Individual and interactive effects of atmospheric PM2.5 and O3 on mortality of circulatory system diseases in Ningxia / 环境与职业医学

Background The impact of atmospheric fine particulate matter (PM2.5) and ozone (O3) on the mortality of circulatory system diseases cannot be ignored. However, whether the interaction between PM2.5 and O3 can affect population health is rarely reported and requires study. Objective To investigate the individual and interactive impacts of atmospheric PM2.5 and O3 on the mortality of circulatory system diseases in the population of Ningxia region. Methods The data of 119647 deaths due to circulatory system diseases, daily average concentrations of atmospheric pollutants, and meteorological data in Ningxia from 2013 to 2020 were retrieved. PM2.5 was divided into low, medium, and high concentrations according to the primary and secondary national limits (35 and 75 μg·m−3) of the Ambient air quality standards. Similarly, O3 was divided into low, medium, and high concentrations according to the national limits (100 and 160 μg·m−3). Using a generalized additive mixed model based on quasi Poisson distribution, the impacts of atmospheric PM2.5 and O3 as well as their interaction on the mortality of circulatory system diseases were analyzed using the population data of Ningxia region. Results During the target period, males and the ≥ 65 year group accounted for larger proportions of deaths due to circulatory system diseases (55.47% and 79.87% respectively). The daily average concentration of PM2.5 (40.25 μg·m−3) exceeded the national primary limit. In the single pollution model, the highest cumulative lag effects for mortality from circulatory system diseases were PM2.5 exposure over previous 1 d (lag01) and O3 exposure for previous 2 d (lag02), and their excess risk (ER) values were 1.03% (95%CI: 0.67%, 1.40%) and 1.02% (95%CI: 0.57%, 1.50%), respectively. The results of concentration stratification analysis showed that the most significant risks of death from circulatory system diseases [ER (95%CI): 1.12% (0.32%, 1.92%) and 0.95% (0.13%, 1.79%) respectively] were found at medium PM2.5 and O3 concentrations. The interaction analysis revealed that under, a synergistic effect on the risk of death from circulatory system diseases was identified (relative excess risk due to interaction=3.08%, attributable proportion of interaction=2.90%, synergy index=1.89) when considering the coexistence of PM2.5 and O3 above the primary limit. As the concentrations of PM2.5 and O3 increased, the synergistic effect increased the risk of death from circulatory system diseases in the general population, men, women, and the ≥ 65 years group. Conclusion Both atmospheric PM2.5 and O3 can increase the risk of death from circulatory system diseases, and the two pollutants have a synergistic effect on the risk of death from circulatory system diseases.

Aprendizaje basado en problemas en modalidad virtual con tutor par en pandemia: Opinión estudiantes primer año de medicina

Propósito del estudio: Conocer la experiencia de estudiantes de primer año de la carrera de Medicina, Universidad Austral de Chile con respecto a tutorías virtuales de ABP realizadas por tutores pares, durante el segundo semestre del 2021. Material y Método: Investigación cuantitativa y cualitativa, transversal, descriptiva. Muestra no probabilística, conformada por 45 estudiantes de medicina que participaron en ABP virtual con tutores/as pares. Recolección de datos mediante encuesta de opinión anónima y voluntaria (Google Forms), compuesta por 2 ámbitos: metodología y rol del tutor/a, considerando preguntas abiertas relacionadas con aspectos facilitadores y obstaculizadores. Análisis de datos cuantitativo con programa Excel, utilizando estadística descriptiva con medidas de frecuencia. Los cualitativos con reducción progresiva. Estudio aprobado por Comité Ético Científico, Servicio de Salud Valdivia. Resultados: Existe un alto grado de satisfacción en los dos ámbitos. Tanto en los resultados cualitativos y cuantitativos los participantes valoran positivamente el desempeño del rol del tutor par, destacando: empatía, compromiso, confianza, facilitador, proporciona retroalimentación y buen ambiente de aprendizaje, permitiendo el aprender en forma colaborativa. A diferencia de lo cuantitativo en lo cualitativo se identifica con mayor frecuencia como factores obstaculizadores, la mala conexión a internet, excesiva carga curricular y desconocimiento de la metodología por parte del tutor. Conclusiones: Si bien la preparación de tutores pares para el desarrollo de las tutorías de ABP es fundamental, más aún lo es para la implementación en modalidad virtual, ya que se enfrentan a otros desafíos como el manejo de plataformas y lograr una comunicación efectiva que permita aprender colaborativamente.

Purpose of the study: To know the experience of first-year medical students at Universidad Austral de Chile regarding virtual Problem-Based learning (PBL) tutorials carried out by peer tutors during the second semester of 2021. Methods: Quantitative and qualitative research, transversal, descriptive. The non-probabilistic sample consisted of 45 medical students who participated in virtual PBL tutorials with peer tutors. Data collection through an anonymous and voluntary opinion survey comprised two areas: methodology and role of the tutor, considering open questions related to facilitating and hindering aspects. Quantitative data analysis was performed using descriptive statistics with frequency measurements. The qualitative ones with progressive reduction. Study approved by the Scientific Ethics Committee, Valdivia Health Service. Results: There is a high degree of satisfaction in all three areas. Both in the qualitative and quantitative results, the participants positively value the performance of the peer tutor, highlighting empathy, commitment, trust, facilitation, feedback, and a good learning environment, allowing collaborative learning. Unlike the quantitative, the qualitative is more frequently identified as hindering factors, poor internet connection, excessive curricular load, and lack of knowledge about the methodology by the tutor. Conclusions: Although the preparation of peer tutors for PBL tutorials is essential, it is even more critical in virtual mode since they face challenges such as managing virtual platforms and achieving effective communication that allows learning collaboratively

Características de pacientes con exacerbación aguda grave de enfermedad pulmonar obstructiva crónica que requirieron ventilación mecánica invasiva en un hospital de Santander durante 2014-2020 / Characteristics of patients with severe acute exacerbation of chronic obstructive pulmonary disease who required invasive mechanical ventilation in a Santander hospital during 2014-2020

Introducción: la enfermedad pulmonar obstructiva crónica es una limitación del flujo de aire por anomalías alveolares. En una exacerbación aguda, la ventilación mecánica no invasiva es la primera línea en el manejo, sin embargo, existen ciertos factores de riesgo que hacen más probable el uso de ventilación mecánica invasiva en estos pacientes, que no están apropiadamente descritos en la literatura científica y que pueden guiar hacia una elección de soporte ventilatorio apropiado. Objetivo: describir los factores que se asociaron con mayor necesidad de ventilación mecánica no invasiva en una cohorte de pacientes hospitalizados con exacerbación aguda de la enfermedad pulmonar obstructiva crónica. Métodos: estudio observacional analítico de corte transversal, con muestreo no probabilístico que incluye todos los pacientes que consultaron a urgencias y fueron hospitalizados por exacerbación aguda de la enfermedad pulmonar obstructiva crónica en un hospital de tercer nivel de Santander, Colombia, durante el período 2014-2020. Resultados: fueron incluidos 81 pacientes, 36 requirieron ventilación mecánica no invasiva y 12 ventilación mecánica invasiva; 25 % de los pacientes con ventilación mecánica no invasiva fallaron a la terapia inicial y demandaron el uso de ventilación mecánica invasiva. Las comorbilidades más frecuentes fueron hipertensión arterial (70,3 %) y cardiopatía (49,38 %); 70 % había tenido exposición al tabaquismo como fumador directo. Conclusiones: el uso de ventilación mecánica invasiva estuvo relacionado de forma estadísticamente significativa en pacientes con perfil de disnea severa, acidosis por parámetros gasométricos, escalamiento antibiótico, uso de corticoides intravenosos, requerimiento de unidad de cuidado intensivo, infecciones asociadas al cuidado de la salud y estancia hospitalaria prolongada.

Introduction: Chronic obstructive pulmonary disease is airflow limitation due to alveolar abnormalities. In an acute exa- cerbation, non-invasive mechanical ventilation is the first line of management, however, there are certain risk factors that make the use of invasive mechanical ventilation more likely in these patients, which are not adequately described in the scientific literature and that can guide towards a choice of appropriate ventilatory support. Objective: To describe the factors that were associated with an increased need for invasive mechanical ventilation in a cohort of hospitalized patients with an acute exacerbation of chronic obstructive pulmonary disease. Methods: Cross-sectional analytical observational study, with non-probabilistic sampling including all patients who consulted the emergency room and were hospitalized for acute exacerbation of chronic obstructive pulmonary disease in a tertiary care hospital in Santander-Colombia during the period 2014-2020. Results: 81 patients were included, 36 required non-invasive mechanical ventilation and 12 invasive me- chanical ventilation. 25 % of the patients with non-invasive mechanical ventilation failed the initial therapy and demanded the use of invasive mechanical ventilation. The most frequent comorbidities were arterial hypertension (70.3 %) and heart disease (49.38 %). 70 % had been exposed to smoking as direct smokers. Conclusions: The use of invasive mechanical ven- tilation was associated in a statistically significant way in patients with a profile of: severe dyspnea, acidosis by gasometric parameters, antibiotic escalation, use of intravenous corticosteroids, intensive care unit requirement, infections associa- ted with health care and prolonged hospital stay.

A review of studies on visual behavior analysis aided diagnosis of autism spectrum disorders / 生物医学工程学杂志

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and repetitive behaviors. With the rapid development of computer vision, visual behavior analysis aided diagnosis of ASD has got more and more attention. This paper reviews the research on visual behavior analysis aided diagnosis of ASD. First, the core symptoms and clinical diagnostic criteria of ASD are introduced briefly. Secondly, according to clinical diagnostic criteria, the interaction scenes are classified and introduced. Then, the existing relevant datasets are discussed. Finally, we analyze and compare the advantages and disadvantages of visual behavior analysis aided diagnosis methods for ASD in different interactive scenarios. The challenges in this research field are summarized and the prospects of related research are presented to promote the clinical application of visual behavior analysis in ASD diagnosis.

Technical status and development trends of electronic tongue / 药学学报

Electronic tongue is one kind of bionic detection technologies, which can objectively reflect the taste of drugs based on electrochemical principle. In this paper, the development histories of electronic tongue both of potential type and voltammetry type were introduced, including their detection principles and key innovation technologies. In order to comprehensively improve the understanding of electronic tongue, its technological progresses, such as the study of dedicated sensors or biosensors for specific tastes, and the development of miniaturized or hybrid devices, were also discussed in detail. And the challenges and countermeasures in the application of electronic tongue were analyzed to provide some suggestions for its further technology promotion.

Reproductive Health Education Using Interactive Learning Approach among the University Students

@#Introduction: This study objectives were to evaluate the youth’s knowledge and awareness of reproductive health issues among the Hashemite University students and to measure the effectiveness of the interactive teaching approach in delivering the reproductive health knowledge course. Methods: Quantitative and qualitative research designs were used. The sample was 160 (two cohorts) undergraduate students who enrolled in the reproductive health course during two semesters at the Hashemite University. Quantitative data was collected from the students before and after receiving a reproductive health course. Qualitative data was collected through focus group discussions. Results: The study results showed an improvement in the reproductive health awareness level of students. There was a statistically significant increase in the total score of knowledge between the pretest (M = 19.97, SD = 3.89) and posttest (M = 21.65, SD = 4.03) for the first cohort at p =.00. There was a statistically significant increase in the total score of knowledge between pretest (M = 19.33, SD = 2.89) and posttest (M = 20.66, SD = 5.78) for the 2nd cohort at p =.00. Qualitative data revealed that the students were very interested in the reproductive health course and found it very useful for themselves, their families, friends, and society. Conclusion: The interactive learning approach was useful in teaching reproductive health course and increased university students’ awareness regarding reproductive health topics, which were important for students. It was recommended by students to teach reproductive health course to other students in all universities using interactive learning.

Combining transcranial magnetic stimulation with interactive virtual scenario training can improve the upper limb motor function of stroke survivors / 中华物理医学与康复杂志

Objective:To observe any effect of combining low-frequency transcranial magnetic stimulation (rTMS) with interactive virtual scenario training on the recovery of upper limb motor function after a stroke.Methods:Ninety stroke survivors were randomly divided into a pseudo-rTMS group, an rTMS group and a combination group, each of 30. In addition to basic medication, conventional rehabilitation and nursing care, the pseudo-rTMS, rTMS and combination groups received either sham rTMS treatment, 1Hz rTMS or virtual situational interaction along with 1Hz rTMS 5 days a week for 4 weeks. Before and after the 4 weeks their motor evoked potentials, cortical latency and central motor conduction time were measured, and surface electromyography was applied to the affected biceps brachii and triceps brachii. Meanwhile, the National Institutes of Health Stroke Scale, the Fugl-Meyer upper extremity assessment and the modified Barthel index were employed to assess the degree of neurological deficit, upper extremity motor function and ability in the activities of daily living (ADL).Results:After the 4-week intervention, a significant improvement was observed in all of the outcome measurements with all three groups. At that time the average scores of the rTMS group were significantly better than the pseudo-rTMS group′s averages but the average scores of the combination group were significantly better than those of either of the other two groups.Conclusion:Repeated application of low-frequency transcranial magnetic stimulation combined with virtual scenario interactive training can effectively improve the upper limb motor function and ADL performance of stroke survivors, and relieve the symptoms of neurological deficit. The combined therapy is worthy of application in clinical practice.

Application of mind mapping combined with interactive communication mode in clinical teaching of Neurosurgery / 中华医学教育探索杂志

Objective:To observe the application effect of mind mapping combined with interactive communication mode in clinical teaching of neurosurgery.Methods:A total of 40 students who practiced in the Department of Neurosurgery in the Affiliated Hospital of Guizhou Medical University from September 2019 to September 2020 were included in the control group, and traditional teaching was adopted; another 40 students who practiced from October 2020 to October 2021 were included in the observation group, and mind mapping combined with interactive communication mode was adopted for teaching. The two groups of students were taught for 2 weeks, and after the teaching, the teaching effect was compared between the two groups. SPSS 25.0 software was used to conduct t-test and Chi-square test. Results:After 2 weeks of teaching, the scores of theoretical knowledge (90.38±4.03) and practical operation skills (93.37±3.48) in the two groups were higher than those before teaching [(85.52±5.26) and (87.25±4.48)], with statistically significant differences ( t=4.63, 6.83, P<0.001). The case analysis score of the two groups was higher than that before teaching, and that of the observation group (86.03±6.07) was higher than that of the control group (79.13±5.57), with statistically significant differences ( t=5.30, P<0.001). The scores of interpersonal communication ability and cooperation ability of the two groups were higher than those before teaching. The scores of interpersonal communication ability (82.53±4.74), cooperation ability (169.73±7.55) of the observation group were higher than those of the control group [(77.93±4.45) and (158.42±8.01)], with statistically significant differences ( t=4.48, 6.49, P<0.001). Conclusion:Mind mapping combined with interactive communication mode can effectively improve the clinical basic knowledge and clinical practice ability of interns in the Department of Neurosurgery, and improve their communication and cooperation ability.

Virtual simulation teaching exploration of clinical laboratory instrumentation based on "Internet +" / 中华医学教育探索杂志

Clinical laboratory instrumentation is a practical course. In order to change the limitations of the experimental site and the lack of large automatic testing instruments in the current teaching, this paper puts forward the idea of virtual simulation teaching of clinical laboratory instrument. Based on the training objective of medical laboratory application-oriented talents, the design and management of virtual simulation teaching of single instrument and comprehensive project training are formed. The teaching effect evaluation and quality control method are constructed, which significantly improves the students' autonomous learning ability and the comprehensive practical ability. It further promotes the connotation construction of medical laboratory experiment teaching with the help of Internet sharing advantages.

Interactive scalp acupuncture for hemiplegic upper extremity motor dysfunction in patients with ischemic stroke: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the curative effect between interactive scalp acupuncture and traditional scalp acupuncture on hemiplegic upper extremity motor dysfunction in the patients with ischemic stroke.@*METHODS@#Seventy cases of hemiplegic upper extremity motor dysfunction of ischemic stroke were randomly divided into an interactive scalp acupuncture group (35 cases, 1 case breaked off) and a traditional scalp acupuncture group (35 cases, 1 case dropped off). The patients of the two groups received the secondary prevention medication and routine rehabilitation therapy. Besides, in the interactive scalp acupuncture group, the upper extremity occupational therapy was operated during the needle retaining of scalp acupuncture; and in the traditional scalp acupuncture group, the upper extremity occupational therapy was delivered after the completion of scalp acupuncture. The same points were selected in the two groups such as Fuxiang head area, Fuxiang upper-limb-shoulder point, Fuxiang upper-limb-elbow point and Fuxiang upper-limb-wrist point. The needles were inserted perpendicularly by flying-needle technique and manipulated by triple technique of gentle twisting, heavy pressure and vibrating. The needles were retained for 30 min. Based on the degree of the upper extremity motor impairment, the regimen of the upper extremity occupational therapy was formulated individually and one treatment took 30 min. In the two groups, the therapies were delivered once daily, 5 times a week, lasting 4 weeks. Before and after treatment, the scores of Fugl-Meyer assessment of upper extremity (FMA-UE), Wolf motor function test (WMFT), the modified Barthel index (MBI) and the modified Ashworth scale (MAS) grade in the two groups were observed before and after treatment.@*RESULTS@#After treatment, the scores of FMA-UE, WMFT and MBI were higher than those before treatment (P<0.01), and MAS grade was improved (P<0.05) in the two groups. The scores of FMA-UE, WMFT and MBI in the interactive scalp acupuncture group were higher than those in the traditional scalp acupuncture group (P<0.01, P<0.05), and there was no statistical significance in the difference of MAS grade between the two groups (P>0.05).@*CONCLUSION@#The interactive scalp acupuncture can effectively improve the motor function of the hemiplegic upper extremities and the activities of daily living in the patients with ischemic stroke and its efficacy is better than traditional scalp acupuncture. But these two types of scalp acupuncture obtain the similar effect on spasticity.

Report on the Implementation of an Interactive Online Hands-on Seminar for Making Rehabilitation Orthosis with Vietnam in the Period of Travel Restriction / 国際保健医療

Background and Objective  The Projects of Global Growth of Medical Technologies, implemented by NCGM since 2015, have contributed to human resource development through on-site training in partner countries and training in Japan. However, since 2020, online training has become mainstream due to the travel restrictions by COVID-19 impact. As one of the projects, the NCGM and Bach Mai Hospital rehabilitation departments in Vietnam held an interactive online hands-on seminar in FY2022 for Vietnamese occupational therapists and others to provide technical guidance for making splint orthoses to rehabilitate patients with hand dysfunction. This paper aims to report on the preparation and implementation process of the seminar and its results.Preparation and Implementation of the Seminar  NCGM (the instructor) and Bach Mai Hospital (the site of the hands-on training) prepared the seminar through regular online meetings, fostering ownership and collaborative planning on the Vietnamese side, and discussed the program development, necessary materials, participant selection, and obtaining authorization from the Vietnamese Ministry of Health. To ensure the quality of the technical instruction, the seminar was connected via Zoom to both NCGM and Bach Mai Hospital, where the live video of the splinting technique was conducted, along with explanations and Q&A sessions. The post-training evaluation was carried out through a questionnaire with self-assessment of the participants about the knowledge and skills they obtained. Outcome and Discussion  As a result, 96% (27/28) of the participants answered that the seminar was “useful for clinical practice,” suggesting that the interactive online hands-on seminar regarding technical instruction in making splint orthosis was as good as or better than the face-to-face training. We found that the Vietnamese side took ownership from the preparatory stage by establishing a regular online meeting system; the quality of the training was assured by live video by both sides, which enabled detailed technical instruction; the training provider’s skills were improved by more detailed preparation; training was cost-effective compared to on-site training or training in Japan; and the materials used and the training videos can be used as teaching materials, which is expected local benefits and sustainability. These findings can be applied to face-to-face training to make the training more effective and extended as a useful method when similar activities are developed in other countries.

Niños y adultos armando un rompecabezas digital e interactivo en el hogar / Children and Adults Assemblig a Digital and Interactive Puzzle at Home / Crianças e adultos montando um quebra-cabeça digital e interativo em casa

Esta investigación se propuso explorar y analizar las características que presenta la interacción entre niños y adultos con un juego digital e interactivo que implica la solución de un problema, el armado de rompecabezas en una tablet. Se realizaron observaciones seminaturalísticas en los hogares y se indagó mediante un cuestionario la tenencia y hábitos de uso de tecnologías. Las interacciones se analizaron con un sistema de categorías construido inductivamente. Adultos y niños participaron de manera activa en la tarea. Los adultos ayudaron a los niños en su mayo-ría por medio de preguntas, guías e informaciones, acompañadas con frecuencia de acciones no verba-les como señalamientos y arrastre de las piezas. Las intervenciones infantiles fueron en su mayoría no verbales. A pesar de encontrar una fuerte presencia de tecnologías en los hogares, se diferenciaron dos grupos respecto a hábitos de uso: un grupo reportó un bajo uso y los niños no accedían a tablets, otro expresó mayor uso y los niños las utilizabancon frecuencia. Las intervenciones en el armado del rompecabezas se diferenciaron en función de la experiencia infantil con tecnologías. Los resultados se discuten a la luz de investigaciones previas sobre la interacción adulto-niño con herramientas analógicas y digitales.

This study aimed to explore and analyze the charac-teristics of the interaction between children and adults with a digital and interactive game that involves solv-ing a problem, that is, assembling puzzles on a tablet. Semi-naturalistic observations of the interactions in the homes were carried out, and the possession and the habits of the use of were investigated through a survey. The interactions were analyzed with an induc-tively constructed category system. Adults and chil-dren actively participated in the task. Adults helped the children mainly through questions, guidance, and information, accompanied frequently by nonverbal actions, such as pointing at and sliding the pieces. Most of the children's interventions were nonverbal. Despite finding a significant technology presence in the homes, two groups were differentiated regard-ing their habits of use. One group reported little use of technology and no access to tablets for children. Another one expressed that the children used tablets frequently. The interventions in the task differed ac-cording to the children's experience with technologies. The results were discussed considering previous research on adult-child interaction with analogical and digital tools.

Esta pesquisa teve como objetivo explorar e analisar as características da interação entre crianças e adultos com um jogo digital e interativo que envolve a resolução de um problema, a montagem de quebra-cabeças em um tablet. Observações seminaturalísticas foram feitas nas residências e a posse e hábitos de uso de tecnologia foram indagados por meio de um questio-nário. As interações foram analisadas com um sistema de categorias construído indutivamente. Adultos e crianças participaram ativamente da tarefa. Os adul-tos ajudavam seus filhos principalmente por meio de perguntas, orientações e informações, muitas vezes acompanhadas de ações não verbais, como apontar e arrastar as peças. As intervenções das crianças foram em sua maioria não verbais. Apesar de constatar uma forte presença de tecnologias nas residências, dois grupos se diferenciaram quanto aos hábitos de uso. Um grupo relatou baixo uso e as crianças não acessavam tablets, outro grupo expressou maior uso e as crianças os utilizavam com frequência. As intervenções na montagem do quebra-cabeça foram diferenciadas de acordo com a experiência da criança com as tecnologias. Os resultados são discutidos à luz de pesquisas anteriores sobre a interação adulto-criança com ferramentas analógicas e digitais.

Resultados de la ventilación asistida ajustada neuronalmente no invasiva y la presión positiva continua nasal en recién nacidos prematuros: revisión sistemática y metanálisis / Outcomes of noninvasive neurally adjusted ventilatory assist and nasal continuous positive airway pressure in preterm infants: a systematic review and meta-analysis

Introducción: los beneficios de la ventilación asistida ajustada neuronalmente (NAVA) en los recién nacidos prematuros son inciertos. El objetivo de este estudio fue explorar si la NAVA no invasiva (NIV) era más beneficiosa para los recién nacidos prematuros que la presión positiva continua nasal (NCPAP). Diseño del estudio: metanálisis de tres ensayos clínicos: dos ensayos controlados aleatorizados y un estudio de grupos cruzados. Se comparó la NAVA-NIV con la NCPAP y se informó sobre el fracaso del tratamiento, la mortalidad y los eventos adversos como resultados principales. Resultados: tres estudios con 173 pacientes (89 recibieron NAVA-NIV) cumplieron los criterios de inclusión en este metanálisis. No se observaron diferencias en el fracaso del tratamiento entre la NAVA-NIV y la NCPAP (razón de riesgos [RR] = 1,09; intervalo de confianza [IC] del 95 % = 0,65-1,84; diferencia de riesgos = 0,02; IC95% = -0,10-0,14; I2 = 33 %; P = 0,23). De manera similar, no hubo diferencias en la mortalidad (RR = 1,52; IC95% = 0,51-4,52; no aplica heterogeneidad). En comparación con la NCPAP, la NAVA-NIV redujo significativamente el uso de cafeína (RR = 0,85; IC 95% = 0,74-0,98; I2 = 71 %; P = 0,03). Conclusiones: en comparación con la NCPAP, no hay evidencia suficiente para sacar una conclusión sobre los beneficios o daños de la NAVA-NIV en los recién nacidos prematuros. Los hallazgos de esta revisión deben confirmarse en ensayos clínicos con una metodología rigurosa y potencia adecuada

Introduction: The benefits of neurally adjusted ventilatory assist (NAVA) in preterm infants are unclear. This study aimed to explore if noninvasive NAVA is more beneficial for preterm infants than nasal continuous positive airway pressure (NCPAP). Study design: Meta-analysis was performed in three clinical trials comprising two randomized controlled trials and one crossover study. We compared NIV-NAVA and NCPAP and reported treatment failure, mortality, and adverse events as the primary outcomes. Results: Three studies including 173 patients (89 of whom underwent NIV-NAVA) were eligible for this meta-analysis. This review found no difference in treatment failure between NIV-NAVA and NCPAP (RR 1.09, 95% CI 0.65 to 1.84; RD 0.02, 95% CI -0.10-0.14; I2=33%, P=0.23). Similarly, there was no difference in mortality (RR 1.52, 95% CI 0.51-4.52, heterogeneity not applicable). Compared with NCPAP, NIV-NAVA significantly reduced the use of caffeine (RR 0.85, 95% CI 0.74-0.98, I2=71%, P=0.03). Conclusions: Compared with NCPAP, there is insufficient evidence to conclude on the benefits or harm of NIV-NAVA therapy for preterm infants. The findings of this review should be confirmed using methodologically rigorous and adequately powered clinical trials.

Interdisciplinaridade em estágio de vivência acadêmica: reconhecimento da atuação profissional no Sistema de Saúde / Interdisciplinarity in an academic experience internship: recognition of professional performance in the Health System / Interdisciplinaridad en prácticas de experiencia académica: reconocimiento de la actuación profesional en el Sistema de Salud

Objetivo: Descrever a experiência de um estágio acadêmico vivenciado por universitários da área da saúde em um município do Baixo Solimões. Síntese dos dados:Trata-se do relato descritivo de um estágio acadêmico extramuro realizado em Manacapuru, Amazonas, ocorrido no período de outubro de 2019 a fevereiro de 2020. A realização da atividade teve a participação de acadêmicos de Medicina, Enfermagem e Odontologia e contou com a aplicação de práticas em saúde direcionadas à atuação individual e coletiva. Tendo como público-alvo os pacientes atendidos por uma Unidade Básica de Saúde (UBS), os universitários auxiliaram na realização de atendimentos eletivos em suas respectivas áreas de atuação e conduziram atividades de educação em saúde como rodas de conversa, gincanas educativas, palestras interativas e educação continuada à equipe da UBS. Conclusão: As práticas e ações em saúde realizadas no período do estágio extramuro proporcionaram uma integração interdisciplinar satisfatória entre os acadêmicos, possibilitando aos mesmos uma vivência apropriada na atenção básica do Sistema Único de Saúde (SUS).

Objective: To describe the experience of an academic internship completed by university students in the health field in a municipality in Baixo Solimões. Data synthesis: This is a descriptive report of an extramural academic internship carried out in Manacapuru, Amazonas, from October 2019 to February 2020. The activity was carried out with the participation of medical, nursing and dentistry students and included the application of health practices aimed at individual and collective action. Having as a target audience the patients assisted by a Primary Health Care (PHC) center, the university students helped in carrying out elective care in their respective fields and conducted health education activities such as conversation circles, educational scavenger hunts, interactive lectures and continuing education for the PHC center team. Conclusion: The health practices and actions carried out during the extramural internship enabled a satisfactory interdisciplinary integration among the students and allowed them to have an appropriate experience in primary care in the Unified Health System (Sistema Único de Saúde ­ SUS).

Objetivo: Describir la experiencia de una pasantía académica vivida por universitarios del área de la salud en un municipio del Baixo Solimões. Síntesis de los datos: Se refiere al informe descriptivo de una pasantía académica extramuros realizado en Manacapuru, Amazonas, ocurrido entre octubre de 2019 y febrero de 2020. La realización de la actividad tuvo la participación de académicos de medicina, enfermería y odontología y contó con la aplicación de prácticas en salud direccionadas a la actuación individual y colectiva. Teniendo como público meta los pacientes atendidos por una Unidad Básica de Salud (UBS), los universitarios ayudaron en la realización de atendimientos electivos en sus respectivas áreas de actuación y condujeron actividades de educación y en salud como charlas, juegos educativos, conferencias interactivas y educación continuada para el equipo de la UBS. Conclusión: Las prácticas y acciones en salud realizadas en el período de la pasantía extramuros proporcionaron una integración interdisciplinar satisfactoria entre los académicos, posibilitando a los mismos una experiencia apropiada en la atención básica del Sistema Único de Salud (SUS).

Conciencia psico-pedagógica comunicativa en la prevención del consumo de psicotrópicos y de las violencias / More awareness psycho-pedagogical for the prevention of psychotropic consumption and violence's

En este artículo se presentan los resultados de una investigación cualitativa hermenéutica cuyo objetivo fue explorar la relación del consumo de psicotrópicos y las variables psicosociales entre 1998-2019 en campus universitarios en una ciudad colombiana, un problema crítico exponencial global de salud pública que poco se afronta desde la prevención real de los factores de riesgo. Se encontró que prevalece el diagnóstico y no se evidencia una intervención preventiva que ayude a la evolución de las causas que inducen a la decisión de consumir o no. El análisis sugiere que: 1) persiste el desafío de ir más allá de las acciones punitivas o permisibles; 2) se requiere incrementar la intervención psicoeducativa que concientice al adicto sobre los riesgos del consumo de psicotrópicos; 3) resulta prioritario, para trascender el diagnóstico, indagar sobre las causas estructurales; y 4) las políticas públicas educativas deben fortalecerse con enfoques psicopedagógicos que estimulen el proceso complejo de la expresividad e impulsen la trazabilidad de la educación y la formación basada en la comunicación bidireccional en familia.

Qualitative research hermeneutical. The objective was to explore relationship of consumption of psychotropics and psychosocial variables, between 1998-2019 at campus and in a Colombian city. It is a critical global public health exponential problem that is little addressed from the risks. It was found that: the diagnosis prevails and there is no evidence of a preventive intervention that helps the evolution of the causes that induces the decision to consume or not. The analysis suggests that: 1) the challenge of going beyond punitive or permissible actions persists; 2) it is need more psychoeducational intervention to make the addict mindful for following other ways; 3) it is urgent to investigate the structural causes beyond making a diagnosis; and 4) build together other psicopedagogical educational public policy that stimulates the complex process of education-training; theses based on two-way expressiveness, optimism, kindness, and promotes the traceability communication in the family and within the curricular plan. For to reduce the multidimensional impact caused by the consumption of psychotropic drugs by human, academic, professional, sociocultural, and economic destabilization

Effects of Interactive Dynamic Scalp Acupuncture on Motor Function and Gait of Lower Limbs after Stroke: A Multicenter, Randomized, Controlled Clinical Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the effects of interactive dynamic scalp acupuncture (IDSA), simple combination therapy (SCT), and traditional scalp acupuncture (TSA) on motor function and gait of the lower limbs in post-stroke hemiplegia patients.@*METHODS@#A total of 231 patients with post-stroke hemiplegia was randomly divided into IDSA (78 cases), SCT (78 cases), and TSA (75 cases) groups by a random number table. Scalp acupuncture (SA) and lower-limb robot training (LLRT) were both performed in the IDSA and SCT groups. The patients in the TSA group underwent SA and did not receive LLRT. The treatment was administered once daily and 6 times weekly for 8 continuous weeks, each session lasted for 30 min. The primary outcome measures included Fugl-Meyer assessment of the lower extremity (FMA-LE), berg balance scale (BBS), modified barthel index (MBI), and 6-min walking test (6MWT). The secondary outcome measures included stride frequency (SF), stride length (SL), stride width (SW), affected side foot angle (ASFA), passive range of motion (PROM) of the affected hip (PROM-H), knee (PROM-K) and ankle (PROM-A) joints. The patients were evaluated before treatment, at 1- and 2-month treatment, and 1-, and 2-month follow-up visits, respectively. Adverse events during 2-month treatment were observed.@*RESULTS@#Nineteen patients withdrew from the trial, with 8 in the IDSA and 5 in the SCT groups, 6 in the TSA group. The FMA-LE, BBS, 6MWT and MBI scores in the IDSA group were significantly increased after 8-week treatment and 2 follow-up visits compared with the SCT and TSA groups (P<0.05 or P<0.01). Compared with pre-treatment, the grade distribution of BBS and MBI scores in the 3 groups were significantly improved at 1, 2-month treatment and 2 follow-up visits (P<0.05 or P<0.01). The SF, PROM-H, PROM-K and PROM-A in the IDSA group was significantly increased compared with the SCT and TSA groups after 8-week of treatment (P<0.05 or P<0.01). Compared with the SCT group, ASFA of the IDSA group was significantly reduced after 8-week of treatment (P<0.05). SF, SL, PROM-K and PROM-A were significantly increased at the 2nd follow-up visit whereas the ASFA was significantly reduced in the IDSA group compared with the SCT groups at 1st follow-up visit (P<0.05 or P<0.01). The SF was significantly increased in the SCT group compared with the TSA group after 8-week treatment (P<0.05). Compared with the TSA group, PROM-K, PROM-A were significantly increased at the 2nd follow-up visit (P<0.05).@*CONCLUSIONS@#The effects of IDSA on lower-limb motor function and walking ability of post-stroke patients were superior to SCT and TSA. The SCT was comparable to TSA treatment, and appeared to be superior in improving the motion range of the lower extremities. (Registration No. ChiCTR1900027206).

Effect of Interactive Dynamic Scalp Acupuncture on Post-Stroke Cognitive Function, Depression, and Anxiety: A Multicenter, Randomized, Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To compare the clinical effects of interactive dynamic scalp acupuncture (IDSA), simple combination therapy (SCT), and traditional scalp acupuncture (TSA) on cognitive function, depression and anxiety in patients with post-stroke cognitive impairment.@*METHODS@#A total of 660 patients with post-stroke cognitive impairment who were admitted to 3 hospitals in Shenzhen City between May 2017 and May 2020 were recruited and randomly assigned to the IDSA (218 cases), SCT (222 cases) and TSA groups (220 cases) according to a random number table. All the patients received conventional drug therapy for cerebral stroke and exercise rehabilitation training. Scalp acupuncture and computer-based cognitive training (CBCT) were performed simultaneously in the IDSA group, but separately in the morning and in the afternoon in the SCT group. The patients in the TSA group underwent scalp acupuncture only. The course of treatment was 8 weeks. Before treatment (M0), 1 (M1) and 2 months (M2) after treatment, as well as follow-up at 1 (M3) and 2 months (M4), the cognitive function of patients was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) Scales; depression, anxiety, sleep quality, and self-care ability of patients were assessed using Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Pittsburgh Sleep Quality Index (PSQI), and Modified Barthel Index (MBI), respectively. During this trial, all adverse events (AEs) were accurately recorded.@*RESULTS@#There were no significant differences in the MMSE, MoCA, HAMD, HAMA, PSQI, and MBI scores among the 3 groups at M0 (all P>0.05). In the IDSA group, the MMSE, MoCA and MBI scores from M2 to M4 were significantly higher than those in the SCT and TSA groups, while the HAMD, HAMA and PSQI scores were significantly reduced (all P<0.01). The changes of all above scores (M2-M0, M4-M0) were significantly superior to those in the SCT and TSA groups (all P<0.01, except M4-M0 of HAMD). At M2, the severity of MMSE, HAMD, HAMA, PSQI and MBI in the IDSA group was significantly lower than that in the SCT and TSA groups (all P<0.01). There was no serious AE during this trial.@*CONCLUSIONS@#IDSA can not only significantly improve cognitive function, but also reduce depression, anxiety, which finally improves the patient's self-care ability. The effect of IDSA was significantly better than SCT and TSA. (Trial registration No. ChiCTR1900027206).

Exploration of the evaluation practice of medical quality management from the perspective of interactive governance / 中华医院管理杂志

Modern medical quality management is characterized by professionalism, continuity and comprehensiveness. It is necessary to strengthen the communication and cooperation among health administrative authorities, medical institutions and professionals. Since 2011, based on the guidance of the interactive governance theory and the governance interface as a platform, Zhejiang Province had explored and established a relatively independent third-party quality evaluation service organization, which aimed to correct such setbacks as the imbalance and inadequacy of medical quality management. Through the interaction of organization interface, management interface, service interface, information interface and method interface, the province had initially achieved the multi-level diagonal governance in medical quality management, and transformed the traditional management relationship into an interactive relationship. This practice had achieved desirable results in improving the quality control work network, updating management methods, and improving medical quality and safety, serving as reference in upgrading the medical quality and safety management of medical institutions in China.

Ethical Issues of Explainable Artificial Intelligence for Medical Applications / 中国医学伦理学

Explainable artificial intelligence (AI) promotes the development of medicine and raises different ethical challenges. This new challenge is manifested in two aspects, including pre-interpretation and post-interpretation. The technical root of the ethical issues leading to the medical application of explainable AI is the negative effects of explainable technology, the social root is the lack of relevant moral principles and legislation, and the root of subjectivity lies in the diversity of interests of various stakeholders. Therefore, the solutions to the problem are to strengthen technological innovation, explainable AI medical application ethics education, training of medical staff and interdisciplinary cooperation, improve relevant moral principles, laws and regulations, and realize personalized interactive interpretation.

Value of an online interactive training program for improving cytopathological diagnostic ability of endoscopists in endoscopic ultrasound-guided fine-needle aspiration of pancreas / 中华消化内镜杂志

Objective:To develop an online interactive cytopathological training program, and to evaluate it for improving the cytopathological diagnostic ability of endoscopists in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreas.Methods:A total of 5 500 cytopathological images were collected from 194 patients with pancreatic solid mass who underwent EUS-FNA in Nanjing Drum Tower Hospital from August 2018 to August 2019. The cell type in each cytopathological picture was labeled by senior cellular pathologists, which was used to build a learning and testing platform for online interactive cytopathological training. Five endoscopists without cytopathological background were invited to participate in this training. Sensitivity, specificity, positive predictive value and negative predictive value of endoscopists in differential diagnosis of cancer and non-cancer before and after training were compared to evaluate the effect of the online interactive cytopathological training program on improving the ability of endoscopists in diagnosis of cytopathology.Results:A cytopathological training platform for endoscopists to learn and take online test was successfully built. Before training, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of diagnosis of cancer and non-cancer for endoscopists were 0.55 (95% CI: 0.53-0.58), 0.32 (95% CI: 0.30-0.35), 0.43 (95% CI: 0.41-0.45), 0.44 (95% CI: 0.41-0.47) and 0.43 (95% CI: 0.42-0.45), respectively. After training, the above indicators were 0.96 (95% CI: 0.95-0.97), 0.70 (95% CI: 0.68-0.73), 0.74 (95% CI: 0.72-0.76), 0.95 (95% CI: 0.94-0.96) and 0.81 (95% CI: 0.80-0.83), respectively, which were significantly improved compared with those before ( P<0.001). Conclusion:The online interactive cytopathological training program can improve the understanding and diagnostic ability of endoscopists in pancreatic cytopathology, help to implement rapid on-site evaluation in the process of EUS-FNA, and improve the diagnostic efficiency of EUS-FNA.