Osteonecrosis of the jaws in patients under osteoporosis treatment: a nine-year experience report

ABSTRACT Objective: This study aimed to report the experience of medication-related osteonecrosis of the jaws (MRONJ) in osteoporotic patients for nine years, and their associated initiating factors. Materials and methods: The numbers of invasive oral procedures (IOP) (tooth extraction, dental implant placement, and periodontal procedures) and removable prostheses performed from January 2012 to January 2021 were obtained from the digital records of a large public dental center. There were an estimated 6,742 procedures performed in patients under osteoporosis treatment. Results: Two cases (0.03%) of MRONJ were registered in nine years amongst patients with osteoporosis who had dental treatment at the center. From the 1,568 tooth extractions, one patient (0.06%) developed MRONJ. There was also one case from the 2,139 removable prostheses delivered (0.05%). Conclusions: The prevalence of MRONJ associated with osteoporosis treatment was very low. The protocols adopted seem to be adequate for the prevention of this complication. The findings of this study reinforce the rare frequency of MRONJ associated with dental procedures in patients submitted to the pharmacological management of osteoporosis. An integral analysis of systemic risk factors and oral preventive strategies may be considered regularly in the dental treatment of these patients.

Risk management: implementation of a clinical protocol for the prevention and management of pediatric falls / Gestión de riesgos: aplicación de un protocolo clínico para la prevención y gestión de caídas pediátricas / Gestão de riscos: implantação de protocolo clínico de prevenção e manejo de quedas pediátricas

ABSTRACT Objective To describe the process of elaboration and implementation of a protocol for the prevention and management of pediatric falls. Method This was an actionresearch developed at a public hospital in Southeast Brazil with 10 members of the multidisciplinary team from the pediatrics, maternity, neonatal intensive care sectors, and the patient safety center. To elaborate the protocol, literature review, three meetings with the group, and two rounds ofonline correction were carried out. Online training was carried out for all professionals and then the use of the protocol was started at the sectors. Results A pediatric fall prevention protocol was implemented. Educational materials were developed and the Humpty Dumpty Falls Scale was chosen to assess the risk of falling. Conclusion The process was conducted in a collective and participatory way. The protocol and the educational materials guide and standardize behavior based on the best evidence and involve users, family members and professionals in the management of the risk of falling.

RESUMEN Objetivo Describir el proceso de elaboración e implementación de un protocolo para la prevención y manejo de caídas pediátricas. Método Investigación-acción desarrollada en un hospital público del Sureste de Brasil, con 10 integrantes del equipo multidisciplinario de los sectores de pediatría, maternidad, cuidados intensivos neonatales y centro de seguridad del paciente. Para la elaboración del protocolo se realizó una revisión bibliográfica, tres encuentros con el grupo y dos rondas de corrección online. Se realizó capacitación en línea para todos los profesionales y luego se inició el uso del protocolo en los sectores. Resultados Se implementó un protocolo de prevención de caídas pediátricas. Se desarrollaron materiales educativos y se definió la escala Humpty Dumpty Falls Scale para evaluar el riesgo de caídas. Conclusión El proceso se llevó a cabo de manera colectiva y participativa. El protocolo y los materiales educativos guían y estandarizan el comportamiento en base a la mejor evidencia e involucran a los usuarios, familiares y profesionales en el manejo del riesgo de caídas.

RESUMO Objetivo Descrever o processo de elaboração e implantação de um protocolo de prevenção e manejo de quedas pediátricas. Método Pesquisa-ação desenvolvida em um hospital público do Sudeste do Brasil, com 10 membros da equipe multidisciplinar dos setores de pediatria, maternidade, terapia intensiva neonatal, e do núcleo de segurança do paciente. Para elaborar o protocolo realizou-se revisão de literatura, três encontros com o grupo e duas rodadas de correção online. Foi realizado treinamento online para todos os profissionais e, depois, iniciado o uso do protocolo nos setores. Resultados Implementado protocolo de prevenção de quedas pediátricas. Definiu-se a escala Humpty Dumpty Falls Scale para avaliação do risco e foram elaborados materiais educativos. Conclusão O processo foi realizado de forma coletiva e participativa. O protocolo e os materiais educativos orientam e padronizam as condutas baseadas nas melhores evidências e envolvem usuários, familiares e profissionais na gestão do risco de queda.

Estructuración del Protocolo Cubano de Actuación para la Atención de Casos COVID-19 / Structuring of the Cuban Protocol of Action for the care of COVID-19 Cases

Introducción: En presencia de la pandemia COVID-19 surge la necesidad de diseñar un protocolo cubano de actuación para la atención de estos casos, cuya elaboración requiere, fundamentalmente, de la selección de los contenidos, así como de una adecuada estructuración. Objetivo: Estructurar el Protocolo Cubano de Actuación para la Atención de Casos COVID-19. Métodos: Se aplicaron los métodos teóricos histórico lógico, análisis documental, sistematización, análisis síntesis y concreción abstracción. Se aplicó la técnica de revisión bibliográfica de documentos normativos, publicaciones científicas indexadas en bases de datos internacionales y sitios web, además de la consulta a especialistas. El proceso de estructuración del Protocolo cubano de actuación para la atención de casos COVID-19 se realizó en tres fases: preestructuración, estructuración y revisión. Resultados: La estructura final del protocolo quedó conformada por cuatro capítulos, bibliografía y anexos. Conclusiones: El diseño de un protocolo de actuación tiene dos procesos fundamentales: la selección de los contenidos y la estructuración, para lo cual se deben conformar los equipos de trabajo correspondientes. La estructuración del Protocolo Cubano de Actuación para la Atención de Casos COVID-19 constituye un proceso metodológico desarrollado en tres fases que facilita su perfeccionamiento mediante la revisión constante. Lo conforma cuatro capítulos que favorece su entendimiento y aplicación al ser un documento que contiene las generalidades, el manejo de casos según grupos y por niveles de atención y traslado, desde el escenario preventivo hasta la atención a los convalecientes e incluye el manejo del cadáver, así como bibliografía consultada y anexos(AU)

Introduction: In presence of the COVID-19 pandemic emerges the need of designing a Cuban protocol of action for the care of these cases, which creation mainly requires the selection of contents, as well as a suitable structuring. Objective: Structure the Cuban Protocol of action for the care of COVID-19 cases. Methods: There were applied the following methods: theoretical historical logical, documental analysis, systematization, synthetic analysis and concreteness abstraction. It was applied the technique of bibliographic review of normative documents, scientific publications indexed in international databases and web sites, in addition to the consultation to specialists. The structuring process of the Cuban Protocol of action for the care of COVID-19 cases was carried out in three phases: pre-structuring, structuring and review. Results: The final structure of the protocol was formed by four chapters, bibliography and annexes. Conclusions: The design of a protocol of action has two main processes: the selection of the contents and the structuring, and for them, the pertinent work teams must be formed. The structuring of the Cuban protocol of action for the care of COVID-19 cases is a methodological process developed in three phases that facilitate its improvement through constant review. It is formed by four chapters that favour its understanding and application being a document that contain the generalities, the management of cases according to groups and by levels of care and transfer, from the preventive scenario to the care to convalescent patients; and includes the management of corpses, as well as consulted bibliography and annexes(AU)

Guía para el Trabajo Clínico en Odontología Durante Pandemia por SARS-CoV-2, en el Hospital Clínico Dra. Eloísa Díaz

RESUMEN: Un nuevo brote de coronavirus anunciado a principios de este año ha sido asociado a la renombrada enfermedad de "COVID-19" que se ha convertido en la más severa pandemia de este siglo. Tal como lo anunció en marzo del 2020, la Organización Mundial de la Salud (OMS), corresponde a una emergencia de salud pública que repercute fuertemente a nivel internacional (Meng et al., 2020). El siguiente artículo busca generar un documento que registre las orientaciones y medidas de prevención de COVID-19 en la odontología basado en la evidencia. Para esto cobra gran importancia las medidas de equipo de protección personal (EPP) que se deben utilizar. Aunque la evidencia es variada y se dice que las medidas estándares no son suficientes para prevenir la diseminación cuando se trabaja con aerosoles (Facultad de Odontología de la Universidad de Chile, 2020), es necesario, de forma paralela que avanza la propagación, ir generando consciencia con medidas muy cuidosas y claras en cada espacio sanitario. Por lo expuesto anteriormente y en consideración el contexto nacional, es necesario definir las medidas standard y específicas para la atención odontológica, en este caso dentro de la Unidad Dental del Hospital Clínico Dr. Eloísa Díaz (HLF).

ABSTRACT: A new coronavirus outbreak announced earlier this year has been associated with the renowned "COVID-19" disease that has become the most severe pandemic of this century. As announced in March 2020, by the World Health Organization (WHO) this corresponds to a public health emergency that has strong repercussions at the international level (Meng et al., 2020). The following article seeks to generate a document that records the guidance and prevention measures of COVID-19 in dentistry based on the evidence. For this, the personal protective equipment (PPE) measures that must be used are of great importance. Although the evidence is varied and it is said that standard measures are not sufficient to prevent dissemination when working with aerosols (Facultad de Odontología de la Universidad de Chile, 2020), it is necessary, as the virus spreads to generate awareness for extremely clear and careful measures for sanitary space in this context. Due to the above and in consideration of the national context, it is necessary to define the standard and specific measures for dental care and in this case within the Dental Unit of the Dr. Eloísa Díaz Clinical Hospital (HLF).

Validação de conteúdo do protocolo de manejo integrado entre tuberculose e diabetes no contexto da Atenção Primária à Saúde / Content validation of the integrated management protocol between tuberculosis and diabetes in the context of Primary Health Care

INTRODUÇÃO: a associação entre Tuberculose (TB) e Diabetes Mellitus (DM) tem representado um grande problema de saúde pública, no Brasil e no mundo. O manejo integrado diabetes-tuberculose é uma demanda da Organização Mundial de Saúde (OMS) e das sociedades científicas na tentativa de evitar as complicações que esta relação pode causar à saúde da população em geral e de contribuir para o controle dessas epidemias, em países, como o Brasil, nos quais as condições socioeconômicas são fatores de risco de grande impacto. OBJETIVO: elaborar e validar o conteúdo de um Protocolo de Manejo Integrado entre Tuberculose e Diabetes Mellitus para pessoas atendidas na Atenção Primária à Saúde. MÉTODOS: estudo desenvolvido em etapas com diferentes delineamentos: metodológico, pesquisa intervenção e avaliativa; de abordagem quantitativa. O local de estudo foi o município de Ribeirão das Neves, Minas Gerais, Brasil. 1) A primeira etapa, de elaboração do protocolo, correspondeu aos processos: - Aproximação do objeto de estudo com pesquisadores e especialistas na temática; - Revisão Integrativa da Literatura sobre os cuidados de manejo integrado; - Elaboração de um protocolo preliminar baseado na revisão e em outros documentos oficiais; - Validação e adequações do conteúdo do protocolo, com especialistas em TB e DM, por meio de quatro oficinas presenciais; - Avaliação do protocolo utilizando o instrumento "Appaisal of guidelines for research e evaluation"- AGREE II; - Avaliação autoreferida do estado de saúde dos pacientes, por meio de entrevista telefônica, selecionados por amostragem por conglomerado (pacientes com DM) e pela Ficha do Sistema de Informação de Agravos de Notificação (pacientes com TB); 2) Na segunda etapa procedeuse à capacitação dos profissionais de saúde, com diferentes abordagens e tecnologias: treinamento presencial e vídeo animação;o primeiro utilizou um instrumento de avaliação (pré e pós-teste) e no segundo a avaliação ocorreu por meio de questionário encaminhado por via eletrônica, no google forms. 3) Na terceira etapa ocorreu a implantação preliminar do protocolo, nas 10 Equipes de Saúde da Família selecionadas no município. A implantação ocorreu em dois momentos: T1- Três meses após a capacitação; T2- seis meses após a capacitação. RESULTADOS: durante a elaboração foram selecionados 20 artigos na revisão integrativa, 60% com baixa evidência científica; foi criado um protocolo de manejo integrado entre tuberculose-diabetes, elaborado por 11 especialistas e validado internamente por 04 avaliadores que atribuíram um índice de validade de concordância (IVC) de 85%, por meio do AGREE II; além da avaliação pelo Programa Nacional de Controle da Tuberculose; durante a capacitação foi realizado treinamento presencial com 86 profissionais apontando que 50% deles desconheciam sobre a associação tuberculose-diabetes; o vídeo animação obteve avaliação positiva de 60 profissionais (100%), como estratégia de educação remota. Na implantação, a avaliação autorreferida identificou 34% de pacientes com diabetes e tosse concomitantes; 37% dos pacientes com tuberculose realizaram glicemia de jejum nos três últimos meses e 12% do total de pacientes com tuberculose possuíam diabetes autodeclarada. CONCLUSÃO: a relevância deste estudo consiste em orientar os profissionais de saúde sobre a melhor assistência aos pacientes com ambos os agravos, a partir da criação de um Protocolo Assistencial para o Manejo Integrado da TB e DM, e avançar em sua implantação, visando a integração de ações interprogramáticas e a integralidade do cuidado. Ademais, este estudo pode contribuir para que o manejo integrado entre TB e DM se torne uma política pública instituída no Brasil.

INTRODUCTION: the association between Tuberculosis (TB) and Diabetes Mellitus (DM) has represented a major public health problem, in Brazil and worldwide. Integrated diabetestuberculosis management is a demand of the World Health Organization (WHO) and scientific societies in an attempt to avoid the complications that this relationship can cause to the health of the general population and to contribute to the control of these epidemics, in countries, like Brazil, in which socioeconomic conditions are risk factors of great impact. OBJECTIVE: to elaborate and validate the content of an Integrated Management Protocol between Tuberculosis and Diabetes Mellitus for people assisted in Primary Health Care. METHODS: a study developed in stages with different designs: methodological, intervention and evaluative research; quantitative approach. The place of study was the city of Ribeirão das Neves, Minas Gerais, Brazil. 1) The first stage, of the elaboration of the protocol, corresponded to the processes: - Approximation of the object of study with researchers and specialists in the theme; - Integrative Literature Review on integrated management care; - Elaboration of a preliminary protocol based on the review and other official documents; - Validation and adaptation of the protocol content, with specialists in TB and DM, through four face-to-face workshops; - Evaluation of the protocol using the instrument "Appaisal of guidelines for research and evaluation" - AGREE II; - Self-reported assessment of the patients' health status, through telephone interviews, selected by cluster sampling (patients with DM) and the Notification Diseases Information System Form (patients with TB); 2) In the second stage, health professionals were trained, using different approaches and technologies: face-to-face training and video animation; the first used an evaluation instrument (pre and post-test) and in the second, the evaluation took place through a questionnaire sent via google forms. 3) In the third stage, the preliminary implementation of the protocol took place in the 10 Family Health Teams selected in the municipality. The implementation took place in two moments: T1 - Three months after the training; T2 - six months after training. RESULTS: during the elaboration, 20 articles were selected in the review, 60% with low scientific evidence; an integrated management protocol between tuberculosis-diabetes was created, elaborated by 11 specialists and validated internally by 04 evaluators who attributed an agreement validity index (CVI) of 85%, through AGREE II; in addition to the evaluation by the National Tuberculosis Control Program; during the training, face-to-face training was carried out with 86 professionals, pointing out that 50% of them were unaware of the tuberculosis-diabetes association; the video animation received a positive evaluation from 60 professionals (100%), as a remote education strategy. At implantation, the self-reported assessment identified 34% of patients with concomitant diabetes and cough; 37% of tuberculosis patients underwent fasting blood glucose in the last three months and 12% of all tuberculosis patients had self-reported diabetes. CONCLUSION: the relevance of this study consists of guiding health professionals on the best care for patients with both conditions, based on the creation of an Assistance Protocol for the Integrated Management of TB and DM, and advancing its implementation, aiming at integration interprogrammatic actions and comprehensive care. In addition, this study can contribute to the integrated management between TB and DM becoming a public policy instituted in Brazil.

Blood components requests at an orthopedic hospital: a critical survey

Abstract Introduction The correct completion of the blood components request form is the starting point to ensure good transfusion care. Many guidelines have been developed to search for hemoglobin values that trigger the need for transfusion and show the importance of Patient Blood Management, a scientific evidence-based approach in processes where transfusion is a possibility, such as in elective surgeries. Objective The cross-sectional study aimed to analyze the transfusion requests at a complex orthopedic hospital over a one-year period. Method The completion quality was classified as Good, Regular, Bad or Very Bad, according to the information given by the physician. Transfusion medicine professionals analyzed the transfusion indication reported on the request form and classified it as Correct, Not based on Patient Blood Management (PBM), in accordance or not with the institutional Maximum Surgical Blood Order Schedule, Impossible to evaluate due to lack of information on the form, and Incorrect. Results The study categorized the completion quality of 2011 requests as Good (8.80%), Regular (9.30%), Bad (72.75%) and Very Bad (9.15%). Analysis of the indications revealed that 54.90% of the requests were in accordance with the current blood transfusion recommendations, and on 23.12% of the forms this field had not been filled out. Conclusion The majority of blood components (63%) requests are in tune with current blood transfusion recommendations, despite the great number of incorrectly completed forms; nevertheless, it is mandatory to reach much better appropriateness rates.

Course of Revision of the Diagnosis and Treatment Protocol for COVID-19 and the Forensic Contribution / 法医学杂志

From January 15 to March 3, 2020, seven editions of the guidelines for the diagnosis and treatment of COVID-19 have been issued successively by the National Health Commission of the People's Republic of China, and the guidelines' name was changed from Guidelines for Diagnosis and Treatment of Novel Coronavirus Pneumonia to Diagnosis and Treatment for COVID-19. It optimized and perfected the etiology, clinical manifestations and types, diagnostic procedures and specific treatment measures of the disease, so that the clinical management of the cases was more scientific. In the revision process of guidelines for diagnosis and treatment, forensic medicine experts have also made some positive suggestions on clinical diagnosis and treatment. Especially regarding the pathological changes of COVID-19, they have repeatedly called for rapid autopsy at different levels. With the support, understanding and cooperation of all parties, pathological examination of more than ten cases of the remains were carried out, which made an important contribution to the understanding of the clinical characteristics and pathological characteristics of the disease and the improvement of treatment plans.

Manejo de nuevos anticoagulantes orales en cirugía oral: Revisión de literatura / Management of new oral anticoagulants in oral surgery: literature review / Gestão de novos anticoagulantes orais na cirurgia oral: Revisão da literatura

En el año 2011 se introdujo una nueva generación de anticoagulantes orales cuyo manejo en cirugía oral aún no está completamente esclarecido. Objetivo: El objetivo de esta revisión fue describir los protocolos existen-tes sobre manejo de pacientes anticoagulados en cirugía oral. Método: Se realizó una búsqueda en PubMed, SCOPUS, EBSCO y BEIC, sin límite de idioma. Resultados: Se encontraron 4781 artículos, de los cuales 19 fueron seleccionados. Conclusión: Se debe evaluar el riesgo tromboembólico y la capacidad de control de un evento hemorrágico antes de suspender el anticoagulante.

In 2011, a new generation of oral anticoagulants was introduced, the management of which in oral surgery has not yet been fully clarified. Objective: The objective of this review was to describe the existing protocols for the management of anticoagulated patients in oral surgery. Method: A search was made in PubMed, SCO-PUS, EBSCO and BEIC, with no language limit. Results: 4781 articles were found, of which 19 were selected. Conclusion: The thromboembolic risk and the ability to control a bleeding event should be evaluated before suspension of the anticoagulant.

Em 2011, foi introduzida uma nova geração de anticoagulantes orais, cujo implicação em cirurgia oral ainda não foi totalmente esclarecida. Objetivo: O objetivo desta revisão foi descrever os protocolos existentes para a gestão de pacientes anticoagulados em cirurgia oral. Método: Foi realizada uma pesquisa no PubMed, SCOPUS, EBSCO e BEIC, sem limite de idioma. Resultados: Foram encontrados 4781 artigos, dos quais 19 foram selecionados. Conclusão: O risco tromboembólico e a capacidade de controlar um evento hemorrágico devem ser avaliados antes da interrupção do anticoagulante.

Protocol for the functional evaluation of the stomatognathic system

Alterations in breathing, chewing and swallowing are considered risk factors for functional disorders on the stomatognathic system. Thus, there is a need to have a protocol for functional evaluation that contributes to systematize the processes and procedures, unifying criteria for diagnosis. The objective of this study was to design a Protocol for the functional evaluation of the stomatognathic system for the Postgraduate Clinic of Orthopedics of the School of Dentistry of the University of Zulia, Venezuela. In a first stage, a situational diagnosis was made. In a second stage, the documentary analysis technique was used, using the search engines Pubmed, Redalyc, SciELO and ScienceDirect. The third stage consisted in the elaboration of the protocol according to the consensus of the resident postgraduate professionals and the evidence found in the review of the scientific literature. The protocol was drawn up, defining its objectives, population, institutional resources and a systematic and detailed ordering of the procedures and tests to be applied for the evaluation of breathing, chewing and swallowing. This protocol will improve the quality of the evaluations and obtain reliable records of the patient's clinical condition

Development of a clinical protocol for detection of cervical cancer precursor lesions / Desenvolvimento de protocolo clínico para detecção de lesões precursoras do câncer de colo uterino / Desarrollo de protocolo clínico para detección de lesiones precursoras del cáncer de cuello uterino

ABSTRACT Objective: to develop and validate the content of a clinical protocol aimed at prevention of cervical cancer in primary care. Method: technological research according to the steps: (1) submission of the project to the research ethics committee; (2) bibliographic survey; (3) elaboration of the clinical protocol; and (4) content validation. In the third step, the information was collected through bibliographic research and gynecology specialists were consulted. For the final step, four judges were selected to evaluate the clinical protocol according to AGREE 2. Domains that reached the minimum level of agreement of 75% in the scores were considered validated. Results: the scores obtained in each domain of the instrument were as follows: domain 1 (scope and purpose) = 87.5%; domain 2 (stakeholder involvement) = 83.3%; domain 3 (development rigor) = 79.7%; domain 4 (clarity of presentation) = 76.3%; domain 5 (applicability) = 78.1%; and domain 6 (editorial independence) = 85.4. Conclusion: the clinical protocol proved to be a validated material with scores above the minimum required. The protocol obtained positive recommendations with modifications and went through adjustments in order to make it more effective.

RESUMO Objetivos: desenvolver e validar o conteúdo de um protocolo clínico direcionado à prevenção do câncer cervical na atenção primária. Método: Trata-se de uma pesquisa de desenvolvimento tecnológico em saúde(8) realizada em quatro etapas: (1) submissão do projeto ao comitê de ética em pesquisa; (2) levantamento bibliográfico; (3) elaboração do protocolo clínico; e (4) validação de conteúdo. Na terceira etapa, as informações foram levantadas mediante pesquisa bibliográfica e consultados especialistas em ginecologia. Para a etapa final, foram selecionados quatro juízes que avaliaram o protocolo clínico segundo o AGREE 2. Foram considerados validados os domínios que obtiveram nível de concordância mínimo de 75% nas pontuações. Resultados: as pontuações obtidas, em cada domínio do instrumento, foram as seguintes: domínio 1 (escopo e finalidade)=87,5%; domínio 2 (envolvimento das partes interessadas)=83,3%; domínio 3 (rigor do desenvolvimento)=79,7%; domínio 4 (clareza da apresentação)=76,3%; domínio 5 (aplicabilidade)=78,1%; e domínio 6 (independência editorial)=85,4. Conclusão: o protocolo clínico mostrou-se um material validado com pontuações superiores ao mínimo exigido. Obteve recomendações positivas com modificações e passou por ajustes a fim de torná-lo mais efetivo.

RESUMEN Objetivos: desarrollar y validar el contenido de un protocolo clínico dirigido a la prevención del cáncer cervical en atención primaria. Método: investigación tecnológica conforme a las etapas: (1) sujeción del proyecto al comité de ética en investigación; (2) levantamiento bibliográfico; (3) elaboración del protocolo clínico; y (4) validación de contenido. En la tercera etapa, las informaciones fueron levantadas mediante investigación bibliográfica y consultados especialistas en ginecología. Para la etapa final, fueron seleccionados cuatro jueces que evaluaron el protocolo clínico según el AGREE 2. Fueron considerados válidos los dominios que obtuvieron nivel de concordancia mínimo de 75% en las puntuaciones. Resultados: las puntuaciones obtenidas, en cada dominio del instrumento, fueron las siguientes: dominio 1 (alcance y finalidad) = 87,5%; dominio 2 (implicación de las partes interesadas) - 83,3%; dominio 3 (rigor del desarrollo) = 79,7%; dominio 4 (claridad de la presentación) = 76,3%; dominio 5 (aplicabilidad) = 78,1% y dominio 6 (independencia editorial) = 85,4. Conclusión: el protocolo clínico se mostró como un material válido con puntuaciones superiores al mínimo exigido. Obtuvo recomendaciones positivas con modificaciones y pasó por ajustes a fin de hacerlo más efectivo.

Guía para trabajos de investigación en muerte súbita cardiovascular: Propuesta cubana / Guidelines for research work on sudden cardiac death: A Cuban proposal

Las enfermedades cardiovasculares constituyen actualmente la causa más frecuente de muerte prematura e invalidez en el mundo y las proyecciones futuras indican que debe seguir siendo la primera causa en los países industrializados. En Cuba existe un subregistro estadístico de esta enfermedad y a partir de las estimaciones realizadas se prevé una tasa específica de fallecimiento inesperado de 105,2 por cada 100 mil habitantes, lo que equivale aproximadamente al 12,3% de las muertes naturales (un episodio cada 45 minutos). En la mayoría de las naciones, la ausencia de protocolos, directrices, guías y algoritmos diagnósticos, que orienten metodológicamente la recogida de los datos, resulta una importante limitante; además, la no estandarización de criterios, en los países donde existen guías para su estudio, contribuye a las diferencias observadas en los informes actuales de series individuales. Por estas razones se presenta una guía para trabajos de investigación sobre muerte súbita cardiovascular, que muestra la sistemática a desarrollar y contiene las principales variables (estudios necrópsicos e investigaciones complementarias), para ser empleada en los trabajos de investigación sobre esta enfermedad en Cuba. Ello permitirá contar con el dato para el registro de la muerte súbita y de las enfermedades que la provocan (cuando se puedan identificar), sin que se produzca otro tipo de subregistro

Heart diseases are nowadays the most frequent cause of premature death and disability in the world and future projections indicate that it should continue to be the leading cause in industrialized countries. There is a statistical underregistration of this disease in Cuba and from the existing estimates, a specific unexpected death rate of 105.2 per 100 thousand inhabitants is expected, equivalent to nearly 12.3% of natural deaths (one episode each 45 minutes). In most nations, the absence of protocols, strategies, guidelines and diagnostic algorithms, which methodologically guide data collection, remains an important limitation. Moreover, the non-standardization of criteria, in countries where there are guidelines for their study, contributes to the differences observed in the current reports of individual series. Hence practice guidelines for research work on sudden cardiac death are presented; showing the systematics to be developed and containing the main variables (necropsy studies and complementary investigation), to be used for research work on this disease in Cuba. This will allow data recording of sudden death and diseases that cause it (when they can be identified), with no other type of under-reporting

Apresentação de um Protocolo Assistencial para Pacientes com Distúrbios da Deglutição / Presentation of a Clinical Practice Protocol for Patients with Swallowing Disorders

RESUMO Objetivo Descrever o processo de implantação de Protocolo Assistencial para os Distúrbios da Deglutição em unidade hospitalar pública de alta densidade tecnológica no Distrito Federal. Método Trata-se de um estudo descritivo do tipo Relato de Experiência com descrição do processo de implantação de Protocolo Assistencial para os Distúrbios da Deglutição em unidade hospitalar pública de alta densidade tecnológica no Distrito Federal. Resultados A implantação do Protocolo consistiu em três etapas de trabalho: Etapa 1 - busca na literatura sobre os procedimentos que caracterizariam as melhores práticas propedêuticas e terapêuticas; Etapa 2 - discussão com equipe multidisciplinar para ajustes necessários à execução da proposta de implantação de um Protocolo Assistencial para os Distúrbios da Deglutição; e Etapa 3 - proposta final do Protocolo Assistencial para os Distúrbios da Deglutição considerando as particularidades do serviço. Conclusão A proposta final do Protocolo Assistencial para os Distúrbios da Deglutição (PADD) apresenta um método sistematizado pré-definido para acompanhar os pacientes com alteração da deglutição de unidades de saúde de alta densidade tecnológica. O PADD propõe-se a favorecer a detecção precoce do distúrbio, a tomada de decisões terapêuticas uniformes, a utilização de métodos propedêuticos e terapêuticos de baixo custo e a auxiliar gestores no processo de avaliar a qualidade do serviço ofertado através da mensuração de indicadores.

ABSTRACT Purpose To describe the implementation process of a Clinical Practice Protocol for Patients with Swallowing Disorders (CPSD) in a public hospital of high technological density in the Federal District of Brazil. Methods This is an Experience Report study which describes the implementation process of a Clinical Practice Protocol for Patients with Swallowing Disorders in a public hospital of high technological density in the Federal District. Results The protocol was implemented in three stages: Stage 1 - literature search on the procedures that characterize the best propaedeutic and therapeutic practices; Stage 2 - discussion with a multidisciplinary team about the adjustments needed to implement the CPSD; and Stage 3 - Final proposal for the protocol implementation considering the particularities of the service. Conclusion The final proposal of the Clinical Practice Protocol for Patients with Swallowing Disorders (CPSD) provides a predefined, systematic method to monitor patients with swallowing disorders in high technological density health facilities. In addition to being inexpensive, the CPSD fosters decision-making, favors early detection of disorders, and assists managers with evaluating the quality of the service offered.

A discussion of reasons and methods of prevention and cure for serious complications of radiofrequency ablations in the treatments of hepatocellular carcinomas / 中华放射学杂志

Objective To investigate the reasons and the methods of prevention and cure for serious complications of radiofrequency ablations in the treatments of hepatocellular carcinomas. Methods A total of 410 patients with BCLC at A or B stage of hepatocellular carcinomas in our hospital were enrolled between November 2014 and June 2009. These patients underwent a total of 504 times radiofrequency ablations for the treatments of liver lesions. This retrospective study analysed the reasons and the strategies of prevention and cure for the serious complications. Results In the patients with a total of 504 times radiofrequency ablations, 2 patients had massive hemorrhage caused by puncture injuries, 2 patients had the tumors which were close to the liver capsules and 1 patient had bile peritonitis caused by the injury of thermal ablation on the gallbladder. The maximum diameter of tumor was 5 cm. That tumor was close to the gallbladder. 2 patients had needle tract metastases caused by incompletely needle path ablations. 1 of the 2 patients had a tumor near the liver capsule, and the other patient had un-enough temperature for needle path ablation. Tumor outbreaks were happened in 2 patients. 1 of the 2 patients had a tumor which was located in the liver capsule and close to the portal vein. The other patient had a 12 cm diameter tumor with rich blood supplement. 2 patients had liver abscesses. 1 of the 2 patients had a tumor near the ascending colon, and the other patient had diabetes. 1 patient had colonic perforation caused by thermal ablation. The tumor in that patient was located in the right hepatic lobe segment and adjacent to the ascending colon. The incidence of serious complications was 1.98% (10/504). Conclusions The incidence of the serious complications of radiofrequency ablations for the treatments of hepatocellular carcinomas is relatively low. The main reasons for the serious complications were direct injuries caused by punctures, heat radiation injuries, tumors adjacent to large blood vessels, gallbladders and intestines, tumors with abundant blood supplement, needle paths fail to cross normal liver tissues, low scores of liver function, weak immune system and diabetes. The key points for avoiding and reducing the serious complications are preoperative evaluations of patients' basic situations, choices of appropriate puncture channels and control ranges of ablations when tumors are close to important blood vessels, intestines and gallbladders.

Outcomes before and after the Implementation of a Critical Pathway for Patients with Acute Aortic Disease

PURPOSE: Acute aortic diseases, such as aortic dissection and aortic aneurysm, can be life-threatening vascular conditions. In this study, we compared outcomes before and after the implementation of a critical pathway (CP) for patients with acute aortic disease at the emergency department (ED). MATERIALS AND METHODS: This was a retrospective observational cohort study. The CP was composed of two phases: PRE-AORTA for early diagnosis and AORTA for prompt treatment. We compared patients who were diagnosed with acute aortic disease between pre-period (January 2010 to December 2011) and post-period (July 2012 to June 2014). RESULTS: Ninety-four and 104 patients were diagnosed with acute aortic disease in the pre- and post-periods, respectively. After the implementation of the CP, 38.7% of acute aortic disease cases were diagnosed via PRE-AORTA. The door-to-CT time was reduced more in PRE-AORTA-activated patients [71.0 (61.0, 115.0) min vs. 113.0 (56.0, 170.5) min; p=0.026]. During the post-period, more patients received emergency intervention than during the pre-period (22.3% vs. 36.5%; p=0.029). Time until emergency intervention was reduced in patients, who visited the ED directly, from 378.0 (302.0, 489.0) min in the pre-period to 200.0 (170.0, 299.0) min in the post-period (p=0.001). The number of patients who died in the ED declined from 11 to 4 from the pre-period to the post-period. Hospital mortality decreased from 26.6% to 14.4% in the post-period (p=0.033). CONCLUSION: After the implementation of a CP for patients with acute aortic disease, more patients received emergency intervention within a shorter time, resulting in improved hospital mortality.

The Long-Term Effect of an Independent Capacity Protocol on Emergency Department Length of Stay: A before and after Study

PURPOSE: In this study, we determined the long-term effects of the Independent Capacity Protocol (ICP), in which the emergency department (ED) is temporarily used to stabilize patients, followed by transfer of patients to other facilities when necessary, on crowding metrics. MATERIALS AND METHODS: A before and after study design was used to determine the effects of the ICP on patient outcomes in an academic, urban, tertiary care hospital. The ICP was introduced on July 1, 2007 and the before period included patients presenting to the ED from January 1, 2005 to June 31, 2007. The after period began three months after implementing the ICP from October 1, 2007 to December 31, 2010. The main outcomes were the ED length of stay (LOS) and the total hospital LOS of admitted patients. The mean number of monthly ED visits and the rate of inter-facility transfers between emergency departments were also determined. A piecewise regression analysis, according to observation time intervals, was used to determine the effect of the ICP on the outcomes. RESULTS: During the study period the number of ED visits significantly increased. The intercept for overall ED LOS after intervention from the before-period decreased from 8.51 to 7.98 hours [difference 0.52, 95% confidence interval (CI): 0.04 to 1.01] (p=0.03), and the slope decreased from -0.0110 to -0.0179 hour/week (difference 0.0069, 95% CI: 0.0012 to 0.0125) (p=0.02). CONCLUSION: Implementation of the ICP was associated with a sustainable reduction in ED LOS and time to admission over a six-year period.

Platelet transfusion for liver cirrhosis patients: Dos and don'ts / 第二军医大学学报

Liver cirrhosis patients often need emergent platelet transfusions to control hemorrhage due to coagulation factor dysfunction, thrombocytopenia or insufficiency, bleeding and other reasons. However, the indications of platelet transfusion should be strictly considered. Here we summarized the dos and don'ts of platelet transfusion in liver cirrhosis patients, hoping to provide a reference for correct platelet transfusion in liver cirrhosis patients.

Assistência aos portadores de feridas: caracterização dos protocolos existentes no Brasil / Assistance to individuals with ulcers: characterization of existing protocols in Brazil / Asistencia a los portadores de heridas: caracterización de los protocolos existentes en Brasil

As feridas crônicas causam imensos problemas, dor permanente, incapacidade, gastos financeiros, afastamento do trabalho e alterações psicossociais em portadores e familiares. Este artigo objetivou caracterizar os protocolos de assistência aos portadores de feridas existentes no Brasil quanto ao ano, local de publicação, tipo de intervenção e nível de atenção, tipo de lesões abrangentes e estruturação. O presente estudo consistiu de uma pesquisa exploratório-descritiva, realizada na Biblioteca Virtual em Saúde e protocolos disponíveis eletronicamente. A coleta de dados ocorreu em maio/2011, usando-se os descritores "feridas" e "protocolos". Foram selecionados trabalhos completos, publicados entre 2004 e abril/2011. Os dados foram coletados com a utilização de um formulário incluindo ano de publicação, local, tipo de intervenção (prevenção ou tratamento) e nível de atenção (atenção básica e de alta complexidade), tipo de lesão e estruturação do protocolo. Durante a coleta foram encontrados oito trabalhos. Os dados foram apresentados em forma de quadro esquemático. Os protocolos tratavam dos itens avaliação do portador e da lesão, procedimentos para realização do curativo e treinamento dos profissionais e educação do paciente, do cuidador e do familiar. Concluiu-se que as feridas necessitam da utilização de protocolos clínicos para padronização das ações de assistência, no sentido de favorecer o processo cicatricial.

Chronic ulcers cause huge problems, pain, permanent disability, spending, work absenteeism and psychosocial changes in patients and relatives. This paper describes the protocols of care for patients with ulcers that exist in Brazil, for the year and place of publication, type of intervention and level of service, type of injuries and comprehensive structure. This is an exploratory-descriptive study, carried out in the Virtual Health Library and protocols available electronically. Data collection occurred in maio/2011, using the keywords "ulcers" and "protocols" and then the complete works, published between 2004 to abril/2011. Data were collected using a form, including the year of publication, location, type of intervention (prevention or treatment) and level of care (primary and tertiary), type of injuries and structure of the protocol. During collection, 8 studies were found. The data were presented in a schematic picture. The protocols dealt with the evaluation of the patient, the lesion procedures for carrying out the dressing and training of professionals and patient education, caregiver and family. It was concluded that the ulcers need to use clinical protocols to standardize actions of care which promote healing.

Las heridas crónicas causan inmensos problemas, dolor permanente, incapacidad, gastos financieros, alejamiento laboral y alteraciones psicosociales de portadores y familiares. Este artículo tiene el objetivo de caracterizar los protocolos de atención a los pacientes con heridas existentes en Brasil en cuanto al año; lugar de publicación; tipo de intervención y el nivel de servicio; tipo de lesiones y estructuración. Se trata de una investigación exploratorio-descriptiva realizada en la Biblioteca Virtual en Salud y protocolos disponibles en formato electrónico. Los datos fueron recolectados en mayo/2011, utilizando las palabras clave "heridas" y "protocolos", seleccionándose trabajos completos, publicados de 2004 a abril/2011. Los datos fueron recolectados a través de un formulario, incluyendo el año de publicación, local, tipo de intervención (prevención o tratamiento) y nivel de atención (atención básica y alta complexidad), tipos de lesiones y estructuración del protocolo. Durante la recolección, fueron encontrados ocho trabajos. Los datos fueron presentados en forma de cuadro esquemático. Los protocolos trataban de la evaluación del portador, de la lesión, procedimientos para la realización del apósito y entrenamiento de los profesionales y educación del paciente, cuidador y la familia. Se concluye que las heridas necesitan de la utilización de protocolos clínicos para estandarizar las acciones de atención, favoreciendo el proceso curativo.

Inequalities in prescription of hydrochlorothiazide for diabetic hypertensive patients in Colombia / Desigualdades en la prescripción de hidroclorotiazida en pacientes hipertensos diabéticos en Colombia

Objective Evaluating differences in the suitable prescription of thiazides in hypertense patients, according to affiliation regime. Materials and methods This was an analytical cross-sectional study. The database from a previous study was used regarding two groups of hypertense patients (subsidised regime and contributory regime) who had attended out-patient consultation between 01-09-2007 and 29-02-2008. Ideal therapy was evaluated in both groups. Univariate and multivariate analysis was carried out. Results 136 patients (contributory: 41.9 percent; subsidised: 58.1 percent). Subsidised regime patients were older (mean=68.8±10) than those from the contributory regime (mean=64.1±11.1) (t-test, p=0.0110). Prescribing antihypertensive drugs was ideal in 49/136 of the patients (36.0 percent). Ideal prescription accounted for 24/79 (30 percent) of the patients in the subsidised regime and 25/57 (43.8 percent) in the contributory one (OR=1.79; 95 percent CI:0.88-3.64). Older people (aged ≥ 65yo) were at risk of receiving a non-ideal prescription (OR=2.12; 95 percentCI:1.02-4.38) whilst this was not so in the subsidised regime (OR=1.62; 95 percent CI:0.78-3.35). Conclusions Ideal prescription of antihypertensive drugs was low in the population being studied. There were differences regarding age ideal prescription but not concerning affiliation regime. It is suggested that a longitudinal study be carried out in the future.

Objetivo Evaluar las diferencias en la adecuada prescripción de tiazidas en pacientes hipertensos, según régimen de afiliación. Materiales y métodos Estudio de corte transversal analítico. Se utilizó la base de datos de un estudio previo, dos grupos de pacientes hipertensos: régimen subsidiado y régimen contributivo que asistieron a consulta externa entre el 01-09-2007 y el 29-02-2008. Se evaluó terapia ideal en los dos grupos. Se realizó análisis univariado y multivariado. Resultados Se estudiaron 136 pacientes (contributivo: 41,9 por ciento; subsidiado: 58,1 por ciento). Los pacientes del régimen subsidiado fueron mayores (promedio= 68,8±10) que los del contributivo (promedio=64,1±11.1) (t-test, p=0,0110). La prescripción de antihipertensivos fue ideal en 49/136 (36,0 por ciento). En el régimen subsidiado la prescripción fue ideal en 24/79 (30 por ciento) y en el contributivo en 25/57 (43,8 por ciento) (OR: 1,79 IC95 por ciento (0,88-3,64)). La edad ≥65años fue riesgo de prescripción no ideal (OR: 2.12, IC95 por ciento(1,02-4,38)), mientras que no lo fue estar en el régimen subsidiado (OR=1,62, IC95 por ciento(0,78-3,35). Conclusiones La prescripción ideal de antihipertensivos es baja. Hay diferencias en la edad, en la prescripción ideal, mas no por régimen de afiliación. Se sugiere un estudio longitudinal en el futuro.

Clinicopathological features and therapy of undifferentiated embryonal sarcoma of liver / 中华肝胆外科杂志

Objective To investigate the clinicopathological features of undifferentiated embryo-nal sarcoma of the liver (UESL). Methods The clinical data of 9 UESL cases treated in our hospital between 1996 and 2007 were retrospectively analyzed. Results The patients were children and young adults. Clinical presentation was typically an abdominal mass that may be accompanied by pain and fe-ver. Tumors were all removed surgically in the 9 patients. Conclusion UESL is an unusual malignan-cy of the liver. Discrepancy of internal architecture between US and CT is one of the important charac-teristic of UESL. Whenever feasible, surgical resection should be attempted as a part of combination modalities. Modern rnultimodal treatment and supportive therapy might promote the survival rate.

Protocolo eletrônico para coleta estruturada de dados clínicos para pacientes pediátricos em terapia nutricional utilizando o SINPE© (Sistema Integrado de Protocolos Eletrônicos) / Electronic protocol for structurated data collection of pediatric patients in nutritional therapy using SINPE© (Integrated System of Electronic Protocols)

OBJETIVO: Criar uma base de dados clínicos de terapia nutricional de pacientes pediátricos, informatizar os dados transformando-os em protocolo eletrônico, criar um meio de integração com outros centros médicos a fim de aplicar a base de dados de maneira multicêntrica. MÉTODO: a base de dados foi desenvolvida a partir de busca na literatura médica, em livros-texto e artigos científicos sobre terapia nutricional em pediatria. Inicialmente foi organizado um protocolo mestre, e posteriormente o mesmo foi dividido em dois protocolos específicos, um de admissão e outro de evolução do paciente. A informatização da base de dados foi realizada mediante programa de computador, desenvolvido em linguagem C# (C - Sharp), pelo laboratório eletrônico de pesquisas clínicas do Hospital de Clínicas da Universidade Federal do Paraná. RESULTADOS: o protocolo eletrônico desenvolvido permite armazenar informações clínicas, laboratoriais e complementares de pacientes pediátricos em terapia nutricional. Após a inclusão hierarquizada de todos os itens, foram distribuídos 6694 itens no protocolo mestre, sendo 392 no item Admissão e 6302 em Evolução. CONCLUSÃO: a criação de uma base de coleta de dados de pacientes pediátricos em terapia nutricional foi possível, a informatização da mesma foi factível e existe a possibilidade de integração de diferentes centros para realização de estudos multicêntricos.

OBJECTIVES: To develop a clinical database for pediatric patients in nutrition therapy, to computerize the database turning it into an electronic protocol, to make the multicentric use of the database possible. METHOD: The database was developed based on medical literature search, using textbooks and scientific studies about pediatric nutrition therapy. It was initially organized in one master protocol and after that divided into two specific protocols, one for patient's admission and other one for evolution. The database computerization was performed using a software developed in the C# (C sharp) language, by the electronic laboratory for clinical research at the Hospital of Clinics from Federal University of Paraná. RESULTS: The electronic protocol allows data collection of clinical, laboratorial and radiological parameters. The final version includes 6694 parameters, 392 distributed in Admission and 6302 in Evolution. CONCLUSION: the creation of a database for pediatric patients in nutrition therapy was possible, the computerization of this database was reliable, there is the possibility of integration between different medical centers for development of multicentric studies, the application of the electronic protocol in the mentioned group of patients was reliable.