Comparative study on the theme of traditional Chinese medicine policies among different provinces of China / 中国药房

OBJECTIVE To clarify the core content of traditional Chinese medicine （TCM） policy in the provinces of China， so as to provide reference for optimizing the structure of the policy system of traditional Chinese medicine in China and assisting the inheritance and innovation of TCM industry in various regions. METHODS The websites of directly affiliated organs in 31 provinces， excluding Hong Kong， Macao and Taiwan， were retrieved to collect the TCM policies released from 2000 to 2021. The importance of keywords in the TCM policies of each province was measured based on term frequency-inverse documentation frequency （TF-IDF） keyword extraction method， and the similarities and differences were analyzed among TCM policies. RESULTS & CONCLUSIONS A total of 99 documents related to TCM policies of various provinces were obtained in this study， most of which were released after 2016. The theme of national TCM policy covered four aspects： building TCM talent team， perfecting TCM service system， strengthening TCM resource management and promoting TCM industry innovation. The TF-IDF values of “medical institutions”“traditional Chinese medicine”“medical treatment” were higher than other keywords in each province， indicating that the provinces paid more attention to the construction of TCM service system and the management of TCM resources than other aspects. Anhui and Jiangsu， Beijing and Henan， Hubei and Jilin， Hubei and Tianjin， and Hubei and Yunnan had the more degree of similarity in TCM policies， which all contained 16 of the same keywords. Therefore， the above regions should be encouraged to strengthen exchanges and cooperation and realize mutual promotion and joint development. Among all the keywords whose importance ratio was greater than 0.2，“ Tibetan medicine” was unique to Qinghai and Tibet，“ disease type” was unique to Guangdong， and the TF-IDF value of “supervision and management” in Beijing was higher， indicating that the emphasis of TCM policy formulation in different provinces was various. Meanwhile， the top 10 keywords of TF- IDF value in all provinces did not have words related to financial input， and the TF-IDF values of “informatization” in most provinces did not rank at the top. It is suggested to increase financial input or encourage social financing， and add “Internet+new business” in the field of TCM.

The Research-Exhibition Method: Collection, Curatorship and Setting Up of Scenes / O Método da Pesquisa-Exposição: Acervo, Curadoria e a Montagem das Cenas / El Método de Investigación-Exposición: Recopilación, Curación y Puesta en Escena

Abstract The relation between science and art has shown potential regarding the investigative contexts of the human and social sciences. Thus, this study aimed to describe the Research-Exhibition method, a theoretical-methodological proposition developed as an innovative proposal for document analysis, especially of documents resulting from participant research and/or other participatory methodologies. Designed from a documental collection referring to a project to continuously train teachers, Research-Exhibition is sustained by three dimensions: the work with the documents; that of setting up the scene in dialogue with the work of Jacques Rancière; and that of the place of researcher-curators. These dimensions enable subjects and collectives' singularities, memories, affections, and subjectivation processes to be brought to the exhibition by various documentary sources.

Resumo As relações entre ciência e arte têm apresentado potencialidades no que diz respeito aos contextos investigativos das ciências humanas e sociais. Neste sentido, este estudo teve por objetivo apresentar o método da Pesquisa-Exposição. Essa proposição teórico-metodológica foi desenvolvida como uma proposta inovadora de análise de documentos, principalmente documentos resultantes de pesquisas participantes e/ou outras metodologias participativas. Desenhada a partir da criação de um acervo documental referente a um projeto de formação continuada de professores, a Pesquisa-Exposição é sustentada em três dimensões: a do trabalho com os documentos; a da montagem da cena, em diálogo com a obra de Jacques Rancière; e a do lugar do pesquisador-curador. Essas dimensões possibilitam trazer à exposição singularidades, memórias, afetos e processos de subjetivação de sujeitos e coletivos, por intermédio das diversas fontes documentais.

Resumen La relación entre ciencia y arte ha mostrado potencialidades con respecto a los contextos investigativos de las ciencias humanas y sociales. En ese sentido, este estudio tuvo como objetivo presentar el método Investigación-Exposición. Esta propuesta teórico-metodológica se desarrolló como una propuesta innovadora para el análisis de documentos, principalmente resultantes de la investigación participante y/u otras metodologías participativas. Diseñada a partir de la creación de un acervo documental referente a un proyecto de formación continua de docentes, la Investigación-Exposición se sustenta en tres dimensiones: el trabajo con los documentos; la puesta en escena, en diálogo con la obra de Jacques Rancière; y la del lugar del investigador-curador. Estas dimensiones permiten traer a la exposición singularidades, memorias, afectos y procesos de subjetivación de sujetos y colectivos mediante diversas fuentes documentales.

Análise de modelos de triagem odontológica / Analysis of dental screening models / Análisis de modelos de cribado dental

Introdução: Diante da realidade virtual que se encontram os procedimentos burocráticos, observa-se a necessidade de se idealizar programas de triagem nas clínicas-escola com os objetivos de se encaminhar pacientes para a clínica mais compatível com as suas necessidades, e substituir os prontuários físicos pelos eletrônicos, numa alternativa ambientalmente correta.Objetivo: Avaliar a efetividade de um modelo de triagem informatizado, comparando-o ao modelo utilizado atualmente, no serviço de Serviço de Triagem e Documentação Odontológica do Departamento de Odontologia da Universidade Federal do Rio Grande do Norte. Metodologia: O estudo realizado foi do tipo descritivo, constituído de uma amostra de 50 pacientes, que foram submetidos ao modelo de triagem utilizado atualmente no Serviço de Triagem e Documentação Odontológica do Departamento de Odontologia da Universidade Federal do Rio Grande do Norte e a triagem com aplicação de um programa informatizado. Foi avaliada a efetividade do dispositivo e feita uma comparação entre os modelos. A análise estatística foi feita por meio do índice de correlação intra-classe, utilizando-se um banco de dados criado no software Statistical Package for Social Sciences, versão 20.0, adotando significância de 95% (p< 0,05).Resultados: Após análise estatística, com realização de correlação entre os resultados do software e o modelo atual de triagem, obteve-se coeficiente de correlação intra-classe de 0,578, com o nível de significância, para avaliação dos dados obtidos de (P<0,05), foi possível evidenciar que ocorreu correlação satisfatória positiva e significativa entre os resultados do software e o modelo atual de triagem.Conclusões:Os resultados denotam concordância entre os modelos de triagem estudados e demonstram que a utilização destes recursos apresenta resultados satisfatórios. Notadamente, evidenciando-se a vantagem da utilização do modelo de triagem informatizado (AU).

Introduction: In view of the virtual reality of bureaucratic procedures, it is necessary to devise screening programs in school clinics to refer patients to the clinic more compatible with their needs and replace physical with electronic records as an environmentally friendly alternative.Objective: To evaluate the effectiveness of a computerized screening model, comparing it to the model currently used in the Dental Documentation and Screening Service of the Dentistry Department of the Federal University of Rio Grande do Norte. Methodology: The descriptive study consisted of a sample of 50 patients who were submitted to the screening model currently used in the abovementioned service and the computerized screening model. The effectiveness of the device was evaluated and a comparison was made between the models. Statistical analysis was made using the intra-class correlation index and a database created in Statistical Package for Social Sciences version 20.0, adopting a significance of 95% (p < 0.05). Results: An intra-class correlation coefficient of 0.578 was obtained with the significance level of p < 0.05. There was a positive and significant satisfactory correlation between the software results and the current screening model.Conclusions: There was agreement between the studied models and the use of these resources yield satisfactory results. Therefore, the advantage of using the computerized screening model was confirmed (AU).

Introducción: Ante la realidad virtual de los trámites burocráticos, surge la necesidad de diseñar programas de cribado en las clínicas docentes con el objetivo de enviar a los pacientes a la clínica más compatible con sus necesidades, reemplazando los registros físicos y electrónicos en una alternativa ambientalmente correcta.Objetivo: Evaluar la efectividad de un modelo de cribado informatizado, comparándolo con el modelo utilizado actualmente en el Servicio de Cribado y Documentación Dental del Departamento de Odontología de la Universidad Federal de Rio Grande do Norte.Metodología: El estudio realizado fue de tipo descriptivo, constituido por una muestra de 50 pacientes que fueron sometidos al modelo de cribado actualmente utilizado en el dicho servicio y al cribado mediante programa informatizado. Se evaluó la efectividad del dispositivo y se realizó una comparación entre los modelos. El análisis estadístico se realizó mediante el índice de correlación intraclase, utilizando una base de datos creada en el software Statistical Package for Social Sciences, versión 20.0, adoptando un nivel de significación del 95% (p< 0,05).Resultados: Luego del análisis estadístico, con correlación entre los resultados del software y el modelo de cribadoactual, se obtuvo un coeficiente de correlación intraclase de 0.578, con nivel de significancia, para evaluación de los datos obtenidos de (P<0.05). Fue posible mostrar que hubo una correlación positiva y significativa satisfactoria entre los resultados del software y el modelo de cribado actual. Conclusiones: Los resultados muestran concordancia entre los modelos de cribado estudiados y demuestran que el uso de estos recursos presenta resultados satisfactorios. En particular, demostrando la ventaja de usar el modelo de cribado computarizado (AU).

An audit of US FDA warning letters issued to sponsors, institutional review boards and investigators over a six-year period.

The present audit was carried out with the objective of evaluating warning letters (WLs) issued to trial sponsors, clinical investigators and institutional review boards (IRBs) by the United States Food and Drug Administration during a six-year period and compare it with two similar earlier audits. WLs were reviewed and classified as per stakeholders and further categorised as per predefined violation themes. The chi-square test was performed for trend analysis of WLs. A total of 62 WLs were issued to the three stakeholders. The maximum number of WLs were issued to the clinical investigators (36/62, 58.06%), followed by sponsors (19/62, 30.64%), and least to the IRBs (7/62, 11.29%). Among sponsors, lack of standard operating procedures for the monitoring, receipt, evaluation and reporting of post-marketing adverse drug events was the most common violation theme (8/19, 42.1%). Among clinical investigators, deviation from investigational plan was the most common violation theme (31/36, 86.11%.). For IRBs, inadequate documentation was the most common violation theme (6/7, 85.71%). We saw an overall reduction in the number of WLs issued to the stakeholders. Thus, we identified multiple areas on which each stakeholder should work for improvement.

Registro em prontuário hospitalar: historicidade e tensionamentos atuais / Hospital records: historicity and current tensions

Resumo Introdução O registro em prontuário configura-se como um instrumento ético-legal de suma importância para os pacientes, a instituição, a equipe de saúde, o ensino e a pesquisa. Objetivo Apresentar o percurso histórico do registro em prontuário no âmbito da saúde e dar luz aos tensionamentos atuais atrelados a esse procedimento. Método Adotou-se como referencial teórico a Política Nacional de Humanização para a apresentação de uma análise reflexiva sobre a temática, a qual ocorreu pautada em levantamento bibliográfico e pesquisa documental envolvendo diretrizes das classes profissionais e documentos do Ministério da Saúde. Resultados O desenvolvimento histórico do prontuário está imbricado ao desenvolvimento da medicina e à evolução da instituição hospitalar, sendo, contemporaneamente, a exigência da qualidade dos registros em prontuário impulsionada por aspectos da gestão institucional. Conclusão Os principais desafios envolvidos na efetivação do procedimento dos registros estão atrelados ao processo de educação inicial e continuada e à necessidade de elucidar modos mais gerenciáveis de documentar a prática clínica, permitindo registros de qualidade, garantia de comunicação de evidências e fomento da prática da clínica ampliada.

Abstract Background The medical record is an ethical legal instrument of paramount importance for patients, the institution, the health team, teaching, and research. Objective To present the historical path of the medical record in the health record and to point out current tensions linked to this procedure. Method The National Humanization Policy was adopted as a theoretical reference for the presentation of a reflexive analysis on the subject, which was based on data obtained from bibliographical research and a documentary study involving guidelines from the professional classes and documents of the Health Ministry. Results The historical development of the medical record is related to the development of medicine and to the evolution of the hospital institution and the current requirement of the quality of medical records is driven by aspects of institutional management. Conclusion The main challenges involved in carrying out the procedure of registers are linked to the process of initial and continuing education and the need to elucidate more manageable ways of documenting clinical practice, allowing quality records, guaranteeing the communication of evidence in the documentation, and promoting the practice of the extended clinic.

A review article on cleaning validation in pharmaceutical industry / Монголын эм зүй, эм судлал

Abstract@#In pharmaceutical industry there are some possibilities of contamination and cross contamination because of improper cleaning of equipment, apparatus, processing area or the starting material, this can lead to severe hazards, therefore in pharmaceutical industry we could not afford any contamination as well as cross contamination. This can be minimized by proper cleaning of equipment, apparatus as well as the processing area. Prevention of cross contamination is one of the most significant conditions of Good Manufacturing Practices for drugs. This is especially topical for a multipurpose (shared) manufacture where several medicinal products, including drugs of different pharmacotherapeutic groups, are produced using the same facilities (manufacturing areas, workrooms, and equipment). The industry is able to achieve these key goals with the help of implementation of GMP. Therefore, a perfect cleaning method is required for avoiding the possibilities of contamination and cross contamination, for this a validated program is required, this program is known as cleaning validation. “Cleaning validation is documented evidence which assure that cleaning of equipment, piece of equipment or system will obtain pre-determined and acceptable limits”.

Consideraciones legales sobre las notas de evolución en odontología / Legal considerations on medical charts in dentistry

El expediente clínico es considerado un documento de importancia médica y legal en donde se integran los datos necesarios para registrar el diagnóstico y los tratamientos realizados en cada paciente. Uno de los elementos más importantes dentro del expediente clínico son las notas de evolución, documentos con los que el odontólogo informa sobre el estado general del paciente y los tratamientos realizados cita tras cita. Existen legislaciones específicas en México que orientan al estomatólogo sobre los componentes mínimos necesarios que una nota de evolución debe tener; sin embargo, una de las omisiones más comunes de los odontólogos es que, por desconocimiento, no se dé la debida importancia a la elaboración de una adecuada nota de evolución, aumentando el riesgo de problemas legales. El objetivo del presente artículo es analizar la importancia de las notas de evolución dentro del expediente clínico, destacando su importancia clínica y legal (AU)

The clinical file is considered a document of medical and legal importance where the data necessary to record the diagnosis and the treatments performed on each patient are integrated. One of the most important elements within the clinical records are the medical charts, documents through which de dentist reports on the general condition of the patient and the treatments performed appointment after appointment. There are specific laws in Mexico that guide the stomatologist on the minimum necessary components that a medical chart must have, however, one of the most common omissions of dentist is that, due to ignorance, due importance is not given to the preparation of an adequate medical chart, increasing the risk of legal problems. The aim of this article is to analyze the importance of the evolution charts within the clinical records, highlighting their clinical and legal importance (AU)

Análisis de los patrones de colaboración del Programa de Doctorado en Documentación e Información Científica / Analysis of collaboration patterns in the Documentation and Scientific Information doctoral training program

El propósito del presente artículo fue analizar los patrones de colaboración del programa de formación doctoral en Bibliotecología y Documentación Científica desarrollado entre la Universidad de La Habana y la Universidad de Granada en el período 2007-2017. Para esto se creó una base de datos en EndNote® x.9, con 396 documentos. Se crearon listados de frecuencia de acuerdo con los indicadores analizados, los cuales se procesaron con los programas Excel y Tableau Public 2020.3 para generar tablas y gráficos. Se utilizó Bibexcel (Olle Persson, Universidad de Umeå, Suecia) para realizar los conteos de frecuencia generales, la generación de matrices y el análisis de las redes de coautoría, cotutoría y de colaboración entre instituciones, en aras de procesarlas con UCINET 6.175. Para su representación reticular se utilizaron NetDraw 2.38 y VOSviewer 1.6.16. La colaboración fue analizada de manera global, por grupos y por tipología documental. Se valoraron las relaciones establecidas para el desarrollo de las investigaciones y para la dirección de las tesis. Para los artículos se analizaron las redes de coautoría y los nexos interinstitucionales. En las tesis se analizaron las relaciones establecidas para la tutoría. Se identificó un predominio de autoría múltiple, mayoritariamente en los artículos científicos. Se aprecian nexos relativamente importantes en la tutoría a partir del establecimiento de relaciones entre los tutores más productivos del programa. A nivel institucional se aprecia un protagonismo de la Universidad de Granada y la Universidad de La Habana por ser las coordinadoras del programa. No obstante, se aprecia una amplia gama de instituciones nacionales. Se reflejan los participantes y tutores más representados(AU)

The purpose of the study was to analyze the collaboration patterns in the Library Science and Scientific Documentation doctoral training program conducted jointly by the University of Havana and the University of Granada in the period 2007-2017. To achieve this end, a database of 396 documents was created on EndNote® x.9. Frequency lists were developed for the indicators analyzed, which were processed with the software Excel and Tableau Public 2020.3 to generate tables and charts. Bibexcel (Olle Persson, Umeå University, Sweden) was used to carry out overall frequency counts, generate matrices, and analyze co-authorship, co-tutorship and collaboration networks between institutions, with a view to processing them with UCINET 6.175. NetDraw 2.38 and VOSviewer 1.6.16 were used for their reticular representation. Collaboration was analyzed globally, by group and by document typology. An assessment was made of the relationships established for research development and thesis guidance. Analysis of papers included co-authorship networks and interinstitutional links, whereas the analysis of theses included the tutoring relationships established. A predominance was found of multiple authorship, mainly in scientific papers. Relatively important links were found in tutoring based on the establishment of relationships between the most productive authors in the program. On an institutional level, leadership by the University of Granada and the University of Havana was observed, being as they are the program coordinators. However, a wide range of national institutions was also found. Reference is made to the best represented participants and tutors(AU)

Análisis cienciométrico de tesis doctorales de terapia ocupacional / Análise cientométrica das teses de doutoramento em terapia ocupacional / Scientometric analysis of occupational therapy Ph.D. theses

Resumen Introducción La Cienciometría es el estudio de los aspectos cuantitativos de la literatura científica y tecnológica, y ayuda a crear una visión amplia de los logros de la investigación en un campo científico. Una tesis doctoral es un estudio de investigación original sobre un área científica realizado por un candidato y se considera un indicador de personal altamente cualificado. Hasta donde sabemos, no se ha realizado ningún análisis cienciométrico en terapia ocupacional em España. Objetivos Caracterizar las tesis doctorales de terapia ocupacional defendidas em España y su tendencia. Metodo: Se ha realizado un estudio cienciométrico, descriptivo y retrospectivo entre 1976 y noviembre de 2019, utilizando la información buscada en las bases de datos TESEO y SOCINTO, el Portal de Ética DART-Europe y el repositório Dialnet. Se realizaron análisis descriptivos y de regresión. Resultados 77 tesis doctorales cumplieron los criterios de inclusión. La regresión lineal refleja una progresión diacrónica con r2= 0,530 con una significación estadística (p<.001). Conclusión La producción de tesis doctorales de terapia ocupacional en España se ha incrementado en las dos últimas décadas. Esta investigación ha contribuido a caracterizar el estado actual de las tesis doctorales de terapia ocupacional defendida em España, considerando el análisis de las tesis doctorales como un importante indicador cienciométrico y siendo el primer estudio de este tipo a nivel mundial.

Resumo Introdução A cienciometria é o estudo dos aspectos quantitativos da literatura científica e tecnológica, contribuindo para criar uma visão ampla dos resultados da investigação num campo científico. Uma tese de doutoramento é um estudo de investigação original sobre uma área científica realizado por um candidato e é considerada uma qualificação pessoal altamente qualificada. Segundo os nossos melhores conhecimentos, não foi realizada qualquer análise cientométrica em terapia ocupacional na Espanha. Objetivos Caracterizar as teses de doutoramento em terapia ocupacional defendidas na Espanha e a suas tendências. Método Foi realizado um estudo cientométrico, descritivo e retrospectivo entre 1976 e novembro de 2019, utilizando a pesquisa de informação nas bases de dados TESEO e SOCINTO, no Portal DART-Europe Etheses e no repositório Dialnet. Foram realizadas análises descritivas e regressivas. Resultados 77 teses de doutoramento cumpriram os critérios de inclusão. A regressão linear reflete uma progressão diacrônica com r2= 0,530, com um significado estatístico (p<.001). Conclusão A produção de teses de doutoramento em terapia ocupacional na Espanha aumentou nas últimas duas décadas. Esta investigação ajudou a caracterizar o estado atual das teses de doutoramento em terapia ocupacional defendidas na Espanha, considerando a análise de teses de doutoramento como um indicador cientificamente importante e sendo o primeiro estudo deste tipo em nível mundial.

Abstract Introduction Scientometry is the study of the quantitative aspects of the scientific and technological literature, helping in creating a broad vision of the research achievements in a scientific field. A Ph.D. thesis is an original research study about a scientific area carried out by a candidate and is considered an indicator of highly qualified staff. To our best knowledge, no scientometric analysis has been performed in occupational therapy in Spain. Objective To characterize occupational therapy Ph.D. theses defended in Spain and its trend. Method A scientometric, descriptive, retrospective study was conducted between 1976 and November 2019, using the information searching in the TESEO and SOCINTO databases, the DART-Europe Etheses Portal, and the Dialnet repository. Descriptive and regression analyses were carried out. Results 77 Ph.D. theses met the inclusion criteria. The linear regression reflects a diachronic progression with r2= 0.530 with a statistical significance (p<.001). Conclusion The production of occupational therapy Ph.D. theses in Spain has been increased in the last two decades. This research has helped to characterize the current state of the occupational therapy Ph.D. theses defended in Spain, considering Ph.D. theses analysis as an important scientometric indicator and being the first study of this type worldwide.

Núcleo de História da Enfermagem no Ceará: luta pela guarda, recuperação, preservação e socialização da profissão / Center for the History of Nursing in Ceará: fight for the safekeeping, recovery, preservation and of the profession's socialization / Centro de Historia de la Enfermería en Ceará: lucha por el resguardo, recuperación, preservación y socialización de la profesión

Objetivo: socializar, por meio de uma visita guiada, o primeiro Museu Cearense que trata da história e memória da Enfermagem, oriundo das conquistas do Núcleo de Documentação, Informação, História e Memória da Enfermagem no Ceará na luta pela guarda, recuperação e preservação desta história no estado. Método: Trata-se de relato de experiência acerca de trabalho realizado para guardar e preservar a história da Enfermagem cearense, que culminou na criação de Museu, per-tencente ao Núcleo de Documentação, Informação, História e Memória da Enfermagem no Ceará, instalado na Universidade Estadual do Ceará. Resultados: São apresentadas duas salas. A sala um é constituída por bandeiras da primeira escola de Enfermagem do estado, quadros, mobiliários e expositores, contendo diversos objetos: livro de registro de acontecimentos, fotos, broches, anéis, entre outros, e na sala dois há documentação, arquivo e acervo de biblioteca. Os materiais/objetos expostos nos museus, cuja busca se deu a partir do envolvimento de pesquisadores, mostram-se indispensáveis para o resgate e a preservação da História da Enfermagem no Ceará. Conclusão: A criação de Museus, além de agregar conhecimento, reúne valor à formação e reconhecimento do profissional de Enfermagem.

Objective: to socialize, through a guided visit, the first Museum of Ceará that deals with the his-tory and memory of Nursing, originating from the conquests of the Nucleus of Documentation, Information, History and Memory of Nursing in Ceará in the struggle for the safekeeping, recovery and preservation of this history in the state. Method: This is an experience report about the work done to save and preserve the history of nursing in Ceará, which culminated in the creation of the Museum, belonging to the Nucleus of Documentation, Information, History and Memory of Nurs-ing in Ceará, installed in the State University of Ceará. Results: Two rooms are presented. Room one consists of flags from the first nursing school in the state, pictures, furniture and displays, containing several objects: registration book of events, photos, brooches, rings, among others, and in room two there is documentation, archive and library collection. The materials/objects exhib-ited in the museums, whose search was based on the involvement of researchers, show themselves indispensable for the rescue and preservation of the History of Nursing in Ceará. Conclusion: The creation of museums, besides aggregating knowledge, adds value to the formation and recognition of the nursing professional.

Objetivo: socializar, a través de una visita guiada, el primer Museo de Ceará que trata de la historia y memoria de la Enfermería, originado por las conquistas del Núcleo de Documentación, Información, Historia y Memoria de la Enfermería en Ceará en la lucha por el resguardo, recuperación y preserva-ción de esta historia en el estado. Método: Este es un informe de experiencia sobre el trabajo realizado para salvar y preservar la historia de la enfermería en Ceará, que culminó con la creación del Museo, perteneciente al Núcleo de Documentación, Información, Historia y Memoria de la Enfermería en Ceará, instalado en la Universidad Estatal de Ceará. Resultados: Se presentan dos salas. La sala uno consta de banderas de la primera escuela de enfermería del estado, cuadros, muebles y expositores, conteniendo varios objetos: libro de registro de eventos, fotos, broches, anillos, entre otros, y en la sala dos hay documentación, archivo y fondo de biblioteca. Los materiales/objetos expuestos en los museos, cuya búsqueda se basó en la participación de los investigadores, se muestran indispensables para el rescate y preservación de la Historia de la Enfermería en Ceará. Conclusión: La creación de museos, además de agregar conocimiento, agrega valor a la formación y reconocimiento del profe-sional de enfermería.

Quality indicators of the nursing process documentation in clinical practice / Indicadores de documentación de calidad del proceso de enfermería en la práctica clínica / Indicadores de qualidade da documentação do processo de enfermagem na prática clínica

ABSTRACT Objectives: to propose quality indicators for clinical nursing documentation Methods: methodological study in which literature review guided the composition of an instrument for evaluating nursing documentation. Two independent professionals evaluated 204 medical records of adult patients. The analysis of this assessment generated quality indicators for clinical nursing documentation. Inter-rater agreement was analyzed by Cohen's kappa. Results: the bibliographic review, analysis by experts and pre-test resulted in 88 evaluation items distributed in seven topics; in 88.5% of the items, inter-rater agreement between strong and almost perfect (k=0.61-1.0) was observed. Analysis of the evaluations generated a global indicator and seven partial indicators of documentation quality. Compliance in the two services ranged between 62.3% and 93.4%. The global indicator showed a 2.1% difference between services. Conclusions: seven quality indicators of clinical nursing documentation and their method of application in hospital records have been proposed.

RESUMEN Objetivos: proponer indicadores de calidad de la documentación clínica de enfermería. Métodos: estudio metodológico en que revisión de literatura orientó la composición de instrumento de evaluación de la documentación de enfermería. Dos profesionales independientes evaluaron 204 prontuarios de pacientes adultos. Análisis de esa evaluación generó indicadores de calidad de la documentación de enfermería. La concordancia interevaluadores fue analizada por Kappa de Cohen. Resultados: revisión bibliográfica, análisis por especialistas y pretest originaron 88 ítems de evaluación distribuidos en siete tópicos; en 88,5% de los ítems, observó concordancia interevaluadores entre fuerte y casi perfecta (k=0,61-1,0). Análisis de las evaluaciones generaron un indicador global y siete indicadores parciales de calidad de la documentación. La conformidad en los dos servicios varió entre 62,3% y 93,4%. Indicador global mostró diferencia de 2,1% entre los servicios. Conclusiones: fueron propuestos siete indicadores de calidad de la documentación de enfermería y su método de aplicación en prontuarios hospitalarios.

RESUMO Objetivos: propor indicadores de qualidade da documentação clínica de enfermagem. Métodos: estudo metodológico em que revisão da literatura norteou a composição de um instrumento de avaliação da documentação de enfermagem. Dois profissionais independentes avaliaram 204 prontuários de pacientes adultos. A análise dessa avaliação gerou indicadores de qualidade da documentação clínica de enfermagem. A concordância interavaliadores foi analisada pelo kappa de Cohen. Resultados: a revisão bibliográfica, análise pelos especialistas e pré-teste originaram 88 itens de avaliação distribuídos em sete tópicos; em 88,5% dos itens, observou-se concordância interavaliadores entre forte e quase perfeita (k=0,61-1,0). Análises das avaliações geraram um indicador global e sete indicadores parciais de qualidade da documentação. A conformidade nos dois serviços variou entre 62,3% e 93,4%. O indicador global mostrou diferença de 2,1% entre os serviços. Conclusões: foram propostos sete indicadores de qualidade da documentação clínica de enfermagem e seu método de aplicação em prontuários hospitalares.

The Importance of Clinical Documentation in the MalaysianDRG Casemix System: A Sequential Explanatory Mixed-Method Study of Ministry of Health Hospitals in Malaysia

@#Introduction: The Ministry of Health (MOH) implemented the MalaysianDRG casemix system in 2010, and two national target indicators on the accuracy and completeness of clinical documentation were introduced to measure its performance. This study aims to show the trend of casemix performance in MOH hospitals and to explore the challenges in meeting these targets. Methods: The study design was sequential explanatory mixed-method design. First, a cross-sectional study described the trend of casemix performance in five MOH hospitals in Malaysia. Second, a single holistic case study of the hospital with the lowest casemix system performance was conducted to explore the perceptions of clinicians regarding the MalaysianDRG casemix and the challenges pertaining to clinical documentation. Purposive sampling was employed, and the case study data collection was carried out using in-depth-interviews, observation, and document reviews. Results: Two hospitals achieved the target in the accuracy of clinical documentation for the main condition (≥90%). For completeness in clinical documentation, four out of five MOH hospitals performed below the target (≤ 60%). Thematic analysis of the data found poor commitment of clinicians towards casemix and a multitude of obstacles in performing clinical documentations. Conclusion: After a decade of its implementation, the performance of the MalaysianDRG casemix system in MOH hospitals is still moderate due to inaccurate and incomplete clinical documentations. The study findings may be used to spread awareness and devise tailored solutions to assist clinicians in paving the way towards future excellence in MalaysianDRG casemix system.

Digitalización de historias clínicas: análisis de un proyecto en un contexto real en el Servicio Extremeño de Salud en España / Medical record digitalization: analysis of a real life project involving the Extremadura Health Service in Spain

Se presenta un estudio de caso en el contexto de la gestión de la información clínica sanitaria, en el que, a partir de la revisión de la literatura científica, se detectó que las tecnologías de la información se han ido introduciendo de manera desigual e irregular en la sanidad pública española. El estudio se planteó como objetivo analizar cómo se realiza un proyecto de digitalización de historias clínicas, el cual condujo a las siguientes preguntas de investigación: ¿Cómo se gestiona la información sanitaria? ¿Cómo se realiza un proyecto de digitalización de historias clínicas en un contexto real? ¿Qué formación tienen los profesionales que participan en el proceso y ¿cuál es el papel de los documentalistas? Se siguió una metodología de investigación cualitativa con perspectiva naturalista, además del análisis de la literatura científica, en la que se presentaron los resultados del estudio basados en la dotación de equipamiento, el servicio de consultoría, la gestión documental y de archivo, además del perfil profesional que se plantea para la ejecución de un proyecto de digitalización de historias clínicas. Se concluye que la gestión de la información no satisface las necesidades del personal sanitario; que no existe un procedimiento documentado para la digitalización de las historias clínicas y que no se requiere la participación de profesionales sanitarios ni de documentalistas, a pesar de que la literatura científica resalta la inestimable participación de estos profesionales(AU)

A health information management case study is presented in a which scientific literature review revealed that information technologies have been incorporated into Spanish public health in an uneven, irregular manner. To corroborate this fact we set ourselves the objective of analyzing the way in which a medical record digitalization project is conducted, which led to the following research questions: How is health information managed? How is a medical record digitalization project conducted in a real life context? What is the background of professionals involved in the process and what is the role of documentalists? Besides examination of the scientific literature, a naturalist qualitative analysis was performed in which the results of the study were presented, based on equipment provision, advisory service, document management and archiving, and the professional profile established for the conduct of a medical record digitalization project. It is concluded that information management does not meet the needs of the health personnel, that a documented procedure is not available for medical record digitalization, and that participation of health professionals and documentalists is not requested, despite the scientific literature highlighting the invaluable participation of these professionals(AU)

Attitudes and opinions of dental practitioners towards the use of clinical photography in Srinagar: a cross sectional study

Background: Clinical photography has become a part of modern-day dental practice. It has been used for dento-legal documentation, diagnosis, clinical assessment, treatment planning, patient motivation, communication with the patient and laboratory, academic purposes and also for marketing. The aim of the study was to assess and determine the knowledge and the extent of the use of photography by dental practitioners of Srinagar city.Methods: A cross-sectional survey involving a questionnaire consisting of 10 questions was distributed among 88 randomly selected dental practitioners of Srinagar city, out of which 72 dental practitioners responded positively and returned the questionnaire. The data collected were computerized and analyzed statistically. The average values of the responses received by groups of questions were analyzed.Results: According to the survey conducted, 52(72.22%) dentists used photography for dental practice. Out of all the dentists surveyed, 63(87.5%) of the dentists knew about the importance of dental photography. It was observed that 40(55.55%) fresher dentists (<5 years’ experience) showed more positive attitude towards the application of photography in their dental practice. It was also revealed that the application of clinical photography among male dentists, dentists with <5 years’ experience and dentists who work with an assistant were significantly higher as compared to other dentists (p<0.05).Conclusions: Hence, from this study, majority of respondents (87.5%) were aware of the importance of dental photography. The reasons which prevented the dentist from using clinical photography were lack of time, expensive instruments, lack of interest and cross infection. Male practitioners were more likely than female practitioners to use clinical photography. Photographic training should hence be inculcated in the curriculum of dentistry. Also dental practitioners should actively participate in CDE programs on Clinical photography to improve the quality of dental practice.

Registro de sobrepeso y obesidad como problema de salud por pediatras de cabecera en una historia clínica electrónica / Recording of overweight and obesity as a health problem by primary care pediatricians in an electronic medical record

Introducción. El subdiagnóstico y subregistro de sobrepeso y obesidad en pediatría es muy frecuente. El uso de una historia clínica electrónica podría contribuir favorablemente. El objetivo fue conocer el porcentaje de registro de este problema por pediatras de cabecera y analizar si se asociaba con la realización de estudios complementarios.Métodos. Estudio de corte transversal. Se evaluó el registro del problema en pacientes pediátricos con sobrepeso y obesidad, y la presencia de resultados de glucemia, triglicéridos y colesterol de alta densidad en pacientes obesos.Resultados. Se analizaron 7471 pacientes con sobrepeso y obesidad; el registro adecuado del problema fue del 19 %. El 44 % de los obesos (n = 1957) tenía registro adecuado y el 32 %, resultados de laboratorio, con asociación significativa entre variables.Conclusiones. Los porcentajes de registro de sobrepeso y obesidad y realización de estudios complementarios fueron bajos. El registro del problema se asoció a mayor solicitud de estudios

Introduction. Under-diagnosis and under-recording of overweight and obesity in pediatrics is very common. Using an electronic medical record may be helpful. The objective was to establish the percentage of recording of this problem by primary care pediatricians and analyze if it was associated with the performance of ancillary tests.Methods. Cross-sectional study. The recording of this problem among overweight and obese pediatric patients and the presence of blood glucose, triglycerides, and high-density lipoprotein cholesterol results in obese patients were assessed.Results. A total of 7471 overweight and obese patients were included; this health problem was adequately recorded in only 19 %. Among all obese patients (n = 1957), 44 % had adequate recording of this health problem; 32 % had lab test results showing a significant association among outcome measures.Conclusions. The percentage of overweight and obesity recording and ancillary test performance was low. Recording was associated with a higher level of test ordering

A prospective closed loop audit on the quality of the operative notes in a general surgical unit in a quaternary care centre

Background: Proper documentation of the surgery done in the form of operative notes is a very important aspect of surgical practice. The aim of this clinical audit was to identify the existing standard of the operative notes written in a general surgical unit in a quaternary care hospital; and to compare it with the recommendations given by Royal College of Surgeons, England (in Good Surgical Practice, 2014) and if needed, to improve the standard of practice.Methods: In the first loop of this prospective audit, 75 consecutive operative notes which were written were compared with the RCS guidelines and the areas which had missing data were identified. These areas were informed to the residents, who are primarily involved in the documentation of the operative notes. The second loop of the audit was conducted after a gap of 4 months involving 75 consecutive operative notes again.Results: The areas which were initially deficient were better documented when analysed in the second loop.Conclusions: Documentation of operative notes does not always comply with the set guidelines as highlighted in the first loop of our audit. But by employing a clinical audit it is possible to identify the existing deficiencies and thereby improving the standards of practice. Also, operative note writing should be taught as part of surgical training. Definitions should be clearly provided, and specific guidelines should be established to improve the quality of the operative notes and their use to improve patient safety.

Development and validation of the Vi-Med® tool for medication review

Clinical pharmacy practice in Vietnam is unregulated by standard procedures, thus motivating this study, whichdeveloped and validated a tool called Vi-Med® for use in supporting medication review (MR) in Vietnamese hospitals.Six clinical pharmacists from six hospitals used the tool, which comprises three forms: Form 1 for the collectionof patient information, Form 2 for the implementation of MR, and Form 3 for the documentation of pharmacistinterventions (PIs). The tool also comes with eight pre-identified drug-related problems (DRPs) and seven PIs.The pharmacists were asked to categorize 30 PI-associated scenarios under appropriate DRPs and correspondinginterventions. Concordance among the pharmacists was assessed on the basis of agreement level (%) and Cohen’skappa (κ). We also evaluated the user-friendliness of the tool using a four-point Likert scale. Concordance in thepanel with respect to DRPs and PIs was substantial (κ = 0.76 and 80.4% agreement) and almost perfect (κ = 0.83 and87.6% agreement), respectively. All the experts were satisfied with the structure and content of Vi-Med®. Five of themevaluated the tool as very suitable, very useful, and definitely fitting for everyday use. Vi-Med® satisfactorily achievedconsistency and user-friendliness, enabling its use in daily clinical pharmacy practice.

Prospects of diabetes registry in suburban community of Nigeria: experience at a private general practice

Background: As part of series of advocacy on development of diabetes register, one of the target health facilities is private general practices. In suburban Kwale community Delta State, Donak hospital was chosen to study the process of developing and implementing diabetes register program. Specific objectives include to evaluate the extent of completeness of data for patients follow-up, diabetes services within the private practice based on data collection, prevalence of high blood pressure, and patients’ compliance with medical appointments.Methods: The study followed a clinical observational method and after necessary ethical considerations, medical information was gotten from the record unit Donak Hospital, Kwale. The patients identified as potential diabetes or prediabetes were contacted for follow-up and 113 (65 females and 48 males) participants consented, all adults. Data collection were those required for a diabetes register proforma and were analyzed using Microsoft Excel Analysis Tool-pack. Results: There was no dedicated diabetes register per se except for usual medical records. The private practice has 100% record of contact details and blood pressure completeness for the participants. The scope of service offered to the patients was basically primary healthcare services. Over 50% of the participants have high blood pressure. On the patients’ compliance with medical check-up; only 23% of the participants complied with check-up appointments.Conclusions: The development of diabetes register in private practices can improve services. These services include documentation of appointments to enable follow-up strategies to encourage compliance to medical check-ups and a record diabetes education that may be provided.

Documentação do processo de enfermagem na prática clínica: construção de indicadores / Documentation of the nursing process in clinical practice: construction of indicators

Introdução: Documentar as ações e informações associadas ao cuidado oferecido ao paciente é uma preocupação constante para os profissionais da saúde. Na enfermagem o planejamento das atividades relacionadas ao cuidado segue um modelo conhecido como Processo de Enfermagem, realizado em cinco etapas: avaliação, diagnóstico, resultados do paciente, prescrição e evolução. Cada etapa deve ser documentada com precisão passando a integrar os registros do prontuário clínico. Essa documentação pode ser avaliada por meio de indicadores: medidas que quantificam os aspectos mensuráveis de uma variável, usadas em programas de melhoria da qualidade. Objetivo: propor indicadores de qualidade da documentação clínica de enfermagem. Método: estudo metodológico, desenvolvido em três etapas: teórica, empírica e analítica. A etapa teórica compreendeu: geração de tópicos de conteúdo e itens de análise documental mediante revisão bibliográfica; análise de conteúdo e semântica realizada por cinco especialistas, dois enfermeiros recém- formados e oito graduandos em enfermagem que revisaram e validaram as definições conceituais e operacionais dos tópicos e as descrições dos itens quanto a sua elegância, clareza e pertinência; confecção do instrumento de avaliação da documentação clínica de enfermagem (IADOCE). Na etapa empírica foi realizada a análise da documentação de enfermagem em 204 prontuários clínicos de pacientes internados por quatro ou mais dias, em 2013, em dois hospitais do município de São Paulo (A e B). Cada prontuário foi analisado por dois enfermeiros (avaliação interpares) que verificaram de forma independente os registros de enfermagem de três datas: da internação, da data central do período de permanência e data de saída do sistema de cuidados. A confiabilidade interpares foi analisada pelo Kappa de Cohen e intervalo de confiança 95%. Na fase final foram propostos sete indicadores da documentação clínica de enfermagem. Para o cálculo dos indicadores foi considerado o percentual de conformidade dos registros documentais com os critérios de avaliação estabelecidos. Resultados: Das 316 descrições de tópicos de conteúdo e itens compilados mediante revisão da literatura, após as análises da etapa teórica, sugestões dos especialistas e pré-teste, resultaram em um instrumento com sete tópicos de conteúdo e 88 itens chamado Instrumento de Avaliação da Documentação Clínica de Enfermagem (IADOCE). A concordância interavaliadores, analisada pelos valores de Kappa situou-se entre mediana e quase perfeita: em 67,3% foi quase perfeita, em 21,2% forte; nos 11,5% restantes, entre moderada e mediana. Foi proposto um Indicador de Qualidade da Documentação Clínica global (IQDCGlobal), derivado de sete IQDC parciais, entre os quais se distribuíram 88 critérios. A conformidade da documentação avaliada com os critérios dos indicadores propostos variou de 0,5% a 100,0%; os IQDC variaram entre 62,33% e 93,48% na instituição A e 72,18% e 84,23% na instituição B. O IQDC global mostrou diferença de 2,1% entre as duas amostras avaliadas. Conclusões: o estudo permitiu propor sete indicadores da qualidade da documentação clínica de enfermagem e o método para sua utilização em prontuários hospitalares. Novos estudos permitirão adequá-los ao uso em outros contextos do cuidado.

Introduction: Documenting the actions and information associated with the care offered to the patient is a constant concern for health professionals. In nursing, the planning of activities related to care follows a model known as the Nursing Process, carried out in five stages: assessment, diagnosis, patient results, prescription and evaluation. Each step must be accurately documented and integrated into the records of the clinical record. This documentation can be evaluated using indicators: measures that quantify the measurable aspects of a variable, used in quality improvement programs. Aim: to propose quality indicators for clinical nursing documentation. Method: methodological study, developed in three stages: theoretical, empirical and analytical. The theoretical stage comprised: generation of content topics and documentary analysis items through bibliographic review; content and semantics analysis carried out by five specialists, two newly graduated nurses and eight nursing undergraduates who reviewed and validated the conceptual and operational definitions of the topics and the item descriptions regarding their elegance, clarity and relevance; making the assessment instrument for clinical nursing documentation (IADOCE). In the empirical stage, the analysis of nursing documentation was performed on 204 clinical records of patients hospitalized for four or more days, in 2013, in two hospitals in the city of São Paulo (A and B). Each medical record was analyzed by two nurses (peer review) who independently checked the nursing records for three dates: admission, the central date of the period of stay and the date of leaving the care system. Peer reliability was analyzed by Cohen\'s Kappa and 95% confidence interval. In the final phase, seven indicators of clinical nursing documentation were proposed. For the calculation of the indicators, the percentage of compliance of the documentary records with the established evaluation criteria was considered. Results: of the 316 descriptions of content topics and items compiled through literature review, after the analysis of the theoretical stage, suggestions from experts and pre-test, resulted in an instrument with seven content topics and 88 items called Documentation Assessment Instrument Nursing Clinic (IADOCE). The inter-rater agreement, analyzed by the Kappa values, was between median and almost perfect: in 67.3% it was almost perfect, in 21.2% strong; in the remaining 11.5%, between moderate and median. A global Clinical Documentation Quality Indicator (IQDCGlobal) was proposed, derived from seven partial IQDCs, among which 88 criteria were distributed. The conformity of the assessed documentation with the criteria of the proposed indicators ranged from 0.5% to 100.0%; the IQDC varied between 62.33% and 93.48% in institution A and 72.18% and 84.23% in institution B. The global IQDC showed a difference of 2.1% between the two samples evaluated. Conclusion: the study allowed us to propose seven indicators of the quality of clinical nursing documentation and the method for its use in hospital records. New studies will allow them to be adapted for use in other care contexts.

Alguns apontamentos linguísticos ao discurso jurídico contemporâneo com vistas a uma ética do cuidado e da proteção à pessoa idosa / Some linguistic notes to contemporary legal discourse with a view to an ethics of care and protection for the elderly / Algunas notas linguísticas al discurso jurídico contemporáneo. con miras a una ética del cuidado y protección para los ancianos

O presente artigo tem por objetivo apresentar algumas considerações linguísticas ao discurso jurídico contemporâneo, no sentido de uma racionalização ou adequação desse discurso em prol da pessoa idosa, muitas vezes já em condição de fragilidade ou dependência, necessitando que a documentação forense possa ganhar mais efetividade, celeridade, cuidado e segurança, com vistas a uma ética do cuidado e da proteção ao longevo. O procedimento metodológico de abordagem do tema aqui adotado é o raciocínio dedutivo-argumentativo, por meio do qual se partirá da ideia da fragilidade da pessoa idosa, que exige uma "mudança de rumo" quanto à celeridade das ações, para que o idoso envolvido possa, ainda dentro dos poucos anos finais de sua vida, desfrutar dos resultados bem-sucedidos das causas forenses.

The purpose of this paper is to present some linguistic notes to contemporary legal discourse, in the sense of rationalizing or adapting this discourse in favor of the elderly person, often already in a condition of fragility or dependence, requiring that the forensic documentation may gain more effectiveness, speed, care and safety, with a view to an ethics of care and long-term protection. The methodological procedure for approaching the theme adopted here is deductive-argumentative reasoning, through which one will start from the idea of the frailty of the elderly person, which requires a "change of course" regarding the speed of the actions, so that the elderly involved can, even within the final few years of your life, enjoy the successful results of forensic causes.

El propósito de este artículo es presentar algunas notas lingüísticas al discurso legal contemporáneo, en el sentido de racionalizar o adaptar este discurso a favor de la persona mayor, a menudo ya en una condición de fragilidad o dependencia, que requiere que la documentación forense pueda obtener más efectividad, rapidez, cuidado y seguridad, con miras a una ética de cuidado y protección a largo plazo. El procedimiento metodológico para abordar el tema adoptado aquí es el razonamiento deductivo-argumentativo, a través del cual se partirá de la idea de la fragilidad de la persona mayor, que requiere un "cambio de rumbo" con respecto a la velocidad de las acciones, para que las personas mayores involucradas puedan, incluso en los últimos años de su vida, disfrute de los resultados exitosos de causas forenses.