Linha de cuidados no tratamento da asma: informações úteis para o gestor / Comprehensive care in asthma treatment: useful information for the health-care manager

Realizou-se, no dia 29 de agosto de 2020, um encontro virtual com gestores, representantes de associações de pacientes e médicos prescritores envolvidos no tratamento da asma, com o objetivo de discutir a necessidade e a viabilidade da incorporação de novas tecnologias para o tratamento dessa patologia. A asma é uma enfermidade caracterizada pela inflamação crônica das vias aéreas. É a principal causa de absenteísmo escolar e laboral e estima-se que seja responsável por até cinco mortes diárias em nosso país. Em pesquisa efetuada em operadora de autogestão, com vidas espalhadas por todo o país, observou-se que essa patologia (associada à doença pulmonar obstrutiva crônica ­ DPOC) acomete quase 7% dos seus segurados e que a utilização do plano foi, nesse grupo, 1,9x maior para consultas, 1,6x maior para exames, 2,5x maior para terapias e 2,9x maior para internações, resultando em um aumento de 25,5% nos gastos assistenciais. Observou-se que é de elevada importância que o gestor tenha um profundo conhecimento de sua carteira e que priorize toda a linha de cuidado do paciente. Dessa maneira, atuando diretamente no controle da severidade da patologia, terão os melhores resultados de qualidade de vida e restringirão os doentes que necessitarão de medicações mais modernas e, também, mais caras, com resultado óbvio no controle de custos. A asma ainda não tem, em geral, para os gestores de operadoras de saúde privadas, no Brasil, uma importância tão grande na sinistralidade das suas carteiras. Os novos imunobiológicos são úteis e efetivos e alguma contrapartida por parte do fabricante, como, por exemplo, o compartilhamento de riscos, pode ser necessária para uma incorporação desse arsenal no Rol de produtos que serão disponibilizados para os pacientes que deles necessitarem

On August 29 (2020), a virtual meeting was held with managers, representatives of patient associations and physicians involved in the treatment of asthma, in order to discuss the need and the feasibility of incorporating new technologies for the treatment of this disease. Asthma is a condition characterized by chronic inflammation of the airways. It is the main cause of school and work absenteeism and it is estimated that it is the cause of up to 5 daily deaths in our country, annually. In a survey carried out at a Health Care Plan, with patients spread across the country, it was observed that this pathology (associated with COPD) affects almost 7% of its insured persons and that the use of the plan was, in this group, 1.9x higher for consultations, 1.6x higher for exams, 2.5x higher for therapies and 2.9x higher for hospitalizations, resulting in a 25.5% increase in the global health care expenses. It was observed that it is highly important that managers have a deep knowledge of his portfolio and that they prioritize the entire process of patient care. In this way, acting directly in the control of the severity of the pathology, they will have the best quality of life results and will restrict the number of patients who will need more modern and also more expensive medications, with obvious impact on costs. Asthma still does not have, for the manager of a Private Health Operator, in Brazil, such importance in the expenses of his portfolio. The new immunobiologicals are useful, effective and some counterpart on the part of the manufacturer, such as, for example, the risk-share agreements, may be necessary for the incorporation of this into the arsenal of products that will be made available to patients that need them

Exploration and practice of using counterpart support resources to improve scientific research level of recipient hospitals / 中华医学科研管理杂志

Objective:Exploring the " bottle neck" factors in the scientific research management of recipient hospitals, making good use of counterpart support resources to help identifying appropriate, tailored strategies of scientific research management that might improve the research capacity of recipient hospitals.Methods:Data were collected according to questionnaire survey and on-site interview, ABC classification method were used to perform statistical analysis, and " bottleneck" factors that constraint the scientific research work of the recipient hospital were summarized.Results:" Insufficient scientific research skills and lacking of talents" and " lacking of scientific research environment and recognition" are the two most prominent factors that negatively affect the scientific research capacity building of the recipient hospitals, followed closely by " the out-dated scientific research policies and lacking support from the hospital leadership" , insufficient of research platform or resources including research funding, as well as other factors. Based on such findings, this article took the First People's Hospital of Kashgar (Guangdong counterpart support) as an example, and tried to discuss some corresponding measures on how to make good use of counterpart support resources.Conclusions:The ABC classification method were used to identify the main " bottleneck" factors, and a series of effective measures that help to making good use of counterpart support resources were explored. As a result, the efficiency of the scientific research management of the recipient hospitals, which in terms of management methods, management concepts and management models, were improved.

Characterization of Intraductal Papillary Neoplasm of the Bile Duct with Respect to the Histopathologic Similarities to Pancreatic Intraductal Papillary Mucinous Neoplasm

Intraductal papillary neoplasms of the bile duct (IPNBs) are known to show various pathologic features and biological behaviors. Recently, two categories of IPNBs have been proposed based on their histologic similarities to pancreatic intraductal papillary mucinous neoplasms (IPMNs): type 1 IPNBs, which share many features with IPMNs; and type 2 IPNBs, which are variably different from IPMNs. The four IPNB subtypes were re-evaluated with respect to these two categories. Intestinal IPNBs showing a predominantly villous growth may correspond to type 1, while those showing papillay-tubular or papillay-villous growth correspond to type 2. Regarding gastric IPNB, those with regular foveolar structures with varying numbers of pyloric glands may correspond to type 1, while those with papillary-foveolar structures with gastric immunophenotypes and complicated structures may correspond to type 2. Pancreatobiliary IPNBs that show fine ramifying branching may be categorized as type 1, while others containing many complicated structures may be categorized as type 2. Oncocytic type, which displays solid growth or irregular papillary structures, may correspond to type 2, while papillary configurations with pseudostratified oncocytic lining cells correspond to type 1. Generally, type 1 IPNBs of any subtype develop in the intrahepatic bile ducts, while type 2 IPNBs develop in the extrahepatic bile duct. These findings suggest that IPNBs arising in the intrahepatic ducts are biliary counterparts of IPMNs, while those arising in the extrahepatic ducts display differences from prototypical IPMNs. The recognition of these two categories of IPNBs with reference to IPMNs and their anatomical location along the biliary tree may deepen our understanding of IPNBs.

Genomic variations in the counterpart normal controls of lung squamous cell carcinomas / 医学前沿

Lung squamous cell carcinoma (LUSC) causes approximately 400 000 deaths each year worldwide. The occurrence of LUSC is attributed to exposure to cigarette smoke, which induces the development of numerous genomic abnormalities. However, few studies have investigated the genomic variations that occur only in normal tissues that have been similarly exposed to tobacco smoke as tumor tissues. In this study, we sequenced the whole genomes of three normal lung tissue samples and their paired adjacent squamous cell carcinomas.We then called genomic variations specific to the normal lung tissues through filtering the genomic sequence of the normal lung tissues against that of the paired tumors, the reference human genome, the dbSNP138 common germline variants, and the variations derived from sequencing artifacts. To expand these observations, the whole exome sequences of 478 counterpart normal controls (CNCs) and paired LUSCs of The Cancer Genome Atlas (TCGA) dataset were analyzed. Sixteen genomic variations were called in the three normal lung tissues. These variations were confirmed by Sanger capillary sequencing. A mean of 0.5661 exonic variations/Mb and 7.7887 altered genes per sample were identified in the CNC genome sequences of TCGA. In these CNCs, C:G→T:A transitions, which are the genomic signatures of tobacco carcinogen N-methyl-N-nitro-N-nitrosoguanidine, were the predominant nucleotide changes. Twenty five genes in CNCs had a variation rate that exceeded 2%, including ARSD (18.62%), MUC4 (8.79%), and RBMX (7.11%). CNC variations in CTAGE5 and USP17L7 were associated with the poor prognosis of patients with LUSC. Our results uncovered previously unreported genomic variations in CNCs, rather than LUSCs, that may be involved in the development of LUSC.

Achievements of urban hospitals′ support for county-level public hospitals / 中华医院管理杂志

The counterpart support by urban hospitals to rural hospitals is an important measure of the healthcare reform and health poverty alleviation, especially useful for reform of county-level public hospitals.A study of the policy development and an analysis on the development status quo of 16 county-level public hospitals following their acceptance of such support in Hunan and Hubei province, confirmed the practical significance of such counterpart support.The authors also found defects in personnel training, technology innovation and policy fine-tuning, in need of improvements.

Construction of the Orthopedics Diagnosis and Treatment System of Intelligent Trauma Medical Center in Southern Xinjiang / 医学信息学杂志

The paper analyzes the status of trauma rescue and treatment informatization in Xinjiang,states the thoughts of construction of intelligent trauma medical center in southern Xinjiang (including the telemedicine system based on regional medical network,orthopedics trauma and disease diagnosis and treatment platform,etc.).It also provides the application examples and discusses the social economic benefits.

Community based Training program: / 国際保健医療

<Dl><b>Purpose:</b><br>To investigate characteristics of community-based issues in nutrition and to assess the effectiveness of a training programme developed to address them.<br><b>Design:</b><br>The JICA trainee was the chief of the nutrition section of the Nepali Ministry of Health. The project was undertaken after reviewing, in co-operation with JICA, the aims and expected results of the programme. The Nepali trainee alone determined the theme of the programme after considering results of an issue analysis. A programme was then designed to link policy with community realities, incorporating lectures, discussion, and on-site practice. Educational materials employed were those already in use in nutrition programmes both within Japan and in other countries. To create a plan of action, the trainee undertook an analysis of the Nepali communities' institutional and human resources. <br>Evaluation of the training programme took place on two levels. The trainee self-evaluated her own issues analysis, community resource assessments, and action plan. Additionally, comments made by the trainee during the training period were recorded, categorized and evaluated.<br><b>Results:</b><Dt>1. The trainee's analysis of the action plan:<br><Dd>1-1. Community issues were analyzed with support of the Japanese staff. The theme of the training was "Awareness of community resources is an essential part of any nutritional programme".<br>1-2. Through the analysis of institutional and human resources, the "Tea Shop" was found to be key to the community's nutritional improvement.<br><Dt>2. Staff analysis of the trainee's comments:<br><Dd>2-1. Five stages in the change of the trainee's attitude were observed.<br>  First stage: Shouldn't the responsibility for resolving nutritional issues be with local workers and organizations?<br>  Second stage: What are the needs of the local citizens?<br>  Third stage: What are the responsibilities of the leaders?<br>  Fourth stage: What is needed for me to fulfill my duties?<br>  Fifth stage: What is the first thing I should do after returning to my office?<br><Dd>2-2. Support by staff was thought to be effective in making clear the tasks required of the trainee, in providing a framework for understanding the issues from the community viewpoint, identifying methods for establishing links between community and government and making government-produced materials relevant to the community, informing the process of educational materials development, and analyzing community resources.</Dl>

A Comparison of pre and post-surgical characteristics in skeletal Class III malocclusion patients using counterpart analysis / 대한치과교정학회지

Enlow's counterpart analysis explains the complex with anatomic and developmental characteristics where craniofacial aspect of individuals has been developed. Counterpart analysis does not compare individual measurement with the normal value from the average of majority but analyzes by comparison of values that each individual has. In this study we examined surgical changes in skeletal Class III malocclusion patients(male 40, female 40) and compared them with normal occlusion patients using counterpart analysis. The results indicated that : 1. Skeletal anterior-posterior discrepancy was relieved by shortening of the ramus width(B3). 2. The ramus alignment(R3, R4) was displaced posteriorly and the occlusal plane angle(R5) was rotated clockwise. 3. Skeletal Class III pattern was relieved in the post-operative group, but differences in the level of the cranium(R1, R2) was remaining compared to the normal occlusion patients. 4. In the comparison of surgery methods, the two-jaw surgery group presented changes in the maxillary length(A4), ramus alignment(R3,R4) and occlusal plane angle(R5) compared to the one-jaw surgery group, but the differences were not significant. In the past study about Korean skeletal Class III patients, the skeletal characteristics are upward backward rotation of the cranial base, posterior displacement of the maxilla, forward inclination of the ramus and lengthening of the mandibular body, but in this study, skeletal Class III pattern was relieved by shortening of the ramus width and maxillary advancement by orthognathic surgery, because orthognathic surgery is usually performed on limited areas in the maxilla and the mandible.

The Achievements in Counterpart Assistance Project and the Economic Model of Promoting the Development of the Universities in the Western Part of China / 中华医学教育探索杂志

The project of counterpart assistance has made great achievements, however, the outlay shortage has become the key restriction in sustainable development and role playing as expected. From the view of long-term development and marketing point, it is a must to discuss the issue of “establishing the satisfied system (or active system) to enhance the development of the universities in the west and how to stimulate these universities to enter into the system”. From the economic model in this paper, we can clearly conclude that the government has played a significant role in the process of the development of the universities in the western part of China.

On Developing Tendency of Counterpart Assistance from Four Sides / 中华医学教育探索杂志

For counterpart assistance in cooperation between two schools, it is the prerequisite to take counterpart assistance seriously at the height of building a well off society in an all round way; it is the most needed connecting point to construct the disciplines and teaching staff; it is the most substantial way to develop distant network teaching; it is the fundamental purpose to benefit the students. We will implement the essential of “Program of Counterpart Assistance for Higher Schools in Western China” proposed by Education Ministry in an all round way according to those “Four Aspects”, which have been proved to be the successful measures and developing tendency in the near future for counterpart assistance.

Study on Korean skeletal Class III craniofacial pattern by counterpart analysis / 대한치과교정학회지

Enlow's counterpart analysis reflects the characteristics of each individual sample to find out the cause of the malocclusion and further applying them to the clinic. Enlow's counterpart analysis was performed on 100 Korean samples (50 male, 50 female) with normal occlusion and 100 skeletal class III patients (50 male, 50 female) scheduled for orthognathic surgery. The following conclusions were obtained. 1. The cause of malocclusion in skeletal class III patients were complex and interrelated ; backward upward rotation of the cranial base, forward inclination of the ramus, increase in the mandibular body length, and posteriorly located maxilla. 2. Seen on R2 (male-1.68mm, female-2.33mm), in skeletal class III, the maxilla is more posteriorly located than the normal group. 3. The cause of malocclusion in skeletal class III patients, consists of retrognathic maxilla(A1) male 22%, female 26%, prognathic mandible(B1) male 44%, female 34%, and combination of an retrognathic maxilla and prognathic mandible were male 28%, female 38%. 4. There was no significant difference in the anterior-posterior length of the maxilla(A4) between skeletal class III males with the normal group, while in the female subjects, the skeletal class III group showed a smaller maxilla(A4) compared to the normal group. 5. In skeletal class III patients the proganthic mandible was primarily caused by the inclination of the ramus(R3, R4) and mandibular body length(B4, B6) rather than ramus width(B3).

Study on the Korean craniofacial skeletal pattern by counterpart analysis / 대한치과교정학회지

Enlow's counterpart analysis explains the complex with anatomic and developmental characteristics where craniofacial aspect of individuals has been developed. The analysis does not compare individual measurement with the normal value from the average of majority but analyzes by comparison of values that each individual has. This study was to clarify the Korean craniofacial skeletal pattern using Enlow's counterpart analysis considering the fact that the craniofacial skeletal pattern has racial and regional variations. This research will be helpful in the future for growth research and research of the orthognathic For this study, the samples were consisted of 100 Korean adult subjects(50 males and 50 females) who had normal occlusion and pleasing face. Measurement points and lines were established using Enlow's counterpart analysis and they were statistically evaluated. The results indicated that: 1. The average angle between PCF and PMV was 38.54 degrees in males and 38.43 degrees in females, and the average Wits' appraisal was -2.51 in males and -2.3 in females. The ramus alignment(R4) was 1.89 in males and 2.36 in females. 2. It shows that females have a longer ramus than the PCF compared to the males, because there was a significant difference in Ramus/PCF horizontal dimensions (Skeletal A3-B3) between female and male subjects 3. It shows that males have a longer mandibular corpus than the maxilla compared to the females, because there was a significant difference in Maxillary/Mandibular arches(Skeletal A4-B4) between male and female subjects 4. In cranial floor+maxilla/ramus+corpus at A and B points(A1-B1), which represents difference in total horizontal length between the maxilla and mandible, there was no significant difference between males and females. In conclusions, compared to Caucasian, Korean have more depressed midface, prognathic mandible, and ramus that rotates inferioposterior. Also, we observe that Korean women have larger ramus posterior cranial base, as compared with Korean men. Consequently, the total length of maxilla and mandible does not show any difference, because man's mandible is longer than maxilla in comparison with woman's one.