Las funciones ejecutivas: su significado y aplicación clínica / Executive functions: meaning and clinical application

Las funciones ejecutivas generalmente se conceptualizan como un conjunto de procesos generales de control de orden superior que trabajan juntos para dirigir y gestionar las funciones cognitivas, emocionales y conductuales, especialmente durante la resolución activa de problemas. Su disfunción es frecuente de ser detectada como comorbilidad de otros trastornos del neurodesarrollo, causa o efecto? La detección precoz de la disfunción ejecutiva y su abordaje terapéutico temprano, mejora el pronóstico global madurativo en el periodo infantojuvenil. Esta sucinta revisión de las funciones ejecutivas intenta resaltar su importancia para el pediatra y su mirada de los trastornos del neurodesarrollo (AU)

Executive functions are typically understood as a set of general higher-order control processes that collectively direct and manage cognitive, emotional, and behavioral functions, especially during active problem solving. Their dysfunction is often detected as a comorbidity of other neurodevelopmental disorders; cause or effect? Early detection of executive dysfunction and a prompt therapeutic approach improves the overall developmental prognosis in childhood and adolescence. This brief review of executive functions aims to highlight their importance for the pediatrician and his/her view of neurodevelopmental disorder (AU)

La importancia de la determinación de la deuda de oxígeno en el perioperatorio / The importance of oxygen debt determination in the perioperative period

Resumen: El fenómeno de la deuda de oxígeno (dO2) descrito hace varias décadas en el contexto del ejercicio físico se ha incorporado progresivamente al terreno de la medicina. En particular se ha utilizado durante los cambios hemodinámicos producidos por la cirugía y la anestesia en los pacientes de alto riesgo. La dO2 se definió como el aumento en la cantidad de oxígeno consumida por el organismo inmediatamente después de realizar un ejercicio físico hasta que el consumo se normaliza nuevamente. En el perioperatorio se llega a producir cuando se presenta un desbalance entre la oferta (DO2) y la demanda de oxígeno (VO2) que lleva a hipoxia tisular. El grado de la dO2 tisular se ha relacionado directamente con la falla de órganos múltiples y morbimortalidad perioperatoria. A pesar de los avances en la medicina, aún no es posible prevenir o disminuir la dO2 con la administración de líquidos o con el uso de agentes vasoactivos. Por lo que un retardo o manejo inadecuado de la hemodinámica perioperatoria producirá hipoperfusión e hipoxia tisular afectando los resultados de la cirugía. El conocimiento y la valoración de la dO2 es esencial durante la anestesia del paciente de alto riesgo. Para lograr este objetivo se requiere del uso de índices adecuados que permitan detectar y cuantificar la hipoperfusión tisular y el desbalance entre la DO2 y la VO2. En esta revisión se presentan los conceptos fundamentales de la dO2, su mecanismo, detección y cuantificación; además de las intervenciones para evitarla o disminuirla y las recomendaciones para los anestesiólogos con el fin de asegurar mejores resultados en los pacientes quirúrgicos de alto riesgo.

Abstract: The phenomenon of oxygen debt (dO2) described several decades ago in the context of physical exercise has been incorporated into medicine, particularly during the hemodynamic changes produced by surgery and anesthesia in high-risk patients. dO2 is defined as the increase in the amount of oxygen consumed by the body immediately after physical exercise until O2 consumption returns to normal. In the perioperative period, an imbalance between oxygen supply (DO2) and demand (VO2) could generate dO2. The degree of tissue dO2 has been directly related to multiple organ failure and perioperative morbimortality. Despite advances in medicine, it is not yet possible to prevent or lower the dO2 with fluid administration or vasoactive agents. Delay or inadequate management of hemodynamics could produce tissue hypoperfusion and hypoxia, affecting surgery outcomes. Knowledge and assessing dO2 during perioperative are essential during anesthesia for high-risk patients. Adequate indices are required to detect and quantify tissue hypoperfusion and the imbalance between DO2 and VO2 during anesthesia. This review presents the mechanism, detection, and quantification of dO2. In addition to interventions to avoid or reduce dO2 and recommendations for anesthesiologists to ensure better results in high-risk surgical patients.

Efetividade de um plano de metas fisioterapêuticas em pacientes internados em uma unidade de terapia intensiva: uma análise retrospectiva vs. prospectiva / Effectiveness of a plan of physiotherapy goals in patients hospitalized in an intensive care unit: a retrospective analysis vs. prospective

Introdução: A fisioterapia na unidade de terapia intensiva (UTI) apresenta como objetivo utilizar estratégias de mobilização precoce a fim de reduzir o impacto da fraqueza muscular adquirida na UTI. Logo, este estudo apresenta como objetivo avaliar a efetividade de um plano de metas fisioterapêuticas para pacientes internados em uma Unidade de Terapia Intensiva.Métodos: Estudo de coorte retrospectivo e prospectivo comparativo realizado em uma UTI de um hospital público de Porto Alegre. Foram incluídos pacientes internados entre os meses de janeiro e junho de 2019, maiores de 18 anos e que tiveram alta da UTI. A coleta de dados foi realizada através de informações e relatório que constam no prontuário eletrônico utilizado na Instituição. Foi analisado o desfecho das metas estabelecidas na admissão para sentar fora do leito e deambular.Resultados: A maioria dos pacientes foi do sexo masculino (57,5%). A média de idade foi de 60,52 ± 17,64 anos. A maioria das metas estabelecidas, tanto para sentar fora do leito como para deambular, foram atingidas (89% e 86,9%, respectivamente). Houve correlação significativa entre o alcance de meta para deambulação e ganho de força muscular pelo escore MRC (p = 0,041) e ganho de força muscular quando comparada admissão e alta da UTI (p = 0,004).Conclusão: Este estudo observou que estabelecer metas para sentar fora do leito e deambular para pacientes internados em UTI é efetivo.

Introduction: Physiotherapy in the intensive care unit (ICU) aims to use early mobilization strategies in order to reduce the impact of muscle acquired weakness in the ICU. Therefore, this study aims to evaluate the effectiveness of a physiotherapeutic goal plan for patients admitted to an Intensive Care Unit. Methods: Retrospective and comparative prospective cohort study carried out in an ICU of a public hospital in Porto Alegre. Patients hospitalized between January and June 2019, over 18 years old and discharged from the ICU were included. Data collection was carried out through information and report contained in the electronic medical record used in the Institution. The outcome of goals established at admission for sitting out of bed and walking was analyzed. Results: Most patients were male (57.5%). The mean age was 63.2 ± 16.2 years. Most established goals, both for sitting out of bed and walking, were achieved (89% and 86.9%, respectively). There was a significant correlation between reaching the ambulation goal and muscle strength gain by the MRC score (p= 0.041) and muscle strength gain when comparing admission and discharge from the ICU (p = 0.004). Conclusion: This study observed that establishing goals for sitting out of bed and walking for ICU patients is effective.

Análisis bibliométrico de la producción científica mundial de enfermería sobre la obesidad infantil

Introducción: La obesidad es una forma de desnutrición cuyas cifras se incrementaron de manera alarmante en los últimos años. Objetivo: Analizar la producción científica realizada por profesionales de enfermería sobre la obesidad infantil en los últimos cinco años. Métodos: Se realizó un análisis bibliométrico en la base de datos Scopus. Se incluyeron artículos originales de acceso abierto, realizados por profesionales de la enfermería entre los años 2017 y 2021. Resultados: Se incluyeron 1207 artículos originales; el crecimiento anual fue de 3,7 %; el autor con mayor productividad fue Keith Godfrey de la Universidad de Southampton (n = 23; 1,91 %); se posicionó el Instituto Liggins de la Universidad de Auckland como la institución con más publicaciones (n = 13; 1,08 %) y la revista Nutrientes como la más influyente (n = 223; 18,48 %). El idioma inglés se prefirió para las publicaciones y la mayoría (n = 9) pertenecía al cuartil 1. El artículo más citado fue el de Pietrobelli y otros, publicado en el 2020 con 167,5 citas por año. Los términos más empleados por los investigadores fueron obesidad infantil, obesidad pediátrica, índice de circunferencia de cintura, actividad física y ganancia de peso corporal. Conclusiones: La producción científica de enfermería sobre obesidad infantil se ha incrementado en los últimos años; los autores e instituciones más influyentes se encuentran en Estados Unidos; las revistas más importantes publican en inglés y pertenecen al cuartil 1; los términos más empleados hacen referencia a la obesidad infantil y sus factores predictivos.

Introduction: Obesity is a form of malnutrition whose figures have increased alarmingly in recent years. Objective: To analyze the scientific production carried out by nursing professionals on childhood obesity in the last five years. Methods: A bibliometric analysis was carried out in Scopus database. Original open access articles were included, carried out by nursing professionals from 2017 to 2021. Results: One thousand two hundred seven (1207) original articles were included; the annual growth was 3.7%; the most productive author was Keith Godfrey of the University of Southampton (n = 23; 1.91%). The Liggins Institute at the University of Auckland was ranked as the institution with the most publications (n = 13; 1.08%) and Nutrients journal as the most influential (n = 223; 18.48%). The English language was preferred for the publications and the majority (n = 9) belonged to quartile 1. The most cited article was the one by Pietrobelli et al, published in 2020 with 167.5 citations per year. The terms most used by the researchers were childhood obesity, pediatric obesity, waist circumference index, physical activity and body weight gain. Conclusions: Nursing scientific production on childhood obesity has increased in recent years; the most influential authors and institutions are in the United States; the most important journals publish in English and in quartile 1; the most frequently used terms refer to childhood obesity and its predictive factors.

Impacts of SVV-guided goal-directed fluid therapy on intraoperative signs, intestinal barrier function and prognosis in patients undergoing laparoscopic radical rectal cancer surgery / 中国医师杂志

Objective:To investigate the impacts of stroke volume variation (SVV)-guided goal-directed fluid therapy on intraoperative signs, intestinal barrier function and prognosis in patients undergoing laparoscopic radical rectal cancer surgery.Methods:A total of 90 patients who underwent laparoscopic radical resection for rectal cancer in Peking University International Hospital from May 2020 to May 2022 were prospectively selected as subjects, and divided into SVV group (45 cases) and traditional infusion group (45 cases) by random number table method. The SVV group was given SVV-guided goal-directed fluid therapy, and the traditional infusion group was given central venous pressure (CVP)-guided goal-directed fluid therapy. The operation-related indicators (urine volume, crystalloid volume, colloid volume, total fluid volume, blood loss and operation time), intraoperative signs indicators[heart rate (HR), CVP, mean arterial pressure (MAP)], intestinal barrier function indicators [diamine oxidase (DAO), D-lactic acid], inflammatory factor levels [interleukin-10 (IL-10), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], and the incidence of complications were compared between the two groups.Results:There was no significant difference in the urine volume, blood loss and operation time between the two groups (all P>0.05), while the crystalloid volume, colloid volume and total fluid volume in the SVV group were greatly lower than those in the traditional infusion group (all P<0.05). There was no significant difference in HR between the two groups at different time points ( P>0.05). Compared with T 0, CVP at T 1 in the two groups was significantly decreased (all P<0.05), and increased at T 2 and T 3 compared with T 1 (all P<0.05). There was no significant difference in MAP at different time points in the SVV group (all P>0.05). The MAP at T 1, T 2 and T 3 in the traditional infusion group was significantly lower than that at T 0 (all P<0.05), and the MAP at T 1, T 2 and T 3 in the SVV group was significantly higher than that in the traditional infusion group (all P<0.05). Compared with T 0, DAO and D-lactic acid levels were significantly increased at T 1, T 3, T 4 and T 5 in the two groups (all P<0.05), and DAO and D-lactic acid levels at T 1, T 3, T 4 and T 5 in the SVV group were significantly lower than those in the traditional infusion group (all P<0.05). Compared with T 0, serum IL-10 level in the two groups was significantly decreased at T 4 ( P<0.05), and serum IL-6 and TNF-α levels were significantly increased at T 4 (all P<0.05). The serum levels of IL-10, IL-6 and TNF-α in the SVV group at T 4 were significantly different from those in the traditional infusion group (all P<0.05). Compared with T 4, the serum levels of IL-10 at T 5 were significantly increased (all P<0.05), while the levels of IL-6 and TNF-α were significantly decreased (all P<0.05), but there was no statistical significance between the two groups (all P>0.05). The incidence of postoperative infection, anastomotic fistula, vomiting and nausea in SVV group (13.33%) was significantly lower than that in traditional infusion group (35.33%) ( P<0.05). Conclusions:SVV-guided goal-directed fluid therapy for patients undergoing laparoscopic radical rectal cancer can effectively stabilize intraoperative vital signs, reduce inflammation, improve intestinal barrier function, and improve prognosis.

Mechanisms of self-control on health behavior change / 中华行为医学与脑科学杂志

Self-control brings important effects on the process and maintenance of health behavior change in individuals, but its mechanism is unclear.Healthy behavior change could be divided into goal-oriented behavior initiation stage, combating habit rejection stage, and habit acquisition and maintenance stage.Established theories of health behavior change mainly focus on the conflict between the goal-directed behavior initiation phase and habitual behavior.It is also indicated that disgust is the key mechanism to restrain the implementation of goal-oriented behavior, but ignore the mechanisms in the action implementation and new behavior acquisition phases.In fact, goal-directed and habitual behaviors work together to ensure that individuals adapt efficiently to their environment.However, when goal-oriented behavior becomes habitual, old habit and new goal-oriented behavior begin to compete, causing conflicts and aversion.The core phase of self-control functioning is just in the confrontation with habit rejection phase.On the one hand, self-control directly assists individual goal-directed behavior habituation through conflict sense adaptation.On the other hand, intensive management and stimulus control indirectly assist goal-directed behavior habituation through the relief of conflict sense.Further exploration of the theory and clinical practice of self-control affecting healthy behavior change is needed in the future.

Differences of resting-state brain functional connectivity in patients with early-onset and late-onset obsessive compulsive disorder and their correlation with cognitive flexibility / 中华行为医学与脑科学杂志

Objective:To explore the differences of the resting-state functional connectivity(FC) between goal-directed network and habituation networks in patients with early- and late-onset obsessive compulsive disorder (OCD) and the correlation between the strength of FC in the differential brain regions and cognitive flexibility.Methods:From October 2019 to April 2021, 40 patients with OCD were included in this study, including 22 patients with early-onset OCD and 18 patients with late-onset OCD.The cognitive flexibility of all subjects was assessed using the Wisconsin card sorting test (WCST), the Stroop task and the trail making test (TMT). The brain regions which were associated with goal-directed network(caudate, orbitofrontal cortex, ventromedial prefrontal cortex, and anterior cingulate cortex) and the brain regions which were associated with habituation network(putamen, supplementary motor area and insula) were selected as FC regions of interest (ROI). The DPABI and SPM12 plug-ins in the matlab2011a platform were used for whole brain FC analysis to compare the difference of FC between patients with early-onset OCD and patients with late-onset OCD on the two networks.The data were analyzed by SPSS 25.0 with χ2 test, independent samples t-test, and Pearson correlation analysis. Results:Compared with patients with early-onset OCD, patients with late-onset OCD had significantly enhanced FC of the left supplementary motor area with the left putamen and left insula.The total number of persistent errors of WCST in patients with late-onset OCD was greater than that in patients with early-onset OCD ((20.61±11.30), (14.95±8.94), P<0.05). The FC of the left putamen-left supplementary motor area was significantly and positively correlated with the total number of sustained responses ( r=0.678, P=0.003) and the total number of incorrect responses ( r=0.590, P=0.013) in patients with late-onset OCD.The FC of the left supplementary motor area-left insula was significantly positively correlated with the number of responses required to complete the first classification in patients with late-onset OCD ( r=0.485, P=0.049). Conclusion:Patients with late-onset OCD have stronger habituation network FC than patients with early-onset OCD, and the enhanced FC correlates with patients' cognitive flexibility performance, while late-onset OCD has more impaired cognitive flexibility than early-onset OCD.

Analysis of the effects of the teaching reform to strengthen the integration of basic medicine and clinical medicine through the National Medical Licensing Examination scores / 中华医学教育探索杂志

Objective:To investigate the effects of teaching reform to strengthen the integration of basic medicine and clinical medicine by analyzing the scores of the National Medical Licensing Examination from 2014 to 2018.Methods:Through the improvement of the training program, the establishment of subject integration courses, the standardization of case teaching mode and the establishment of comprehensive medical experiment courses, the teaching reform of the combination of basic medicine and clinical medicine was carried out. The differences in the scores of the National Medical Licensing Examination between the students from Dalian University and those from the whole country were compared, including the average total scores, the passing rates, the average mastery rates of the basic medicine, and the average mastery rates of the cognitive level of the basic medicine.Results:In 2014, 2015 and 2016, the average total scores of the students from Dalian University were 384.70±53.62, 395.45±50.49, and 401.43±50.88, respectively, which were lower than those from the whole country (396.15±58.85, 400.78±56.88, and 405.15±58.06). The average mastery rates of the basic medicine of the students from Dalian University were 56.28%, 62.45%, and 64.92%, respectively, lower than those from the whole country (58.41%, 62.46%, and 65.36%). The average mastery rates of the basic medicine of the students form Dalian University from 2014 to 2016 were lower than those from the whole country, and those were higher in 2017 to 2018 than the whole country. The average total scores of the students form Dalian University in 2017 and 2018 were 397.11 and 400.26 ± 61.15, respectively, higher than those from the whole country (388.91 and 397.01±58.35). The average mastery rates of the basic medicine of the students form Dalian University were 61.53% and 59.85%, respectively, higher than those from the whole country (58.64% and 58.38%). The total passing rates of the students from Dalian University in 2014 and 2016 were 91.11% and 72.73%, respectively, lower than those from the whole country (91.18% and 73.75%), while in 2015, 2017 and 2018 those were 76.47%, 77.78%, and 77.59%, respectively, all higher than those from the whole country (73.59%, 74.29%, and 76.89%). All the data showed a trend of increase with the teaching reform process.Conclusion:Strengthening the teaching reform of the combination of basic medicine and clinical medicine during the learning stage of basic medicine could improve students' learning interest and attention to the basic medical knowledge, strengthen the understanding of the relevance of basic medicine to clinical medicine, and play a positive role in the cultivation of medical students' post competency and the achievement of the goal of training applied medical talents.

Energetically promote the high-quality development of occupational health work / 中国职业医学

The 20th National Congress of the Communist Party of China proposed a new concept of high-quality development. The prevention and control of occupational diseases embodies the development of “people-oriented” concept. Research on new technologies, new materials, new processes, new forms of work organization, as well as actively addressing the opportunities and challenges posed by climate change, aging, and green transformation of energy (“Double Carbon” Goal) to occupational health will have a profound impact on the safety, health, and well-being of workers. It is necessary to fully implement the new development concept, promote healthy work styles and lifestyles, provide comprehensive and lifelong health services for workers, promote the high-quality development of occupational health work, safeguard the health of workers, and contribute to the construction of Healthy China.

Application of single-arm objective performance criteria/performance goal in acupuncture-moxibustion clinical trials / 中国针灸

Due to various constraints, such as clinical implementation conditions and unique characteristics of acupuncture-moxibustion, some randomized controlled trials (RCTs) of acupuncture-moxibustion still suffer from relatively low quality and limited applicability. The single-arm objective performance criteria/performance goal can be considered as an ideal supplementary and alternative research approach to RCTs. In this paper, the feasibility of applying the single-arm objective performance criteria/performance goal in acupuncture-moxibustion clinical research is explored from the limitations of conducting acupuncture-moxibustion RCTs, the principles, the essential design considerations and key statistical steps. In addition, illustrative examples are provided. The objective is to offer insights into resolving practical difficulties in acupuncture-moxibustion clinical research.

Intraoperative Blood Pressure Lability Acts as a Key Mediator in the Impacts of Goal-Directed Fluid Therapy on Postoperative Complications in Patients Undergoing Major Spine Surgery / 中国医学科学杂志(英文版)

Objective Although goal-directed fluid therapy (GDFT) has been proven to be effective in reducing the incidence of postoperative complications, the underlying mechanisms remain unknown. The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications. We further tested the role of this mediation effect using mean arterial pressure, a hemodynamic indicator. Methods This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis. We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications. We conducted mediation analysis using the mediation package in R (version 3.1.2), based on 5,000 bootstrapped samples, adjusting for covariates. Results Among the 300 patients in the study, 40% (120/300) developed postoperative complications within 30 days. GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders (odds ratio: 0.460, 95% CI: 0.278, 0.761; P = 0.003). The total effect of GDFT on postoperative complications was -0.18 (95% CI: -0.28, -0.07; P < 0.01). The average causal mediation effect was -0.08 (95% CI: -0.15, -0.04; P < 0.01). The average direct effect was -0.09 (95% CI: -0.20, 0.03; P = 0.17). The proportion mediated was 49.9% (95% CI: 18.3%, 140.0%). Conclusions The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications. Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.

Establecimiento de metas como técnica motivacional en deportistas / Estabelecimento de metas como técnica motivadora para esportistas / Setting goals as a motivational technique in athletes

RESUMEN Introducción: El establecimiento de metas es un proceso fundamental en el entrenamiento deportivo y puede ser utilizado como una técnica motivacional en el deporte para manejar los recursos psicológicos del deportista y el equipo en aras de potenciar la cohesión y lograr sus aspiraciones. Objetivo: Analizar la pertinencia de la aplicación de un programa de intervención psicológica sustentado en el establecimiento de metas como técnica motivacional en el equipo femenino categoría 13-14 años de Polo Acuático de la Escuela de Iniciación Deportiva Escolar Eide "Marcelo Salado", de Villa Clara, Cuba. Materiales y métodos: La metodología empleada incluye diversos métodos y técnicas de investigación de naturaleza cuantitativa y cualitativa. Se utilizaron el análisis ssíntesis, observación, entrevista, cuestionario de establecimiento de metas, técnica de completamiento de frases, el cuestionario de estilo de dirección, la triangulación y el preexperimento. Se calcularon medidas descriptivas de posición como la media y la moda. Se utilizó la prueba de hipótesis no paramétrica de rangos señalados de Wilcoxon para comprobar si los cambios antes y después de la intervención eran significativos. Resultados: Los datos susceptibles de medición fueron procesados estadísticamente mediante el software SPSS para Windows versión 17.0 Los resultados demuestran la influencia del programa de intervención aplicado para el mejoramiento del establecimiento de metas del equipo. Conclusiones: Valoran la contribución de la aplicación del programa de intervención psicológica, en el establecimiento de metas de manera más objetivas, claras y comprensibles en las deportistas y en el desarrollo de la esfera motivacional al utilizar las potencialidades del trabajo del equipo deportivo como grupo.

SÍNTESE Introdução: O estabelecimento de metas é um processo fundamental no treinamento esportivo e pode ser usado como uma técnica motivacional no esporte para administrar os recursos psicológicos do atleta e da equipe, a fim de aumentar a coesão e alcançar suas aspirações. Objetivo: analisar a relevância da aplicação de um programa de intervenção psicológica baseado no estabelecimento de metas como técnica motivacional na equipe de pólo aquático feminina de 13-14 anos da Escuela de Iniciación Deportiva Escolar Eide "Marcelo Salado", em Villa Clara, Cuba. Materiais e métodos: a metodologia empregada inclui vários métodos e técnicas de pesquisa de natureza quantitativa e qualitativa. Foram utilizadas análise-síntese, observação, entrevista, questionário de estabelecimento de metas, técnica de preenchimento de frases, questionário de estilo de gestão, triangulação e pré-experimentação. Foram calculadas medidas descritivas de posição, tais como média e modo. O teste de hipóteses Wilcoxon não paramétrico assinado foi usado para testar se as mudanças antes e depois da intervenção eram significativas. Resultados: Os dados mensuráveis foram processados estatisticamente usando o software SPSS para Windows versão 17.0. Os resultados demonstram a influência do programa de intervenção aplicado na melhoria da definição das metas da equipe. Conclusões: a contribuição da aplicação do programa de intervenção psicológica no estabelecimento de metas mais objetivas, claras e compreensíveis para as atletas e no desenvolvimento da esfera motivacional, utilizando o potencial do trabalho da equipe esportiva como um grupo.

ABSTRACT Introduction: Goal setting is a fundamental process in sports training and can be used as a motivational technique in sports to manage the resources of the athlete and the team in order to enhance cohesion and achieve their aspirations. Objective: To analyze the relevance of the application of a psychological intervention program based on the establishment of goals as a motivational technique in the women's team category 13-14 years of Water Polo of the School of Sports Initiation School Eide " Marcelo Salado", of Villa Clare, Cuba. Materials and methods: The methodology used includes various research methods and techniques of a quantitative and qualitative nature. Analysis-synthesis, observation, interview, goal setting questionnaire, sentence completion technique, management style questionnaire, triangulation and pre-experiment were used. Descriptive measures of position such as the mean and mode were calculated. The Wilcoxon signed ranks nonparametric hypothesis test was used to test whether the changes before and after the intervention were significant. Results: The measurable data were statistically processed using the SPSS software for Windows version 17.0. The results demonstrate the influence of the intervention program applied to improve the team's goal setting. Conclusions: They value the contribution of the application of the psychological intervention program, in the establishment of goals in a more objective, clear and understandable way in the athletes and in the development of the motivational sphere when using the potentialities of the work of the sports team as a group.

Women's Empowerment: Bringing Women’s Rights and Health into Focus- A Comparative Analysis of State Fact Sheets of National Family Health Survey (NFHS)-4 & 5

Introduction: Women’s empowerment is a crucial factor for economic and social growth. India being committed to making women contribute equally to the growth of the country by 2030 (SDG-5), this study highlighted the major shortcomings in the domain of Women’s health, social and economic growth parameters. Methods: For this study, data related to health and non-health parameters were used from National Family Health Survey factsheets. In reference to “the Global Gender Gap measure by the World Economic Forum”, the indicators have been classified into 4 broad themes, for each of which, indicators were se-lected from NFHS factsheet for analysis, interpretation, and reporting. Results: A2.9% increase in the child sex ratio from 991 to 1022 females per 1000 males over the last two NFHS rounds, indicates a significant societal shift in the country. Out of 21 selected indicators, 4 pa-rameters namely Screening test for cervical and breast cancer, Marriage of women before 18 years of age and Anaemia amongst women have shown a negative change over the past 5 years. Conclusion: The study found that, India has made significant progress around the health, education, economic and social empowerment parameters. But to get an adequate assessment of developments, we need to expand the basket of indicators to holistically analyze change.

Elements of realistic goal-setting model

@#Goal setting leads to improved clinical outcomes, a more client-centered approach, enhanced motivation and psychological adaptation, and enhanced collaboration between client and clinician. However, goal setting remains problematic for both clients and clinicians. The purpose of this conceptual framework is to provide elements to consider when facilitating a collaborative goal-setting as supported by several theoretical concepts. Using the Goal-Setting Theory, Person-Environment-Occupational-Performance Model, Dekker’s tool in setting meaningful goals in rehabilitation, and Canadian Model of Client-Centered Enablement, the authors have identified eleven (11) essential elements, which are the following: external factors, global meaning, collaborate, coordinate, consult, design, clarity, challenge, self-efficacy, commitment, and overall occupation-centered goal. By considering the various elements presented, occupational therapists can avoid having unrealistic expectations from clients during the process of goal setting.

Risk stratification and low-density lipoprotein cholesterol goal attainment rates in patients with very high-risk or extreme high-risk atherosclerotic cardiovascular diseases regarding three guidelines / 中华内科杂志

Objective:To explore the differences of risk stratification of very high-risk or extreme high-risk atherosclerotic cardiovascular diseases (ASCVD) and the attainment rates of low-density lipoprotein cholesterol (LDL-C) management targets evaluated by three different criteria, and the causal attributions of these differences.Methods:Patients with ASCVD were consecutively enrolled from January 1 to December 31 in 2019, and were evaluated for very high-risk or extreme high-risk and LDL-C goal attainment rates with 2018 American guideline on the management of blood cholesterol (2018AG), 2019 China Cholesterol Education Program (CCEP) Expert Advice for the management of dyslipidemias (2019EA) and 2020 Chinese expert consensus on lipid management of very high-risk ASCVD patients(2020EC), respectively. The causal attributions of the differences in attainment rates were analyzed as well.Results:A total of 1 864 ASCVD patients were included in this study. According to 2018AG, 2019EA and 2020EC, the proportions of the patients with very high-risk or extreme high-risk were 59.4%, 90.7%, and 65.6%, respectively. The absolute LDL-C target attainment rates were 37.2%, 15.7%, and 13.7%, respectively, the differences between each two rates were statistically significant (all P<0.001). As to the differences in attainment rates between 2020EC and 2018AG, 61.5% were due to the different LDL-C goal attainment values and 38.5% were caused by the different risk stratifications, while for the differences between 2020EC and 2019EA attainment rates, different LDL-C goal attainment values were responsible for 13.2%, and different risk stratifications were responsible for 86.8% of the differences. Conclusions:There are significant differences in the proportions and LDL-C attainment rates among the three different criteria for very high-risk or extreme high-risk ASCVD. 2020EC showed a moderate proportion of patients with extreme high-risk, and had the lowest LDL-C attainment rate. The differences between 2020EC and 2018AG are mainly due to the LDL-C target values, and the differences between 2020EC and 2019EA are mainly caused by the risk stratifications.

Application of methoxyamine combined with target guided fluid in elderly patients undergoing pancreaticoduodenectomy / 中国医师杂志

Objective:To investigate the effect of methoxyamine combined with target guided fluid in elderly patients undergoing pancreaticoduodenectomy.Methods:90 elderly patients undergoing pancreaticoduodenectomy were randomly divided into methoxyamine group and control group, with 45 cases in each group. The patients in both groups were treated with intravenous inhalation combined anesthesia. The stroke volume variation (SVV) was maintained at 7%-10% and the central venous pressure (CVP) was 4-8 cmH 2O. In methoxyamine group, 3 μg/(kg·min) methoxyamine was continuously pumped, while the control group was pumped with the same amount of normal saline at the same speed. The intraoperative infusion volume, urine volume, bleeding volume, blood transfusion cases, intraoperative mean arterial pressure, heart rate, blood gas analysis results, B-type natriuretic peptide (BNP), creatinine, urea nitrogen level and postoperative exhaust time were compared between the two groups. Results:Compared with the control group, the patients in methoxyamine group had less infusion volume, urine volume, lower postoperative BNP level and heart rate, shorter postoperative exhaust time (all P<0.05), and higher mean arterial pressure ( P<0.05). There was no significant difference in blood loss, blood transfusion cases, PaO 2, PaCO 2, pH, creatinine and urea nitrogen between the two groups (all P>0.05). In addition, the number of patients in the methoxyamine group who used pressor drugs was less than that in the control group ( P<0.05), and the frequency of bradycardia was more than that in the control group ( P<0.05). The proportion of tachycardia and urapidil was similar in the two groups (all P>0.05). Conclusions:Methoxyamine combined with target guided fluid therapy can reduce the intraoperative infusion volume of pancreaticoduodenectomy in elderly patients, stabilize circulation, shorten postoperative exhaust time, and contribute to the recovery of gastrointestinal function.

Practical research on goal-oriented hierarchical responsibility system in emergency standardized training and teaching / 中华医学教育探索杂志

Objective:To explore the practical effect of goal-oriented hierarchical responsibility system in the teaching of emergency standardized training.Methods:A total of 43 residents who rotated in the Emergency Department of Huashan Hospital Affiliated to Fudan University from March 2019 to August 2019 were selected as the control group, and traditional teaching was implemented. Another 41 residents who rotated from September 2019 to March 2020 were selected as the research group, and the goal-oriented hierarchical responsibility system of teaching was implemented. They were all taught for 3 months, and the scores of theoretical and clinical skills, clinical comprehensive ability and teaching recognition before and after teaching were compared between the two groups. SPSS 24.0 was used for t-test and Chi-square test. Results:After teaching, the scores of theoretical knowledge questions, question and answer questions and case analysis in the two groups were higher than those before teaching ( P<0.05), and the scores of the research group were higher than those in the control group ( P<0.05). After teaching, the scores of 8 items in the study group on understanding of skill indications, anatomy and operation, preparation before operation, aseptic operation, operation ability, post-operation treatment, communication ability, humanistic care and overall performance were higher than those in the control group ( P<0.05). The recognition rates of teaching management, teaching methods, teaching content and teaching effect in the research group were higher than those in the control group ( P<0.05). Conclusion:The application of goal-oriented hierarchical responsibility system in the teaching of standardized training of emergency residents is helpful to improve their theoretical and clinical skill examination results and clinical ability, with high degree of teaching recognition.

Discussion on the role of goal-oriented comprehensive teaching method in the rotation of breast surgery residents / 中华医学教育探索杂志

Objective:To explore the application effect of the goal-oriented comprehensive teaching method in the rotation of breast surgery residents.Method:A total of 40 residents who rotated in the Department of Breast Surgery of Xiangya Hospital of Central South University from January 2019 to January 2020 were selected as the control group, and another 41 residents who rotated from February 2020 to February 2021 were selected as the study group. The control group adopted the traditional teaching method, while the study group adopted the goal-oriented comprehensive teaching method. The scores of theory and skill operation examination after teaching, nurses' clinical ability before and after teaching and satisfaction with teaching were compared between the two groups. SPSS 25.0 was used for independent sample t test, paired t test and chi-square test. Results:After teaching, the scores of theory and skill operation in the study group were significantly higher than those in the control group [(86.19±4.64) vs. (79.27±5.36), (89.32±5.47) vs. (84.51±6.22)], with statistical differences ( P<0.05). After teaching, the scores of clinical abilities of the two groups were higher than those before teaching ( P<0.05), and the scores of clinical abilities of the study group were higher than those in the control group, with statistical differences ( P<0.05). The satisfaction with teaching form, content, effect and comprehensive evaluation of the study group were higher than that of the control group, with statistical differences ( P<0.05). Conclusion:The application of the goal-oriented comprehensive teaching method in the teaching of rotation training of residents in the department of breast surgery can enhance their learning and mastering of theoretical knowledge, operational skills and the cultivation of clinical ability, and improve the teaching quality, with high teaching satisfaction.

Influence of King's theory of goal attainment combined with goal setting on the effect of standardized training of general practitioners / 中华医学教育探索杂志

Objective:To explore the impact of King's theory of goal attainment combined with goal setting on the effect of standardized training of general practitioners.Methods:A total of 39 general practitioners who underwent the standardized training in The Fifth Affiliated Hospital of Xinjiang Medical University from January 2019 to January 2020 were classified as control group, and traditional teaching was adopted. Another 42 general practitioners who underwent the training in The Sixth Affiliated Hospital of Xinjiang Medical University during the same period were classified as a research group, and the teaching based on King's theory of goal attainment combined with goal setting was adopted. The theoretical knowledge and operational skills scores, changes in clinical comprehensive ability before and after the training, and teaching recognition were compared between the two groups. SPSS 25.0 was used for t test and chi-square test. Results:After the training, the scores of theoretical knowledge and operation skills of the research group were both higher than those of the control group [(92.83±5.62) vs. (85.47±12.11); (90.15±7.22) vs.(83.36±11.24)]. There was no significant difference between the two groups in the scores of inquiry and communication ability, problem-solving ability, general medical thinking ability, interpretation ability of auxiliary examination results, clinical analysis and decision-making ability, team cooperation ability, community common disease diagnosis and treatment ability and humanistic care ability before the training ( P>0.05); the above scores were all improved after the training ( P<0.05), and the above scores of the research group were significantly higher than those of the control group ( P<0.05). The total recognition of teaching in the research group was 95.24%(40/42), which was significantly higher than that 76.92%(30/39) in the control group ( P<0.05). Conclusion:The application of King's theory of goal attainment combined with goal setting in standardized training of general practitioners can effectively improve the level of general practitioners' theoretical knowledge, operational skills, clinical comprehensive ability and recognition of teaching.

A social cognitive perspective on occupational identity development in college students

Occupational identity is a central concept of career development, by providing a sense of direction and meaning across career development. This study aimed to examine how this concept can be associated with career processes through model formed by a set of socio-cognitive factors. The participants were 358 college students at a Brazilian university who completed measures of occupational identity, environmental supports and barriers, self-efficacy, goal progress, and academic satisfaction. Analysis indicates that the occupational identity status was partially well predicted by the combination of self-efficacy to cope with barriers, supports, academic satisfaction, and goal progress. These results highlight that students with a positive sense of competencies to deal with barriers and adequate levels of academic satisfaction would easily establish an occupational identity. (AU)