A step toward revamping MD pharmacology curriculum by National Medical Commission: An envisioned transition from bench-side training to bedside training

With a vision to meet the changing trends and recent developments in the field of pharmacology and therapeutics, the postgraduate medical education board of the national medical commission has put forth amendments to the existing guidelines for the MD pharmacology course. Major changes include introducing a district residency-based program for 3 months apart from the clinical postings and more focus is given to the areas of rational prescribing, pharmacovigilance, and ethical aspects of research. These amendments come as a new ray of hope in developing the postgraduate student as a complete professional equipped to meet the increasing standards in the workplace be it a hospital or a research arena. Including the simulation-based approaches for training as a lesson learned from the pandemic and adopting patient-oriented learning during the course are some of the key changes in the new guidelines. This review focuses on highlighting these amendments and correlating the same with the current scenario and discusses the future areas that can be improved for comprehensive development in the pharmacology curriculum.

Analysis and thoughts on the settings of sub-campus of public hospitals directly under the National Health Commission of China / 中华医院管理杂志

Objective:To analyse the settings of sub-campus of public hospitals directly under the National Health Commission, so as to provide research reference and suggestions for further promoting the scientific and standardized construction of sub-campuses of public hospitals.Methods:Data before August 30, 2022 were collected from the official websites of the hospitals in question including their introduction, overview, navigation, news and other categories of information.Relevant literatures on multi-campus published by hospitals under the direct management of the National Health Commission were obtained from the China National Knowledge Network, which was identified by searching the keywords " sub or multi-campus hospital" with " author affiliation", using such search conditions as " MeSH major topic" or " title/keywords/abstract" of the studied hospitals in advanced search builder. Descriptive analysis and frequency analysis were conducted on the numbers, the construction reasons, geographical location, operation scale, characteristics and positioning of the sub-campuses in the studied hospitals.Results:Of the 44 such hospitals, 30 had a total of 50 sub-campuses in operation. Generally there were two modes of construction. 35 were newly constructed and 15 formed by mergers; 37 sub-campuses were built and put into operation since 2010. Sub-campuses were usually located in the same area of the main campus, with 11 in the same area of the same city and areas, 35 in different areas of the same city, and 4 in different cities; the average geographical distance between the sub-campus and the main hospital campus was 31.18 kilometers; 27 sub-campuses had beds ≤ 500, 12 sub-campuses had beds between 501-1 000, 11 had beds>1 000; 14 specialized sub-campuses and 31 out of the 35 comprehensive sub-campuses clearly indicating their characteristics of specialized departments, and 1 other (research institute areas with research beds).Conclusions:Future proofing is characteristic of these public hospitals in terms of their sub-campus construction, regional setting, planning and positioning, and functional layout. However, both government regulatory departments and public hospitals should comprehensively consider and make prudent decisions on the planning, investment, demonstration, layout, and other aspects of the construction of sub-campuses of hospitals.

La verdad como camino: comisiones de la verdad en américa latina

Muchos países del mundo, en especial de Latinoamérica, Asia y África, han atravesado en las últimas décadas por etapas difíciles -dictaduras y conflictos armados- que generaron la perpetración sistemática y generalizada de violaciones graves a los derechos humanos. Y gran parte de estas naciones ha implementado en sus procesos transicionales hacia la consolidación del posconflicto o de la democracia una Comisión de la Verdad, a fin de ajustar cuentas con ese pasado violento. Es la memoria histórica lo que se construye allí y que busca dejar atrás un periodo complicado para dar paso a un nuevo tipo de Estado. En este artículo se busca conocer las diversas Comisiones de la Verdad en América Latina, proponiendo una clasificación de las mismas en cuanto a los grandes retos que tuvieron que enfrentar para cumplir con su misión, lo que es válido en el sentido de que estas instancias se constituyen en los referentes más próximos de la Comisión para el Esclarecimiento de la Verdad, la Convivencia y la No Repetición que está funcionando hoy en día en Colombia y que tiene como meta conducir a "una ruta para cerrar de manera definitiva el conflicto armado y dejar a las nuevas generaciones una nación en la que se pueda convivir y se respete la dignidad humana" (Comisión de la Verdad). La metodología que se aborda aquí es la del Estudio de Casos, en el marco del Método Comparativo. La elección del análisis cualitativo fundamentado en el método comparativo se basa en conceptos expresados por especialistas como los ingleses Tom Mackie y David Marsh, que avalan la importancia de comparar fenómenos políticos entre dos o más unidades de estudio, al ser prácticamente imposible, en la investigación social, utilizar un diseño experimental perfectamente contralado, con variables exactas (Mackie y Marsh, 1997, pp. 188 ).

Many countries in the world, especially in Latin America, Asia, and Africa, have been going through difficult processes in the last decades -dictatorships and armed conflicts - that generated the systematic and widespread perpetration of serious human rights violations. And several of these nations have implemented a Truth Commission in their transitional processes towards the consolidation of the post-conflict or democracy, in order to settle accounts with that violent past. It is a historical memory that is being built there, one that seeks to leave behind a complicated period to give way to a new type of State. This article seeks to review the various Truth Commissions in Latin America, proposing a classification of them in terms of the great challenges they had to face to fulfill their mission, which is valid in the sense that these instances constitute the closest references of the Commission for the Clarification of Truth, Coexistence, and Non-Repetition that is working today in Colombia, and which aims to lead to "a route to permanently close the armed conflict, and leave to the new generations, a nation in which human dignity can be lived together and respected" . The methodology addressed here is that of the Case Study, within the framework of the Comparative Method. The choice of qualitative analysis based on the comparative method is based on concepts expressed by specialists such as the English Tom Mackie and David Marsh, who support the importance of comparing political phenomena between two or more study units, as it is practically impossible in social research, use a perfectly controlled experimental design, with exact variables.

Implementation of Competency-based Medical Education in Forensic Medicine and Toxicology in Indian Medical Education — A Viewpoint on Challenges and Way Forward

The changing disease burden, living conditions and anticipations of end-users in health care have resulted in the decision of regulatory bodies in the Indian medical education system to shift the MBBS curriculum from Traditional to Competency-Based Medical Education (CBME).The efforts taken by the National Medical Commission (NMC) erstwhile Medical Council of India (MCI) to successful implementation of the herculean task of shifting curriculum are praiseworthy. MCI initiated a National Faculty Development Programme (FDP) in 2009 in all medical colleges under its ambit.MCI started with five regional centres, which now expanded to 22 centres, out of which 12 are regional centres, and 10 are advanced nodal centres. Nearly 44932 faculties were trained till December 2018. Despite all the advantages of CBME & the efforts taken up by governing bodies, there are many challenges. Some are common for all subjects, but few are unique or specific to a subject. This article views the possible challenges and the way forward for the successful implementation of CBME in Forensic Medicine and Toxicology.

National Medical Commission Act, 2019 – the need for parity

The National Medical Commission (NMC) has replaced the erstwhile Medical Council of India with the intention of bringing about positive reforms in medical education and enforcing ethical standards in the practice of medicine in India. The NMC Act of 2019, under clauses 3 and 4 of Section 30, details the procedure of grievance redressal. However, these clauses in their current form empower doctors and patients unequally. While the Act empowers an aggrieved medical professional to approach the relevant appellate fora under the NMC, it is silent on a similar opportunity for an aggrieved patient or caregiver to appeal against the decision of a State Medical Council. There is a need to amend these clauses to ensure equitable opportunity for aggrieved patients to appeal against decisions of the State Medical Councils to ensure justice.

Adaptação transcultural de instrumentos avaliativos em cuidados paliativos: revisão integrativa da literatura / Cross-cultural adaptation of assessment tools in palliative care: integrative literature review / Adaptación transcultural de instrumentos de evaluación en cuidados paliativos: revisión integradora de la literatura

Diante da necessidade de reflexão sobre processos de adaptação transcultural de instrumentos avaliativos utilizados no contexto de Cuidados Paliativos, este estudo teve por objetivo realizar uma revisão integrativa da literatura e analisar estratégias metodológicas e cuidados técnicos para sua implementação à luz das diretrizes propostas pela International Test Commission. Foi realizada busca eletrônica nas bases indexadoras PubMed, BVS e SciELO, cruzando-se palavras-chave/descritores: cross-cultural adaptation, translation, validation, palliative care, end-of-life, no período entre 2006 e 2019. Foram selecionados artigos publicados em português, espanhol ou inglês, voltados à adaptação para o Brasil de instrumentos avaliativos em Cuidados Paliativos, totalizando 12 artigos para análise na íntegra. As etapas de adaptação transcultural foram apresentadas, porém poucos estudos descreveram o conjunto de categorias internacionalmente recomendadas. Essa baixa adesão às diretrizes internacionais sugere necessidade de maior sistematização metodológica e detalhamento dos resultados das pesquisas. (AU)

Considering the need for reflection on the processes of cross-cultural adaptation of assessment instruments used in the context of Palliative Care, this study aimed to conduct an integrative literature review and analyze methodological strategies and technical care for their implementation, considering the guidelines proposed by the International Test Commission. An electronic search was performed in the PubMed, BVS and SciELO indexing databases, crossing the keywords/descriptors: cross-cultural adaptation, translation, validation, palliative care, and end-of-life, for publications between 2006 and 2019. Articles published in Portuguese, Spanish or English, which focused on adapting Palliative Care assessment instruments to Brazil were selected, retrieving 12 articles for full analysis. The steps of cross-cultural adaptation were presented, however few studies described the set of internationally recommended categories. This low adherence to international guidelines suggests the need for greater methodological systematization and detailing of research results. (AU)

Ante la necesidad de reflexionar sobre los procesos de adaptación transcultural de los instrumentos de evaluación utilizados en el contexto de los Cuidados Paliativos, este estudio tuvo como objetivo realizar una revisión integradora de la literatura y analizar estrategias metodológicas y cuidados técnicos para su implementación a la luz de las directrices propuestas por la Internacional Test Commission. Se realizó una búsqueda electrónica en las bases de datos de indexación PubMed, BVS y SciELO, vinculando palabras clave/descriptores: cross-cultural adaptation, translation, validation, palliative care, end-of-life, entre 2006 y 2019. Fueron seleccionados artículos publicados en portugués, español o inglés, orientados a la adecuación de instrumentos de evaluación en Cuidados Paliativos a Brasil, recuperando a 12 artículos para análisis completo. Se presentaron etapas de adaptación transcultural, pero pocos estudios describieron el conjunto de categorías recomendadas internacionalmente. Esta baja adherencia a las directrices internacionales sugiere la necesidad de mayor sistematización metodológica y pormenorización de los resultados de investigación. (AU)

Errores en el registro de datos del sistema intrahospitalario de distribución de medicamentos / Erros in the data registry of the intra-hospital system of drug distribution

INTRODUCCIÓN: los sistemas intrahospitalarios sobre la distribución de medicamentos comprenden múltiples procesos en cadena, con la participación de diferentes personas por lo que es susceptible a la generación de errores. OBJETIVO: el propósito fue conocer la generación de posibles errores durante el proceso de registro de datos en el sistema intrahospitalario de distribución de medicamentos del Instituto Gastroenterológico Boliviano Japonés de Cochabamba. METODOLOGÍA: estudio observacional, descriptivo y transversal; donde se utilizó una lista de cotejos para la revisión del registro realizado en los formularios: kardex, recetario/recibo y hoja de tratamiento en el servicio de internación, así como también el registro de medicamentos dispensados realizado en el servicio de farmacia. RESULTADOS: en el servicio de internación se identificó errores de omisión en el kardex de tratamiento, específicamente en el registro de la forma farmacéutica: comprimidos y frascos. En el servicio de farmacia también se encontró errores de omisión en el registro de las mismas formas farmacéuticas. En los servicios de internación y farmacia, se encontró errores de comisión con el registro de dosis diferente en los formularios recibo recetario y hoja de tratamiento y de medicamento dispensado respectivamente superior al 30% en todos los casos. CONCLUSIONES: los errores identificados en el servicio de internación fueron errores de registro de tipo omisión y comisión. En el servicio de farmacia, los errores encontrados fueron errores de registro de tipo comisión.

Introduction: the intra-hospital drug distribution system, comprise multiple chain processes, with the participation of different people, which is susceptible to the generation of errors. Objective: the purpose was to know the generation of possible errors during the data registration process in the intra-hospital drug distribution system of the Japanese Bolivian Gastroenterological Institute of Cochabamba. Methodology: observational, descriptive and cross-sectional study; where a checklist was used to review the record made in the forms: kardex, recipe book / receipt and treatment sheet in the hospitalization service, as well as the record of dispensed drugs made in the pharmacy service. Results: in the hospitalization service, errors of omission were identified in the treatment kardex, specifically in the registry of the pharmaceutical form: tablets and bottles. In the pharmacy service, errors of omission were also found in the registry of the same pharmaceutical formulations. In the hospitalization and pharmacy services, commission errors were found with the registration of different doses in the forms of prescription, receipt and treatment sheet and of dispensed medication, respectively, higher than 30% in all cases. Conclusions: the errors identified in the hospitalization service were omission and commission type registry errors. In the pharmacy service, the errors found were commission-type registration errors.

Elementos facilitadores no processo de doação de órgãos na perspectiva dos profissionais / Facilitating elements in the organ donation process from the perspective of professionals

Objetivou identificar os elementos facilitadores no processo de doação de órgãos e tecidos para transplante, na perspectiva dos profissionais das Comissões Hospitalares de Transplantes. Estudo descritivo, qualitativo, realizado com 20 profissionais que compõem as Comissões Intra-Hospitalares de Doação de Órgãos e Tecidos para Transplante. A coleta de dados ocorreu por meio de entrevista semiestruturada, analisados por meio da técnica do Discurso do Sujeito Coletivo. Emergiram três ideias centrais que versaram sobre os profissionais atuantes na Terapia Intensiva e Emergência como membros da Comissão Hospitalar de Transplantes; Suporte da Central Estadual de Transplante; Coordenação da Comissão Hospitalar de Transplantes. Identificou-se como elementos facilitadores no processo de doação de órgãos e tecidos os profissionais das comissões do quadro funcional das respectivas unidades envolvidas no processo. É necessário um serviço organizado e articulado, de profissionais capacitados e de liderança resolutiva para garantir sucesso no processo de doação de órgãos e tecidos para transplantes.

This work has aimed to identify the facilitating elements in the organ and tissue donation process for transplantation from the perspective of professionals from Brazilian Hospital Transplantation Commissions. This is a descriptive, qualitative study conducted with twenty professionals who make up the In-Hospital Commissions for Organ and Tissue Donation for Transplantation. Data collection took place through semi-structured interviews analyzed using the Collective Subject Discourse technique. Three central ideas have emerged, which address the professionals working in Intensive Care and Emergency as members of the Hospital Transplantation Commission (CHT), the Support from the State Transplant Center (CET), and the Coordination of the Hospital Transplantation Commission. The facilitating elements of the organ and tissue donation process were the professionals of the commissions from the respective units involved in the process. An organized and articulated service, with trained professionals and resolute leadership, is necessary to ensure the success in the organ and tissue donation process for transplantation.

Comparison of Shanghai water quality standard for drinking water with domestic and foreign standards and its influence after implementation / 上海预防医学

Objective:To explore the differences between shanghai water quality standards for drinking water （DB31/T 1091-2018） and domestic and foreign water quality standards， and to compare the improvement of water quality before and after the implementation of DB31/T 1091-2018. Methods:To compare shanghai water quality standard for drinking water with domestic and foreign standards in terms of index number， indicators of disinfectants and their by-products， increased indicators， and revised indicators， and the key water quality indicators before and after the standard implementation in Pudong New Area of Shanghai were investigated. Results:The number of new standard increased from one hundred and six to one hundred and eleven. Among them， the number of conventional indicators increased from forty-two to forty-nine， while the number of unconventional indicators decreased from sixty-four to sixty-two，seven new conventional indicators were added， and the limit value of seventeen conventional indicators was revised and so on. By analyzing water quality monitoring data of New standard before implementation （2017） and after implementation （2019） at water plants of Pudong New Area of Shanghai ， it is found that the total number of bacteria （Z=-2.772，P<0.01）， and carbon tetrachloride （Z=-5.570，P<0.01），trichloromethane （Z=-5.685，P<0.01）， turbidity （Z=-4.168，P<0.01）， total dissolved solids （Z=-7.061，P<0.01）， and total hardness （Z=-2.338，P<0.05）， oxygen consumption （Z=-2.580，P<0.05）， anion synthetic detergent （Z=-2.162，P<0.05）， total chlorine （Z=-2.826，P<0.01）， there were significant statistical differences between the two groups， while there were no statistical differences between the other indicators. Conclusion:The new standard refers to the domestic and foreign drinking water standards， tends to the high and strict requirements， and pushes the improvement water quality of the centralized water supply units， which need to carry out in-depth treatment process transformation， in order to further optimize the water quality.

Contribuições técnicas e socioculturais da prevenção quaternária para a atenção primária à saúde: caminhos e desafios / Technical and socio-cultural contributions of quaternary prevention for primary health care: paths and challenges / Contribuciones técnicas y socioculturales de prevención cuaternaria para la atención primaria de salud: caminos y desafíos

Introdução: No contexto do Sistema Único de Saúde, o conceito da prevenção quaternária adentra timidamente os níveis de atenção à saúde, no entanto, sofre expansão significativa no âmbito da atenção primária à saúde. Objetivo: Identificar por meio da sistematização de evidências científicas, as contribuições técnicas e socioculturais da prevenção quaternária no âmbito da atenção primária à saúde no Brasil. Métodos: Trata-se de uma revisão integrativa de estudos presentes nas bases de dados científicas da Scientific Electronic Library Online, Biblioteca Virtual em Saúde, biblioteca virtual da Comissão de Aperfeiçoamento de Pessoal do Nível Superior e MEDLINE via PubMed com a utilização dos descritores "prevenção quaternária" e "atenção primária à saúde", em inglês e português. Resultados: O corpus de análise foi composto por 22 artigos, sendo que a produção científica sobre o tema se deu de forma mais intensa a partir do ano de 2015 e, em sua maioria, possuíam como abordagem metodológica ensaios teóricos. Dentre as contribuições técnicas destacaram-se a introdução do ensino da prevenção quaternária de modo continuado aos graduandos e profissionais; a construção de protocolos e documentos de amparo profissional; a utilização de modelos explicativos dinâmicos na socialização do quadro clínico; a conduta profissional com os usuários e as contribuições socioculturais envolvendo mudanças na percepção profissional e comunitária sobre o fenômeno saúde-doença, assim como o incentivo a práticas de desmedicalização sociocultural em relação à dor, incapacidade, desconforto, envelhecimento, nascimento e morte. Conclusão: Apesar do reconhecimento das potencialidades da prevenção quaternária, faz-se necessário fortalecer estratégias que possibilitem o desenvolvimento de políticas públicas para fomentar e gerenciar alianças estratégicas com tomadores de decisão, profissionais de saúde e cidadãos, para fomentar a redução de diagnósticos e tratamentos excessivos, contribuindo com a qualidade do cuidado.

Introduction: In the context of the Unified Health System, the concept of quaternary prevention shyly enters the levels of health care, however, undergoes significant expansion in the scope of primary health care. Objective: To identify, through the systematization of scientific evidence, the technical and socio-cultural contributions of quaternary prevention within the scope of primary health care in Brazil. Methods: This is an integrative review of studies present in the scientific databases of the Scientific Electronic Library Online, Regional Portal of the Virtual Health Library of the Latin American and Caribbean Center on Health Sciences Information of the Pan American Health Organization, virtual library of the Higher Education Personnel Improvement Commission, and MEDLINE through PubMed using the descriptors "quaternary prevention" and "primary health care", in English and Portuguese. Results: The corpus of analysis consisted of 22 articles, and the scientific production on the topic took place more intensively from the year 2015 and, for the most part, had theoretical essays as methodological approach. Among the technical contributions, we highlight the introduction of teaching on quaternary prevention in a continuous way to undergraduates and professionals; the construction of protocols and documents of professional support; the use of dynamic explanatory models in the socialization of the clinical picture and professional conduct with users and socio-cultural contributions involve changes in the professional and community perception about the phenomenon of illness and health conception, as well as the incentive to practices of socio-cultural demedicalization in relation to pain, disability, discomfort, aging, birth, and death. Conclusion: Despite the recognition of the potential of quaternary prevention, it is necessary to strengthen strategies that enable the development of public policies to foster and manage strategic alliances with decision makers, health professionals and citizens, to promote the reduction of excessive diagnoses and treatments, contributing to the quality of care.

Introducción: En el contexto del Sistema Único de Salud, el concepto de prevención cuaternaria entra tímidamente en los niveles de atención de salud, sin embargo, experimenta una expansión significativa en el alcance de la Atención Primaria de Salud. Objetivo: Identificar, a través de la sistematización de evidencia científica, las contribuciones técnicas y socioculturales de la prevención cuaternaria en el ámbito de la Atención Primaria de Salud en Brasil. Métodos: Esta es una revisión integradora de estudios presentes en las bases de datos científicas de la Biblioteca Electrónica Científica en línea, Portal Regional de la Biblioteca Virtual en Salud del Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud de la Organización Panamericana de la Salud, biblioteca virtual de la Comisión de Mejoramiento del Personal de Educación Superior y MEDLINE a través de PubMed utilizando los descriptores de prevención cuaternaria y atención primaria de salud, en inglés y portugués. Resultados: El corpus de análisis estuvo conformado por 22 artículos, siendo la producción científica sobre el tema más intensiva desde 2015 y, en su mayor parte, tuvo ensayos teóricos como abordaje metodológico. Entre los aportes técnicos, destacamos la implantación de la docencia en prevención cuaternaria de forma continua a estudiantes de pregrado y profesionales; construcción de protocolos y documentos de apoyo profesional, uso de modelos explicativos dinámicos en la socialización del cuadro clínico y conducta profesional con los usuarios y los aportes socioculturales implican cambios en la percepción profesional y comunitaria sobre el fenómeno de la enfermedad y la concepción de la salud, así como el incentivo a prácticas de desmedicalización sociocultural en relación al dolor, discapacidad, malestar, envejecimiento, nacimiento y muerte. Conclusión: A pesar del reconocimiento del potencial de la prevención cuaternaria, es necesario fortalecer estrategias que permitan el desarrollo de políticas públicas para fomentar y gestionar alianzas estratégicas con los tomadores de decisiones, profesionales de la salud y ciudadanos, para promover la reducción de diagnósticos y tratamientos excesivos, contribuyendo a la calidad de la atención.

Comissão Nacional da Verdade e regime militar: representações sociais de estudantes universitários / The National Truth Commission and the military regime: social representations of university students / La Comisión Nacional de La Verdad y el régimen militar: representaciones sociales de estudiantes universitarios

Este estudo teve como objetivo analisar as representações sociais construídas por estudantes universitários acerca da Comissão Nacional da Verdade (CNV) e do regime militar brasileiro, bem como verificar as aproximações entre essas representações. A amostra foi composta por 200 estudantes. Os instrumentos de coleta de dados foram: questionário de dados sociodemográficos e questionário de evocação livre de palavras referente aos estímulos "CNV" e "regime militar brasileiro". Os dados foram submetidos à análise estrutural das representações sociais com o auxílio do software EVOC (2005). Os resultados indicam que a primeira representação se ancora na segunda. Porém, trata-se de representações autônomas e independentes uma da outra. A representação da CNV apresenta característica predominantemente humanista, representada pelo elemento "necessário-verdade", enquanto a representação do regime militar brasileiro demonstra ser essencialmente negativa e com característica ideológica representada pelo elemento "ditadura". Os resultados indicam o apoio do grupo pesquisado para com o resgate da memória de violações de direitos humanos ocorridas no País naquele período histórico.

This study aimed to analyze the social representations shaped by university students about the National Truth Commission (CNV) and the Brazilian military regime, as well as to verify the approximations between these representations. The sample consisted of 200 students. The data collection instruments were sociodemographic data and free evocation questionnaires referring to the "CNV" and the "Brazilian military regime" stimuli. Data were submitted to structural analysis of social representations with the support of the EVOC software (2005). Results indicate that the first representation is anchored in the second. However, these are autonomous and independent representations of each other. The CNV representation is predominantly humanistic, represented by the "necessary truth" element, while the representation of the Brazilian military regime proves to be essentially negative and ideologically characterized by the "dictatorship" element. These results indicate the research group's support to recall the memory of human rights violations that took place in the country in that historical period.

Este estudio tuvo como objetivo analizar las representaciones sociales formadas por estudiantes universitarios sobre la Comisión Nacional de la Verdad (CNV) y el régimen militar brasileño, así como verificar las aproximaciones entre estas representaciones. La muestra estuvo compuesta por 200 estudiantes. Los instrumentos de recolección de datos fueron un cuestionario de datos sociodemográficos y otro sobre evocación libre de palabras que se referían a los estímulos de la "CNV" y del "régimen militar brasileño". Los datos se sometieron a un análisis estructural de representaciones sociales con la ayuda del software EVOC (2005). Los resultados indican que la primera representación está anclada en la segunda. Sin embargo, estas son representaciones autónomas e independientes entre sí. La representación de la CNV es predominantemente humanista, representada por el elemento "verdad necesaria", mientras que la representación del régimen militar brasileño demuestra ser esencialmente negativa e ideológicamente caracterizada por el elemento "dictadura". Estos resultados indican el apoyo del grupo investigado al rescate de la memoria de violaciones de derechos humanos que tuvieron lugar en el país en ese período histórico.

To build a well-developed wound repair department in China with the original mind and mission / 中华烧伤杂志

Based on the spirit of the regulations about diagnosis and treatment of chronic skin wounds just issued by National Health Commission, we systematically review the history of the construction of wound repair department in China and discuss the opportunities and challenges faced by the construction of wound repair department in China. We emphasize on seizing historical opportunities and grasping the development direction of the discipline with the original mind and mission to build a well-developed wound repair department in China, so as to benefit the majority of patients.

Study on Commission Management System of Basic Medical Insurance in the United States and Its Enlightenment to China / 中国药房

OBJECTIVE：To provide referen ce for improving commission management system of medical insurance in China. METHODS：By analyzing the problems of commission management system of medical insurance in China ，studying the specific types，responsibility division and its features of basic medical insurance contractors in the United States ，the suggestions were put forward for improving corresponding system in China. RESULTS & CONCLUSIONS ：There are some problems in the entrusted management of medical insurance in China ，including that the fair competition mechanism has not been established ；the operation and management of social security fund lacks of supervision mechanism ；the role of the government is unclear and inexperienced ； the imperfect supervision mechanism causes follow-up problems ；it is still uncertain whether the entrusted management system can improve the efficency of medical insurance management. In the United States ，the way of entrusted management of medical insurance was to introduce the third-party management. The contractors employed by the Centers for Medicare and Medicaid Services in the United States mainly included medical insurance contractor ，zone program integrity contractor ，comprehensive error rate test review contractor and statistical contractor ，supplemental medical review contractor ，qualified independent contractor and so on ，among which medical insurance contractor was in the core position. Each contractor had a clear division of labor in handling medical claims ，preventing medical fraud ，reviewing the correctness of payments ，evaluating medical records and handling appeals. This mode greatly reduced the work pressure of the government ，improved the efficiency of medical insurance management and operation，and promoted the continuous improvement of the whole system. It is suggested that China should expand the scope of social agency management ，clarify the responsibilities of government and social resources ，introduce various types of social economic organizations and establish a complete and effective performance supervision and management system in order to improve the modernization level of China ’s medical insurance governance.

Implications of applicators orientations on bladder, and rectal doses in gynecological mHDR brachytherapy: A retrospective analysis of reproducibility in multi-fractionated regimen

Introduction: Variation of doses due to positional uncertainties of applicators based on orthogonal radiograph has been evaluated by several researchers. The present study has analyzed the various possibilities of special alterations of applicator placements in intracavitary brachytherapy (ICBT) and its impact on the dose to target volume, rectum, and bladder. An innovative approach has been suggested to quantify and utilize the special coordinates for reproducibility of applicator based on the pelvic bone landmark. Materials and Methods: A total of 27 fractions of 9 (n = 9) cancer cervix patients treated with external beam radiotherapy followed by ICBT have been evaluated retrospectively. The first fraction of each patient was planned as per the International Commission on Radiation Units and Measurements report 38 guidelines and was considered reference for consecutive fractions regarding dwell positions, dose to target volume, bladder, and rectum points. For each fraction, positioning of applicators regarding their spatial orientations with respect to pelvic bone landmarks and their correlation with dose to bladder and rectum was recorded and analyzed. Results: It was found that mean angulations between (1) the two applicator points with respect to tip of central tandem (α), (2) the two applicator points with junction point situated on the sacrum bone (β) and (3) the angle between the line joining applicator points and a point defined on pelvic bone (γ) is 62.20° ± 5.74°, 37.13° ± 5.64° and 105.51° ± 6.58°, respectively. Bladder dose increased with increment in α but decreased with increase of β and γ. Dose to rectum remained unaffected for γ. Mean distance from couch top to tip of central tandem and two ovoids is, respectively, 11.17 cm and 8.70 cm. Conclusion: Optimal plans even with orthogonal radiographs may be generated by verifying the application based on the parameters mentioned in the present study and computed tomography-based plans could be utilized more effectively instead of doing automatic or manual optimization. Whereever orthogonal radiograph based or template based ICBT practices is performed this study may create a dataset to have an optimal treatment plan even without three-dimensional images

A comissão nacional da verdade e a construção de memórias sociais / The national truth commission and the construction of social memories / La comisión nacional de la verdad y la construcción de memorias sociales / Commission nationale sur la vérité et la construction de mémoires sociales

A Comissão Nacional da Verdade (CNV) foi uma iniciativa visando esclarecimento sobre violações de direitos humanos cometidos entre 1964 e 1985. Por sua intrínseca participação social, pode-se também estudar uma característica da memória social, que é o esquecimento. Com o objetivo de analisar os aspectos psicossociais da memória em relação à ditadura por meio da percepção e sentimentos gerados em torno da CNV, 159 participantes (51,6% mulheres, 68,6% de esquerda), estudantes da Universidade do Estado do Rio de Janeiro, foram entrevistados e responderam questões atitudinais e emocionais sobre a CNV. Os resultados evidenciaram que o conhecimento sobre a Comissão e a orientação política dos entrevistados têm efeitos significativos sobre o conjunto de variáveis analisadas. Participantes auto declarados de esquerda apresentaram maior acordo com a atuação da CNV, além de maior intensidade de sentimentos positivos e negativos. Participantes auto declarados de direita apresentaram maior concordância com ações de esquecimento. Esta pesquisa traz contribuições ao estudo das atitudes e da memória social frente à CNV e se constitui como fonte geradora de novas hipóteses sobre o tema.

The Brazilian National Truth Commission (NTC) was an initiative aimed at clarifying human rights violations that occurred between 1964 and 1985. Because of its intrinsic socialparticipation, it allows the study of one characteristic of social memory, which is forgetfulness. With the aim of exploring psycho-social aspects such as perceptions and attitudes toward Brazilian Truth Commission, 159 participants (51.6% women, 68.6% left-wing) undergrad students from the State University of Rio de Janeiro were interviewed and answered attitudinal and emotional questions about the NTC. The results revealed that knowledge about the NTC andpolitical orientation have significant effects on the set of analyzed variables. The self-declared left-wing participants have had a greater agreement with NTC enterprises, in addition to having a greater intensity of positive and negative feelings about the NTC. The self-declared right-wing participants have had a greater agreement with forgetfulness actions. This research brings important contributions to the study of attitudes and social memory toward Brazilian Truth Commission, and facilitates the development of new hypotheses about social memories.

La Comisión Nacional de la Verdad fue una iniciativa para esclarecimiento sobre violaciones de derechos humanos cometidos entre 1964 y 1985. Por el motivo de su participación social intrínseca, también es posible estudiar una característica de la memoria social, que es el olvido. Con el objetivo de explorar aspectos de la memoria de la ditadura militar, 159 participantes (51,6% mujeres, 68,6% con orientación política de izquierda), estudiantes de la Universidad del Estado de Río de Janeiro fueron entrevistados y respondieron cuestiones actitudinales y emocionales sobre la CNV Los resultados muestran que el conocimiento sobre la CNVy la orientación política tienen efectos significativos sobre el conjunto de variables analizadas. Participantes auto declarados de izquierda presentaron mayor acuerdo con la actuación de la CNV, además de mayor intensidad de sentimientos positivos y negativos. Los participantes auto declarados de la derecha, tienen mayor concordancia con acciones de olvido. Esta investigación trae contribuciones al estudio y se constituya como como una fuente generadora de nuevas hipótesis sobre la memoria social.

La Commission nationale de la vérité (CNV) était une initiative visant à clarifier les violations des droits de l'homme commises entre 1964 et 1985. Par saparticipation sociale intrinsèque, onpeut également étudier une caractéristique de la mémoire sociale, à savoir l'oubli. Avec le but d'analyser les aspects psychosociaux de la mémoire en relation avec la dictature à travers la perception et les sentiments générés autour de la CNV, 159 participants (51,6% de femmes, 68,6% de gauche), étudiants de l'Université de l'État de Rio de Janeiro (Brésil), ont été interrogés et ont répondu à des questions d'attitude et d'émotion au sujet de la CNV. Les résultats ont montré que la connaissance de la Commission et l'orientation politique des personnes interrogées avaient des effets significatifs sur l'ensemble des variables analysées. Les participants autoproclamés de gauche ont montré un plus grand accord avec les performances du CNV, ainsi qu'une plus grande intensité de sentiments positifs et négatifs. Les participants auto-déclarés de droite ont montré un plus grand accord avec les actions d'oubli. Cette recherche apporte des contributions à l'étude des attitudes et de la mémoire sociale devant la CNV et constitue une source de nouvelles hypothèses sur le sujet.

Processo de trabalho da comissão de doação de órgãos e tecidos: percepção da equipe / Work process of the organ and tissue donation committee: team perception

Objective: to know the team's perception of the work process of an Intra-Hospital Transplant Organ and Tissue Donation Commission (CIHDOTT). Method: descriptive research of qualitative nature. Held with ten CIHDOTT members from a public hospital in northwestern Paraná. Single interviews were recorded, transcribed and subjected to thematic content analysis. Results:Three thematic categories emerged, which relate the daily work activities of the service, the challenges experienced in the work of CIHDOTT and themotivational factors of acting on the committee. Final Considerations: To the ceaseless work towards greater organ and tissue uptake in line with the need to comply with current legislation, workers face major challenges related to the hospital's physicalstructure and the understanding of aspects that surround their roles by professionals outside the committee. However, the humanization of the peculiar care provided and the teamwork of the current CIHDOTT motivate them.

Objetivo: conhecer a percepção da equipe sobre o processo de trabalho de uma Comissão Intra-Hospitalar de Doação de Órgãos e Tecidos para Transplante (CIHDOTT). Método: pesquisa descritiva, de natureza qualitativa. Realizada com dez membros de uma CIHDOTT de um hospital público do Noroeste do Paraná. As entrevistas individuais foram gravadas, transcritas e submetidas à análise de conteúdo temática. Resultados: Emergiram três categorias temáticas, as quais relacionam as atividades laborais cotidianas do serviço, os desafios vivenciados no trabalho da CIHDOTT e os fatores motivacionais de atuar na comissão. Considerações Finais: Ao trabalho incessante rumo à maior captação de órgãos e tecidos alinhada à necessidade de cumprir a legislação vigente, os trabalhadores enfrentam grandes desafios relacionados à estrutura física hospitalar e o entendimento de aspectos que entornam sua função por profissionais externos à comissão. Porém, a humanização do cuidado peculiar prestado e o trabalho em equipe da atual CIHDOTT os motivam.

Utilização de indicadores de desempenho em um Comitê de Ética em Pesquisa no Rio de Janeiro - Brasil / Utilización de indicadores de desempeño en un Comité de Ética en Investigación en Rio de Janeiro, Brasil / Use of Performance Indicators in a Research Ethics Committee in Rio de Janeiro, Brazil

Resumo: O presente estudo tem como principais objetivos utilizar os indicadores desenvolvidos como ferramenta para avaliar o desempenho do Comitê de Ética em Pesquisa de uma instituição Federal no Rio de Janeiro, quanto à eficiência e eficácia de sua operação, e determinar os motivos que fazem com que a duração do processo de aprovação dos projetos analisados exceda a meta de 60 dias. Com base em uma revisão da literatura foram desenvolvidos indicadores para avaliar os processos do CEP usando um modelo de estrutura-processo-resultado. Para observar tendências nos indicadores avaliados, foram extraídos e analisados os dados relacionados a todos os protocolos submetidos ao CEP entre janeiro de 2009 e dezembro de 2014. O comitê de ética do presente estudo utilizou indicadores para identificar os pontos críticos dos seus processos e assim melhorar seu desempenho.

Resumen: El presente estudio tiene como principales objetivos utilizar los indicadores desarrollados como herramienta para evaluar el desempeño del Comité de Ética en Investigación de una institución Federal en Rio de Janeiro, en cuanto a la eficiencia y eficacia de su operación, y determinar los motivos que hacen que la duración del proceso de aprobación de los proyectos analizados exceda la meta de 60 días. Con base en una revisión de la literatura fueron desarrollados indicadores para evaluar los procesos del CEI usando un modelo de estructura-proceso-resultado. Para observar tendencias en los indicadores evaluados, fueron extraídos y analizados los datos relacionados a todos los protocolos sometidos al CEI entre enero de 2009 y diciembre de 2014. El comité de ética del presente estudio utilizó indicadores para identificar los puntos críticos de sus procesos y, así, mejorar su desempeño.

Abstract: The main objective of this study is to use the indicators developed as a tool to evaluate the performance of the Research Ethics Committee of a Federal institution in Rio de Janeiro, regarding the efficiency and effectiveness of its operation, and determine the reasons that make that the length of the approval process of the analyzed projects exceeds the 60-day goal. Based on a review of the literature, indicators were developed to evaluate the processes of the RES using a structure-process-result model. To observe trends in the indicators evaluated, the data related to all the protocols submitted to the RES between January 2009 and December 2014 were extracted and analyzed. The ethics committee of the present study used indicators to identify the critical points of its processes in order to improve its performance.

Comissão setorial de avaliação do colégio politécnico (UFSM): diagnóstico orçamentário-financeiro / Sector assessment committee of the polytechnical college (UFSM): analysis of the budgetary-financial / Comisión sectorial de evaluación del colegio politecnico (UFSM): diagnóstico presupuestario financiero

Este estudo tem como objetivo analisar o diagnóstico orçamentário-financeiro da Comissão Setorial de Avaliação do Colégio Politécnico, vinculado à Universidade Federal de Santa Maria, a fim de identificar as ações da referida Comissão no direcionamento dos recursos financeiros, oriundos da Comissão Própria de Avaliação da instituição. Do ponto de vista metodológico, esta é uma pesquisa do tipo investigativo-documental com abordagem descritivo-quantitativa, valendo do método descrito e pela ótica de um estudo de caso no Colégio Politécnico/UFSM. Para coleta dos dados foram utilizados indicadores do Sistema de Informações Educacionais, obtidos junto à Direção Administrativa do Órgão. Esta análise permitiu a divulgação do orçamento financeiro da CSA/Politécnico, bem como a demonstração do uso do recurso financeiro direcionado às ações e propósitos estabelecidos no planejamento estratégico da UFSM.(AU)

The objective of this study is to analyze the budgetary-financial diagnosis of the Polytechnic Sector Evaluation Commission, linked to the Federal University of Santa Maria, in order to identify the actions of the said Commission in regard to financial resources from the institution's Self Evaluation Commission. From the methodological point of view, this is a research-documentary research with a descriptive-quantitative approach, using the method described and from the perspective of a case study in the Polytechnic College. For data collection, indicators of the Educational Information System were obtained from the administrative sector. This analysis allowed the disclosure of the financial budget of the CSA/Polytechnic, as well as the demonstration of the use of financial resources directed to the actions and purposes established in UFSM's strategic planning.(AU)

Este estudio tiene como objetivo analisar el presupuesto financiero de la Comisión Sectorial de Evaluación del Colegio Politecnico, vinculado a la Universidad Federal de Santa Maria, con la finalidad de identificar las acciones de dicha Comisión en el direccionamiento de los recursos financieros, originarios de la Comisión Propia de Evaluación de la institución. Del punto de vista metodologico, esta es una pesquisa investigativo-documental con abordaje descriptivo-cuantitativo, valiendo del metodo descripto y por la optica de un estudio de caso en el Colegio Politecnico/UFSM. Para colecta de datos fueron utilizados indicadores del sistema de informaciones educacionales, obtenidos junto a la dirección administrativa del órgano. Este análisis permitió la divulgación del presupuesto financiero de la CSA/ Politecnico, así como la demostración del uso de recursos financieros dirigidos a las acciones y propósitos establecidos en la planificación estratégica de UFSM.(AU)

Improvement of education for clinical nutrition interns based on Joint Commission International standards / 中华医学教育探索杂志

Huashan Hospital became the first Academic Medical Center Hospital accredited by Joint Commission International (JCI) in 2013. The Department of Clinical Nutrition has constantly improved internship education through the introduction of JCI standards. Based on the flexible combination of teaching and practicing modules, clinical nutrition knowledge is closely integrated with professional dietitian skills, and in-depth practical training helps students to acquire much more experience of the occupation as a dietitian. Teachers think highly of students' initiative and knowledge conversion ability, and in the recent five years, undergraduate projects have been enhanced in both quantity and quality.

Commissioning and testing of treatment planning system model of an Edge accelerator with a high-definition multi-leaf collimator / 中华放射肿瘤学杂志

Objective To investigate the commissioning and testing of the Eclipse model of an Edge accelerator with high-definition muhi-leaf collimator (HD-MLC).Methods The percentage depth dose (PDD),profile,output factor measured by Razor and CC13 were statistically compared with the standard data.Penumbra,transmission factor (TF),leakage,concave-convex groove,accuracy of movement and dosimetry leaf gap (DLG) were measured with EBT3,electronic portal image device (EPID) and PTW SRS1000&SRS1500.The optimal DLG/TF was acquired when the γ pass rate of test cases was the highest.The point dose of regular fields,intensity-modulated radiation therapy (IMRT) and volume-modulated radiation therapy (VMAT) was verified with FC65-G.The planar dose of these case was verified with Octavius 4D and EBT3.Results The measured PDD data were consistent with the standard data.The measured penumbra of 3 cm and 4 cm square fields was smaller,whereas that of 6 cm square field was larger than the standard values.The left and right edge,field size,center of the field were distributed within the range of-1.0-0.4 mm、0.2-1.7 mm,-0.3-1.9 mm and-0.1-0.8 mm,respectively.The mean penumbra of the left and right MLC in different positions were (2.5±0.042) mm and (2.7±0.005) mm.The leakage of MLC was 0.009-0.016.The measured DLG/TF was 0.1861 cm/0.0116 and the optimal DLG/TF was 0.015 cm/0.014.The differences of point dose of all the test cases except the one which was in the low-dose area were within ±3％.Local and global γ pass rates of all IMRT were 79.81％-100％ and 96.3％-100％ (3％/3 mm),71.3％-98.9％ and 94.3％-99.8％ for VMAT cases.Conclusions This method can accurately test and commission the Eclipse treatment planning model of Edge Linac equipped with HD-MLC.