Pre-established Guidelines Research Articles

Drug Traceability using Blockchain

The medicine supply tracking system that has been built uses blockchain-based technology to address the widespread problem of counterfeit pharmaceuticals. The solution utilizes the decentralized structure of blockchain to guarantee confidentiality and transparency in the prescribed medicine distribution chain. The blockchain tracks an individual drug's path from producer to customer, providing auditable and immutable documentation of its legitimacy and provenance. Smart contracts automate procedures and enforce pre-established guidelines. "Examples include confirming the authenticity of medicines and triggering alarms for questionable activity. The technique reduces the possibility of counterfeit medicines entering the market by eliminating the need for trust in middlemen through decentralized consensus procedures. In the end, the blockchain-based medicine traceability system improves patient safety by enabling the quick identification and removal of fake medicines from the market.

Unusual discovery of metastatic GTT causing death in a young woman

Gestational trophoblastic disease corresponds to cystic degeneration of the trophoblast villi with excessive secretion of choriogonatrophinic hormone (HCG), groups together lesions : · Benign lesions known as hydatidiform moles (partial or complete) · Malignant lesions known as gestational trophoblastic tumors (GTT), comprising : o Choriocarcinomas o Invasive moles o Trophoblastic tumors of the implantation site (TTSI) Diagnosis is based on questioning and clinical examination, while paraclinical tests, especially ultrasound and Beta HCG, establish the diagnosis of hydatidiform mole. However, TTG may require other tests, and histology confirms the diagnosis. Management is based on a protocol codified according to pre-established guidelines. We report a rare case of an unusual presentation of metastatic GTT causing death in a 32 year old woman just one month post partum.

Innovación educativa con redes sociales aplicada a la asignatura de Salud Pública

IntroductionSocial networks are currently a common means of accessing health information, but they are only sometimes scientifically supported. The study has its objectives the construction of a scale that allows measuring satisfaction after implementing a teaching strategy based on the use of social networks for the dissemination of reliable health content and to assess said satisfaction in nursing students studying the subject of public health. Material and methodsDescriptive and cross-sectional study with 221 2nd year Nursing students enrolled in the public health subject recorded and uploaded to social networks videos with health content prepared by them, contrasted, and following pre-established guidelines. Their satisfaction was determined through a 19-item Likert scale. ResultsThe psychometric properties of the scale were determined: reliability of 0.933 and sample adequacy (Kaiser-Meyer-Olkin:0.897; Bartlett X2 = 1313.285; p < 0.001). Exploratory factor analysis provides a 5-factor solution with reliabilities of 0.842, 0.842, 0.882, 0.759, and 0.765. Overall satisfaction with the strategy is 69.04%, and the averages for the five factors are enjoyment of the activity 58.27%, interest in the subject 67.66%, capacity development 69.78%, teamwork 76.25%, and usefulness of the videos 81.31%. ConclusionThe scale used is a good instrument for measuring satisfaction after the activity based on the correct use of social networks in health education. The impact of the activity was positive among students, so that it could be recommended as a complement to the teaching of public health.

Guidelines on how to monitor gestational weight gain during antenatal care.

Gestational weight gain (GWG) should be tracked at all antenatal consultations, and pregnant women should gain weight according to pre-established guidelines. The recommendation on weight gain varies according to the pre-pregnancy nutritional status (body mass index – BMI).

Impact of Point-of-Care Assays for Hemostasis Monitoring According to Type of Donor in a Cohort of Liver Transplant Recipients

• Donation after circulatory death liver transplant offers excellent outcomes. • Perioperative hemostasis monitoring protocols with a viscoelastic point-of-care testing assay reduce blood loss and transfusion volume. • Use of machine perfusion is likely to further expand donation after circulatory death liver transplant. The aim is to compare 2 groups of liver transplant recipients, according to type of donor, within the framework of a hemostasis monitoring program using a point-of-care testing assay in terms of reduction in transfusion of blood products. This retrospective analytical observational study included 527 liver transplant recipients from 2014 to 2021. Of these, 460 were recipients of livers from donation after brain death (DBD) and 67 were orthotopic liver transplant recipients with donation after cardiac death (DCD). Statistical analysis of differences between the 2 groups included a series of intraoperative variables of blood product consumption: erythrocyte concentrate (red blood cells), fresh frozen plasma, platelets, and fibrinogen concentrates guided by algorithm with a viscoelastic technique using the ClotPro analyzer. The transfusion management was decided according to pre-established guidelines and cutoff values. The mean follow-up period was 40.3 months. Transfused red blood cells and fibrinogen units were significantly higher in the DBD group. The percentage of retransplant was significantly higher in the DCD group, and vascular complications were significantly more frequent in the DCD group ( P < .05). Cox univariate analysis showed that the DCD group had a risk ratio of death significantly higher than 1. Intraoperative monitoring of hemostasis with a point-of-care testing assay reduced blood product requirements. Type of donor had prognostic utility in our cohort. We hypothesize that other variables such as extraction technique, methods used to preserve the allograft, and later complications have a significantly greater impact than perioperative hemostasis management on retransplant rates and death.

Translation, cross-cultural adaptation, and psychometric properties of the Urdu version of Rand Short Form 36-item survey (SF-36) among patients with lumbar radiculopathy

Background and aimsAlthough Rand Short Form 36-item (SF-36) questionnaire is a frequently used tool for evaluating a patient's quality of life in both clinical and research settings, but its translation into Urdu language and its psychometric properties has not been tested before, in accordance to the pre-established guidelines. This study aimed to translate and assess the psychometric properties of Urdu version of SF-36 (SF-36-U) in lumbar radiculopathy patients. MethodsIn this cross-sectional study, one hundred and eight patients of lumbar radiculopathy filled SF-36-U questionnaire, Urdu version of Oswestry Disability Index (ODI-U) and visual analogue scales for pain (VAS pain) at baseline and after 7 days. Two types of reliability i.e. internal consistency and test-retest reliability while three types of validity i.e. face, content, and construct validity were evaluated. Psychometric properties were assessed contrary to the a priori hypothesis and alpha level was kept at < 0.05. ResultsSF-36-U presented good to excellent test-retest reliability for all eight domains (ICC2,1 = 0.75–0.92). Internal consistency was also acceptable for all domains (Cronbach's alpha = 0.73–0.90). Face and content validity were found to be good. Pearson correlation revealed moderate to strong correlations of SF-36-U domains with ODI-U (r = 0.43–0.54), VAS pain (r = 0.32–0.49) and each of its own question (r = 0.37–0.88) which shows good construct validity. ConclusionSF-36-U revealed acceptable psychometric properties and is considered as a reliable and valid questionnaire for assessing the health-related quality of life in Urdu-speaking patients having lumbar radiculopathy.

Clinical recommendations to prevent and treat postpartum urinary retention

Postpartum urinary retention (PPUR) is considered a urinary disorder and although it is not associated with mortality, its morbidity is significant. It is believed that pre-established guidelines, added to the findings of the puerperal physical examination, can support a professional's clinical practice and, consequently, preserve the structural and functional autonomy of the woman's urinary system. Thus, the aim of this study is to establish a consensus among experts on a proposal for evidence-based clinical recommendations to prevent and treat PPUR. This is a descriptive-exploratory study, of a quantitative nature, developed using the Delphi technique. An initial proposal was elaborated with 48 evidence-based clinical recommendations, distributed into three domains. The first round of the Delphi Panel consisted of 19 experts, the second of 16 experts, and the third of 13 experts. At the end of the Delphi Panel, 27 (56.3%) recommendations obtained a consensus greater than 90%. Of these, nine (33.3%) aimed at preventing overt and hidden PPUR, and belonged to Domain – 1, nine (33.3%) aimed at treating overt and hidden PPUR and belonged to Domain – 2, and nine (33.3%) aimed at bladder reeducation in persistent PPUR and belonged to Domain - 3. It is considered that the recommendations approved through this consensus support the decision-making of professionals in the face of the inherent risks of PPUR, which can cause overdistension of bladder function, irreversible damage to the detrusor muscle, as well as recurrent urinary tract infections and difficulty in permanent urinary elimination.

Integrative systematic review of psychodrama psychotherapy research: Trends and methodological implications.

BackgroundPsychodrama is an experiential psychotherapy in which guided role-play is used to gain insights and work on personal and interpersonal problems and possible solutions. Despite the wealth of literature describing clinical work, psychodrama intervention research is relatively scarce compared to other psychotherapies and psychological interventions.ObjectiveFor this reason we implemented the integrative approach to systematic review that authorizes the combination of publications with diverse methodologies and all types of participants, interventions, comparisons, and outcomes. Our aim was to produce a comprehensive summary of psychodrama intervention research in the last decade that critically evaluates methodological issues to inform future studies.MethodsWe searched four major electronic databases (PsycINFO, PubMEd, Scopus by Elsevier, and Web of Science) for peer-reviewed articles on psychodrama interventions published in English between 1 January 2007 and 31 December 2017. The quality of qualitative and mixed methods studies was assessed on the basis of pre-established guidelines, and the risk of bias was assessed for all quantitative randomized control studies, consistent with the PRISMA protocol.FindingsThe database search and a hand search resulted in 31 psychodrama intervention publications. Overall, these studies examined the effects of psychodrama on more than 20 different outcomes and most studies had adult clients. The next largest group was adolescents, whereas only two studies involved children. Thus psychodrama intervention research in the last decade suggests there are promising results in all methodologies, and highlights the need to enhance methodological as well as reporting quality and to theorize and examine modality-specific mechanisms that lead to therapeutic change. Recommendations to improve methodology, transparency, and specificity in reporting future psychodrama and other psychotherapy research are discussed.

O polo de apoio presencial como espaço de gestão e autonomia na EAD. As contingências na Gestão da EAD

Este artigo revela os resultados de pesquisa sobre três polos de apoio presencial ligados a modalidade a distância, considerando os processos de gestão e autonomia no contexto em que atuam. Trata-se de dois momentos de análise, respectivamente relacionados à estruturação dos polos, a partir de diretrizes preestabelecidas e da discussão sobre a realidade cultural e contingencial existente neste espaço; e, por fim à utilização da técnica da entrevista semiestruturada para a análise do processo de gestão e autonomia existente nos polos pesquisados. Para a aplicação da pesquisa foram realizadas entrevistas com os coordenadores dos respectivos polos (dois localizados no Estado de São Paulo e um no Estado do Paraná), sendo dois destes polos de ordem privada e o outro de ordem pública. Como resultado, obtém-se que apesar das diretrizes preestabelecidas, os polos possuem um modelo contingencial e, portanto, cultural de adaptação à realidade em que se instalam, compreendendo uma gestão voltada a adequações e readequações diante de um contexto em constante desenvolvimento. Quanto à autonomia revela-se a existência de trâmites não negociáveis relacionados às bases legais que os regulamentam, contudo, estabelecidos estes parâmetros, a autonomia se determina pela tomada de decisão deste gestor diante da realidade em que se instala.

Merging video coaching and an anthropologic approach to understand health care provider behavior toward hand hygiene protocols.

We used videorecordings of routine care to analyze health care providers' deviance from protocols and organized follow-up interviews that were conducted by an anthropologist and a nurse. After consent, health care workers were recorded during routine care by an automatic video remote control. Each participant was invited to watch her or his recorded behaviors on 2 different videos showing routine practices and her or his deviance from protocols, and to comment on them. After this step an in-depth interview based on preestablished guidelines was organized and explanations regarding the observed deviance was discussed. This design was intended to reveal the HCWs' subjectivity; that is, how they perceive hand hygiene issues in their daily routine, what concrete difficulties they face, and how they try to resolve them. We selected 43 of 250 videorecordings created during the study, which allowed us to study 15 out of 20 health care professionals. Twenty out of 43 videos showed 1 or more breaches in the hand hygiene protocol. The breaches were frequently linked to glove abuse. Deviance from protocols was explained by the health care workers as the result of an adaptive behavior; that is, facing work constraints that were disconnected from infection control protocols. Professional practices and protocols should be revisited to create simple messages that are adapted to the mandatory needs in a real life clinic environment.

A Program for Optimizing the Use of Antibiotics in the Hospital Setting: Experience in a Spanish Regional Hospital

We here describe the implementation of a program for optimizing the use of antibiotics (PROA) in a 128-bed regional hospital in Barakaldo, Spain, and the results obtained at 6 months. The study was a quasi-experimental prospective intervention study using a historical control group. A non-restrictive intervention model to help prescription, with a direct and bidirectional intervention was developed. The program consisted of an optimization audit of the use of antibiotics without pre-established personalized guidelines. Variables assessed included antibiotic consumption and costs, cost per process, mean hospital stay, and percentage of hospital readmissions. Data obtained during the 6-month study period (November 2013-April 2014) were compared with data collected between November 2012 and April 2013. A total of 307 audits were performed. In 65.8% of cases, treatment was discontinued between the 7th and the 10th day. The main reasons of treatment discontinuation were completeness of treatment (43.6%) and lack of indication (14.7%). The reduction of pharmaceutical expenditure was 8.59% (P=0.049) and 5.61% of the consumption in defined daily dose (DDD)/100 stays (P=0.180). The costs by processes in general surgery showed a 3.14% decrease (P=0.001). These results confirm the efficiency of implementing programs for optimizing the use of antibiotics in medium-sized hospitals with limited resources.

Una Nueva Clasificación Gammagráfico-Funcional de los Hipertiroidismos

OBJETIVOS: La ausencia de una clasificación de los hipertiroidismos (HT) universalmente aceptada, dificulta la toma de decisiones, interpretación de series y homologación de los resultados terapéuticos. Proponemos una clasificación en base al estudio gammagráfico - funcional de nuestros pacientes. MATERIALES Y MÉTODOS: Revisamos retrospectivamente todos los casos de pacientes tiroidectomizados en nuestro servicio entre 1967 y 1997. Se seleccionó a aquellos con un estudio funcional indicativo de HT. Todos fueron manejados según un protocolo que incluía el pre, intra y postoperatorio. RESULTADOS: De 2559 tiroidectomías realizadas en el periodo de estudio, 694 se llevaron a cabo bajo la indicación de HT (27,1%). Gammagráficamente, clasificamos a los casos en: Hipercaptación Parenquimatosa, la cual podía ser Difusa, Difusa Sembrada de Nódulos fríos o Difusa con al menos un Nódulo Captante, e Hipercaptación Nodular (Nódulos Tiroideos de Función Autónoma (NTFA), que se dividió en NTFA Solitario o Adenoma Tóxico y NTFA Múltiple o Bocio Multinodular Tóxico. CONCLUSIONES: Esta clasificación de los HT en base a gammagrafía es práctica por ser un estudio de rutina; presenta una alta sensibilidad para la detección de nódulos permitiendo valorar su, grado funcional y el del parénquima circundante y permite protocolizar la decisión terapéutica y, a veces, la elección de la técnica quirúrgica.

Clarifying the Differences between Training, Development, and Enrichment: The Role of Institutional Belief Constructs in Creating the Purpose of Faculty Learning Initiatives

AbstractMany training issues arise as a matter of course at colleges and universities that are intended to bring greater efficiencies and compliance with preestablished operational guidelines. While vital, these issues are distinctively different from the issues surrounding professional development of the faculty. This chapter addresses those differences.

Atendimento pré-hospitalar à múltiplas vítimas com trauma simulado

OBJETIVO: Analisar a qualidade do atendimento pré-hospitalar realizado pelas agências em Vitória-ES. MÉTODOS: Estudo retrospectivo realizado nos arquivos da Liga Acadêmica de Cirurgia e Atendimento ao Trauma do Espírito Santo (Lacates) dos dados de 40 vítimas de um acidente simulado entre um ônibus e dois automóveis. Os pacientes foram assistidos por quatro equipes: Corpo de Bombeiro Militar do Espírito Santo, Samu 192, Guarda Municipal e Defesa Civil. A atuação dessas equipes foi avaliada pela Lacates, através da análise do check-list com orientações pré-estabelecidas para cada vítima. RESULTADO: O Corpo de Bombeiros Militar do Espírito Santo (CBMES), que desencarcerou as vítimas, delimitou as zonas de perigo e realizou a triagem pelo método START atuou corretamente em 92,5% dos casos. O Samu 192 que atendeu as vítimas pelo método mnemônico (ABCDE) no posto médico avançado agiu corretamente em 92,5% dos casos, no quesito Via Aérea; 97,5%, no Respiração; 92,5%, no Circulação; 90%, no Avaliação Neurológica; e 50%, no Exposição e Controle do Ambiente. A análise conjunta do ABCDE mostrou que o atendimento foi correto em 42,5% dos casos. O transporte dos pacientes foi realizado corretamente em 95% dos casos. A Guarda Municipal garantiu a perviedade das avenidas para transporte dos pacientes, e a Defesa Civil coordenou eficazmente o trabalho das equipes envolvidas no posto de comando. CONCLUSÃO: A triagem e o transporte foram executados satisfatoriamente, entretanto, maior atenção deve ser dada à exposição e proteção contra hipotermia das vítimas, já que esse item comprometeu o tratamento.

&lt;b&gt; Aulas de educação física e inclusão: um estudo de caso com a deficiência física &lt;/b&gt;

http://dx.doi.org/10.5902/1984686X2284Este estudo teve como objetivo descrever a participação de um aluno com deficiência física em aulas de Educação Física em uma turma do 2º ano do Ensino Fundamental de uma escola regular. Foram observadas sete aulas de Educação Física da turma, as informações foram registradas em uma Ficha de Observação e, posteriormente, foi aplicada uma entrevista com roteiro pré-estabelecido ao aluno com deficiência. Os dados foram analisados a partir de duas categorias: a) Aluno com Deficiência e a Participação nas Aulas de Educação Física e b) O Relacionamento entre aluno com Deficiência e Colegas. A partir dos dados observou-se que a maioria das atividades propostas pela professora nas aulas de Educação Física favoreceu a inclusão do aluno que possuía deficiência física, além disso, houve interação entre ele e os colegas. Sendo assim, podemos afirmar que a inclusão está sendo efetivada na turma e nas aulas de Educação Física pesquisadas.Palavras-chave: Educação Inclusiva. Inclusão. Educação Física. Deficiência Física.

Implementation of an INR self-testing and self-management programme in common ambulatory private practice: our experience with 90 patients

INR self-testing devices allow patients on vitamin K antagonists (VKA) to determine their INR and then have their VKA dose adapted by a physician (INR self-testing, ST) or adapt it themselves according to pre-established guidelines (INR self-management, SM). The safety, efficacy and advantages of ST and SM have been demonstrated, but their use remains limited. In an effort to improve the availability of ST and SM, we tested the hypothesis that implementing a teaching programme for ST and SM in a small structure in common ambulatory private practice is feasible, safe and can lead to high patient satisfaction. Patients on long-term anticoagulation were assigned to a specific training programme. Patients used the CoaguChek (S then XS) INR testing system. Technical problems, adverse events and INR values were then recorded during the first year of follow-up and analysed. Patient satisfaction data were obtained via a specific questionnaire. 169 patients were referred and 90 included in the teaching programme. 80 performed SM and 10 performed ST. 54 patients (60%) returned the 1-year questionnaire with complete INR data available for 35 patients. The percentage of INR in the target range (target ± 0.5) was 60.6%. The rate of major adverse clinical events (MACE) was 3.7 per 100 patient-years. The main reported advantages were a reduction in visits to the INR testing facility and increased autonomy. There was better venous to capillary INR correlation with the CoaguChek XS than with the S (p <0.025). The development in a small structure in common ambulatory practice of a specific teaching programme made ST and SM available to a new patient population. It led to high patient satisfaction, significantly reducing the burden of VKA monitoring. These results were obtained while preserving the safety and efficacy standards of VKA treatment and favour greater expansion of ST and SM programmes.

Does Home Sleep Testing Impair Continuous Positive Airway Pressure Adherence in Patients With Obstructive Sleep Apnea?

The increasing recognition of obstructive sleep apnea (OSA) and demand for polysomnography has created a need for home sleep testing (HST) using unattended diagnostic and titration studies. Although these studies increase access to care and reduce cost, the limited interaction with sleep laboratories may negatively affect positive airway pressure (PAP) adherence. We sought to determine the difference in PAP use between HST and traditional in-laboratory studies. This observational cohort study included 210 patients with OSA classified into three equal groups. Following preestablished guidelines, group 1 underwent unattended, type III home diagnostic and unattended home auto-adjustable PAP (APAP) titrations; group 2 underwent in-laboratory, type I diagnostic and continuous PAP titration studies; group 3 underwent type I diagnostic and APAP titration studies. Group 1 was primarily managed and educated in a primary care clinic, whereas groups 2 and 3 received extensive education in an academic sleep medicine center. Objective measures of PAP use during the first 4 to 6 weeks of therapy were compared between groups. Type of study and location of care did not affect PAP adherence. PAP was used for 70%, 73%, and 72% of nights in groups 1, 2, and 3, respectively (P = .94). Mean hours of nightly use (4.4 ± 2.0 h, 4.7 ± 1.5 h, and 4.6 ± 1.5 h; P = .98) was also similar. Regular use was observed in 54%, 51%, and 50% of subjects (P = .84). Discontinuation rates were similar between groups. PAP usage did not differ between those undergoing HST vs in-laboratory studies. HST offers a more accessible and cost-effective alternative without compromising therapeutic adherence.

The Case Against 'Health Courts'

This report evaluates a proposal to replace the current civil justice system for compensating patients who have been injured by medical malpractice with a system called “health courts,” in which claims that were not settled in response to an apology and offer of settlement on behalf of providers would be adjudicated by medically-trained decision-makers employing pre-established guidelines and schedules.The report concludes that the health court proposal is ill-conceived, that it would be unfair to patients, that it would be unlikely to achieve its objectives, and that such of its goals as are reasonable can be achieved more fairly and with greater efficiency under the existing civil justice system.

The Number of Voiding Radiographs During Cystourethrography in Women With Stress Incontinence or Prolapse Can Be Reduced to Enhance Safety Without Compromising Study Interpretation

Based on a prior study, over 60% of the average radiation dose per cystourethrography (CU) originated from lateral radiograph images (RI). This analysis focuses on the feasibility of decreasing the number of RI without compromising study interpretation. Following IRB approval, all RIs from the initial study in women with incontinence and/or bladder prolapse were assessed at random for reading consistency (inter-rater reliability (IRR)) and reliability (intra-rater reliability (IaRR)) by four independent reviewers. Interpretation guidelines on urethral readability were established and 15 repeated RIs tested for IaRR. Two months later, the reviewers selected the best two RIs for each CU with the RI presented in a random order. From 88 CU exams providing 304 RIs, good IRRs for readability (kappa=0.82, ICC=0.80) and interpretation (kappa=0.60, ICC=0.57) were found between reviewers. Mean IaRR for readable versus unreadable categories was 87% and among readable images was 95% for interpretation. The RIs judged best had a high IRR (kappa=0.83, ICC=0.83) and were predominantly from the early and middle phases of the void. A high level of agreement was found for urethral readability and interpretation between reviewers of varying experience using pre-established guidelines. No more than 3 RIs were required for study interpretation and those views were from the early to middle phase of voiding, thus allowing a radiation dose reduction without compromising the quality of the CU exam. Neurourol. Urodynam. 28:385-389, 2009. (c) 2008 Wiley-Liss, Inc.

Choice of Law in International Child Support Obligations: Hague or Vague, and Does it Matter?- An American Perspective

This article explores, through American eyes, the choice of law rules associated with the child support aspects of the proposed Hague Convention on the International Recovery of Child Support and Other Forms of Family Maintenance. It considers the role these rules play in capturing the “construct” that is the “family” for the purposes of child support by implicitly determining who is an acceptable claimant and who is an appropriate obligor. In addition, the rules determine which jurisdiction's law will establish the amount of support and thus, implicitly, they determine which jurisdiction sets the standards for family “performance”. American constitutional law demands a connection between the individual to be burdened and the jurisdiction imposing that burden. The proposed rules seem designed to take this into account, but doing so requires the scheme to abandon a preference for relying on the law of the creditor's habitual residence. American child support proceedings use pre-established guidelines to determine the amount of any child support award. These guidelines, which are premised on economic conditions in the individual states, are not suited to dealing with international disputes. The cases suggest that American courts are reluctant to abandon the efficiency of the guidelines in favor of detailed fact based analysis, even if the result is an “inappropriate” order - certainty comes at a price.