Construction of Evidence Body for Revision of Safety Information on Package Inserts of Chinese Patent Medicines in Post-marketing： Taking Xiaoke'an Capsules as an Example / 中国实验方剂学杂志

ObjectiveTo construct the evidence body for revision of safety information on package inserts of Chinese patent medicines in post-marketing by taking Xiaoke'an capsules as an example， so as to provide reference for the revision of instructions of Chinese patent medicines in post-marketing. MethodThe construction of the evidence body was guided by the theory of traditional Chinese medicine（TCM） and the Technical Guiding Principles for Revision of Safety Information Items in Instructions for TCMs After Marketing， and 8 categories and 25 specific items were taken as the main body of the evidence body， and information inclusion， integration， screening and improvement were carried out， then expert demonstrations were conducted， and finally modifications were made based on the opinions of the Center for Drug Evaluation to complete the revision of the safety information in the instructions of Xiaoke'an capsules. Result［Adverse reactions］ of Xiaoke'an capsules was revised to "monitoring data show that the following adverse reactions can be seen with this product：individual hypoglycemic reaction reports". ［Contraindications］ was revised to "contraindicated for those allergic to this product and its ingredients". ［Precautions］ was revised to "（1）pregnant women should use with caution， （2）elderly people should consult a physician， （3）people with spleen deficiency and dampness， spleen and stomach deficiency and cold， or those who eat less and have diarrhea should use with caution， （4）this product contains ginseng， should not be taken at the same time with TCM prescriptions or patent medicines containing veratrum and Wulingzhi， （5）pay attention to monitoring blood sugar during medication， （6）if any other discomfort occurs during medication， you should seek medical attention in time". The warning was revised to "use with caution by pregnant women， and pay attention to regular monitoring of blood sugar". ConclusionIn accordance with the content and process of the evidence body for the revision of safety information in the instructions， the revision of the safety information in the instructions of Xiaoke'an capsules has been completed， providing a strong basis for the rational and safe use of medication in the clinic.

Methods of Delivering Oral Hygiene Instructions Among Orthodontic Patients: The Past, Current and Future (Cara Penyampaian Arahan Penjagaan Kebersihan Mulut Kepada Pesakit Ortodontik: Dahulu, Kini dan Akan Datang) / Jurnal Sains Kesihatan Malaysia

@#This review paper aims to present the evolution in methods of delivering oral hygiene information to orthodontic patients. Orthodontic fixed appliance treatment confers numerous benefits to patients in terms of occlusion, function and aesthetics, but it is associated with unwanted consequences due to challenges in maintaining oral hygiene. The ways of delivering oral hygiene information to patients have progressed over the years. Recent years have seen an increase in the popularity of incorporating technology in delivering oral hygiene information and monitoring of oral hygiene practices. The use of video-based instructions to web-based platforms such as Massive Open Online Course (MOOC) and social media platforms such as YouTube, Instagram and TikTok have all become a mode of oral hygiene information conveyance. Mobile apps are now a popular means to keep track of oral care practices such as toothbrushing frequency. The active ingredients of oral care products have improved providing a greater anticariogenic and antiplaque effect to the user as have the design of toothbrushes and even dental floss. In the future, more advanced technology may be used, such as artificial intelligence (AI) and machine learning, to create intelligent machines that can help educate patients on oral health maintenance and improvement.

Application of Trados software in the English translation of Chinese patent medicine instructions / 中国药房

OBJECTIVE To standardize the English translations of the current Chinese patent medicine （CPM） instructions in order to increase its English translation quality and improve its readability. METHODS In an attempt to standardize its English translation， 64 CPM instructions were collected as samples for translation projects in Trados， using its two core functions of translation memory and terminology， combined with pre-editing （PRE） and post-editing （PE） skills. RESULTS The results showed that translation projects had up to 21.65% perfect match. Based on translation project practice， it is proposed to use the free translation or transcreation plus transliteration method to translate product names of CPM， and apply two human-computer interaction translation modes：“ machine translation （MT）+computer-assisted translation （CAT）+PE” and “PRE+MT+CAT+PE”， which are adopted in the translation of weak literary sections and strong literary sections， respectively. CONCLUSIONS The application of CAT not only improves the translation quality and the translation mode， reduces the translation cost， and maintains the consistency and style of the translation， but also accumulates language assets for future use， providing a novel reference for translating traditional Chinese medicine literature.

"Instrução sobre a escolha, preparação e remessa das sementes e cebolas das plantas, que se mandarem vir de África e do Brasil" / "Instruction on the selection, preparation and shipment of seeds and bulbs of plants, which are ordered to be brought from Africa and Brazil"

Resumo Manuscrito inédito, datado de 1802, que trata dos métodos a utilizar na recolha e remessa de sementes, tubérculos e bulbos das colônias da África e do Brasil para o Complexo de História Natural da Ajuda, em Portugal.

Abstract Unpublished manuscript, dated 1802, dealing with methods to be used in collecting and shipping seeds, tubers and bulbs from colonies in Africa and Brazil to the Natural History Complex of Ajuda, in Portugal.

Evaluación de estrategias para la indicación de instrucciones postoperatorias en exodoncia: Estudio clínico aleatorizado. Primera etapa / An evaluation of strategies for postoperative indications in tooth extraction: A randomised clinical trial. First Stage

Introducción: la exodoncia presenta diversos factores que influyen en el éxito del período postoperatorio. El aprendizaje de las indicaciones postoperatorias ha evidenciado influir en la morbilidad, complicaciones y calidad de vida del paciente durante sus cuidados postoperatorios. Sin embargo, la estrategia de aprendizaje convencional para entregar las instrucciones postoperatorias verbal-escrita (VE) no toma en cuenta el posible compromiso cognitivo, psicológico y emocional del individuo, realizando una entrega de instrucciones indiferente al estado del paciente. Materiales y métodos: los pacientes serán asignados aleatoriamente a grupos divididos según estrategia de aprendizaje utilizada: convencional VE y psicopedagógica visual, auditiva y kinésica (VAK). Inmediatamente posterior al procedimiento se realizará la explicación de los cuidados postoperatorios según grupo. Se realizará una encuesta inmediatamente posterior a la entrega de instrucciones, luego a las 24 horas y a los 7 días luego de la cirugía, con el objetivo de evaluar el grado de retención. Finalmente, para comparar, se contrastaron las medias de cada grupo en los tres tiempos de aplicación. Resultados: se observa una media mayor en el grupo VAK, visible en todos los tiempos de aplicación, donde observamos una tendencia a presentar mejores niveles de retención. Diferencias aun no estadísticamente significativas, ya que la muestra aún no representa el total del muestreo calculado. Discusión: los resultados preliminares nos muestran que la estrategia visual-kinésica-auditiva es superior a la convencional en cuanto a nivel de retención, lo cual podría convertirla en un método de elección al momento de entregar indicaciones post exodoncia, para tener un resultado postoperatorio óptimo.

Introduction: Tooth extractions present several factors that affect the success of the postoperative period. The correct learning of the postoperative instructions has shown to affect the morbidity, complications, and quality of life of the patient after the surgery. Neverthe-less, the conventional verbal-written (VW) learning strategy to give the postoperative indications doesn't consider the possible cognitive, psychological and emotional compromise of the patient. Methods: The patients were assigned randomly into two groups, according to the learning strategy used: conventional (VW) and a psycho-pedagogical visual, auditive, and kinesic learning strategy (VAK). After extraction, the patients were explained about the postoperative care, according to the group they belonged to. A survey was conducted immediately, one day, and seven days after the procedure to record the grade of retention of the information. The means of each group were compared. Results: A higher mean was observed in the VAK group, which is visible in all the application times, determining a tendency to present better levels of retention of the information. The differences are not yet statistically significant, as the sample does not represent the total of patients previously considered. Discussion: The preliminary results show that the VAK strategy is superior to the conventional one regarding the level of retention of the information, becoming the method of choice when giving postoperative indications after dental extractions to develop a more optimal postoperative result

Effectiveness of Oral Hygiene Instruction on the Periodontal Health Among Adults: A Systematic Review

ABSTRACT@#Oral health professionals frequently provide oral hygiene instruction (OHI) during dental visits, yet the evidence for its effectiveness is inconclusive. The main objective of this study was to examine the evidence on the effectiveness of various oral hygiene teaching approaches on periodontal health in adults. The study searched the PubMed, Google Scholar and Scopus databases for reports published between January 2000 and June 2020 in the English language. The quality of the selected papers was evaluated using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by two authors. Overall, five reports met the inclusion and exclusion criteria. The heterogeneity of outcome measurements across studies did not allow for direct comparison. Verbal and brochures were among the methods used in the studies. OHI was found to have short-term (up to 13 weeks) effects on dental plaque levels and/or gingiva bleeding. No significant differences were noted among the different oral hygiene methods affecting periodontal health. There is evidence that OHI is effective in reducing plaque and gingival bleeding scores in adult individuals, but it is still unclear if the effect continues beyond 13 weeks. No single method can be highlighted as the best medium of instruction.

Statistical analysis of medication information labeling of pregnant women and lactating women in the instructions of antiarrhythmic drugs / 中国药房

OBJECTIVE To provide reference for standardizing the labeling of medication information for pregnant women and lactating women in the instructions of antiarrhythmic drugs. METHODS The instructions of antiarrhythmic drugs were collected from the terms of “medication reference ”on official website of Yimaitong Technology Co. ，Ltd. The labeling of medication information of pregnant women and lactating women were sorted out ，counted and analyzed with reference to the Detailed Rules for Specifications of Instructions of Chemical Drugs and Therapeutic Biological Products issued by the State Food and Drug Administration. RESULTS A total of 111 instructions of antiarrhythmic drugs were collected in this study ，of which 102 instructions were marked with “medication for pregnant women ”（91.89％），of which the proportion of those with medication guidance and without medication guidance were 75.68％ and 16.22％ respectively. Eighty-eight drug instructions were marked with the item “medication for lactating women ”（79.28％），of which the proportion of those with medication guidance and without medication guidance were 70.27％ and 9.01％ respectively. Among different categories of antiarrhythmic drugs ，the best labeling of “medication for pregnant women ”was class Ⅰ antiarrhythmic drugs （100％），while class Ⅲ drugs（25.00％）were most missing ； class Ⅳ antiarrhythmic drugs （94.44％）were the best labeled for “medication for lactating women ”，while class Ⅰ（26.47％）were the most missing . There were differences in the labeling contents of “medication for pregnant women ”and“medication for lactating women ”in some drug instructions of the same variety from different manufacturers. Among the 99 drug instructions of domestic pharmaceutical enterprises ， 92 listed the items of “medication for pregnant women”and“medication for lactating women ”，and the proportions of them with medication guidance were 74.75％ and 69.70％ respectively；among the 12 drug instructions of foreign pharmaceutical enterprises ，10（83.33％）listed the items of “medication for pregnant women ”and“medication for lactating women ”，and the proportion with medication guidance was 83.33％ and 75.00％ respectively. CONCLUSIONS There are some problems in the labeling content of domestic antiarrhythmic drug instructions，such as the lack of information related to “medication for pregnant women ”and“medication for lactating women ”， the confusion of guidance expression ， the inconsistent content of drug instructions of the same variety from different manufacturers，the lag of modification and update ，and the poor standardization of drug instructions. Drug supervision and administration departments and drug manufacturers should pay attention to them and constantly strengthen the management and standardization of instructions.

Impact of verbal instructions on pelvic floor contraction in the immediate postpartum / Impacto das instruções verbais na contração do assoalho pélvico no puerpério imediato

Abstract Introduction: Pregnancy predisposes the emergence of pelvic floor dysfunctions (PFD), postpartum being the opportune moment to assess these muscles. Objective: To investigate the effect of instructions and verbal feedback on the contraction capacity of pelvic floor muscles (PFM) in postpartum women. Methods: Quasi-experimental study with 109 women in the immediate vaginal postpartum at a reference maternity hospital in Fortaleza, Ceará state, Brazil. PFM were visually inspected using the visual contraction scale (0 = no visible contraction; 1 = weak visible contraction; 2 = visible contraction with perineal elevation), in addition to observing the use of accessory muscles and movements. Assessments occurred in consecutive moments: 1 - PFM contraction at a verbal command; 2 - contraction after instructions on structure, function and correct contraction; and 3 - contraction after feedback on the use of accessory muscles and reinforcement of correct contraction. Cochran's Q test and a 5% significance level were used to compare the outcomes between different moments. Results: At the first assessment, 15.6% of the postpartum women did not exhibit visible PFM contraction (grade 0). Of these, 70.5% changed their contraction grade after instructions and feedback. At the end, 45.9% of women correctly contracted their PFM with perineal elevation (grade 2) (p < 000.1). The use of accessory muscles (abductors, abdominals and gluteal) declined after instructions and feedback (p < 000.1). Perineal trauma, forceps delivery, previous information and fear of feeling pain were not associated with contraction grade. Conclusion: Instructions and verbal feedback are useful tools for correct PMF contraction in the immediate postpartum.

Resumo Introdução: A gestação predispõe o surgimento de disfunções do assoalho pélvico (DAP), sendo o pós-parto momento oportuno para avaliar essa musculatura. Objetivo: Investigar o efeito das instruções e feedback verbais na capacidade de contração dos músculos do assoalho pélvico (MAP) em puérperas. Métodos: Estudo quase-experimental com 109 mulheres no pós-parto vaginal imediato em uma maternidade de referência em Fortaleza-CE. Realizou-se inspeção visual dos MAP pela escala visual de contração (0 = nenhuma contração visível; 1 = contração visível fraca; 2 = contração visível com elevação perineal), além de observação da utilização de musculatura e movimentos acessórios. As avaliações foram em momentos consecutivos: 1 - contração dos MAP ao comando verbal; 2 - contração após instruções sobre estrutura, função e correta contração; e 3 - contração após feedback sobre a utilização de musculatura acessória e reforço da correta contração. Para comparação dos desfechos entre os momentos foi utilizado o teste Q de Cochran e significância de 5%. Resultados: No primeiro momento, 15,6% das puérperas não apresentaram contração visível dos MAP (grau 0). Dessas, 70,5% modificaram o grau de contração após instruções e feedback. Ao final, 45,9% das mulheres contraíram corretamente os MAP com elevação perineal (grau 2) (p < 000,1). A utilização de músculos acessórios (adutores, abdominais e glúteos) diminuiu após instruções e feedback (p < 000,1). Trauma perineal, parto a fórceps, informações prévias e medo de sentir dor não se associaram ao grau de contração. Conclusão: Instruções e feedback verbais são ferramentas úteis para contração correta dos MAP no pós-parto imediato.

Technical specification for Instructions for Clinical Application of Chinese Patent Medicines in China Association of Chinese Medicine / 中国中药杂志

In order to solve the problems of confusion in clinical medication and imperfect instructions in Chinese patent medicines(CPMs), the Standardization Department of the China Association of Chinese Medicine and Center for Pharmacovigilance and Rational use of Chinese Medicine in Beijing University of Chinese Medicine jointly compiled the Instructions for Clinical Application of Chinese Patent Medicines(CPMs). As the interpretation and supplement of drug instruction information, it aims to guide clinical safety and rational use of CPMs. In addition, the technical specification for clinical application description of CPMs has been formulated, which covers the seven processes of "carding instructions, clinical investigation, data retrieval, data screening, evidence classification, path transformation and writing format". It will enable readers of Instructions for Clinical Application of Chinese Patent Medicines to understand the work behind the compilation.

Simplified instructional phrasing in dispatcher-assisted cardiopulmonary resuscitation - when 'less is more'

INTRODUCTION@#In our national emergency dispatch centre, the standard protocol for dispatcher-assisted cardiopulmonary resuscitation (DACPR) in out-of-hospital cardiac arrests (OHCAs) involves the instruction 'push 100 times a minute 5 cm deep'. As part of quality improvement, the instruction was simplified to 'push hard and fast'.@*METHODS@#We analysed all dispatcher-diagnosed OHCAs over four months in 2018: January to February ('push 100 times a minute 5 cm deep') and August to September ('push hard and fast'). We also performed secondary per-protocol analysis based on the protocol used: (a) standard (n = 48); (b) simplified (n = 227); and (c) own words (n = 231).@*RESULTS@#A total of 506 cases were included: 282 in the 'before' group and 224 in the 'after' group. Adherence to the protocol was 15.2% in the 'before' phase and 72.8% in the 'after' phase (p < 0.001). The mean time between instruction and first compression for the 'before' and 'after' groups was 34.36 seconds and 26.83 seconds, respectively (p < 0.001). Time to first compression was 238.62 seconds and 218.83 seconds in the 'before' and 'after' groups, respectively (p = 0.016). In the per-protocol analysis, the interval between instruction and compression was 37.19 seconds, 28.31 seconds and 32.40 seconds in the standard protocol, simplified protocol and 'own words' groups, respectively (p = 0.005). The need for paraphrasing was 60.4% in the standard protocol group and 81.5% in the simplified group (p < 0.001).@*CONCLUSION@#Simplified instructions were associated with a shorter interval between instruction and first compression. Efforts should be directed at simplifying DACPR instructions.

Analysis on Revision of Chinese Patent Medicine Instructions in China from 2010 to 2020 / 中国药房

OBJECTIVE：To furt her standardize and improve the drug instructions of Chinese patent medicine ，and to promote its clinical safe and rational use. METHODS ：The varieties of Chinese patent medicines with clear content revision issued by the website of the State Drug Administration from January 2010 to June 2020 were inquired. The revised contents ，characteristics and deficiencies were summarized and analyzed to put forward the revision suggestions. RESULTS & CONCLUSIONS ：Among 107 Chinese patent medicine varieties the instruction content of which were revised clearly ，safety items were the focus of revision ；106 types（99.07％）were revised in terms of “contraindications”，103 types（96.26％）were revised in terms of “precautions”，102 types（95.33％）were revised in terms of “ADR”，49 types（45.79％）were revised in terms of “warning words ”，etc. The main dosage forms involved in the revision were oral preparations ，followed by injections and a small amount of external/rectal/vaginal dosage forms. The revised content highlighted the TCM syndrome types applicable to Chinese patent medicine ，emphasized the precautions for the use of Chinese patent medicine containing toxic and chemical components and detailed the medication precautions for special groups. However ，there were still some problems ，such as lack of quantitative expression ，lack of systematic and comprehensive drug interaction tips ，and other related items that had not been revised needed to be improved. In order to promote the safe and rational use of Chinese patent medicine ，it is suggested that the revision of Chinese patent medicine instructions should focus on safe drug use ，provide clear ADR monitoring data ，clear and specific medication attention and systematic and comprehensive drug interaction.

Brief analysis on instructions of pediatric Chinese patent medicines in National Essential Drug Catalogue / 中草药

There are only 22 varieties of pediatric drugs in National Essential Drug Catalogue (2018 Edition), including five chemicals and 17 Chinese patent medicines (13 prescriptions). Chinese patent medicines are widely used to treat pediatric diseases. The formulations of Chinese patent medicines are mostly derived from ancient classic prescriptions, based on the theory of syndrome differentiation and treatment of traditional Chinese medicine. The instruction of Chinese patent medicine as a document to guide the use of medicines, the specification and integrity of it directly affects whether Chinese patent medicine is used safely and effectively. This paper investigates the instructions of pediatric Chinese patent medicines in National Essential Drug Catalogue (2018 Edition) comparing with the relevant requirements of the United States and Japan, analyzes the toxicity and contraindication of Chinese patent medicines for pediatrics, summarizes the problems existing in these instructions, and puts forward some suggestions. The result shows that there are few kinds of proprietary Chinese patent medicines for pediatrics. There exist common shortcomings in the instructions of Chinese patent medicines for pediatrics, such as unlabeled contents, unnormalized indications, unclear usage and dosage, unknown contraindications and unclear precautions. This study provides a basis for further perfecting the instructions of Chinese patent medicines, and it is helpful to promote the safe and rational use of medicines for children.

Efeito da Formação de Classes de Estímulos Equivalentes e de Procedimentos de Facilitação na Emergência de Analogia / Effect of Equivalent Stimulus Class Formation and Facilitation Procedures on the Emergence of Analogy

Resumo Buscou-se verificar os efeitos da formação de classes de estímulos equivalentes e de dois procedimentos de facilitação na emergência de respostas de analogia, comparando os resultados obtidos nos testes de analogia de acordo com o procedimento de facilitação e com o fornecimento de instrução. Participaram 30 universitários. Foram ensinadas as relações AB e AC entre figuras abstratas e testadas as relações de simetria, transitividade e analogia. Os participantes que não apresentaram essas relações foram expostos aos procedimentos de facilitação. Doze participantes responderam por analogia antes do procedimento de facilitação, cinco de oito (62%), após Facilitação 1 e três de dez (33%), após Facilitação 2. Dos sete participantes expostos à instrução, seis responderam por analogia. A formação das classes não foi suficiente para a emergência das respostas de analogia e alguns participantes podem ter respondido ao Teste de Analogia sob controle de apenas alguns aspectos dos pares de estímulos.

Abstract The goals were to verify the effects of the formation of equivalent stimulus classes and two facilitation procedures on the emergence of analogy responses and to compare the results obtained in the analogy tests according to the facilitation procedure and the provision of instruction. Participants were 30 undergraduate students. AB and AC relations were taught with abstract pictures, then symmetry, transitivity, and analogy relations were tested. Participants who did not show these relations were exposed to the facilitation procedures. Twelve participants responded by analogy before the facilitation procedure, five of eight (62%) after Facilitation 1 and three of ten (33%) after Facilitation 2. Of the seven participants exposed to the instruction, six responded by analogy. Class formation was not enough for the emergence of analogy responses, and some participants might have responded to the Analogy Test under the control of only some aspects of the stimulus pairs.

Analysis on the Publication of Revision Notices of Drug Instructions and Related Status in China in 2015-2019 / 中国药房

OBJECTIVE： To analyze the situation of drug instruction revision and promote the standardization. METHODS： By reviewing the laws and regulations on the management of drug instructions in China， inquiring the official documents of drug instruction revision during Jan. 2015 to May 2019， the types of drugs involved and the revised items were analyzed， and the contents and shortcomings of the drug instructions and their revision process were summarized. RESULTS： A total of 112 revision notices were issued in 5 years （20， 28， 19， 34， 11 revision notices in 2015-2019， respectively）， involving 270 varieties. There were 109 prescription drugs， 161 OTC， 158 Chinese medicines， 105 chemicals， and 2 biological products. The revised items mainly focus on safety information such as precautions， adverse reactions， contraindications， and additional warnings， including 100， 85， 103， 52 items. However， in combination with clinical practice， the author found that there were still some problems， such as non-standard writting drug instructions， lack of supervision on the implementation of the revision， and no notification to the relevant users after the revision， which seriously threatened the safety of drug use. CONCLUSIONS： The included specifications of drug instructions are not well regulated， the implementation of the revised instructions is not doing well， the delineation of rights and obligations is confused， and the legal binding force is not strong. The standardization of drug instructions in China needs further improvement.

Determinants of Compliance to Work Instructions among Forklift Operators in a Steel Industry

@#Safe behavior is a form of behavior to act safelyduring work, to reduce and prevent work accidents. This study aimed to look at correlation between age, job experience, motivation, knowledge, attitude, availability of work instruction and worker compliance to work instruction among forklift operator. Questionnaire was used to determine age, job experience, motivation, knowledge, attitude, and availability of work instruction. Observation method was used to measure worker compliance to work instructions. The collected data were analyzed using logistic regression and bootstrap to find which variable had strong relationship with worker compliance to work instructions. The results indicated that motivation had significant correlation with workers compliance to work instruction. It could be concluded that motivation was a significant determinant compared to work instruction among forklift operator. It is therefore recommended that company perform routine inspection and safety training of forklift operation.

Game and Regulatory Suggestions in the Revision Process of Drug Instructions for Domestic Pharmaceutical Companies / 中国药学杂志

OBJECTIVE: To analyze the rational behaviors of pharmaceutical companies when modifying drug instructions, and puts forward policies and suggestions for promoting these enterprises to actively modify drug instructions. METHODS: The game theory is used to analyze the game equilibrium between enterprises and the market (patients and their agents -doctors) or the relevant government departments when they modify the instructions of the pharmaceutical enterprises in China. RESULTS: Based on cost considerations, enterprises are unwilling to modify drug instructions voluntarily. CONCLUSION: The drug regulatory departments in China should improve the relevant laws and regulations, and formulate specific operational drug instructions to modify the program.These measures would reduce the cost of enterprises to take the initiative to modify the drug instructions, and encourage the patient (and also be a doctor) to actively report the problem of adverse drug reactions caused by the unmodified instructions and increase penalties for not actively modify the behavior of drug instructions.At last the pharmaceutical companies could timely and actively modify instructions.

Pre-recorded instructional audio vs. dispatchers' conversational assistance in telephone cardiopulmonary resuscitation: A randomized controlled simulation study / 世界急诊医学杂志（英文）

BACKGROUND:To assess the effectiveness of the telephone chest-compression-only cardiopulmonary resuscitation (CPR) guided by a pre-recorded instructional audio when compared with dispatcher-assisted resuscitation. METHODS:It was a prospective, blind, randomised controlled study involving 109 medical students without previous CPR training. In a standardized mannequin scenario, after the step of dispatcher-assisted cardiac arrest recognition, the participants performed compression-only resuscitation guided over the telephone by either:(1) the pre-recorded instructional audio (n=57); or (2) verbal dispatcher assistance (n=52). The simulation video records were reviewed to assess the CPR performance using a 13-item checklist. The interval from call reception to the first compression, total number and rate of compressions, total number and duration of pauses after the first compression were also recorded. RESULTS:There were no significant differences between the recording-assisted and dispatcher-assisted groups based on the overall performance score (5.6±2.2 vs. 5.1±1.9, P>0.05) or individual criteria of the CPR performance checklist. The recording-assisted group demonstrated significantly shorter time interval from call receipt to the first compression (86.0±14.3 vs. 91.2±14.2 s, P<0.05), higher compression rate (94.9±26.4 vs. 89.1±32.8 min-1) and number of compressions provided (170.2±48.0 vs. 156.2±60.7). CONCLUSION:When provided by untrained persons in the simulated settings, the compression-only resuscitation guided by the pre-recorded instructional audio is no less efficient than dispatcher-assisted CPR. Future studies are warranted to further assess feasibility of using instructional audio aid as a potential alternative to dispatcher assistance.

Common use of sedatives and analgesics for off-label uses / 中国小儿急救医学

The use of analgesics and sedatives are mostly beyond drug instructions. In this article,we described the types,indications,populations,dosages,frequencies,and the ways of delivery of analgesia and sedative drugs which usually used in pediatrics.

Literature Analysis on the Effects of Smoking on Drugs / 医药导报

Objective To explore the effects of smoking on medications and provide an accurate and reliable evidence for smoking patients. Methods The drug instructions were surveyed from Datong medical drug counselling software database, and then the effects of smoking on drugs were analyzed by the drug instructions combined with the literature reports. Results There were 48 drugs varieties which might interact with smoking in Chinese drug instructions filtered from Datong medical drug counselling software database,which was much less than the report surveyed based on the FDA drug instructions(188 drugs varieties),there were another 37 varieties that off the instructions,reported by literatures interacted with smoking.Analysis revealed that smoking effects on drugs mainly by means of changing the pharmacokinetics and reducing the efficacy through inducing the CYP1A2,increasing the morbidity of some diseases such as cardiovascular disease,and increasing the adverse drug reactions.It was found that dosages of 8 drugs varieties need to be adjusted in smokers which were mainly or partly metabolized by CYP1A2.They are hydrochloride erlotinib,theophylline,riociguat,insulin,warfarin,clozapine,olanzapine and chlorpromazine. Dosage of 9 drugs varieties may need to be increased in smokers. Conclusion For the purpose of rational drug use,dosage of a variety of drugs should be adjusted in smokers.

Compliance to mothers' instructions with medical treatment / Obediência às instruções maternas em situação de tratamento médico / Obediencia a las instrucciones maternas para el tratamiento médico

Atopic dermatitis is a chronic skin disease with unknown etiology and high incidence in childhood. Although the response of following medical recommendations is an important behavior to control the symptoms, there are high rate responses of nonfollowing prescriptions, described as noncompliance. This study evaluated, in a brief direct assessment, the control exerted by direct and indirect instructions, verbalized by mothers, in compliance with medical treatment. Four girls, ages 9, 12, 13 and 14, diagnosed with atopic dermatitis and theirs mothers. They were scheduled outpatients at the dermatology department of a tertiary university hospital. The behavioral assessment was conducted according to a brief multielement experimental design in three phases. The use of direct instructions increased the probability of compliance behaviors, especially when associated with physical guide and praise. The results of this study can be important to identify the most important variables in the treatment of children with atopic dermatitis and to develop group or individual intervention programs.

A dermatite atópica é uma doença crônica de pele com etiologia desconhecida e alta incidência na infância. Embora a emissão de respostas para o seguimento de recomendações médicas seja um importante comportamento para o controle dos sintomas, existe elevadas taxas de respostas de não seguimento das recomendações médicas, compreendida como desobediência ou não adesão. O presente estudo avaliou, em uma breve avaliação direta, o controle exercido por instruções diretas e indiretas, verbalizadas pelas mães, no comportamento de obediência às em situação de tratamento médico. Participaram do estudo quatro meninas, com idades entre 9 e 14 anos, diagnosticadas com dermatite atópica e suas mães. Elas foram recrutadas no departamento de dermatologia de ambulatório de especialidades de um hospital escola. A avaliação comportamental foi realizada por meio do delineamento experimental de multielementos, realizado em três fases. O uso de instruções diretas aumentou a probabilidade de emissão de comportamentos de obediência, especialmente quando associados ao uso de condução física e elogios. Os resultados deste estudo podem ser importantes para identificar as variáveis mais importantes no tratamento de crianças com dermatite atópica e para desenvolver programas de intervenção individuais ou em grupo com esta população.

La dermatitis atópica es una enfermedad crónica de la piel con etiología desconocida y de alta incidencia en la infancia. Aunque es importante seguir las recomendaciones médicas, hay altas influencias para no seguir las recomendaciones médicas, descriptas como desobediencia. Este estudio evaluó, en una breve evaluación directa, el control ejercido por las instrucciones directas e indirectas, verbalizada por las madres durante la situación de tratamiento médico. El estudio evaluó a cuatro niñas con dermatitis atopica, entre nueve y catorce años, y a sus madres. Las evaluaciones ocurrirán con pacientes reclutado en el departamento de dermatología de un hospital-escuela. Las evaluaciones ocurrirán en tres etapas según el delineamiento experimental de multielementos. El uso de instrucciones directas e indirectas aumentó la probabilidad de conductas de obediencia, especialmente asociada con la conducción física y el elogio. Los resultados de este estudio pueden ser relevantes para identificar las variables más importantes para el tratamiento de niños con dermatitis atópica y para el desarrollo de programas de intervenciones individuales o grupales.