical patients (age>18years), between February 2014 and June 2015, that received low-dose 3F-PCC (Profilnine® ), of which seven patients met established exclusion criteria. PCC was dosed according to an institutional perioperative algorithm. Allogeneic transfusions were recorded before and after PCC administration (n=107). The incidence of postoperative thromboembolic events was determined within 30days of surgery, and Factor II levels were measured in a subset of patients (n=20) as a quality control measure to avoid excessive PCC dosing. Total allogeneic blood product transfusion reached a mean of 12·4±9·9 units before PCC and 5·0±6·3 units after PCC administration (P<0·001). The mean PCC dose was 15·8±7·1IU/kg. Four patients (3·8%) each experienced an ischaemic stroke on postoperative day 1, 2, 4 and 27. Seven patients (6·5%) had acquired venous thromboembolic disease within 10 days of surgery. Median factor II level after transfusion algorithm adherence and PCC administration was 87%. 3F-PCC use for refractory bleeding after cardiovascular surgery resulted in reduced transfusion of allogeneic blood and blood products. Adherence to this algorithmic approach was associated with an acceptable incidence of postoperative thrombotic/thromboembolic complications.

Research review on coaches' perceptions regarding the teaching strategies experienced in coach education programs

Using a learner-centered perspective underpinned by a constructivist view of learning, the aim of this research was to analyze the scientific articles published from 2009 to 2016 concerning sports coaches' perceptions on the teaching strategies experienced in coach education programs. The search for articles took place across six databases: PUBMED, SCOPUS, Web of Science, PyscNET, ERIC, and SPORTDiscus. Two peer-reviewed journals related to sports coaching that were not indexed in the aforementioned databases at the time of the review were also screened. A total of 1937 articles were initially found with 17 eventually deemed appropriate for incorporation into the review after applying the established exclusion criteria. Three themes related to interactive, reflective, and assessment activities were generated from an inductive thematic analysis conducted on the coaches' quotes extracted from the reviewed articles. In general, it was revealed that coaches mostly held positive perceptions of situations and experiences that positioned them at the center of the learning process through interaction and reflection. Suggestions are discussed to address coaches' negative perceptions on the assessment strategies experienced and to improve the integration of learner-centered approaches in coach education initiatives.

Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2016.

The objectives were to critically appraise the emergency medicine (EM) medical education literature published in 2016 and review the highest-quality quantitative and qualitative studies. A search of the English language literature in 2016 querying MEDLINE, Scopus, Education Resources Information Center (ERIC), and PsychInfo identified 510 papers related to medical education in EM. Two reviewers independently screened all of the publications using previously established exclusion criteria. The 25 top-scoring quantitative studies based on methodology and all six qualitative studies were scored by all reviewers using selected scoring criteria that have been adapted from previous installments. The top-scoring articles were highlighted and trends in medical education research were described. Seventy-five manuscripts met inclusion criteria and were scored. Eleven quantitative and one qualitative papers were the highest scoring and are summarized in this article. This annual critical appraisal series highlights the best EM education research articles published in 2016.

3D Printing in Liver Surgery: A Systematic Review.

Rapid growth of three-dimensional (3D) printing in recent years has led to new applications of this technology across all medical fields. This review article presents a broad range of examples on how 3D printing is facilitating liver surgery, including models for preoperative planning, education, and simulation. We have performed an extensive search of the medical databases Ovid/MEDLINE and PubMed/EMBASE and screened articles fitting the scope of review, following previously established exclusion criteria. Articles deemed suitable were analyzed and data on the 3D-printed models-including both technical properties and desirable application-and their impact on clinical proceedings were extracted. Fourteen articles, presenting unique utilizations of 3D models, were found suitable for data analysis. A great majority of articles (93%) discussed models used for preoperative planning and intraoperative guidance. PolyJet was the most common (43%) and, at the same time, most expensive 3D printing technology used in the development process. Many authors of reviewed articles reported that models were accurate (71%) and allowed them to understand patient's complex anatomy and its spatial relationships. Although the technology is still in its early stages, presented models are considered useful in preoperative planning and patient and student education. There are multiple factors limiting the use of 3D printing in everyday healthcare, the most important being high costs and the time-consuming process of development. Promising early results need to be verified in larger randomized trials, which will provide more statistically significant results.

Feedback in Medical Education: A Critical Appraisal.

The objective was to review and critically appraise the medical education literature pertaining to feedback and highlight influential papers that inform our current understanding of the role of feedback in medical education. A search of the English language literature in querying Education Resources Information Center (ERIC), PsychINFO, PubMed, and Scopus identified 327 feedback-related papers using either quantitative (hypothesis-testing or observational investigations of educational interventions), qualitative methods (exploring important phenomena in emergency medicine [EM] education), or review methods.Two reviewers independently screened each category of publications using previously established exclusion criteria. Six reviewers then independently scored the remaining 54 publications using a qualitative, quantitative, or review paper scoring system. Each scoring system consisted of nine criteria and used parallel scoring metrics that have been previously used in critical appraisals of education research. Fifty-four feedback papers (25 quantitative studies, 24 qualitative studies, five review papers) met the a priori criteria for inclusion and were reviewed. Eight quantitative studies, nine qualitative studies, and three review papers were ranked highly by the reviewers and are summarized in this article. This inaugural Council of Emergency Medicine Residency Directors Academy critical appraisal highlights 20 feedback in medical education papers that describe the current state of the feedback literature. A summary of current factors that influence feedback effectiveness is discussed, along with practical implications for EM educators and the next steps for research.

Critical Appraisal of Emergency Medicine Education Research: The Best Publications of 2014.

The objective was to critically appraise and highlight rigorous education research study articles published in 2014 whose outcomes advance the science of emergency medicine (EM) education. A search of the English language literature in 2014 querying Education Resources Information Center (ERIC), PsychINFO, PubMed, and Scopus identified 243 EM-related articles using either quantitative (hypothesis-testing or observational investigations of educational interventions) or qualitative (exploring important phenomena in EM education) methods. Two reviewers independently screened all of the publications using previously established exclusion criteria. Six reviewers then independently scored the 25 selected publications using either a qualitative or a quantitative scoring system. Each scoring system consisted of nine criteria. Selected criteria were based on accepted educational review literature and chosen a priori. Both scoring systems use parallel scoring metrics and have been used previously within this annual review. Twenty-five medical education research papers (22 quantitative, three qualitative) met the criteria for inclusion and were reviewed. Five quantitative and two qualitative studies were ranked most highly by the reviewers as exemplary and are summarized in this article. This annual critical appraisal series highlights seven excellent EM education research studies, meeting a priori criteria and published in 2014. Methodologic strengths in the 2014 papers are noted, and current trends in medical education research in EM are discussed.

Critical appraisal of emergency medicine education research: the best publications of 2013.

The objective was to critically appraise and highlight methodologically superior medical education research articles published in 2013 whose outcomes are pertinent to teaching and education in emergency medicine (EM). A search of the English-language literature in 2013 querying Education Resources Information Center (ERIC), PsychINFO, PubMed, and Scopus identified 251 EM-related studies using hypothesis-testing or observational investigations of educational interventions. Two reviewers independently screened all of the publications and removed articles using established exclusion criteria. Six reviewers then independently scored the remaining 43 publications using either a qualitative a or quantitative scoring system, based on the research methodology of each article. Each scoring system consisted of nine criteria. Selected criteria were based on accepted educational review literature and chosen a priori. Both scoring systems used parallel scoring metrics and have been used previously within this annual review. Forty-three medical education research papers (37 quantitative and six qualitative studies) met the a priori criteria for inclusion and were reviewed. Six quantitative and one qualitative study were scored and ranked most highly by the reviewers as exemplary and are summarized in this article. This annual critical appraisal article aims to promote superior research in EM-related education, by reviewing and highlighting seven of 43 major education research studies, meeting a priori criteria, and published in 2013. Common methodologic pitfalls in the 2013 papers are noted, and current trends in medical education research in EM are discussed.

Critical Appraisal of Emergency Medicine Education Research: The Best Publications of 2012

The objective was to critically appraise and highlight medical education research published in 2012 that was methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine (EM). A search of the English language literature in 2012 querying Education Resources Information Center (ERIC), PsychInfo, PubMed, and Scopus identified EM studies using hypothesis-testing or observational investigations of educational interventions. Two reviewers independently screened all of the publications and removed articles using established exclusion criteria. This year, publications limited to a single-site survey design that measured satisfaction or self-assessment on unvalidated instruments were not formally reviewed. Six reviewers then independently ranked all remaining publications using one of two scoring systems depending on whether the study methodology was primarily qualitative or quantitative. Each scoring system had nine criteria, including four related to methodology, that were chosen a priori, to standardize evaluation by reviewers. The quantitative study scoring system was used previously to appraise medical education published annually in 2008 through 2011, while a separate, new qualitative study scoring system was derived and implemented consisting of parallel metrics. Forty-eight medical education research papers met the a priori criteria for inclusion, and 33 (30 quantitative and three qualitative studies) were reviewed. Seven quantitative and two qualitative studies met the criteria for inclusion as exemplary and are summarized in this article. This critical appraisal series aims to promote superior education research by reviewing and highlighting nine of the 48 major education research studies with relevance to EM published in 2012. Current trends and common methodologic pitfalls in the 2012 papers are noted.

Incidência e prevalência de úlcera por pressão no CTI de um Hospital Público do DF

doi: 10.5216/ree.v12i4.8481 A úlcera por pressão (UP) é um problema de saúde que envolve a equipe multiprofissional de uma Unidade de Terapia Intensiva (UTI), sobretudo a equipe de Enfermagem. Podem agravar o quadro clínico do paciente aumentando o tempo de internação. Objetivou-se neste estudo verificar a prevalência pontual e a incidência das UP na UTI Adulto de um serviço de Saúde Público do Distrito Federal. Estudo descritivo e quantitativo de caráter observacional, realizado no período de outubro/2006 a julho/2007. A amostra constituiu de todos os clientes internados na UTI no período da coleta e que atendessem aos critérios de exclusão estabelecidos. Foi elaborado um instrumento de coleta de dados previamente validado. A prevalência pontual identificada foi de 57,89%. A incidência estabelecida foi de 37,03% corroborando com a literatura. Cerca de metade das úlceras apareceram entre o 2º e o 4º dia de avaliação. Segundo a Escala de Braden, 55,5% dos pacientes apresentavam alto risco de desenvolver UP, destes, 40% desenvolveram. Os resultados obtidos fornecem subsídios que podem contribuir para melhorar a assistência prestada aos pacientes e para implementação de estratégias de redução destes agravos. Descritores: Úlcera por pressão; Unidades de Terapia Intensiva; Enfermagem; Incidência; Prevalência.

Does Hepatorenal Syndrome Affect the Result of Liver Transplantation? Clinical Observations

Hepatorenal syndrome (HRS) is a reversible, functional renal failure that occurs in patients with advanced hepatic failure. However, the reported rates of complete recovery of renal function and patient survivals after orthotopic liver transplantation (OLT) are variable. The aim of this study was to compare the outcomes after OLT between patients with HRS and those without HRS (no-HRS). We established exclusion criteria to select study patients who underwent OLT in a single center between January 2005 and October 2008. The exclusion criteria included the following: (1) malignancy, (2) <18 years of age, (3) other than primary OLT, (4) ABO mismatch or hemophilia, (5) no liver cirrhosis, and (6) survival >1 month after OLT. We selected 71 subjects, including 8 HRS and 63 no-HRS patients. No significant differences were observed in the estimated glomerular filtration rate (eGFR) between the 2 groups except for a lower eGFR on the day of and 1 month after OLT in the HRS group: 108.3 ± 40.5 versus 31.4 ± 14.1 mL/min and 85.4 ± 15.0 versus 57.3 ± 12.1 mL/min ( P = .000 and P = .014, respectively). The renal function of 6/7 HRS patients who survived >1 year improved. The 1-year patient survival rate after OLT in HRS patients was similar to that without HRS: 95% versus 86% ( P = .37). We concluded that HRS had minimal effects on patient survival and return of acceptable renal function.