A Framework of Utility for Creating a Place for Interprofessional Continuous Dialogue: Focusing on the Community Care Conference / 日本プライマリ・ケア連合学会誌

Introduction: To clarify the utility of a community care conference that incorporated continuous dialogue between multiple professions.Methods: Group interviews were conducted with nine facilitators in March 2019, and the data were qualitatively, inductively analyzed.Results: Six categories of utility were extracted: "the changing atmosphere of the community care conference," "new groups of people participating," "getting to know people from other professions," "building relationships with people from other professions," "changing perspectives on the case study," and "changing the quality of assistance. " Conclusion: A conceptual framework of utility of these meetings was identified, which is transformed qualitatively through the following three stages: "transforming the location," "transforming interprofessional relationships and perspectives," and "transforming assistance."

Application of digital 3D printed model combined with case-based learning in practice teaching of oral and maxillofacial surgery / 中华医学教育探索杂志

Objective:To investigate the application effect of the combined teaching model of digital 3D printed model and Tencent conference in case-based learning (CBL) teaching of oral and maxillofacial surgery.Methods:A total of 80 undergraduates in the classes of 2015 and 2016 were selected from School of Stomatology, Qingdao University. The students in the class of 2015 received traditional teaching, and those in the class of 2016 received the combined CBL teaching model of 3D printed model and Tencent conference. A questionnaire survey was used to evaluate the teaching effect, and theoretical examination was used to assess comprehensive abilities of the two groups. SPSS 24.0 was used to perform the chi-square test and the t-test. Results:There was no significant difference in the degree of satisfaction with teaching between the combined CBL teaching model of 3D printed model and Tencent conference and the traditional teaching model ( P>0.05), and both models were generally recognized and accepted by students. The experimental group had a significantly higher score than the control group (94.05±4.16 vs. 86.10±3.37, P<0.05). Conclusion:The combined teaching model of digital 3D printed model and Tencent conference integrates the advantages of the Internet and digital information and thus provides a certain reference for the teaching methods for other majors in stomatology.

GMIA-Breast Oncoplastic and Reconstruction Society consensus on operative standards of breast cancer surgery / 南方医科大学学报

The Breast Cancer Surgery Operative Standards Consensus Conference aimed to establish industry technical standards and improve breast cancer surgery practices by addressing controversial and operative breast cancer surgery-related issues in clinical practice.The conference was led by the Breast Oncoplastic and Reconstruction Branch of Guangdong Medical Industry Association (GMIA) and involved 85 breast surgeons with expertise in breast cancer conserving, oncoplastic, and reconstructive surgery.Consensus was reached through 3 meetings.The first meeting brought up the topics of interest, and evidence summaries were presented for debate during the second meeting; the third meeting was held to reach consensus recommendation for selected topics.Pre-defined consensus criteria required that the consensus was reached only when more than 70% of the panelists agreed on the topic.Out of the 57 questions set for voting, 11 operative standards were recommended as Preferred, and one was recommended as Considered.Preferred operative standards included surgical details in breast conserving surgery, mastectomy, reconstructive surgery, surgical treatment of phyllodes tumor.Selected topics that did not reach consensus among the panelists were also discussed.These Preferred operative standards could help guide clinical surgical practice in routine patient care.

The Role of Radiation Oncologist in Palliative Care Conferences in Cancer Hospital

Sometimes palliative radiotherapy (pRT) is not always used appropriately. In our institution, radiation oncologists started to participate the palliative care conferences from September 2021. Between September 2021 and August 2022, 26 (7.6%) of 341 patients presented at this conference were considered candidates for pRT. Finally, 11 patients (3.2%) underwent pRT (ulcerative breast cancer, 2; metastatic spinal cord compression, 1; re-irradiation, 6; peritoneal dissemination, 1; multiple liver metastases, 1). The participation of radiation oncologists at the palliative care conference is thought to facilitate the treatment option of palliative radiotherapy.

Deliberative dialogue on euthanasia in girls, boys and adolescents. Prequel to the Cabildo Ciudadano (Citizen Council) carried out in Colombia

Background: To date, there is a lack of published information on the utilization of the Deliberative dialogue methodology and the right to a dignified death in minors under 18 years of age in Colombia and Latin America. Objective: To examine the issue of children and adolescents' entitlement to a dignified death, including the criteria for exclusion, and to formulate a comprehensive plan for pediatric palliative care. A public policy document will be created with the aim of supporting the implementation of Resolution 825/2018. Methods: Participatory Action Research utilizing a Deliberative dialogue methods that has been adapted based on feminist epistemological principles. Results: The outcome of the exercise was the production of a document containing Public Policy recommendations regarding euthanasia in minors and its submission to the Ministry of Health and Social Protection of Colombia a few days prior to the release of the Resolution regulating the right to a dignified death for this population. Additionally, the conclusions of this event enabled the creation of a guide for the implementation of (Cabildos Ciudadanos) Citizen Council, in which girls, boys, and adolescents are included, trans-disciplinarity is encouraged, and feminist epistemological foundations are explored. Conclusions: The deliberative dialogue method may serve as a cost-efficient alternative to replace or complement participatory approaches utilized in the development of public health guidelines and policies.

Antecedentes: En Colombia y Latinoamérica no se cuenta con registros publicados de temas abordados desde los metodos del diálogo deliberativo frente a temas de salud sobre la población pediátrica. Objetivo: El diálogo deliberativo fue utilizado para deliberar sobre el derecho a la muerte digna en niñas, niños y adolescentes, sus criterios de exclusión, y el marco de acción de los cuidados paliativos pediátricos. Métodos: Investigación acción participativa recurriendo a la metodología Deliberative Poll. Resultados: Redacción de un documento de recomendaciones de Política Pública en torno a la eutanasia en población pediátrica y entrega del mismo al Ministerio de Salud y Protección Social de Colombia días previos a la expedición de la Resolución que reglamentó el derecho a morir con dignidad para esta población; así mismo, las conclusiones de este ejercicio posibilitaron la estructuración de una guía metodológica para la realización de Cabildos Ciudadanos en donde se integra a niñas, niños y adolescentes. Conclusiones: el diálogo deliberativo puede constituirse en una alternativa costo-eficiente para reemplazar o complementar metodologías de participación empleadas en la construcción de lineamientos y políticas públicas en salud.

Consenso Colombiano de Tratamiento del Espectro de Acretismo Placentario (EAP) / Colombian Consensus on the Treatment of Placenta Accreta Spectrum (PAS)

RESUMEN Introducción: el espectro de acretismo placentario (EAP) es una condición asociada a sangrado masivo posparto y mortalidad materna. Las guías de manejo publicadas en países de altos ingresos recomiendan la participación de grupos interdisciplinarios en hospitales con recursos suficientes para realizar procedimientos complejos. Sin embargo, algunas de las recomendaciones de estas guías resultan difíciles de aplicar en países de bajos y medianos ingresos. Objetivos: este consenso busca formular recomendaciones generales para el tratamiento del EAP en Colombia. Materiales y métodos: en el consenso participaron 23 panelistas, quienes respondieron 31 preguntas sobre el tratamiento de EAP. Los panelistas fueron seleccionados con base en la participación en dos encuestas realizadas para determinar la capacidad resolutiva de hospitales en el país y la región. Se utilizó la metodología Delphi modificada, incorporando dos rondas sucesivas de discusión. Para emitir las recomendaciones el grupo tomó en cuenta la opinión de los participantes, que lograron un consenso mayor al 80 %, así como las barreras y los facilitadores para su implementación. Resultados: el consenso formuló cinco recomendaciones integrando las respuestas de los panelistas. Recomendación 1. Las instituciones de atención primaria deben realizar búsqueda activa de EAP en pacientes con factores de riesgo: placenta previa e historia de miomectomía o cesárea en embarazo previo. En caso de haber signos sugestivos de EAP por ecografía, las pacientes deben ser remitidas de manera inmediata, sin tener una edad gestacional mínima, a hospitales reconocidos como centros de referencia. Las modalidades virtuales de comunicación y atención en salud pueden facilitar la interacción entre las instituciones de atención primaria y los centros de referencia para EAP. Se debe evaluar el beneficio y riesgo de las modalidades de telemedicina. Recomendación 2. Es necesario que se definan hospitales de referencia para EAP en cada región de Colombia, asegurando el cubrimiento de la totalidad del territorio nacional. Es aconsejable concentrar el flujo de pacientes afectadas por esta condición en unos pocos hospitales, donde haya equipos de cirujanos con entrenamiento específico en EAP, disponibilidad de recursos especializados y un esfuerzo institucional por mejorar la calidad de atención, en busca de tener mejores resultados en la salud de las gestantes con esta condición. Para lograr ese objetivo los participantes recomiendan que los entes reguladores de la prestación de servicios de salud a nivel nacional, regional o local vigilen el proceso de remisión de estas pacientes, facilitando rutas administrativas en caso de que no exista contrato previo entre el asegurador y el hospital o la clínica seleccionada (IPS). Recomendación 3. En los centros de referencia para pacientes con EAP se invita a la creación de equipos que incorporen un grupo fijo de especialistas (obstetras, urólogos, cirujanos generales, radiólogos intervencionistas) encargados de atender todos los casos de EAP. Es recomendable que esos grupos interdisciplinarios utilicen el modelo de "paquete de intervención" como guía para la preparación de los centros de referencia para EAP. Este modelo consta de las siguientes actividades: preparación de los servicios, prevención e identificación de la enfermedad, respuesta ante la presentación de la enfermedad, aprendizaje luego de cada evento. La telemedicina facilita el tratamiento de EAP y debe ser tenida en cuenta por los grupos interdisciplinarios que atienden esta enfermedad. Recomendación 4. Los residentes de Obstetricia deben recibir instrucción en maniobras útiles para la prevención y el tratamiento del sangrado intraoperatorio masivo por placenta previa y EAP, tales como: la compresión manual de la aorta, el torniquete uterino, el empaquetamiento pélvico, el bypass retrovesical y la maniobra de Ward. Los conceptos básicos de diagnóstico y tratamiento de EAP deben incluirse en los programas de especialización en Ginecología y Obstetricia en Colombia. En los centros de referencia del EAP se deben ofrecer programas de entrenamiento a los profesionales interesados en mejorar sus competencias en EAP de manera presencial y virtual. Además, deben ofrecer soporte asistencial remoto (telemedicina) permanente a los demás hospitales en su región, en relación con pacientes con esa enfermedad. Recomendación 5. La finalización de la gestación en pacientes con sospecha de EAP y placenta previa, por imágenes diagnósticas, sin evidencia de sangrado vaginal activo, debe llevarse a cabo entre las semanas 34 y 36 6/7. El tratamiento quirúrgico debe incluir intervenciones secuenciales que pueden variar según las características de la lesión, la situación clínica de la paciente y los recursos disponibles. Las opciones quirúrgicas (histerectomía total y subtotal, manejo quirúrgico conservador en un paso y manejo expectante) deben incluirse en un protocolo conocido por todo el equipo interdisciplinario. En escenarios sin diagnóstico anteparto, es decir, ante un hallazgo intraoperatorio de EAP (evidencia de abultamiento violáceo o neovascularización de la cara anterior del útero), y con participación de personal no entrenado, se plantean tres situaciones: Primera opción: en ausencia de indicación de nacimiento inmediato o sangrado vaginal, se recomienda diferir la cesárea (cerrar la laparotomía antes de incidir el útero) hasta asegurar la disponibilidad de los recursos recomendados para llevar a cabo una cirugía segura. Segunda opción: ante indicación de nacimiento inmediato (por ejemplo, estado fetal no tranquilizador), pero sin sangrado vaginal o indicación de manejo inmediato de EAP, se sugiere realizar manejo en dos tiempos: se realiza la cesárea evitando incidir la placenta, seguida de histerorrafia y cierre de abdomen, hasta asegurar la disponibilidad de los recursos recomendados para llevar a cabo una cirugía segura. Tercera opción: en presencia de sangrado vaginal que hace imposible diferir el manejo definitivo de EAP, es necesario extraer el feto por el fondo del útero, realizar la histerorrafia y reevaluar. En ocasiones, el nacimiento del feto disminuye el flujo placentario y el sangrado vaginal se reduce o desaparece, lo que hace posible diferir el manejo definitivo de EAP. Si el sangrado significativo persiste, es necesario continuar con la histerectomía haciendo uso de los recursos disponibles: compresión manual de la aorta, llamado inmediato a los cirujanos con mejor entrenamiento disponible, soporte de grupos expertos de otros hospitales a través de telemedicina. Si una paciente con factores de riesgo para EAP (por ejemplo, miomectomía o cesárea previa) presenta retención de placenta posterior al parto vaginal, es recomendable confirmar la posibilidad de dicho diagnóstico (por ejemplo, realizando una ecografía) antes de intentar la extracción manual de la placenta. Conclusiones: esperamos que este primer consenso colombiano de EAP sirva como base para discusiones adicionales y trabajos colaborativos que mejoren los resultados clínicos de las mujeres afectadas por esta enfermedad. Evaluar la aplicabilidad y efectividad de las recomendaciones emitidas requerirá investigaciones adicionales.

ABSTRACT Introduction: Placenta accreta spectrum (PAS) is a condition associated with massive postpartum bleeding and maternal mortality. Management guidelines published in high income countries recommend the participation of interdisciplinary teams in hospitals with sufficient resources for performing complex procedures. However, some of the recommendations contained in those guidelines are difficult to implement in low and medium income countries. Objectives: The aim of this consensus is to draft general recommendations for the treatment of PAS in Colombia Materials and Methods: Twenty-three panelists took part in the consensus with their answers to 31 questions related to the treatment of PAS. The panelists were selected based on participation in two surveys designed to determine the resolution capabilities of national and regional hospitals. The modified Delphi methodology was used, introducing two successive discussion rounds. The opinions of the participants, with a consensus of more than 80 %, as well as implementation barriers and facilitators, were taken into consideration in order to issue the recommendations. Results: The consensus drafted five recommendations, integrating the answers of the panelists. Recommendation 1. Primary care institutions must undertake active search of PAS in patients with risk factors: placenta praevia and history of myomectomy or previous cesarean section. In case of ultrasound signs suggesting PAS, patients must be immediately referred, without a minimum gestational age, to hospitals recognized as referral centers. Online communication and care modalities may facilitate the interaction between primary care institutions and referral centers for PAS. The risks and benefits of telemedicine modalities must be weighed. Recommendation 2. Referral hospitals for PAS need to be defined in each region of Colombia, ensuring coverage throughout the national territory. It is advisable to concentrate the flow of patients affected by this condition in a few hospitals with surgical teams specifically trained in PAS, availability of specialized resources, and institutional efforts at improving quality of care with the aim of achieving better health outcomes in pregnant women with this condition. To achieve this goal, participants recommend that healthcare regulatory agencies at a national and regional level should oversee the process of referral for these patients, expediting administrative pathways in those cases in which there is no prior agreement between the insurer and the selected hospital or clinic. Recommendation 3. Referral centers for patients with PAS are urged to build teams consisting of a fixed group of specialists (obstetricians, urologists, general surgeons, interventional radiologists) entrusted with the care of all PAS cases. It is advisable for these interdisciplinary teams to use the "intervention bundle" model as a guidance for building PAS referral centers. This model comprises the following activities: service preparedness, disease prevention and identification, response to the occurrence of the disease, and debriefing after every event. Telemedicine facilitates PAS treatment and should be taken into consideration by interdisciplinary teams caring for this disease. Recommendation 4. Obstetrics residents must be instructed in the performance of maneuvers that are useful for the prevention and treatment of massive intraoperative bleeding due to placenta praevia and PAS, including manual aortic compression, uterine tourniquet, pelvic packing, retrovesical bypass, and Ward maneuver. Specialization Obstetrics and Gynecology programs in Colombia must include the basic concepts of the diagnosis and treatment of PAS. Referral centers for PAS must offer online and in-person training programs for professionals interested in improving their competencies in PAS. Moreover, they must offer permanent remote support (telemedicine) to other hospitals in their region for patients with this condition. Recommendation 5. Patients suspected of having PAS and placenta praevia based on imaging, with no evidence of active vaginal bleeding, must be delivered between weeks 34 and 36 6/7. Surgical treatment must include sequential interventions that may vary depending on the characteristics of the lesion, the clinical condition of the patient and the availability of resources. The surgical options (total and subtotal hysterectomy, one-stage conservative surgical management and watchful waiting) must be included in a protocol known by the entire interdisciplinary team. In situations in which an antepartum diagnosis is lacking, that is to say, in the face of intraoperative finding of PAS (evidence of purple bulging or neovascularization of the anterior aspect of the uterus), and the participation of untrained personnel, three options are considered: Option 1: In the absence of indication of immediate delivery or of vaginal delivery, the recommendation is to postpone the cesarean section (close the laparotomy before incising the uterus) until the recommended resources for safe surgery are secured. Option 2: If there is an indication for immediate delivery (e.g., non-reassuring fetal status) but there is absence of vaginal bleeding or indication for immediate PAS management, a two-stage management is suggested: cesarean section avoiding placental incision, followed by uterine repair and abdominal closure, until the availability of the recommended resources for safe surgery is ascertained. Option 3: In the event of vaginal bleeding that prevents definitive PAS management, the fetus must be delivered through the uterine fundus, followed by uterine repair and reassessment of the situation. Sometimes, fetal delivery diminishes placental flow and vaginal bleeding is reduced or disappears, enabling the possibility to postpone definitive management of PAS. In case of persistent significant bleeding, hysterectomy should be performed, using all available resources: manual aortic compression, immediate call to the surgeons with the best available training, telemedicine support from expert teams in other hospitals. If a patient with risk factors for PAS (e.g., myomectomy or previous cesarean section) has a retained placenta after vaginal delivery, it is advisable to confirm the possibility of such diagnosis (by means of ultrasound, for example) before proceeding to manual extraction of the placenta. Conclusions: It is our hope that this first Colombian consensus on PAS will serve as a basis for additional discussions and collaborations that can result in improved clinical outcomes for women affected by this condition. Additional research will be required in order to evaluate the applicability and effectiveness of these recommendations.

Histopathological study of tumor budding in colorectal carcinoma and its correlation with clinicopathological parameters

Background: Colorectal cancer (CRC) is the third most common cancer worldwide. “Tumor budding,” defined by the presence of five or less tumor cell cluster in the invasive front of tumor, is a strong, reproducible, and independent prognostic marker of the biological aggressiveness of the tumor. Aim and Objective: The present study was conducted to assess the correlation of clinicopathological parameter with tumor budding in CRC. Materials and Methods: Sixty patients presenting with colectomy specimens with known histological diagnosis of colorectal adenocarcinoma were included in the study. Histological examination with hematoxylene and eosin stain and immunohistochemistry with pancytokeratin (Pan-CK) was performed in equivocal cases. Tumor budding was counted and scored as per international tumor budding consensus conference, 2016, recommended criteria. Tumor budding was correlated with other relevant clinicopathological parameters. Results: The age distribution ranged from 19 to 78 years with a peak incidence in the age group of 41–50 years (31.7%). Low-grade tumor budding was seen in 20%, intermediate grade budding in 16.7%, and high-grade tumor budding in 63.3%. No correlation could be established between age, sex, site, size of tumor, lymphovascular invasion, histological grade, and budding intensity. However, association between tumor budding and nodal involvement, perineural invasion and higher American Joint Committee on Cancer stage has been found to be statistically significant in this study. Conclusions: Tumor budding is emerging to be a promising and powerful predictor of nodal metastasis and a higher stage of the tumor. Immunohistochemistry with Pan-CK can aid in the grading of tumor budding and buid consensus.

Calidad de las conferencias: un instrumento para su evaluación / Quality of lectures: an instrument for their evaluation

RESUMEN Introducción: desde la evaluación de las conferencias se puede contribuir a elevar la calidad de las clases. Objetivo: diseñar un instrumento para la evaluación de las conferencias en la carrera de Medicina. Métodos: se realizó una investigación con dos fases: en la primera se diseñó el instrumento a partir de la utilización de métodos téoricos y empíricos. En la segunda, mediante un estudio descriptivo transversal, se evaluó la validez de la guía. Se utilizó en una muestra de 90 conferencias escogidas al azar de las carreras de Medicina, Estomatología y Enfermería impartidas en el hospital Dr. Agostinho Neto durante el año 2017. Resultados: se diseña una guía de observación compuesta por indicadores que estructuran las dimensiones: condiciones organizativas e higiénico-sanitarias del aula, calidad de la introducción, el desarrollo y las conclusiones de la clase. Se demuestra pertinencia del instrumento para evaluar la calidad de las conferencias: insuficiencias en el uso de la pizarra (68,6 %); diapositivas con deficiente calidad (62,8 %); no orientación de trabajo independiente (54,3 %). Conclusiones: el instrumento puede contextualizarse en todos los perfiles de la educación médica y contribuye a la objetividad en la comparación de resultados de las diferentes comprobaciones, facilita la realización de estudios para evaluar la evolución de la calidad del proceso enseñanza-aprendizaje, permite asignar prioridades por el departamento de docencia del centro para la superación profesoral, así como evaluar el impacto de los programas de superación pedagógica del claustro.

ABSTRACT Introduction: the evaluation of lectures can contribute to improve the quality of lessons. Objective: to design an instrument for the evaluation of lectures in Medicine major. Methods: a two-phase research was carried out: in the first phase, the instrument was designed based on the use of theoretical and empirical methods. In the second, by means of a cross-sectional descriptive study, the validity of the guide was evaluated. It was used in a sample of 90 lectures randomly chosen from the Medicine, Dentistry and Nursing majors taught at Dr. Agostinho Neto Hospital during 2017. Results: an observation guide is designed comprising indicators that structure the dimensions: organizational and hygienic-sanitary conditions of the classroom, quality of the introduction, development and conclusions of the lectures. The relevance of the instrument to evaluate the quality of the lectures is demonstrated: insufficiencies in the use of blackboard 68,6 %; slides with deficient quality 62,8 %; no orientation of independent work 54,3 %. Conclusions: the instrument can be contextualized in all the profiles of medical education and contributes to the objectivity in the comparison of results of the different verifications, it facilitates the understanding of studies to evaluate the evolution of the quality of the teaching-learning process, it also allows assigning priorities by the teaching department of the center for the training of professors, as well as evaluating the impact of the programs of pedagogical training for the teaching staff.

Ensaios clínicos em congressos médicos: estudo sobre conflito de interesses / Clinical trials in medical congresses: a study on conflicts of interest / Ensayos clínicos en congresos médicos: un estudio sobre conflicto de intereses

Resumo Este artigo busca investigar conflitos de interesses envolvendo a apresentação de ensaios clínicos em congressos brasileiros de cinco especialidades médicas, ocorridos entre 2004 e 2018. Foram estudados 407 resumos em 22 anais. Após aplicar critérios de seleção, obteve-se um corpus de 77 ensaios. Detectou-se maior frequência de conflitos de interesses envolvendo ensaios com drogas para as quais não havia genéricos/similares ( p =0,000), sendo que em 48% daqueles em conflito de interesses não houve declaração. Os resultados favoráveis à droga-teste ocorreram em 90,9% do total de ensaios, mas em 48,6% deles não foi reportado valor de p . As categorias terapêuticas mais testadas foram imunossupressores e imunomoduladores, antidiabéticos e antineoplásicos, que, juntas, representaram 68,9% do total de drogas envolvidas. Os resultados apontam conflitos de interesses ocultos, supervalorização de resultados positivos de drogas-testes, nem sempre com evidências suficientes, e concentração de produção em drogas de alto custo.

Abstract This article seeks to investigate conflicts of interest involving the presentation of clinical trials in Brazilian congresses of five medical specialties between 2004 and 2018. A total of 407 abstracts in 22 annals were studied. After applying selection criteria, we reached a corpus of 77 essays. A higher frequency of conflicts of interest was found involving essays with drugs for which no generic/similar option was available (p=0.000), and 48% of those with a conflict of interest declared nothing. Favorable results to the test drug occurred in 90.9% of the total of essays, but 48.6% of them lacked the p-value. The most tested therapeutic categories were immunosuppressors and immunomodulators, antidiabetic, and antineoplastic, which, together, amounted to 68.9% of the total of the involved drugs. The results pointed to hidden conflicts of interest, overvaluing of positive results of test drugs, not always with sufficient evidence, and focus of production on high-cost drugs.

Resumen Este artículo analiza los conflictos de intereses en ensayos clínicos presentados en congresos brasileños de cinco especialidades médicas, realizados entre 2004 y 2018. Se analizaron 407 resúmenes de 22 anales. Tras aplicados los criterios de selección se obtuvo un corpus de 77 ensayos. Hubo una mayor frecuencia de conflictos de intereses en ensayos con medicamentos para los que no había medicaciones genéricas/similares ( p =0,000), y el 48% con conflictos no hubo su declaración. Los resultados favorables para droga prueba están en el 90,9% del total de ensayos, pero el 48,6% de ellos no informó el valor de p . Las categorías terapéuticas más probadas fueron inmunosupresores e inmunomoduladores, antidiabéticos y antineoplásicos, que juntas compusieron el 68,9% del total de fármacos. Los resultados apuntan a conflictos de intereses ocultos, sobreestimación de los resultados positivos de las drogas prueba, no siempre con evidencia suficiente, y concentración de la producción en medicamentos de alto costo.

Consenso colombiano de expertos sobre recomendaciones basadas en evidencias para el diagnóstico, el tratamiento y el seguimiento de la enfermedad de Fabry con compromiso renal

Contexto: la enfermedad de Fabry se comporta como una enfermedad crónica con compromiso multisistémico y alto costo en salud. Objetivo: generar recomendaciones basadas en la evidencia para el diagnóstico, el tratamiento y el seguimiento de la enfermedad de Fabry con compromiso renal mediante un consenso de expertos. Metodología: a partir de la búsqueda de evidencia en Pubmed, Embase y Google Scholar entre 2010 y agosto 2020, se formulan recomendaciones sobre la definición, el diagnóstico y el tratamiento de la enfermedad de Fabry en población adulta, las cuales se consultan a un panel de expertos a través de la metodología de consenso Delphi modificado. La calidad de los documentos se evaluó por equipo metodológico aplicando herramientas en función del tipo de documento incluido. Resultados: se formularon 53 recomendaciones sobre la definición, el diagnóstico y el tratamiento. Un panel de cinco expertos clínicos nacionales e internacionales externos al grupo desarrollador participaron en la consulta preconsenso y 50 recomendaciones fueron acordadas para su inclusión, para tres de ellas se requirió una sesión formal de consenso que se dio en una ronda, incorporando tres nuevas recomendaciones. Conclusiones: las recomendaciones basadas en evidencia y experticia clínica permitirán orientar de manera estandarizada a nivel nacional y regional, el diagnóstico y el tratamiento de pacientes con sospecha o enfermedad de Fabry con compromiso renal.

Background: Fabry disease behaves like a chronic condition, with multisystem involvement and high health care costs. Objective: To generate evidence-based recommendations for the diagnosis, treatment and follow-up of the Anderson-Fabry disease with renal commitment, through an expert consensus. Methodology: Based on the search of evidence in PubMed, Embase and Google Scholar between 2010 and August, 2020, recommendations on the definition, diagnosis and treatment of Fabry Disease in adult population were formulated after consulting with an expert panel through the modified Delphi consensus methodology. The quality of the documents was assessed by methodological team applying tools according to the type of document included. Results: 53 recommendations for the definition, diagnosis and treatment were formulated. A panel of five national and international clinical experts external to the developer group participated in the pre-consensus consultation and 50 recommendations were agreed upon for their inclusion. For 3 recommendations, a formal consensus session which took place in one round was required, and 3 new recommendations were incorporated. Conclusions: The recommendations based on evidence and clinical expertise will allow us to guide the diagnosis and treatment of patients with Fabry disease with renal involvement or suspicion thereof in a standardized manner at national and regional levels.

Minutes of the 24th National Conference of Neurology of Chinese Medical Association / 中华神经科杂志

The 24th National Conference of Neurology of Chinese Medical Association was held in Zhuhai City, Guangdong Province during September 23-26,2021.The conference adopted a combination of online and offline methods, with a total of 2 plenary meetings, 20 special seminars, 284 invited reports, 382 papers exchanged at the conference and 1 088 papers exchanged on the wall. The conference focused on cerebrovascular diseases, epilepsy, cognitive disorders, myopathy, peripheral neuropathy, neurodegenerative diseases, nerve infectious diseases, demyelinating diseases, neuroimmune diseases, genetic and metabolic nerve diseases, nerve rehabilitation, anxiety and depression, headache, sleep disorders, nerve nursing, nerve intervention, neuroimaging, neuroelectrophysiology, translational medicine, precision medicine and other related nervous system diseases. There were more than 7 000 participants who attended this conferece.

Posicionamento da ANCP e SBGG sobre tomada de decisão compartilhada em cuidados paliativos / Posicionamiento de la ANCP y SBGG sobre la toma de decisiones compartida en cuidados paliativos / Position statement of ANCP and SBGG on shared decision-making in palliative care

Os cuidados de saúde com pacientes portadores de doenças graves usualmente implicam a necessidade de tomada de um grande número de decisões, envolvendo desde a forma como a informação é compartilhada até quais procedimentos diagnósticos ou terapêuticos serão adotados. A maneira como tais decisões são tomadas têm importantes implicações do ponto de vista individual e coletivo, podendo contribuir tanto para o alívio como para o agravamento do sofrimento. No presente documento de consenso, o Comitê de Bioética da Academia Nacional de Cuidados Paliativos (ANCP) e a Comissão Permanente de Cuidados Paliativos da Sociedade Brasileira de Geriatria e Gerontologia (SBGG) adotam os princípios da escuta compassiva proposto por Saunders, da natureza do sofrimento proposto por Cassel, dos cuidados preservadores da dignidade propostos por Chochinov e da humildade cultural como ponto de partida para a construção de um posicionamento oficial da ANCP e SBGG acerca do processo de tomada de decisão compartilhada em cuidados paliativos. O posicionamento estabelece que, em contraposição aos modelos paternalistas e consumistas, o processo de tomada de decisão no âmbito dos cuidados paliativos deve seguir o modelo mutualista de decisão compartilhada, no qual as decisões são construídas a partir do diálogo entre profissionais de saúde e pacientes/familiares. O documento estabelece os pressupostos deste processo, os limites da autonomia de pacientes/familiares e profissionais de saúde, a distinção entre tratamentos fúteis e potencialmente inapropriados, bem como ratifica sua incompatibilidade com quaisquer formas de coerção e conflitos de interesse alheios ao melhor interesse dos pacientes.

Los cuidados de salud de pacientes portadores de enfermedades graves usualmente implican la necesidad de tomar un gran número de decisiones, que abarcan desde cómo se comparte la información hasta qué procedimientos diagnósticos o terapéuticos se adoptarán. La forma en que se toman tales decisiones tiene importantes implicaciones desde el punto de vista individual y colectivo, y puede contribuir tanto a aliviar como a agravar el sufrimiento. En el presente documento de consenso, el Comité de Bioética de la Academia Nacional de Cuidados Paliativos (ANCP) y la Comisión Permanente de Cuidados Paliativos de la Sociedad Brasileña de Geriatría y Gerontología (SBGG) adoptan los principios de la escucha compasiva propuesta por Saunders; de la naturaleza del sufrimiento propuesta por Cassel, de los cuidados preservadores de la dignidad propuestos por Chochinov y de la humildad cultural como punto de partida para la construcción de un posicionamiento oficial de la ANCP y SBGG sobre el proceso de toma de decisiones compartidas en cuidados paliativos. El posicionamiento establece que, en contraposición a los modelos paternalistas y consumistas, el proceso de toma de decisiones en el ámbito de los cuidados paliativos debe seguir el modelo mutualista de decisión compartida, donde las decisiones son construidas a partir del diálogo entre los profesionales de salud y los pacientes/familiares. El documento establece los supuestos de este proceso, los límites de la autonomía de los pacientes/familiares y de los profesionales de la salud, la distinción entre los tratamientos inútiles y los potencialmente inapropiados, así como ratifica su incompatibilidad con cualquier forma de coerción y los conflictos de intereses distintos del interés superior de los pacientes.

Health care for patients with serious illnesses usually implies the need to make a large number of decisions, ranging from how information is shared to which diagnostic or therapeutic procedures will be adopted. The method of such decision-making has important implications from an individual and collective point of view and may contribute to either relieving or aggravating suffering. In this consensus document, the Bioethics Committee of the Brazilian National Academy of Palliative Care (ANCP) and the Permanent Committee on Palliative Care of the Brazilian Geriatrics and Gerontology Society (SBGG) adopt the principles of compassionate listening proposed by Saunders, of the nature of suffering proposed by Cassel, of dignity-preserving care proposed by Chochinov, and of cultural humility as a starting point for the construction of an official position of ANCP and SBGG on shared decision-making in palliative care. The position statement posits that, unlike paternalistic and consumerist models, the decision-making process in the sphere of palliative care must follow the mutualistic model of shared decision, where decisions are built based on dialogue between healthcare professionals and patients/family. The document sets forth the assumptions of this process, the limits of autonomy of patients/family and healthcare professionals and the distinction between futile and potentially inappropriate treatments, besides ratifying its incompatibility with any forms of coercion and conflict of interest foreign to the best interests of patients.

O "estranho" freudismo autodeclarado de Lacan em Caracas: Lacan, apenas um comentador de Freud / L'« étrange ¼ freudisme autoproclamé de Lacan à Caracas: Lacan, juste un commentateur de Freud: / The "strange" Lacan's self-declared Freudianism in the Caracas: Lacan, only a commentator on Freud

Resumo: Buscou-se, neste artigo, questionar o freudismo autodeclarado de Lacan na Conferência de Caracas com base na identificação de um equívoco de transcrição dessa conferência. Demonstrou-se que, por estar em total desconformidade com o que foi desenvolvido nessa ocasião como um todo, esse equívoco de transcrição não faz outra coisa que evidenciar, ao invés de esconder, a oposição de Lacan a Freud, manifesta nos adjetivos jocosos atribuídos por Lacan à segunda tópica freudiana, legado de Freud que Lacan não compartilha. Demonstrou-se que a filiação de Lacan a Freud faz parte de um projeto rigoroso de revisão crítica por meio do qual Lacan submete os conceitos e articulações propostos por Freud ao que chamou, em 1954, de "método dos comentários", relativo a uma recusa inicial de compreender as formulações freudianas, pela qual, segundo Lacan, empurra-se a porta da compreensão analítica. Por essa razão, propomos, neste trabalho, que Lacan não recusaria a alcunha de ser "apenas" um comentador de Freud. Ao final, o que ficará evidente não é propriamente o tipo de freudismo reivindicado por Lacan, mas aquele que é negado por ele, que, por sua vez, é denegado pela edição da Conferência de Caracas analisada neste trabalho.

L'« étrange ¼ freudisme autoproclamé de Lacan à Caracas : Lacan, juste un commentateur de Freud:Cet article cherche à interroger le freudisme autoproclamé de Lacan dans la Conférence de Caracas à partir de l'identification d'une erreur dans la transcription de cette conférence. On y démontre qu'étant en total désaccord avec ce qui se développait à cette occasion dans son ensemble, cette erreur de transcription ne fait que souligner, plutôt que masquer, l'opposition de Lacan à Freud, manifestée dans les adjectifs moqueurs attribués par Lacan à la seconde topique freudienne, héritage de Freud que Lacan ne partage pas. Ainsi, la démonstration est faite également que l'affiliation de Lacan à Freud s'inscrit dans un projet rigoureux de revue critique à travers lequel Lacan soumet les concepts et articulations proposés par Freud à ce qu'il a appelé, en 1954, la « méthode des commentaires ¼, concernant un refus initial de comprendre les formulations freudiennes, par laquelle, selon Lacan, la porte de la compréhension analytique est poussée. Pour cette raison, nous proposons, dans cet ouvrage, que Lacan ne refuserait pas l'épithète de n'être « que ¼ un commentateur de Freud. À la fin, ce qui deviendra évident, ce n'est pas exactement le type de freudisme revendiqué par Lacan, mais celui qui est nié par lui, ce qui, à son tour, est nié par l'édition de la Conférence de Caracas analysée dans cet ouvrage.

The "strange" Lacan's self-declared Freudianism in the Caracas: Lacan, only a commentator on Freud:This article seeks to question Lacan's self-declared Freudianism in the Caracas Conference based on the identification of a mistake in the transcription of that conference. It was shown that, as it was in total disagreement with what was developed on that occasion as a whole, this mistaken transcription does nothing more than highlight, rather than hide, Lacan's opposition to Freud, manifested in the jocular adjectives attributed by Lacan to the second Freudian topic, a legacy of Freud that Lacan does not share. It was demonstrated that Lacan's affiliation with Freud is part of a rigorous project of critical review through which Lacan submits the concepts and articulations proposed by Freud to what he called, in 1954, the "method of comments", relating to a first refusal to understand Freud's formulations, which, according to Lacan, pushes the door to analytical understanding. For this reason, we propose, in this work, that Lacan would not refuse the epithet of being "only" a commentator on Freud. In the end, what will become evident is not exactly the type of Freudianism claimed by Lacan, but that which is denied by him, which, in turn, is denied by the edition of the Caracas Conference analyzed in this work.

Análisis descriptivo de los trabajos científicos presentados en la Segunda Conferencia Internacional Chilena de Psicosis 2020 / Descriptive analysis of the posters abstracts submitted to the Chilean International Conference in Psychosis 2020

INTRODUCCIÓN: Dentro de los desafíos de la investigación en Psicosis en Chile y el mundo se encuentra el desarrollo de polos académicos de investigación en estados mentales de riesgo (EMARS). En este artículo se realiza un análisis descriptivo de los resúmenes de los trabajos científicos presentados en la II conferencia internacional: Desafíos Clínicos y terapéuticos en Psicosis realizada en Octubre del 2020. MÉTODOS: Se realizó una selección y premiación del mejor trabajo de acuerdo a un sistema de puntuación realizado por un comité científico ad-hoc. Luego se sistematizó la información en una tabla resumen para su posterior análisis descriptivo cualitativo. RESULTADOS: Se seleccionaron 12 trabajos. El 75% de los trabajos seleccionados abordan el tema de la detección precoz e intervención temprana en psicosis, en particular en la temática EMARS. Asimismo, el 40% de los trabajos presentados provienen de regiones de la zona centro-sur de nuestro país. El 83% de los trabajos realizan un diseño experimental con reclutamiento de pacientes o discusión de casos clínicos complejos. CONCLUSIÓN: Los trabajos seleccionados dan cuenta del interés por el mejoramiento en el diagnóstico y terapéutica en este ámbito. Se debe potenciar el trabajo de investigación y asistencial en Chile en el ámbito de los EMARS.

INTRODUCTION: Within the challenges of research in Psychosis in Chile and the world is the development of academic research poles in mental states of risk (EMARS). This article makes a descriptive analysis of the summaries of the scientific papers presented at the II international conference: Clinical and therapeutic challenges in Psychosis held in October 2020. METHODS: The best work was selected and awarded according to a scoring system carried out by an ad-hoc scientific committee. The information was then systematized in a summary table for subsequent qualitative descriptive analysis. RESULTS: 12 papers were selected. 75% of the selected works address the issue of early detection and early intervention in psychosis, particularly the EMARS theme. Likewise, 40% of the papers presented come from regions of the south-central zone of our country. 83% of the works carry out an experimental design with recruitment of patients or discussion of complex clinical cases. CONCLUSION: The selected works show the interest in the improvement in diagnosis and therapy in this area. Research and assistance work in Chile should be promoted in the field of EMARS.

The origin and development of Banff classification on allograft pathology and its effects in promoting organ transplantation / 器官移植

The Banff conference on allograft pathology (Banff conference) and the establishment of Banff classification on allograft pathology (Banff classification) are milestones in the development of international allograft pathology. At present, all organ transplantation centers around the world routinely perform pathological diagnosis by biopsy of the transplant kidney according to Banff classification. Subsequently, the consensus process and update mode of Banff classification for transplant kidney was quickly extended to transplant heart, lung, liver, pancreas, and small intestine, etc. The Banff conference has not only become a thematic meeting that includes the pathology study and discussion of various transplant organs, but also gradually developed unified diagnostic standard for the biopsy of each transplant organ, which better promoted the accurate diagnosis and treatment of complications after organ transplantation. This article summarized the history of international allograft pathology research, the Banff conference and Banff classification in promoting organ transplantation, which aimed to provide a reference for the smooth development of clinical organ transplantation.

A Conferência que virou (quase só) história / The Conference that became (almost only) history / La Conferencia que se convirtió (casi solo) en historia

Esta nota de conjuntura avalia o processo decorrente da I Conferência Nacional de Comunicação (Confecom), tendo em vista o marco de dez anos de sua realização. O autor argumenta que o principal resultado da Conferência foi abrir espaço para o Estado brasileiro superar a ausência de um sistema regulatório e de regras que redesenhassem o sistema de comunicação brasileiro. Ao decidir não ocupar este espaço aberto, o governo federal perdeu a última oportunidade que se abriu para estabelecer uma nova dinâmica para o setor. São analisadas também as modificações no cenário político e econômico desde a realização da Conferência. O autor conclui que, embora os apontamentos dados pela Confecom em relação à convergência tecnológica não respondam a especificidades do momento atual, poderiam, se tivessem sido efetivados, ter preparado o país para enfrentar os desafios novos e conter a força política e econômica dos atores do setor.

This conjuncture note assesses the process resulting from the I Conferência Nacional de Comunicação ­ Confecom (I Communication National Conference), in view of the ten-year mark of its realization. The author argues that the main result of the Conference was to open space for the Brazilian State to overcome the absence of a regulatory system and rules that could redesign the Brazilian communication system. In deciding not to occupy this open space, the Federal Government missed the last opportunity that opened up to establish a new dynamic for the sector. Changes in the political and economic scenario since the Conference were also analyzed. The author concludes that, although the outcomes of the Confecom regarding technological convergence do not respond to specificities of the present moment, they could, if they had been implemented, have prepared the country to face the new challenges and contain the political and economic strength of the sector players.

Esta nota de coyuntura evalúa el proceso resultante de la I Conferência Nacional de Comunicação ­ Confecom (I Conferencia Nacional de Comunicación), en vista de los diez años de su realización. El autor argumenta que el principal resultado de la Conferencia fue abrir un espacio para que el Estado brasileño supere la ausencia de un sistema regulatorio y reglas que rediseñarían el sistema de comunicación brasileño. Al decidir no ocupar este espacio abierto, el Gobierno Federal perdió la última oportunidad que se abrió para establecer una nueva dinámica para el sector. También se analizaron los cambios en el escenario político y económico desde la Conferencia. El autor concluye que, aunque las respuestas dadas por la Confecom con respecto a la convergencia tecnológica no respondan a especificidades del momento actual, si hubieran sido implementadas, podrían haber preparado al país para enfrentar los nuevos desafíos y contener la fuerza política y económica de los actores del sector.

Health protection guideline of conference designated hotel during COVID-19 outbreak / 中华预防医学杂志

This guideline stipulates the management requirements, personal protection and comprehensive security of conference designated hotels. It is applicable to the unified standard prevention and control of conference designated hotels during COVID-19 outbreak.

The Effects of Joint Case Conferences with Visiting Nurses on Discharge Planning Ability of Ward Nurses / 日本プライマリ・ケア連合学会誌

Objective: To improve the discharge planning ability of ward nurses, we carried out case conferences for discharged patients involving both ward nurses and visiting nurses, and assessed their effects.Methods: We compared the discharge planning ability of ward nurses with and without experience in home visits before discharge. The study involved 74 nurses from eight wards in three hospitals. We analyzed changes in the discharge planning ability of the 62 nurses without home visit experience after the case conferences.Results: Ward nurses with experience in home visits before discharge had significantly higher discharge planning ability than those without such experience. After a case conference, the discharge planning ability significantly changed for nurses without experience in home visits. Their attitude toward home care changed, and they recognized its importance, associating it with the words "poor-rich", "dirty-clean", and "confined-free". They also scored higher on the Discharge Planning Process Evaluation Measurement (DCP-PEM) for "understands the importance of educating the patient's family", and "devises a plan taking health care needs into account", and on the Discharge Planning Process Scale for hospital ward nurses for "makes contact with a care manager as early as possible".Conclusions: Involving ward nurses in home visits before discharge and case conferences with visiting nurses were effective educational methods to improve their discharge planning ability in the affective and psychomotor domain.

Educational Problem-solving Conference as Work-based Faculty Development / 医学教育

We conducted a case conference to solve problems in teaching practices and for clinician teachers to discuss various issues occurring in the field. The conference was based on the presentation of individual educational practice cases from faculty development workshops approved by the Ministry of Health, Labor and Welfare. We prepared two months before the event and dealt with four cases on the day of the event. During the discussion, we tried to link educational problems with a theory or a conceptual framework in medical education so that participants, including case presenters, would have a better understanding of clinical training settings. In addition, communication across disciplines was facilitated through discussions. This attempt has the potential to contribute to the development of a community of practice related to cross-disciplinary education. The key to success for this case conference was the "interpreter" role. The person in that role considers the background and context of practice and links practice with theory appropriately. In addition, faculty development for educators who can play the role will also be an issue in the future.

Report and Proposals on Participation in International Congress on Complementary Medicine Research (ICCMR) 2019 as the Members of International Committee of Japanese Society for Oriental Medicine / 日本東洋医学雑誌

The Japan Society for Oriental Medicine has established various committees, which are working every day to disseminate Japanese traditional herbal medicine (Kampo) and support the activities of academic members. As the members of the International Committee and the medical doctors who conduct research and clinical practice of Kampo at the university hospital, the authors participated in the 14th International Congress on Complementary Medicine Research held in Australia in May 2019. To improve the international recognition and international dissemination of Japanese Kampo, we held the Japanese Kampo Symposium on gastrointestinal diseases successfully. While it was realized that there was an international big interest in Japanese Kampo, it seemed that Kampo researchers in Japan lack the ability to dispatch of information at international conferences compared to neighboring countries such as Korea and China.