Cooperación entre médicos del departamento de emergencias y dermatólogos por telemedicina / Cooperation between emergency department physicians and dermatologists via telemedicine

Las intercurrencias dermatológicas agudas son un motivo de consulta frecuente a las centrales de emergencias, y generalmente los médicos de atención primaria se ocupan del primer nivel de atención. Puede ser necesaria una interconsulta con expertos, aunque no siempre estén disponibles. Ante la necesidad de facilitar dicha interacción a distancia, en Julio 2022 se implementó una herramienta de teledermatología en un hospital de alta complejidad en Buenos Aires, Argentina. Este servicio se limitó a días hábiles con horario restringido, permitiendo la comunicación entre médicos del departamento de emergencias y dermatólogos, a través de WhatsApp institucional. El dermatólogo podía verificar datos de salud relacionados al paciente (ej: comorbilidades y medicación crónica) mediante revisión de la historia clínica electrónica, para decidir sobre un plan de acción. Se evaluó la perspectiva de los usuarios a través de un formulario electrónico tras 3 meses de implementación. Los resultados evidenciaron que la mayoría (85%) de los profesionales conocía la herramienta, y el 57% la había usado al menos una vez. Se obtuvo una mediana de 9 puntos (de una escala de Likert del 1 al 10) sobre la recomendación hacia otro profesional. El teletriage dermatológico resultó beneficioso y fue aceptado, tanto por médicos de guardia como por especialistas. Ante las demoras en la atención ambulatoria, ha resultado una alternativa útil para evitar derivaciones innecesarias y/o acelerar aquellas que verdaderamente lo ameritan. Sin embargo, representa una forma de comunicación informal desde el punto de vista de almacenamiento de datos. Será necesario reflexionar sobre estos tópicos pendientes de esta experiencia asistencial como legalidad, seguridad y confidencialidad (AU)

Acute skin conditions are a frequent reason for consultation in emergency departments, and primary care physicians generally handle them. They might require referrals to experts, who are not always readily available. Recognizing the need to facilitate such interactions remotely, a teledermatology triage tool was implemented in July 2022 at a high-complexity hospital in Buenos Aires, Argentina. The service was limited to business days with restricted hours, enabling communication between emergency department physicians and dermatologists through institutional WhatsApp. Dermatologists could access patient-related health data (e.g., comorbidities and chronic medication) through the electronic medical record to determine an appropriate course of action. The perspective of users was evaluated through an electronic questionnaire after three months of application. Results showed that most professionals were aware of the tool (85%), and 57% used it at least once. The median rating for recommending the tool to other professionals was 9 points (on a Likert scale from 1 to 10). Dermatological teletriage proved beneficial and was well-received by emergency physicians and specialists. In the face of delays in outpatient care, it has been a useful alternative to avoid unnecessary referrals and expedite those that are warranted. However, it represents an informal method of communication with regard to data storage. It will be necessary to rethink on improvements in pending topics such as legal limitations, security, and confidentiality of this healthcare experience (AU)

O efeito da pandemia por COVID-19 no atendimento da síndrome coronariana aguda: coorte retrospectiva / The impact of the COVID-19 pandemic on the management of acute coronary syndrome: a retrospective cohort study

OBJETIVO: avaliar a contribuição da pandemia por COVID-19 sobre os tempos de atendimento e desfechos clínicos de admissões relacionadas à Síndrome Coronariana Aguda. MÉTODO: Coorte retrospectiva. Os dados foram analisados pelo SPSS, versão 20.0, empregados em testes paramétricos e não paramétricos para comparar os grupos. Aplicado o Modelo linear generalizado para análise multivariada. RESULTADOS: Incluídos 434 pacientes no período pré-pandemia e 430 durante a pandemia. Delta-t foi maior no período durante a pandemia (p=0,003). Não encontramos diferença nos tempos de atendimento e mortalidade. Admissão no período da pandemia (RR1,56; IC95%:1,30-1,87) e ter diagnóstico de cardiopatia isquêmica prévio (RR1,82; IC95%:1,50-2,20) foram associados ao aumento do Delta-t. CONCLUSÃO: Não houve diferença no número de pacientes que acessou a emergência por Síndrome Coronariana Aguda nos períodos analisados. Apesar do Delta-t ter sido maior durante a pandemia, não foram observados piores desfechos clínicos.

OBJECTIVE: To assess the impact of the COVID-19 pandemic on response times and clinical outcomes of acute coronary syndrome admissions. METHOD: Retrospective cohort study. Data were analyzed using SPSS version 20.0 with parametric and non-parametric tests for group comparisons. Generalized linear modeling was used for multivariate analysis. RESULTS: 434 patients were included in the pre-pandemic period and 430 during the pandemic. Delta-t was higher during the pandemic period (p=0.003). There were no differences in response times and mortality. Admission during the pandemic period (RR 1.56; 95% CI: 1.30-1.87) and a previous diagnosis of ischemic heart disease (RR 1.82; 95% CI: 1.50-2.20) were associated with increased delta-t. CONCLUSIONS: There was no difference in the number of patients presenting to the emergency department with acute coronary syndrome during the periods analyzed. Despite longer Delta-t during the pandemic, no worse clinical outcomes were observed.

Acute exogenous intoxications in childhood: factors related to hospitalization / Intoxicações exógenas agudas na infância: fatores relacionados à internação hospitalar

ABSTRACT Objective: To describe the profile of children assisted in the Emergency Room of a Children reference Hospital in the South of Brazil, victims of acute poisoning between 2016 and 2021, to characterize the toxic agents and to present the factors related to hospitalization. Methods: Retrospective, descriptive and observational study with data collection from medical records at a children's hospital from July 2016 to June 2021 based on the compulsory notification forms. The characteristics of victims, of the incident, the type and class of the substance involved, the procedures demanded and the need for the Intensive Care Unit were evaluated. The outcome considered was hospitalization. Absolute and relative frequencies were calculated for the categorical variables and measures of central tendency and dispersion for the numerical ones. Binary logistic regression was performed to identify variables related to hospitalization. Results: There were 411 consultations, with the mean age of 7.2±5.5 years, and predominance of females (59.9%). Most of the poisoning occurred at home (82.1%) and orally (93.7%). Chemicals or cleaning products were the main agents in children up to 1 year of age, whereas in the other age groups accidents occurred most frequently with medicines. Hospital admission occurred in 38.7% of the cases, with related variables being: number of agents, type of substance involved, medication that acts on the Central Nervous System, recurrence, motivation (accidental/intentional), and performance of simple exams. Conclusions: More preventive actions are needed, such as legislation, as well as greater guidance to parents on how to store products in the domestic environment, in order to reduce the number of exogenous intoxications in the pediatric population.

RESUMO Objetivo: Descrever o perfil das crianças atendidas na emergência de um hospital de referência pediátrica no sul do Brasil, vítimas de intoxicação exógena aguda entre 2016 e 2021, caracterizar os agentes tóxicos e descrever os fatores que se relacionam à internação hospitalar. Métodos: Estudo descritivo e analítico, com dados de prontuários de hospital pediátrico entre julho de 2016 e junho de 2021, por consulta às fichas de notificação compulsória. Foram avaliadas características das vítimas; do incidente; tipo de substância envolvida e classe; procedimentos realizados; necessidade de internação hospitalar, desfecho e necessidade de UTI. Calcularam-se frequências absolutas e relativas para as variáveis categóricas e medidas de tendência central e dispersão para as numéricas. Regressão logística binária foi realizada para identificar as variáveis associadas à internação. Resultados: Houve 411 atendimentos, com idade média de 7,2±5,5 anos, predomínio do sexo feminino (59,9%). A maioria das intoxicações ocorreu em domicílio (82,1%) e por via oral (93,7%). Produtos químicos ou de limpeza foram majoritários nas crianças com até um ano de idade, sendo os medicamentos os principais agentes nas demais faixas etárias. Resultaram em internações 38,7% dos casos, sendo as variáveis associadas: quantidade de agentes envolvidos, tipo de substância envolvida, medicamento que atua no Sistema Nervoso Central, recorrência, motivação (acidental/intencional) e realização de exames simples. Conclusões: Mais ações preventivas são necessárias, como legislações e maior orientação aos pais sobre a forma de armazenamento de produtos em ambiente doméstico, de modo a reduzir o número de intoxicações exógenas na população pediátrica.

Factors related to Nursing workload in the Oncology assistance provided to hospitalized women / Factores relacionados con la carga de trabajo de enfermería en la atención oncológica de mujeres hospitalizadas / Fatores relacionados à carga de trabalho da enfermagem na assistência oncológica de mulheres hospitalizadas

Objective: to evaluate the Nursing workload and its related factors in the assistance provided to hospitalized women with gynecological and breast cancers, according to the Nursing Activities Scores adapted for cancer patients. Method: a cross-sectional and epidemiological study. The participants were women with gynecological and/or breast cancer, over 18 years of age, and hospitalized for a minimum period of 24 hours. The following was collected from the medical records: sociodemographic and clinical data, Karnofsky Performance Status and workload, according to the adapted Nursing Activities Score. The factors related to workload were analyzed by means of multiple linear regression. Results: the mean Nursing Activities Scores was 29.3%, denoting seven hours of daily care per patient. The factors related to workload differed according to the breast or gynecological cancer diagnosis (β=-0.01; p<0.001), clinical or surgical treatment (β=-0.03; p<0.001) and functional capacity at admission (β=0.07; p<0.001), as per the Karnofsky Performance Status. Conclusion: there was greater workload for the care of women with gynecological cancer undergoing clinical treatment and with lower functional capacity at admission. The findings reveal directions for optimization of resources and improvements in work processes and flows, in order to promote a favorable work environment and good quality assistance.

Objetivo: evaluar la carga de trabajo de enfermería y los factores relacionados con la atención de mujeres hospitalizadas con cáncer ginecológico y de mama, según el Nursing Activities Scores adaptado para pacientes oncológicos. Método: estudio epidemiológico y transversal. Participaron mujeres con cáncer ginecológico y/o de mama, mayores de 18 años, hospitalizadas por un período mínimo de 24 horas. De las historias clínicas se recolectaron datos sociodemográficos y clínicos, Karnofsky Performance Status y carga de trabajo, según el Nursing Activity Score adaptado. Los factores relacionados con la carga de trabajo se analizaron mediante regresión lineal múltiple. Resultados: el puntaje promedio del Nursing Activity Scores fue del 29,3%, lo que indica que se brindan siete horas diarias de atención por paciente. Los factores relacionados con la carga de trabajo difirieron según diagnóstico de cáncer de mama o ginecológico (β=-0,01; p<0,001), tratamiento clínico o quirúrgico (β=-0,03; p<0,001) y capacidad funcional al momento del ingreso (β=0,07; p< 0,001), conforme a la escala Karnofsky Performance Status . Conclusión: hubo una mayor carga de trabajo en la atención a mujeres con cáncer ginecológico en tratamiento clínico y con menor capacidad funcional al momento del ingreso. Los hallazgos revelan información útil para optimizar recursos, mejorar procesos y flujos de trabajo, con el fin de promover un ambiente de trabajo favorable y una atención de calidad.

Objetivo: avaliar a carga de trabalho da enfermagem e seus fatores relacionados na assistência às mulheres hospitalizadas com cânceres ginecológicos e mamários, segundo o Nursing Activities Scores , adaptado a pacientes oncológicos. Método: estudo epidemiológico de corte transversal. Participaram mulheres com câncer ginecológico e/ou mamário, maiores de 18 anos, hospitalizadas por período mínimo de 24 horas. Coletados, do prontuário, dados sociodemográficos, clínicos, Karnofsky Performance Status e carga de trabalho, segundo Nursing Activities Score adaptado. Os fatores relacionados à carga de trabalho foram analisados por regressão linear múltipla. Resultados: pontuação média do Nursing Activities Scores foi 29,3%, denotando sete horas de assistência diária por paciente. Os fatores relacionados à carga de trabalho diferiram conforme diagnóstico de câncer de mama ou ginecológico (β= - 0,01; p<0,001), tratamento clínico ou cirúrgico (β= - 0,03; p<0,001) e capacidade funcional na admissão (β= 0,07; p<0,001), pelo Karnofsky Performance Status . Conclusão: evidenciou-se maior carga de trabalho para atendimento de mulheres com câncer ginecológico sob tratamento clínico e com menor capacidade funcional na admissão. Os achados revelam direcionamentos para otimização de recursos, melhorias em processos e fluxos de trabalho, a fim de promover ambiente laboral favorável e assistência de qualidade.

Photobiomodulation for Oral Mucositis - A Microcosting and Budget Impact Analysis from a Brazilian Perspective

ABSTRACT Objective: To measure the costs of preventive and therapeutic protocols of Photobiomodulation (PBM) for oral mucositis (OM) and their budgetary impact on Brazil's Ministry of Health (BMH). Material and Methods: A partial economic analysis was performed to estimate the costs using a bottom-up approach from a social perspective. Monetary values were assigned in Brazilian reais (BRL). The costs of the preventive protocol were calculated for five, 30, and 33 consecutive PBM sessions, depending on the antineoplastic treatment instituted. The costs of the therapeutic protocol were calculated for 5 or 10 sessions. The annual financial and budgetary impact was calculated considering the groups of oncologic patients with a higher risk of development of OM, such as those with head and neck and hematological cancer and pediatric patients. Results: The cost of a PBM session was estimated at BRL 23.75. The financial impact of providing one preventive protocol per year for all oncologic patients would be BRL 14,282,680.00, 0.030% of the estimated budget for hospital and outpatient care of the BMH in 2022. The financial and budgetary impacts of providing one treatment for OM for all patients in one year would be BRL 2,225,630.31 (0.005%, most optimistic scenario) and BRL 4,451,355.63 (0.009%, most pessimistic scenario). Conclusion: The budgetary impact of implementing PBM protocols in the Brazilian Healthcare System is small, even in a pessimistic scenario.

Let ′Rare Disease′ Been Seen: Delving into the Building up of Resource and Information Service in Medical Libraries for Rare Diseases / 罕见病研究

With the development of the diagnosis and treatment for rare diseases and the promotion of the construction of ′Double First-Class′ Universities in China, the libraries of medical schools have to make full use of their strengths to better face new challenges in discipline construction proactively. This article refers to resource and information service practices related to the rare disease carried out by medical libraries in China and in other countries; explores the possibilities of building up the resource and information in the future, aiming at improving the awareness of rare diseases among medical students, researchers, and the general public. The article also focuses on the need for strengthening the support for teaching and research into rare diseases, hoping to contribute to the overall improvement of the diagnosis, treatment, and educational research in rare diseases in China.

Application of FMEA model and 6S management method in reducing dispensing errors in PIVAS of children’s hospitals / 中国药房

OBJECTIVE To reduce dispensing errors in pharmacy intravenous admixture service （PIVAS） of children’s hospitals. METHODS The risk of dispensing procedures in our PIVAS was identified by applying failure mode and effect analysis （FMEA） model. Potential failure modes that might lead to dispensing errors in each link were determined， and failure causes were analyzed. The severity， incidence and detection degree of potential failure modes were quantitatively scored， and their risk priority number （RPN） was calculated to screen failure modes that needed to be improved in priority； the corresponding improvement measures were developed by 6S management method from six aspects， namely， finishing （seiri）， rectifying （seiton）， sweeping （seiso）， sanitation （seiketsu）， literacy （shitsuke） and safety. The effect of intervention before and after rectification was evaluated. RESULTS Based on the RPN， 32 potential failure modes were selected， of which a total of 18 critical failure modes that needed to be improved in priority. After implementing corresponding measures according to 6S management method， the RPN of 18 critical failure modes decreased. The total RPN decreased from 497 to 142 with a decrease rate of 71.43%. The error rates of 15 critical failure modes were significantly lower than before implementation （P＜0.05）. CONCLUSIONS Applying FMEA model and 6S management method to the risk control of all aspects of PIVAS workflow can effectively reduce the risk of PIVAS dispensing errors and ensure the safety of children’s intravenous medication.

2022 Country Report on Medical Rehabilitation Services, Quality and Safety in Health Care System / 中国康复理论与实践

ObjectiveTo analyze the medical services, quality and safety of rehabilitation medicine departments in general hospitals and rehabilitation hospitals in 2021 in perspectives of structure, segment and outcome quality. MethodsWe analyzed the data from National Clinical Improvement System of the National Health Commission, involving 9 328 hospitals, including all secondary and above general hospitals and rehabilitation hospitals, as well as traditional Chinese Medicine hospitals and integrated traditional Chinese and Western medicine hospitals in 2021. A total of 2 513 sampling hospitals that equipped with rehabilitation wards were included. ResultsAmong the 9 328 general hospitals surveyed this year, only 2 713 had rehabilitation wards. In general hospitals, the average number of physicians per bed in 56.77% hospitals, the average number of rehabilitation therapists per bed in 80.36% hospitals, and the average number of nurses per bed in 53.53% hospitals did not meet the national requirements, and the average number of rehabilitation medical personnel per bed in rehabilitation medicine departments in different regions was significantly different. The rates of early rehabilitation intervention were 13.45%, 20.67% and 29.74% respectively in department of orthopedics, department of neurology and intensive care units in general hospitals. The average improvement rate of activities of daily living of discharged patients was 77.87% in rehabilitation department of general hospitals, and 69.01% in rehabilitation hospitals. ConclusionIn 2021, professional medical services, quality and safety of rehabilitation medicine in China have improved steadily. However, most general hospitals in China still have not configured the rehabilitation wards, and there are problems such as the total number of rehabilitation medical personnel in the country does not meet the requirements, early rehabilitation intervention is significantly insufficient, and the implementation of important evaluation and therapies is deficient. The effect of rehabilitation still needs to improve. It is necessary to continuously promote capacity building of the medical rehabilitation to improve the quality of medical rehabilitation services.

Assistive technology application in educational contexts: policy framework and core areas / 中国康复理论与实践

ObjectiveTo study domestic and international policies and core areas related to assistive technology services for children with disabilities, to explore the application of assistive technology for children with special needs in the educational context. MethodsBased on the relevant policies and theoretical frameworks of policies on assistive technology services of United Nations, World Health Organization (WHO) and China, the policy frameworks and core areas of assistive technology in the educational context were analyzed using the theories of the six elements of the WHO assistive technology service system and the 5P service model, as well as the international and domestic classifications and directory lists of assistive technologies. ResultsInternational Classification of Functioning, Disability and Health (ICF) gave the definition and classification of assistive technology in educational scenarios. With the Convention on the Rights of Persons with Disabilities (CRPD) as the core and the Assistive Technology for Children with Disabilities (ATD) strategy as the centerpiece of the international policy, the core areas of assistive technology application in educational settings were established with the 5P Model, consisting of five related areas, namely individuals, policies, products, practitioners and service delivery, based on the six elements of the WHO assistive technology service system, namely leadership and governance, financing, human resources for health, service delivery, medical technology and health information system. The ecosystem focused on people, policies, products, practitioners and services that promote access to and use of assistive technology. ConclusionThe policy and core areas for the application of assistive technology in educational contexts are formed on the basis of ICF, with the CRPD at the core, and the strategy of ATD, to define scientifically the definition; and promote assistive technology services for children with disabilities from the perspective of the right to comprehensive, efficient, and child-centered development, to provide usable, accessible, affordable, adaptable, acceptable and quality assistive technology services to ensure that children with disabilities enjoy equal and quality education, and to improve the quality of life and well-being. A human-centered assistive technology ecosystem can be established using 5P Model, to innovate and develop assistive technology services for children with disabilities.

The Practice of Cross-Cultural Medical Services in the United States and Its Enlightenment to China / 中国医学伦理学

This paper collected and sorted out the cross-cultural medical practice in the top 20 US hospitals in 2019-2020 through web surveys, and summarized the concepts, featured projects and models of cross-cultural medical services in American hospitals. Generally, hospitals in the US advocate the service concept of "patient-centered", provide full-process services before, during and after the treatment, involving appointments, accommodation, transportation, language translation, medical process management, etc., and attach great importance to the role of culture factors in medical treatment and cross-cultural medical education and training for employees. On this basis, it is proposed that Chinese medical institutions should focus on the following aspects in the development of foreign-related medical services: conform to international medical service concepts and standards, improve the cross-cultural medical competence of medical staff and other groups, explore cross-cultural medical service models with localized characteristics, and build the international image of the hospital with the construction of international environment.

Research on Satisfaction Degree of Doctor-patient Communication Quality based on Patient Perception / 中国医学伦理学

Objective sampling method was used to conduct a questionnaire survey on outpatients in two hospitals in Guangdong province in order to evaluate patients’ satisfaction with the quality of medical service. This paper explored the factors that affect patients’ evaluation of medical service quality, and found that patients’ age was negatively correlated with the evaluation of medical service quality. It is suggested that the establishment of friendly medical institutions should be carried out according to the national policy. At the same time, the management mechanism of hospital should be improved, the number of medical service centers for "efficient" should be increased, and the medical service personnel should be regularly trained; carry out medical knowledge education in community, improve the popularization of personal medical knowledge and close the cognitive gap between doctors and patients.

Leptospirosis Knowledge, Attitude, and Practice of Town Service Workers in Kuching, Malaysia

@#Introduction: This study aimed to evaluate town service personnel’s knowledge, attitudes, and practices (KAP) regarding leptospirosis prevention and the influencing factors to its practice. Methods: A cross-sectional study was conducted in Kuching, Malaysia, involving town service workers using a self-administered validated questionnaire comprising sociodemographic and KAP information. The eligibility criteria included 18 years old and above and having worked for more than six months. The KAP was determined using descriptive analysis, and associations were identified using logistic regression analysis. Results: About 189 town service workers responded, giving a response rate of 87.5%, and a majority of them were Bumiputera Sarawak, with a mean age of 38.6 (±11.00) years old. The mean duration of employment was 9.3 (±6.99) years. About 88.9% had good knowledge of leptospirosis. Meanwhile, 85.2% and 79.9% had satisfactory attitudes and good practices. The knowledge on the aetiology of leptospirosis ranged from 25% to 94%. No significant association was found between the knowledge score and income with the practice score. The attitude score (AOR 1.161; 95% CI = 1.090, 1.238; p = 0.000) and working experience (AOR 1.174; 95% CI = 1.023, 1.346; p = 0.022) were found to be significantly associated with their practice score. Conclusion: Most town service workers have good knowledge and practice regarding leptospirosis prevention. Workers with good attitudes demonstrate good practising habits toward leptospirosis prevention. Awareness and activities related to disease prevention should be encouraged to ensure the continuity of a positive attitude.

A cross-sectional study of contraceptive use and healthcare status among women at different times in the postpartum period / 上海预防医学

ObjectiveTo investigate the use of contraceptive methods， and to evaluate maternal healthcare services utilization among women within 2 years in Pudong New Area of Shanghai. MethodsA cross-sectional survey was conducted using a questionnaire for women at different postpartum periods who visited a community health clinic with their children from June to November 2021. Data were analyzed using χ2 test and binary logistic regression. ResultsAmong the 1 946 postpartum women surveyed， 1 934 were either married or cohabiting， and1 430 had resumed their sexual life. Among women at 4， 6， 12， 18 and 24 months postpartum， the contraceptive prevalence rates （CPR） were 92.34% （193/209）， 92.16% （235/255）， 87.31% （282/323）， 91.95% （297/323） and 90.00% （288/320）， respectively. The modern contraceptive prevalence rates （mCPR） were 87.08% （182/209）， 87.06% （222/255）， 82.04% （265/323）， 83.09% （271/323） and 85.31% （273/320）， respectively， while the unmet contraceptive needs （UMNs） were 7.66% （16/209）， 7.84% （20/255）， 11.46% （37/323）， 6.81% （22/323） and 10.00% （32/320）， respectively. The use rates of long-acting reversible contraceptive （LARC） methods among women at 6， 12， 18 and 24 months postpartum period were 0.39% （1/255）， 2.17% （7/323）， 0.31% （1/323）， and 2.81% （9/320）， respectively. Among all surveyed subjects， 32.17% （626/1 946） had received postpartum contraceptive services only once， while 27.85% （542/1 946） had not received any postpartum contraceptive services. Binary logistic regression analysis indicated that the use of contraceptive methods among postpartum women was associated with whether relevant educational services were received after childbirth and during postpartum home visits （all P<0.05）. ConclusionPostpartum women have unmet needs for contraception. Contraceptive guidance at the 42-day postnatal healthcare visit needs to be further strengthened and postpartum contraceptive education could be integrated into the pregnancy care. The quality and effectiveness of contraceptive education during delivery and postpartum home visits， and even at the 42-day postnatal healthcare visit need to be further explored.

Outpatient health service utilization and its influencing factors among pneumoconiosis patients combined with tuberculosis / 环境与职业医学

Background Tuberculosis is the most common complication of pneumoconiosis, which accelerates the progression of pneumoconiosis. Pneumoconiosis combined with tuberculosis is a major health risk. Objective To understand the outpatient health service utilization for patients of pneumoconiosis combined with tuberculosis and its main influencing factors. Methods A stratified random sampling combined with non-random sampling was used to select 11181 pneumoconiosis patients in 27 provincial administrative regions (excluding Shanghai, Tianjin, Hainan, Tibet Autonomous Region, Taiwan, Hongkong and Macao Special Administrative Regions) from December 2017 to June 2021. A self-constructed questionnaire, i.e. Health Seeking Behaviors of Pneumoconiosis Patients and Their Influencing Factors, was used, which included basic information, outpatient and inpatient service utilization, and influencing factors of medical treatment behaviors of pneumoconiosis patients. The effective recovery rate of the questionnaire was 90.7%. All patients of pneumoconiosis combined with tuberculosis (n=762) were included as the study subjects. The difference of outpatient utilization in the past two weeks, choosing medical institutions, and the reasons of not seeking medical treatment between urban and rural areas, and the influencing factors of outpatient service utilization were analyzed. Results The study subjects were mainly silicosis combined with tuberculosis (502 cases, 65.9%) and coal workers' pneumoconiosis combined with tuberculosis (232 cases, 30.5%), aged (58.6±12.5) years old. The main region was Western China (45.1%), followed by Eastern China (22.1%), Centeral China (20.2%), and Northeastern China (12.6%). The outpatient utilization rate in the past two weeks was 38.5% (293/762), and the main medical institutions consulted were municipal or provincial hospitals (32.0%), district or county hospitals (28.6%), and township hospitals or health service centers (17.5%). Short distance (20.7%), the availability of specialist outpatient services (16.7%), high level of medical care (14.8%), and low medical cost (12.3%) were the main reasons in choosing medical institutions. Higher proportion of patients seeking medical services due to acute exacerbation in rural areas was reported than in urban areas in the past two weeks (P<0.01). In addition to being hospitalized (113 cases, 41.4%) and self-purchasing medicine (46 cases, 16.8%), the reasons for not seeking medical treatment were self-perceived mild symptoms (15.0%) and high medical cost without reimbursement (9.5%). The multiple regression results showed that outpatient rate for patients of pneumoconiosis combined with tuberculosis in the western region was higher than that in the eastern region (OR=1.66, 95%CI: 1.03, 2.68); patients with an annual personal income of 10000-35500 yuan had a higher outpatient rate than the > 35500 yuan income group (OR=2.54, 95%CI: 1.49, 4.36); the outpatient rate of silicosis patients was higher than that of coal workers' pneumoconiosis (OR=1.83, 95%CI: 1.23, 2.72); the outpatient rate of patients with clinically diagnosed cases (no classified stage of pneumoconiosis) was higher than that of patients with stage I pneumoconiosis (OR=2.32, 95%CI: 1.24, 4.31). Exacerbation of pneumoconiosis-related symptoms in past two weeks (OR=4.26, 95%CI: 2.89, 6.28), occupational injury insurance (OR=0.49, 95%CI: 0.30, 0.80), and hospitalization in past one year (OR=2.37, 95%CI: 1.41, 3.97) were the main factors influencing the outpatient health service utilization among patients of pneumoconiosis combined with tuberculosis. Conclusion The outpatient rate of patients of pneumoconiosis combined with tuberculosis is higher than that of patients of pneumoconiosis without tuberculosis. The utilization of outpatient services is related with disease factors and socio-economic security factors.

Artificial intelligence application in hospital pharmaceutical service：a bibliometric analysis / 中国药房

OBJECTIVE To analyze the current status and trend in the application of artificial intelligence in pharmaceutical service in China and globally. METHODS The research literature on the application of artificial intelligence technology in the field of hospital pharmaceutical service from database establishment to June 16， 2023， was searched in Web of Science and CNKI. The authors， countries/regions， institutions and the co-occurrence， clustering， and emergence of keywords were visually processed and analyzed using tools including Endnote， CiteSpace， and Python. RESULTS & CONCLUSIONS Overall， 1 190 global literature and 178 Chinese literature were included. The number of publications issued in China and globally is increasing year by year， yet a gap remains in the quantity and quality of Chinese research compared with global research. Europe and the United States have built a close cooperation network in this field， while China’s regional development in this field remains imbalanced. Global research hotspots mainly focus on the development and application of high-end technologies such as machine learning， natural language processing, and deep learning； Chinese research concentrates more on actual medical services and medical policies， especially in promoting rational drug use， prescription review， and the development of traditional Chinese medicine.

Serviço de convivência e fortalecimento de vínculos: reXistências por via do acontecimento / A public service for youth: community identity through resistance / Un service public pour la jeunesse: l'identité communautaire par la résistance / Un servicio público para los jóvenes: identidad comunitaria por vía de la resistencia

Este texto traz um relato de experiência advindo das atividades de uma orientadora social realizado no Serviço de Convivência e Fortalecimento de Vínculos (SCFV) de um Centro de Referência de Assistência Social (Cras) situado na Grande Florianópolis (SC). O serviço integrou 20 jovens com idade entre 12 e 18 anos no espaço de uma instituição de formação policial. Este trabalho analisará: (1) um acontecimento ocorrido na instituição policial; (2) quais foram os seus desdobramentos; e (3) como a orientadora social atuou na mediação do grupo. A análise da do relato de experiência e a mediação da orientadora social foram embasadas no conceito de acontecimento de Gilles Deleuze. No decorrer dos encontros, a instituição parceira do projeto adotou medidas disciplinares que desqualificavam a cultura proveniente dos cotidiano dos(as) jovens participantes, o que levou o grupo a constituir uma identidade coletiva a partir da resistência à violência simbólica. Assim, diante da situação-problema, tornou-se possível uma experiência de fortalecimentos de laços comunitários

This paper discusses a situation that occurred in a public youth service for young people living in vulnerable city areas. The service worked with 20 young people aged between 12 and 18 years and the meetings took place at a police training institution. Inspired by Gilles Deleuze's theory, this text analyzes 1) an event that occurred at the police institution, 2) their consequences and 3) how the professional responsible dealt with the event in a group context. At some point in the meetings, the police training institution adopted disciplinary measures that disqualified the participants' culture, leading the group to create a collective identity to resist symbolic violence. Thus, a community gathering experience emerged in the face of the conflicted situation

Le texte discute une situation survenue dans une fonction publique désignée pour accueillir des jeunes vivant dans des quartiers vulnérables. Le service comprenait 20 jeunes de 12 à 18 ans et les réunions se sont déroulées dans un établissement de formation policière. Inspirées par la théorie de Gilles Deleuze, ce texte analyse 1) un événement survenu dans l'institution policière, 2) qu'elles en ont été ses conséquences et 3) comment le professionnel responsable a agi pour faire face à l'événement dans un contexte de groupe. À un moment donné au cours des réunions, l'institution de formation a adopté des mesures disciplinaires qui disqualifiaient la culture des jeunes participants, ce qui a conduit le groupe à se forger une identité collective basée sur la résistance à la violence symbolique. Par conséquent, une expérience de rassemblement communautaire a émergé face à la situation conflictuelle

El texto se refiere a una situación ocurrida en un servicio público designado para trabajar con jóvenes que viven en zonas vulnerables de la ciudad. El servicio incluyó a 20 jóvenes de entre 12 y 18 años y las reuniones se ubicaron en una institución de capacitación policial. Este texto analiza 1) un suceso que ocurrió en la institución policial, 2) cuáles fueron sus consecuencias y 3) cómo actuó el profesional responsable del servicio para enfrentar el suceso en un contexto grupal. El análisis de esta situación y la referencia teórica que apoyó los actos profesionales se inspiraron en la teoría de Gilles Deleuze. En algún momento de los encuentros, la institución de capacitación policial adoptó medidas disciplinarias que descalificaron la cultura de los jóvenes participantes, lo que llevó al grupo a constituir una identidad colectiva basada en la resistencia contra la violencia simbólica. Por lo tanto, ante la situación conflictiva, fue posible una experiencia de reunión comunitaria

Facteurs associés à la survenue du diabète chez les patients admis dans les services d' accueil des urgences de deux hôpitaux de Dakar en 2018 (Sénégal): Étude transversale / NA

Introduction :Au Sénégal, le profil épidémiologique en termes de diabète n'est pas clairement établi chez les patients reçus dans les services d'accueil des urgences (SAUs). L'objectif était de déterminer les facteurs associés à la survenue du diabète chez les patients admis dans les SAUs de deux hôpitaux de Dakar.Méthodes : L'étude était transversale et analytique. La collecte des données a eu lieu du 25 janvier au 05 mars 2018. La taille de l'échantillon était de 615 patients. L'entretien en face en face était réalisé. Les facteurs de risque étaient identifiés à l'aide d'une régression logistique. Les résultats étaient exprimés à l' aide de l'odds ratio ajusté (ORa) et entouré de son intervalle de confiance à 95% (IC95%) Résultats : Les patients étaient des hommes, âgés de moins de 40 ans, mariés et sans emploi dans respectivement 52,4%, 44,5%, 64,5% et 53,3% des cas. En outre, la consommation des fruits et légumes et la pratique du sport étaient insuffisantes chez respectivement 96,4% et 72% des patients. Par ailleurs, 16,9% des sujets interrogés étaient diabétiques. Les facteurs de risque de la survenue de la maladie étaient l'âge avancé, le statut sans emploi et l'obésité: patients âgés entre 40 et 69 ans (ORa=21,184; IC95%=[6,11-73,41]), patients âgés d'au moins 70 ans (ORa=12,62; IC95%=[3,29-48,28]), patients sans travail (ORa=3,47; IC95%=[1,69-7,10]) et patients obèses (ORa=3,17; IC95%=[1,35-7,45]).Conclusion : La fréquence du diabète est élevée chez les patients admis en consultation dans les SAUs des hôpitaux de Dakar. Cette étude montre que recherche du diabète chez cette catégorie de patients devrait être une pratique courante et qu'il urge de mettre en place des actions de promotion de la santé.

Arranjos assistenciais em uma rede atenção psicossocial no sul do Brasil / Arreglos asistenciales en una red de apoyo psicosocial en sur de Brasil / Care arrangements on a psychosocial care network in southern Brazil

RESUMO. A implementação da reforma psiquiátrica é tema de recorrentes discussões no campo da saúde mental. Essa implementação não é padrão para todas as localidades brasileiras, uma vez que depende dos recursos materiais, humanos e aspectos culturais de cada região. A esta singularidade retoma-se a noção de arranjo assistencial. Este trabalho se propôs a conhecer a implementação numa regional de saúde da região Sul. Foi realizado um mapeamento descritivo, seguindo método empírico-fenomenológico. Descrevem-se serviços que acolhem todos os públicos, mas que encontram dificuldades no trabalho com a população usuária de álcool e outras drogas. Foram elencados sete dispositivos assistenciais: acolhimento, grupos terapêuticos, oficinas, atendimentos individuais, uso da medicação, encaminhamentos e reuniões de equipe. Expõe-se a ideia de que a estrutura de um serviço de saúde mental não pode ser estanque. Os arranjos assistenciais estão relacionados às vivências e soluções criativas e humanas como também práticas irrefletidas e normatizadoras na atenção do sofrimento mental.

RESUMEN. La implementación de la reforma psiquiátrica no se encuentra estandarizada para todas las regiones brasileras, una vez que eso depende de recursos materiales, humanos y de aspectos culturales. Por cuenta de esta singularidad, se retoma la noción de arreglo asistencial. En este trabajo se propone conocer la implementación en una regional de salud de sur de Brasil. Se realizó un mapeo descriptivo, siguiendo el método empírico-fenomenológico. Se describen servicios que acogen a todos los públicos, pero que encuentran dificultades en el trabajo con usuarios de alcohol y drogas. Fueran enumerados siete dispositivos asistenciales: Acogimiento, grupos terapéuticos, talleres, atendimientos individuales, uso de medicación, encaminamientos y reuniones de equipo. Se expone la idea de que la estructura de un servicio de Salud Mental no puede ser hermética. Los arreglos asistenciales están relacionados con las vivencias y soluciones creativas y humanas como también prácticas irreflexivas y normalizadoras en la atención del sufrimiento mental.

ABSTRACT. The psychiatric reform is not standard in all Brazilian places, as it depends on different factors such as material, human and cultural aspects of each region. As for its singularity, it is seen as a care arrangement. This article aims to study the psychosocial care network on a regional health department in south Brazil. A descriptive mapping has been performed, following the empirical-phenomenological method. The services described welcome the entire community, people from all walks of life, but when it comes Drug and Alcohol addicted, the approach becomes more challenging. There have been seven care services listed: Hosting, Therapeutic Groups, Workshops, Individual Treatment, Medication usage, Referrals and Support Group Meetings. The approach for care arrangement is related to the creative experiences and human solutions as well as thoughtless and normative practices in the attention of mental suffering.

Profile of cardiovascular diseases and physiotherapeutic intervention in a hospital emergency service / Perfil das doenças cardiovasculares e atuação fisioterapeutica em um serviço de emergência hospitalar

Abstract Introduction Cardiovascular disease (CVD) is the lead-ing cause of death globally, with a high proportion of hospitalizations and costs. In view of this, it is essential to understand the main CVDs in patients admitted to hospital emergency services and the role of physiotherapists, in order to plan and direct health services, and to denote participation and encourage specific physiotherapy training in the context of tertiary care. Objective To outline the profile of cardiovascular emergencies and to evaluate physiotherapy in adult patients in the emergency department of a hospital in the interior of the state of São Paulo. Methods This was an observational study which analyzed 1,256 on-call records over a period of eight months. The data collected included age, gender, cardiovascular diagnostic hypothesis and physiotherapy treatment carried out. Results A total of 75 patients with cardiovascular emergencies were included, the most prevalent of which were: heart failure (n = 21), acute coronary syndrome (n = 14), acute myocardial infarction (n = 13), bradyarrhythmia (n = 6) and hypertensive crisis (n = 5). Regarding physiotherapeutic actions and their applications, the most frequent were invasive mechanical ventilation management (n = 34), lung re-expansion maneuvers (n = 17), orotracheal intubation assistance (n = 17), non-invasive mechanical ventilation (n = 14), bronchial hygiene maneuvers (n = 12), kinesiotherapy (n = 10) and sedation (n = 10). Conclusion Heart failure and acute coronary syndrome were the cardiovascular diseases that caused the most admissions to the hospital emergency department and that the procedures with an emphasis on the respiratory system were the most applied.

Resumo Introdução As doenças cardiovasculares (DCV) repre-sentam a principal causa de morte global, destacando-se em internações e gastos. Diante disso, é essencial compreender as principais DCV em pacientes admitidos em serviços de emergência hospitalar e a atuação do fisioterapeuta para planejamento e direcionamento dos serviços de saúde e para denotar a participação e incentivar formações fisioterapêuticas específicas no contexto da atenção terciária. Objetivo Traçar o perfil de emergências cardiovasculares e avaliar a atuação fisioterapêutica em pacientes adultos de serviço de emergência de um hospital no interior do estado de São Paulo. Métodos Trata-se de um estudo observacional, em que foram analisadas 1.256 fichas de passagem de plantão, no período de oito meses. Os dados coletados foram idade, sexo, hipótese diagnóstica cardiovascular e tratamento fisioterapêutico realizado. Resultados Foram incluídos 75 pacientes que apresentavam o perfil de emergências cardiovasculares, sendo as mais prevalentes: insuficiência cardíaca (n = 21), síndrome corona-riana aguda (n = 14), infarto agudo do miocárdio (n = 13), bradarritmia (n = 6) e crise hipertensiva (n = 5). Em relação à atuação fisioterapêutica e suas aplicações, as mais frequentes foram manejo da ventilação mecânica invasiva (n = 34), manobras de reexpansão pulmonar (n = 17), auxílio a intubação orotraqueal (n = 17), ventila-ção mecânica não invasiva (n = 14), manobras de higiene brônquica (n = 12), cinesioterapia (n = 10) e sedestação (n = 10). Conclusão A insuficiência cardíaca e a síndrome coronária aguda foram as doenças cardiovasculares que mais ocasionaram internação no serviço de emergência hospitalar e as condutas com ênfase no aparelho respiratório foram as mais aplicadas.

Uso dos serviços de saúde por pessoas idosas em áreas rurais e urbanas do Brasil / Health services utilization by older adults in rural and urban areas of Brazil

Resumo Objetivo Avaliar o uso dos serviços de saúde por pessoas idosas residentes em áreas urbanas e rurais do Brasil. Método Estudo transversal que analisou dados da Pesquisa Nacional de Saúde 2019, referentes aos moradores idosos (≥60 anos) selecionados nos domicílios, totalizando 22.728 entrevistas (3.300 em área rural e 19.426 em área urbana). Foram estimadas para as áreas rurais e urbanas as prevalências de cadastro na Estratégia Saúde da Família, intervalo de tempo da última consulta médica e odontológica, procura do serviço nas últimas duas semanas, última aferição da pressão arterial e da glicemia e avaliados os fatores associados à utilização dos serviços de saúde médicos e odontológicos nos últimos 12 meses. Resultados A autopercepção da saúde como 'muito boa' ou 'boa' foi maior na área urbana (47,32%), assim como a proporção de pessoas idosas que relataram consulta médica e odontológica nos últimos 12 meses (90,54%). Evidenciou-se menor frequência do acompanhamento da aferição de pressão arterial (81,30%) e da glicemia (45,83%) em áreas rurais. As pessoas idosas que possuem baixa escolaridade, residem em áreas rurais, na região Norte são as que possuem menor chance de utilização dos serviços. Conclusão A população idosa residente em área rural apresenta piores condições de saúde em relação à população residente em área urbana.

Abstract Objective To assess health services utilization by older adults in urban and rural areas of Brazil. Method A cross-sectional study was conducted analyzing data from the 2019 National Health Survey on older adults (≥60 years) selected from households based on 22,728 interviews (3,300 in rural and 19,426 in urban areas). For rural and urban areas, the prevalence of Family Health Strategy enrolment, time since last medical and dental visit, service use in past 2 weeks, and last blood pressure and blood glucose measurements were estimated. Also, the factors associated with medical and dental health services utilization in the past 12 months were explored. Results Self-rated health of "Very good" or "Good" was greater in urban areas (47.32%), as was the proportion of older adults reporting a medical or dental visit within the last 12 months (90.54%). Rates of blood pressure (81.30%) and glucose (45.83%) monitoring were lower in rural areas. Older individuals that had low education, resided in rural areas, and the North region, had a lower likelihood of using health services Conclusion The older population living in rural areas had poorer health status compared with the urban population.