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.

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.

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.

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.

Consultas tardías en los servicios de emergencias pediátricas durante la pandemia por COVID-19 en Uruguay, entre el 13 de marzo y el 29 de julio de 2020

En diciembre de 2019, en Wuhan, China, se detectaron los primeros casos de SARS-CoV-2. En Uruguay, desde el 16 de marzo de 2020 se suspendieron las actividades de enseñanza, deportivas y espectáculos públicos. Varios países reportaron una marcada disminución de las visitas a urgencias. Algunos niños presentaron enfermedades ocasionales o descompensaciones de enfermedades crónicas, consultando en forma tardía con el riesgo que ello implica. El objetivo de este trabajo es realizar una descripción de las consultas tardías durante la pandemia. Se realizó un estudio multicéntrico y descriptivo entre el 13 de marzo y el 29 de julio de 2020. Se definió consulta tardía como los ingresos por injurias agudas con más de 6 horas de evolución, fiebre mayor a 72 horas de evolución, dificultad respiratoria con más de 12 horas de evolución, síntomas agudos, como dolor abdominal, de más de 24 horas de evolución, síntomas de más de 12 horas de evolución en niños con enfermedades crónicas que determinaron descompensación e ingreso. Se incluyeron 27 centros. Se registraron un total de 34.260 consultas en urgencia, se incluyeron 189 niños para el estudio. El promedio de edad fue de 6 años; 17 pacientes requirieron ingreso a unidad de cuidados intensivos (UCI). Predominó la apendicitis entre los diagnósticos al alta. Esta investigación puso en evidencia la existencia de consultas tardías en nuestro país. Esto contribuye a ponderar el impacto negativo de la pandemia en la población pediátrica.

Summary: In December 2019, the first cases of SARS-CoV-2 were detected in Wuhan. In Uruguay, since March 16, teaching, sports and public entertainment activities were suspended. Several countries reported a marked decrease in emergency room visits. Some children presented occasional illnesses or decompensations from chronic illnesses, consulting late with the risk that this implies. The objective of the work is to make a description of late consultations during the pandemic. A multicenter and descriptive study was carried out between March 13 and July 29, 2020. "Late consultation" was defined as admissions for: Acute injuries with more than 6 hours of evolution, fever greater than 72 hours of evolution, difficulty respiratory disease with more than 12 hours of evolution, acute symptoms such as abdominal pain of more than 24 hours of evolution, symptoms of more than 12 hours of evolution in children with chronic diseases that determined decompensation and admission. 27 centers were included. A total of 34260 emergency consultations were registered, 189 children were included for the study. The average age was 6 years. 17 patients required admission to the ICU. Appendicitis predominated among the diagnoses at discharge. This research revealed the existence of late consultations in our country. This helps to weigh the negative impact of the pandemic on the pediatric population.

Em dezembro de 2019, em Wuhan, foram detectados os primeiros casos de SARS-CoV-2. No Uruguai, desde 16 de março, as atividades de ensino, esporte e entretenimento público foram suspensas. Vários países relataram uma diminuição acentuada nas visitas ao pronto-socorro. Algumas crianças apresentavam doenças ocasionais ou descompensações de doenças crônicas, consultando tardiamente os riscos que isso implica. O objetivo do trabalho é fazer uma descrição das consultas tardias durante a pandemia. Um estudo multicêntrico e descritivo foi realizado entre 13 de março e 29 de julho de 2020. Consulta tardia foi definida como internações por: Lesões agudas com mais de 6 horas de evolução, febre maior que 72 horas de evolução, dificuldade respiratória com mais de 12 horas de evolução, sintomas agudos como dor abdominal com mais de 24 horas de evolução, sintomas com mais de 12 horas de evolução em crianças com doenças crônicas que determinaram descompensação e internação. 26 centros foram incluídos. Um total de 34.260 consultas de emergência foram registradas, 189 crianças foram incluídas no estudo. A idade média era de 6 anos. 17 pacientes necessitaram de internação na UTI. Apendicite predominou entre os diagnósticos na alta. Esta pesquisa revelou a existência de consultas tardias em nosso país. Isso ajuda a pesar o impacto negativo da pandemia na população pediátrica.

Desafios para o suporte à amamentação em homens transgêneros sob à luz da interseccionalidade / Intersectionality and challenges in support for chest-feeding transgender men

Resumo O objetivo deste artigo é apreender os desafios nas vivências dos usuários e profissionais de Banco de Leite Humano no atendimento a homens transgêneros no contexto da amamentação sob à luz da Interseccionalidade. Estudo qualitativo descritivo-exploratório a partir de entrevistas realizadas com seis profissionais do Banco de Leite Humano, que atenderam previamente homens trans no contexto de amamentação, e dois homens trans bissexuais, que amamentaram ao peito. Os dados foram tratados pela Análise Temática com auxílio do software Atlas.ti versão 9.0. Observam-se lacunas nas esferas educacionais, institucionais e na gestão, associadas a questões pessoais e sociais, que reproduzem um modelo pré-concebido normativo, desconsiderando as singularidades requeridas no atendimento à população trans no contexto da amamentação. A cisheteronormatividade e a supremacia do profissional operam em âmbitos pessoais, sociais e institucionais para a segregação de homens transgêneros nos serviços de suporte à amamentação. A análise interseccional destes desafios permite uma visão global dos fatores de segregação e a implementação de políticas públicas promotoras da justiça social.

Abstract This article tried, from an intersectional standpoint, to grasp the challenges experienced by health professionals and service users of human milk banks in provision of care for transgender men chestfeeding. This exploratory, descriptive qualitative study drew on interviews of six human milk bank staff, who had previously assisted trans men in relation to chestfeeding and two bisexual trans men, who chestfed. The data was treated by thematic analysis, supported by Atlas.ti software, version 9.0. Lacunas in the educational, institutional and management spheres, associated with personal and social issues, reproduce a pre-conceived normative model and disregard the special demands of providing chestfeeding care for the trans population. Cisheteronormativity and "professional supremacy" operate in personal, social and institutional respects to segregate transgender men in lactation support services. Intersectional analysis of these challenges affords an overall view of segregative factors and enables public policies to be introduced to promote social justice.

Torsades de pointes and myocardial infarction following reversal of supraventricular tachycardia with adenosine: a case report

ABSTRACT Adenosine is an antiarrhythmic drug that slows conduction through the atrioventricular node and acts as a coronary blood vessel dilator. This case report highlights two unusual life-threatening events following the use of adenosine to revert supraventricular tachycardia in a structurally normal heart: non-sustained polymorphic ventricular tachycardia and myocardial infarction. A 46-year-old woman presented to the emergency department with a two-hour history of palpitations and was diagnosed with supraventricular tachycardia. Vagal maneuvers were ineffective, and after intravenous adenosine administration, the patient presented with chest pain and hypotension. The rhythm degenerated into non-sustained polymorphic ventricular tachycardia and spontaneously reverted to sinus rhythm with ST elevation in lead aVR and ST depression in the inferior and anterolateral leads. The patient spontaneously recovered within a few minutes. Despite successful arrhythmia reversal, the patient was admitted to the intensive care unit because of an infarction without obstructive atherosclerosis. This report aims to alert emergency physicians about the potential complications associated with supraventricular tachycardia and its reversal with adenosine.

Centros de Atenção Psicossocial e formação profissional para oferta das Práticas Integrativas e Complementares: estudo com profissionais ofertantes dos serviços / Psychosocial care centers and professional training for the provision of integrative and complementary practices: a study with professionals offering these services / Centros de Atención Psicosocial y formación profesional para oferta de las Prácticas Integradoras y Complementarias: estudio con profesionales ofertantes de los servicios

Estudos sobre a formação em Práticas Integrativas e Complementares têm se concentrado na análise curricular dos cursos da Saúde e as pesquisas abrangendo as percepções dos profissionais a respeito dos processos formativos devem ser mais elucidadas. O estudo objetiva identificar os processos de formação e capacitação dos profissionais ofertantes de Práticas Integrativas e Complementares nos Centros de Atenção Psicossocial de uma região metropolitana. Trata-se de um estudo descritivo, exploratório, de abordagem qualitativa. Realizaram-se entrevistas semiestruturadas com 45 profissionais, as quais foram posteriormente analisadas segundo a Análise de Conteúdo Temática. As pós-graduações, graduação, formações em serviço e o ensino privado foram as trajetórias adotadas pelos profissionais, revelando a existência de uma formação difusa para a oferta no cenário investigado. Esses resultados podem subsidiar o planejamento de estratégias educacionais para a ordenação dos recursos humanos em Práticas Integrativas e Complementares.

Studies of training in integrative and complementary practices have concentrated on the analysis of the curriculums of health courses and further more in-depth research into professionals' perceptions about training processes is needed. This study aimed to identify training processes and capacity building for professionals who offer integrative and complementary practices in psychosocial care centers in a metropolitan region. We conducted an exploratory descriptive study involving semi-structured interviews with 45 professionals. The interview transcripts were analyzed using content analysis. The most common routes taken by the professionals were post-graduate qualifications, degrees, in-service training and private education. The results reveal that training in this area was diffuse. Our results can inform the development of educational strategies for the organization of human resources in the area of integrative and complementary practices.

Los estudios sobre la formación en Prácticas Integradoras y Complementarias se han concentrado en el análisis curricular de los cursos de la salud y las investigaciones que incluyen las percepciones de los profesionales con relación a los procesos de formación deben elucidarse más. El objetivo del estudio es identificar los procesos de formación y capacitación de los profesionales ofertantes de Prácticas Integradoras y Complementarias en los Centros de Atención Psicosocial de una región metropolitana. Se trata de un estudio descriptivo, exploratorio, de abordaje cualitativo. Se realizaron entrevistas semiestructuradas con 45 profesionales que fueron posteriormente analizadas según el Análisis de Contenido Temático. Los postgrados, graduación, formaciones en servicio y la enseñanza privada fueron las trayectorias adoptadas por los profesionales, revelando la existencia de una formación difusa para la oferta en el escenario investigado. Esos resultados pueden subsidiar la planificación de estrategias educativas para la ordenación de los recursos humanos en las Prácticas Integradoras y Complementarias.

Aprendizaje servicio virtual: prácticas profesionales de terapia ocupacional a través de la telesalud en contexto de confinamiento / Aprendizagem em serviço virtual: práticas profissionais de terapia ocupacional através da telessaúde no contexto do confinamento / Virtual service learning: professional practices of occupational therapy through telehealth in the context of confinement

El objetivo de este estudio es analizar los aportes y desafíos que se presentan en la formación y en la intervención cuando estudiantes de terapia ocupacional realizan su práctica profesional a través de la telesalud, durante el periodo de confinamiento por pandemia Covid-19. Se utiliza como enfoque metodológico una sistematización de experiencia de tipo cualitativa. Se produce la información por medio de cuatro grupos focales y diez entrevistas semiestructuradas. Se realiza un análisis del contenido temático. Se establecen cuatro temas: 1) vínculo terapéutico y Aprendizaje-Servicio por telesalud, 2) aprendizajes alcanzados por telesalud, 3) lo que no se aprende fácilmente por telesalud y 4) prácticas pedagógicas de apoyo al aprendizaje en telesalud. Esta modalidad se potenciaría si se cuenta con la tecnología adecuada, si las atenciones son frecuentes y si se prepara a los cuidadores-familiares para apoyar los procesos de atención.

The objective of this study is to analyze the contributions and challenges that arise in training and intervention when occupational therapy students carry out their professional practice through telehealth, during the period of confinement due to the Covid-19 pandemic. A qualitative systematization of experience is used as a methodological approach. The information is produced through four focus groups and ten semi-structured interviews. An analysis of the thematic content is carried out. Four themes are established: 1) therapeutic link and Service-Learning through telehealth, 2) learning achieved through telehealth, 3) what is not easily learned through telehealth and 4) pedagogical practices to support learning in telehealth. This modality would be enhanced if there is adequate technology if care is frequent and if family caregivers are prepared to support the care processes.

O objetivo deste estudo é analisar as contribuições e desafios que surgem na formação e intervenção quando os estudantes de terapia ocupacional realizam a sua prática profissional através da telessaúde, durante o período de confinamento devido à pandemia de Covid-19. Uma sistematização qualitativa da experiência é utilizada como abordagem metodológica. As informações são produzidas por meio de quatro grupos focais e dez entrevistas semiestruturadas. É realizada uma análise do conteúdo temático. São estabelecidos quatro temas: 1) vínculo terapêutico e aprendizagem-serviço por meio da telessaúde, 2) aprendizagem alcançada por meio da telessaúde, 3) o que não se aprende facilmente por meio da telessaúde e 4) práticas pedagógicas de apoio à aprendizagem em telessaúde. Essa modalidade seria potencializada se houvesse tecnologia adequada, se o cuidado fosse frequente e se os cuidadores familiares estivessem preparados para apoiar os processos de cuidado.