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Resumen El Servicio Mejor Niñez es un organismo público que tiene como objetivo garantizar la protección de derechos de niños, niñas y adolescentes al amparo de la Ley N.º 21302. En los últimos años, se ha visto cuestionado tanto por la opinión pública como por organismos internacionales, por incumplimiento de las funciones para la cual se creó. En esta línea, el objetivo de esta investigación se centró en la percepción de los profesionales interventores sobre la vulneración de derechos sobre niños, niñas y adolescentes en la zona centro-sur de Chile. Estas personas son profesionales en Psicología y Trabajo Social que durante años han trabajado en programas de protección de vulneración de derechos, y han desempeñado un rol protector en cuanto a la protección de estos derechos. Para ello, se utilizó un método cualitativo basado en un enfoque fenomenológico, a partir de entrevistas que permitieron conocer los significados y percepciones sobre su ejercicio profesional. Los resultados destacan la visión opuesta y extrema de los profesionales sobre el proceso de intervención (satisfactoria y frustrante), así como la diversidad de modelos o enfoques utilizados en el proceso, lo que parece indicar que no existe una sistematización teórica en cuanto a la intervención que cada programa utiliza. Se estableció una reflexión importante sobre la ejecución de políticas en infancia y adolescencia que buscan promover el desarrollo integral en el marco postpandemia por COVID-19, considerando que muchas personas menores de edad se vieron nuevamente expuestas a vulneraciones de derechos durante el proceso de pandemia.
Abstract The Childhood Improvement Service is a public agency whose objective is to guarantee protection of the rights of children and adolescents with respect to the enactment of Law No. 21302. This has been questioned in recent years by both public opinion and international organizations, in relation to a failure to fulfill the functions for which it was created. In this sense, the objective of this research focused on the perception of professionals involved in children's and adolescents' rights in the central-south zone of Chile. The professionals are psychologists and social workers who have worked to protect the rights circumscribing the different types of interventions and multidisciplinary approaches carried out. For this purpose, a qualitative method was used in phase with a phenomenological approach, based on interviews that allowed ascertaining the meanings and perceptions regarding their professional practice. The results highlight the opposed and extreme views of the professionals in the intervention process (satisfactory versus frustrating), as well as the diversity of models or approaches used in the process, which seems to indicate that there is no theoretical systematization regarding the intervention applied by each program. Establishing an important reflection on the implementation of policies in childhood and adolescence that seek to promote integral development in the post-Covid-19 Pandemic framework.
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Humanos , Masculino , Femenino , Defensa del Niño , Estudio de Vulnerabilidad , Chile , Entrevista , COVID-19RESUMEN
Aunque los cogollos de la palma de iraca pueden ser empleados como fuente para la alimentación humana, la mayoría de la información disponible es para la producción de artesanías. Se evaluó la respuesta a la impregnación al vacío (IV) de cogollos frescos de palma de iraca (CFPI), con una solución isotónica de NaCl (0,6 %). Se utilizó la metodología de superficie de respuesta, con un diseño central compuesto ((=1), considerando las siguientes variables independientes: el diámetro de los cogollos (10-15 mm), el tiempo en la etapa de vacío T1 (3-5 minutos) a presión de vacío (4.1 kPa) y el tiempo en la etapa a presión atmosférica local (85,32 kPa), T2 (3-5 min). Las variables dependientes que se tomaron en cuenta fueron fracción volumétrica de impregnación en la etapa de vacío (X1), deformación volumétrica final (g), fracción volumétrica final (X) y porosidad eficaz (Ee). La dinámica de la IV del CFPI identificó que el proceso comporta una expansión volumétrica en la matriz, la cual, finalmente, contribuye a la transferencia de masa del líquido isotónico al interior de la estructura. La microestructura porosa del CFPI es compatible con el proceso de IV, permitiendo los siguientes parámetros de impregnación: g1 (0,451%), X1 (11,457%), g (2,569%), X (17,386%) y Ee (17,036%). La respuesta a la IV en los CFPI identifica a esta matriz alimentaria como adecuada, para la incorporación de componentes fisiológicamente activos.
Although the buds of the iraca palm could be employed as a source of human food, most of the information available is to produce handicrafts. The response to vacuum impregnation (VI) was evaluated in fresh iraca palm buds (FIPB) with an isotonic NaCl solution (0.6 %). The response surface methodology was obtained, with a central compound design (a= 1), considering the following independent variables: The diameter of the buds (10-15 mm), the time in the vacuum stage T1 (3-5 minutes) at vacuum pressure (4.1 kPa) and the time in the stage at local atmospheric pressure (85.32 kPa), T2 (3-5 min). The dependent variables considered were the volumetric fraction of impregnation in the vacuum stage (X1), the final volumetric deformation (g), the final volumetric fraction (X), and the effective porosity (Ee). FIPB VI dynamics identified that the process involves a volumetric expansion in the matrix, which ultimately contributes to the mass transfer of the isotonic liquid into the structure. The porous microstructure of the FIPB is compatible with the VI process, allowing the following impregnation parameters: g1 (0.451 %), X1 (11.457 %), g (2.569 %), X (17.386%), and Ee (17.036 %). The response to VI in FIPB identifies this food matrix as suitable for the incorporation of physiologically active components.
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Purpose: The aim of this study was to evaluate the efficacy of the illuminated chopper?assisted cataract surgery in terms of shortening the surgical time and reducing the use of pupil expansion devices in eyes with iris challenges. Methods: This was a retrospective case series of a university hospital. Four hundred forty?three eyes of 433 consecutive patients who underwent illuminated chopper?assisted cataract surgery were included in this study. Cases with preoperative or intraoperative miosis, iris prolapse, and intraoperative floppy iris syndrome were included in the iris challenge group. Use of tamsulosin, iris hooks, pupil size, surgical time, and improved visibility (100/surgical time × pupil size) were compared between eyes with and without iris challenges. Mann–Whitney U test, Pearson’s Chi?square test, and Fisher’s exact test were used for statistical analysis. Results: Of 443 eyes, 66 were included in the iris challenge group (14.9%). Tamsulosin use was more common in patients with iris challenges and iris hooks were used more frequently (9.1% vs. 0%, P < 0.001) in patients with iris challenges than in those without iris challenges. Pupil size was smaller in patients with iris challenges (6.01 vs. 7.64 mm, P < 0.001). However, surgical time was not different (16.9 vs. 16.5 min, P = 0.064) between the two groups. As a result, improved visibility was calculated to be higher in patients with iris challenges (1.05 vs. 0.81, P < 0.001). Conclusion: In terms of surgical time and improved visibility, using the illuminated chopper simplified cataract surgery involving iris challenges. The use of an illuminated chopper is expected to be a good solution for challenging cataract surgeries.
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Objective:To evaluate the effectiveness of prevention and control of coal-burning-borne endemic fluorosis in Sichuan Province, and to provide basis for further development of targeted prevention and control measures.Methods:According to the requirements of the Implementation Plan for the Elimination and Evaluation of Coal-burning-borne Endemic Fluorosis in Sichuan Province, from 2018 to 2021, the assessment of the elimination of coal-burning-borne endemic fluorosis was carried out in all the endemic fluorosis villages of 23 counties (cities, districts) in Sichuan Province. In each village, 30 households were selected to be investigated the use of improved stoves, the drying of corn and pepper for human consumption, and the prevalence of dental fluorosis among all children aged 8 - 12 years old in the village.Results:A total of 222 242 households were surveyed in 1 640 villages, 196 towns, 23 counties (cities, districts) in Sichuan Province. Among them, the rate of qualified improved stoves was 99.99% (222 238/222 242), the correct use rate of qualified improved stoves was 99.90% (212 026/222 238), and the correct drying rate of corn and pepper for human consumption was 99.96% (212 630/212 721). A total of 135 125 children aged 8 to 12 years old were examined, and 5 927 cases of dental fluorosis were detected. The prevalence of dental fluorosis in children was 4.39%. The grading of dental fluorosis was mainly very mild and mild, which were 2.71% (3 656/135 125) and 1.32% (1 783/135 125), respectively. In the county-level self-assessment of 1 640 villages, 1 621 villages had reached the elimination standard, with the elimination rate of 98.84%. Taking counties as a unit, the elimination rate of diseased villages ranged from 96.69% to 100.00%, and 23 diseased counties (cities, districts) had reached the elimination standard. In the provincial-level review results of 174 villages with endemic fluorosis, 174 diseased villages had reached the elimination standard, with the consistency rate of 98.85% (172/174) with the county-level self-assessment results. Among them, except for Gulin County, the consistency rate of self-assessment results was 7/9, the consistency rate of other counties (cities, districts) was 100.00%.Conclusions:The prevention and control of coal-burning-borne endemic fluorosis in Sichuan Province has achieved remarkable results, and all the diseased counties (cities, districts) have reached the elimination standard. In the future, we should continue to take active prevention and control measures to ensure that the elimination status is maintained.
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Objective:To learn about the changes of the condition of coal-burning-borne endemic arsenism, the use of improved stoves and the formation of health-related behaviors in Shaanxi Province, and evaluate the effect of prevention and control measures.Methods:From 2015 to 2020, according to the "Implementation Plan for Monitoring Coal-burning-borne Endemic Arsenism in Shaanxi Province", regular field surveys were carried out in 4 natural villages, 2 counties in Ankang City and Hanzhong City, Shaanxi Province, to learn about the basic prevention and control situation in the monitoring village. Using the simple random sampling method, 10 families in each village were selected to investigate the use of stoves and the formation of health-related behaviors, and 5 of these families were selected to collect coal samples for arsenic content determination in accordance with the "Determination of Arsenic in Coal" (GB/T 3058-2008). According to the "Diagnosis of Endemic Arsenicosis" (WS/T 211-2015), the condition of the people exposed to high arsenic coal in the monitoring village was investigated. Urine samples of 30 adult patients (half males and half females) with arsenic poisoning were collected, the content of arsenic in urine was determined by the "Urine-Determination of Arsenic-Silver Diethyldithiocarbamate-Triethanolamine-Spectrophotometric Method" (WS/T 28-1996).Results:A total of 240 households were monitored in the past 6 years, and the quality conformance and correct utilization rates of improved stoves in the households monitored in the disease areas remained at 100.00% in 2018 - 2020. The utilization rate of clean energy increased from 75.00% (30/40) in 2015 to 100.00% (40/40) in 2018 - 2020 (χ 2trend = 25.5, P < 0.001). The 73.75% (177/240) of households using a variety of clean energy. From 2018 to 2020, the correct drying, storage and pre-processing washing rates of corn and pepper continued to reach 100.00% (40/40). The arsenic content of coal ( n = 120) in the disease areas was (118.09 ± 57.91) mg/kg, ranging from 16.70 to 280.94 mg/kg. The detection rate of arsenic poisoning decreased from 6.34% (231/3 646) in 2015 to 2.90% (109/3 754) in 2020 (χ 2trend = 121.8, P < 0.001), and no skin cancer or Bowen's disease was detected. The geometric mean of arsenic content in urine ( n = 720) was 0.038 1 mg/L, ranging from 0.000 5 to 0.312 9 mg/L. Conclusions:The condition of coal-burning-borne endemic arsenism areas in Shaanxi Province has reached the national elimination standard. The quality and correct utilization rate of improved stoves and the rate of using clean energy have increased. The healthy-related behaviors the people in the endemic areas have been basically formed. The prevention and control work has achieved good results.
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Objective:To evaluate the effect of the improved team-based learning (TBL) teaching method in the undergraduate probation course of ophthalmology based on the goal of cultivating excellent doctors.Methods:The undergraduates of clinical medicine were randomly divided into experimental group and control group. The control group ( n=50) was given conventional ophthalmology probation teaching, while the experimental group ( n=50) was given ophthalmology probation teaching of improved TBL teaching method. The theoretical examination performance and skill assessment results of students in the two groups were compared, and the subjective evaluation of the students on the teaching was also compared. SPSS 23.0 was used to conduct t-test and Wilcoxon's rank sum test. Results:The theoretical examination performance of experimental group (29.68±4.52) was better than that of control group (27.84±4.33), with significant differences ( P<0.05); the skill assessment results of experimental group (32.88±5.05) were also better than those of the control group (30.88±6.99), with significant differences ( P<0.05); the subjective evaluation of teaching effect in each item of experimental group was better than that of control group ( P<0.05). Conclusion:The improved TBL teaching method can not only improve students' theoretical knowledge and experimental skills, but also improve students' self-study and teamwork ability, which will provide a feasible educational reform plan for achieving the goal of cultivating excellent doctors.
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OBJECTIVE@#To explore the effect of a modified three-point bending fracture device for establishing a rabbit model of closed tibial fracture.@*METHODS@#The model of closed tibial fracture was established in 40 6-month-old male New Zealand white rabbits with a body weight of 2.5 to 3.0 kg, and the model was verified at 6 weeks after operation. Five rabbits underwent pre modeling without temporary external fixation before modeling, and then were fractured with a modified three-point bending fracture device;35 rabbits underwent formal modeling. Before modeling, needles were inserted, and splints were fixed externally, and then the fracture was performed with a modified three-point bending fracture device. The fracture model and healing process were evaluated by imaging and histopathology at 2 hours, 4 weeks, and 6 weeks after operation.@*RESULTS@#Two hours after modeling, the prefabricated module showed oblique fracture in varying degrees and the broken end shifted significantly;Except for 1 comminuted fracture, 2 curved butterfly fractures and 2 without obvious fracture line, the rest were simple transverse and oblique fractures without obvious displacement in formal modeling group. According to the judgment criteria, the success rate of the model was 85.71%. Four weeks after modeling, the fixed needle and splint of the experimental rabbits were in good position, the fracture alignment was good, the fracture line was blurred, many continuous callus growths could be seen around the fracture end, and the callus density was high. Six weeks after modeling, many thick new bone trabeculae at the fracture, marginal osteoblasts attached, and a small number of macrophages were seen under the microscope. The intramembrane osteogenesis area was in the preparation bone stage, the medullary cavity at the fracture had been partially reopened, the callus was in the absorption plastic stage, and many osteoclasts were visible. The X-ray showed that the fracture line almost disappeared, part of the medullary cavity had been opened, the external callus was reduced around, the callus was in the plastic stage, and the bone cortex was continuous. It suggests that the fracture model showed secondary healing.@*CONCLUSION@#The improved three-point bending fracture device can establish a stable rabbit model of closed tibial fracture, and the operation is simple, which meets the requirements of closed fracture model in basic research related to fracture healing.
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Conejos , Masculino , Animales , Callo Óseo , Curación de Fractura , Fracturas de la Tibia/cirugía , Osteogénesis , RadiografíaRESUMEN
Objective:To explore the protective effect and mechanism of improved St. Thomas solution on canine skeletal muscle ischemia-reperfusion injury (IRI).Methods:Between March 2021 and September 2021, in the experimental operating room at the Air Force Hospital of the PLA Eastern Theater Command, 16 Beagles were randomly divided into control group, IRI group, IRI+NS group, and improved St. Thomas group, 4 in each group. The canine skeletal muscle IRI model was established, and the canine vital signs were monitored by pre-perfusion with improved St. Thomas perfusate [potassium chloride (KCl), magnesium sulfate (MgSO 4), and NaHCO 3 (pH adjusted)]. The pathological damage of canine skeletal muscle was explored by hematoxylin eosin (HE) staining, electron microscope detection and tissue wet/dry weight ratio, and blood vessel density. Hypoxia performances were detected by labeling blood vessels and hypoxia-inducible factor-1α (HIF-1α). The IRI model of L6 rat myoblasts was established, and the components of St. Thomas perfusion solution were pre incubated to explore the effect on the inhibition of cell proliferation. And by detecting reduced nicotinamide adenine dinucleotide phosphate (NADPH), F2 isoprostane (F2-isoprostane), interleukin 1β(IL-1β), tumour necrosis factor alpha (TNF-α), myeloperoxide enzyme (MPO), glutathione peroxidase (GSH-Px), etc. to explore its protective mechanism. Statistical software SPSS 23.0 was used for statistical analysis, A P<0.05 was set as statistically significant. Results:In the improved St. Thomas group, the vital signs of the dogs were relatively stable, the amount of maintained dopamine was less, the histopathological structure of the gastrocnemius muscle tended to be intact, the swelling of tissue cells and mitochondria was significantly relieved, and the tissue wet/dry weight ratio was less than that in the IRI group ( P=0.046). Pre-incubated with therapeutic doses of MgSO 4 or NaHCO 3, the proliferation rate of L6 cells was higher than that of IRI group ( P<0.01, P=0.005), NADPH ( P=0.004, P=0.001), F2-isoprostane ( P<0.01, P=0.01), IL-1β ( P=0.02, P=0.015), TNF-α ( P<0.01, P<0.01), MPO ( P<0.01, P<0.01) were all lower than those in the IRI group, except GSH-Px that was higher than what in the IRI group ( P<0.01). Conclusion:Pre-perfusion of the improved St. Thomas solution can stabilise the vital signs of dogs in a short period of time. The solution can improve the state of skeletal muscle cells, improve tissue hypoxia, and reduce the damage of skeletal muscle tissue cells through anti-inflammatory and anti-oxidative stress.
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【Objective】 To optimize the existing spin-EB method and promote human induced pluripotent stem cells (hiPSCs) differentiate into megakaryocytes (MKs). 【Methods】 In this study, the initial inoculation amount of hiPSCs was increased from 3 500 cells/well to 8 000 cells/well, and the size of EB was increased. By observing the generation time of EB- hematopoietic cells during differentiation, and detecting the proliferation of CD34+ hematopoietic progenitor cells and CD41+ MKs in different stages, it was studied whether the optimized scheme could promote the differentiation of hiPSCs into hematopoietic progenitor cells(HPCs) and MKs. 【Results】 By increasing the initial inoculation amount of hiPSCs and the size of EB, the differentiation of hiPSCs into HPCs and MKs and the cell production efficiency can be promoted. 【Conclusion】 Our research describes an optimized and repeatable differentiation method, which can produce hematopoietic progenitor cells and mature MKs from hiPSCs in a relatively short time with higher yield. It is of great clinical significance and broad scientific research prospect to continuously optimize the culture scheme of hiPSCs differentiation to produce MKs and platelets in vitro, and to promote large-scale platelet generation in vitro in transfusion medicine.
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Objective:To explore the application of comprehensive simulated delivery room skill training combined with improved objective teaching in obstetric nursing teaching.Methods:A total of 84 nurses who practiced in the Department of Obstetrics of Nanjing Hospital of Traditional Chinese Medicine from August 2019 to August 2020 were selected as the research objects, and were divided into control group and research group according to the sequence of admission of practice nurses, with 42 nurses in each group. The control group adopted traditional teaching methods, and the research group adopted comprehensive simulated delivery room skill training combined with improved target teaching mode. The teaching effect of the two groups of practice nurses was evaluated by theoretical assessment, skill operation assessment and teaching satisfaction rate. SPSS 22.0 was used for t test and chi-square test. Results:The total score of theory assessment, single choice, multiple choice, blank filling, noun explanation, short answer and case analysis of practical nursing students in the study group were better than those in the control group, with statistically significant differences ( P<0.05). The results of practical skills operation and comprehensive quality ability evaluation of practice nurses in the study group were better than those in the control group, and the difference was statistically significant ( P<0.05). The teaching satisfaction rate of practice nurses in the control group was 80.95%(34/42), and that in the research group was 97.62%(41/42), with statistically significant differences ( χ2=6.10, P=0.014). Conclusion:The skill training of comprehensive simulated delivery room combined with improved objective teaching can improve the theoretical knowledge, practical skills and comprehensive quality of obstetric practice nurses, and improve the teaching satisfaction rate and obstetric nursing teaching quality of practical nurses.
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Objective:To explore the application effect of improved urinary control technology in patients with benign prostatic hyperplasia (BPH).Methods:A total of 83 BPH patients admitted to Taihe County People′s Hospital of Anhui Province from June 2017 to August 2020 were selected and divided into the control group (41 cases) and the observation group (42 cases) by a random number table. The control group performed transurethral plasma kinetic enucleation of prostate (PKEP), and the observation group performed modified urinary control technology. The general conditions of surgery, voiding function, urinary control function, sexual function and complication rate were compared between the two groups.Results:Compared with the control group, theoperation time in the observation group was longer and the postoperative hospital stay was shorter: (78.67 ± 20.04) min vs. (69.52 ± 18.66) min, (8.64 ± 2.66) d vs. (10.95 ± 3.01) d, there were statistical differences ( P<0.05). The postvoid residual (PVR) and the maximum flow rate (Q max) in the two groups at 1 month and 3 months after operation had no significant differences ( P>0.05). The incidence of urinary incontinence in the observation group at 24 h, 1 week, and 2 weeks after extubation were lower than those in the control group: 11.90%(5/42) vs. 36.59% (15/41), 4.76%(2/42) vs. 21.95%(9/41), 2.38%(1/42) vs. 19.51%(8/41), there were statistically differences ( P<0.05). After operation for 3 months, the total incidence of adverse events in the observation group was lower than that in the control group: 4.76% (2/42) vs. 19.51% (8/41), P<0.05. Conclusions:The improved urinary control technology has a significant application effect in BPH patients. It can effectively improve the patient′s urination function, protect urinary control and sexual function.
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Avicel is made of a mixture of microcrystalline cellulose (MCC) and carboxymethyl cellulose (CMC), and used for virus plaque assay. The avicel in common use is produced by FMC Biopolymer. Due to the relatively fixed proportion of MCC and CMC, avicel in common use is not suitable for plaque determination experiment of all types of viruses. In this study, we evaluated the effect of avicel made of different proportions of MCC and CMC on virus plaque assay, and developed an improved avicel virus plaque assay featured with simple and convenient operation, good practicability and high stability. To generate avicel overlays with different proportions of MCC and CMC, twelve different 2×avicel solutions were prepared. Their overall viscosity and bottom viscosity were measured to evaluate the ease of operation. The results showed that most of the 2×avicel solutions (except the 4.8% MCC+1.4% CMC and 4.8% MCC+1.0% CMC group) were easy to absorb and prepare nutrient overlap than 2×CMC solution. In order to find the best scheme to detect the titer of porcine epidemic diarrhea virus (PEDV), these avicel overlay solutions with different proportion of MCC and CMC were used as a replacement in the standard plaque assay. By comparing the size, clarity, stability and titer accuracy of virus plaque, we identified that 0.6% MCC and 0.7% CMC was the most preferable composition of avicel overlay for PEDV plaque assay. In conclusion, we developed an improved virus plaque assay based on avicel, which may facilitate the research of virus etiology, antiviral drugs and vaccines.
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Animales , Carboximetilcelulosa de Sodio/química , Celulosa/química , PorcinosRESUMEN
Objective:To perform cross-cultural adaption of the KING′s Parkinson′s Disease Pain Scale (KPPS), explore its reliability and validity in Chinese Parkinson′s disease (PD) patients, and to create the new version of the pain scale which adapts to the Chinese PD patients.Methods:This study enrolled 225 patients, including 121 men and 104 women who were selected from the Outpatient Center of Movement Disorders Clinic of the Second Affiliated Hospital of Soochow University from July 2018 to July 2020. All patients completed the evaluation of the Chinese Version of KPPS (KPPS-CV). According to the preliminary evaluation results, the expert group modified KPPS-CV after discussion, and developed a Modified KPPS-CV (MKPPS-CV). These patients then completed the MKPPS-CV evaluation during the 3-month follow-up. Cross-cultural adaptation was performed according to published international guidelines that include translation, back-translation, expert review, and pretesting. The following psychometric properties were evaluated: basic item analysis; floor and ceiling effects; construct validity; content validity; criterion validity (Spearman′s rho between the KPPS-CV and Numeric Rating Scale); internal consistency reliability (Cronbach′s alpha); test-retest reliability (intra-class correlation coefficient, ICC).Results:In item analysis, 50% of the items had poor discrimination (critical ratio<3.0), and floor effect was found in all domains (proportion of 0 point>15%). The items were reclassified after exploratory factor analysis. The content validity of item 3, item 10 and item 11 was low (item-level content validity index<0.78). Criterion validity showed the highest correlations (Spearman′s rho>0.88) between the KPPS-CV and Numeric Rating Scale. While overall scale reliability was minimally acceptable at 0.46, which showed a poor reliability of this scale. Test-retest reliability was excellent for each item (Spearman's rho>0.85). The Cronbach′s alpha of MKPPS-CV (0.76) was higher than that of KPPS-CV (0.46). It showed a great improvement after the modifying.Conclusions:When using scales that are not developed for local populations, differences in culture and clinical practices should be taken into account. MKPPS-CV is an acceptable, valid measure to evaluate pain in Chinese PD patients, which is more suitable for Chinese people.
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Introducción: Múltiples son los esfuerzos realizados para incluir los protocolos de recuperación mejorada como un indicador de calidad en la atención al paciente quirúrgico, bajo la premisa de acelerar la recuperación de los enfermos, sin que esto vaya en detrimento del proceso asistencial y obtener su alta satisfacción. Para ello se hace necesario el desarrollo de la investigación avalada por la mejor evidencia científica y práctica. Objetivo: Estimar, a través de la literatura publicada, la efectividad de la aplicación de los protocolos de recuperación precoz sobre la evolución perioperatoria de pacientes a los que se les realizan procedimientos quirúrgicos cardíacos. Método: Se incluyeron ensayos clínicos controlados y aleatorizados, publicados entre enero del año 2013 y mayo de 2020. La revisión sistemática se realizó según las recomendaciones del manual 5.1.0 para revisores de la biblioteca Cochrane. Resultados: Se analizaron 6 estudios (687 pacientes/Grupo estudio=345, Grupo Control=342). La calidad metodológica de la mayoría de las investigaciones evaluadas fue buena. Se muestra una superioridad de los protocolos, ya que se acompañan de una disminución en la incidencia de complicaciones perioperatorias (RR=0,61 [0,40, 0,93]). De forma similar se encuentran relacionados con la disminución la estadía hospitalaria (diferencia de medias, efecto aleatorio, fue de -2,98 [-3,31, -2,65]. Conclusiones: A pesar de los pocos estudios incluidos, la evidencia sugiere que estos programas mejoran la evolución perioperatoria de los pacientes(AU)
Introduction: Multiple efforts are made to include improved recovery protocols as an indicator of quality in care for surgical patients, under the premise of accelerating the recovery of patients, without this being detrimental to the care process, and thus guarantee high patient satisfaction. In view of this, the development of research supported by the best scientific and practical evidence is necessary. Objective: To estimate, through the published literature, the effectiveness of the application of early recovery protocols on the perioperative evolution of patients who undergo cardiac surgical procedures. Method: Randomized controlled clinical trials, published between January 2013 and May 2020, were included. The systematic review was carried out according to the recommendations of the Cochrane Library manual 5.1.0 for reviewers. Results: Six studies were analyzed (687 patients/study group: 345, control group: 342). The methodological quality of most of the researches assessed was good. A superiority of the protocols is shown, since they are accompanied by a decrease in the incidence of perioperative complications (RR=0.61 [0.40, 0.93]). Similarly, they are related to the decrease in hospital stay (mean difference, random effect, was -2.98 [-3.31, -2.65]). Conclusions: Despite the few studies included, the evidence suggests that these programs improve the perioperative outcome of patients(AU)
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Humanos , Masculino , Femenino , Recuperación Mejorada Después de la Cirugía/normas , Atención al Paciente , Procedimientos Quirúrgicos Cardíacos/métodos , Apoyo a la Investigación como Asunto , /métodos , Tiempo de InternaciónRESUMEN
Introducción: Múltiples son los artículos publicados que abordan el tema de la ciencia abierta y su importancia para la sociedad, especialmente para la comunidad de investigadores. Esta constituye, ineludiblemente, el presente y futuro de las revistas científicas como método de expandir las investigaciones con alta calidad y credibilidad. La ciencia abierta como movimiento, tiene varios componentes y dentro de ellos, la gestión de citas y referencias de datos, códigos y materiales, que fundamentan la necesidad de que los autores tengan disponibles los contenidos subyacentes a los artículos que se publican y que constituyen la base de los resultados obtenidos en cada investigación. Objetivo: Evaluación de la eficacia de los protocolos de recuperación mejorada en cirugía cardiaca. Métodos: El protocolo que se propone fue elaborado por la investigadora principal (registro público cubano de ensayos clínicos RPCEC00000304) y se describe acorde a las recomendaciones de la lista internacional de chequeo para ensayos clínicos (SPIRIT). Conclusiones: Estarían en relación a si se puede demostrar, después de terminada la investigación, si el protocolo motivo de la Intervención, es mejor, igual o peor que el protocolo de control(AU)
Introduction: There are multiple articles published that address the subject of open science and its importance for society, especially for the research community. This constitutes, inevitably, the present and future of scientific journals as a method of expanding research with high quality and credibility. Open science, as a movement, has several components including the management of citations and references of data, codes and materials, which support the need for authors to have available the underlying content of the articles published and constituting the base for the results obtained in each investigation. Objective: Assessment of the efficacy of improved recovery protocols in cardiac surgery. Methods: The proposed protocol was prepared by the main researcher (Cuban public registry of clinical trials: RPCEC00000304) and is described according to the recommendations of the international checklist for clinical trials (SPIRIT). Conclusions: They would be related to whether it can be demonstrated, after the end of the investigation, if the protocol reason for the intervention is better, equal to, or worse than the control protocol(AU)
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Humanos , Masculino , Femenino , Isquemia Miocárdica/epidemiología , Recuperación Mejorada Después de la Cirugía/normas , Atención Perioperativa/normas , Medicina Perioperatoria/métodosRESUMEN
Introducción: Las personas con tratamiento quirúrgico presentan ansiedad, lo cual impide llegar al periodo operatorio en óptimas condiciones. El cuidado espiritual puede resultar efectivo en momentos como este. Objetivo: Evaluar el efecto del cuidado espiritual en el nivel de ansiedad situacional en pacientes quirúrgicos. Métodos: Investigación cuantitativa, preexperimental con pretest postest, en el Hospital Regional de Ayacucho, Perú, durante marzo a mayo de 2016. Población constituida por 123 pacientes quirúrgicos, entre los que se seleccionaron 30 entre 24 y 57 años, con ansiedad y dispuestos a participar en la investigación. La ansiedad se midió con el Test de Zung, las necesidades espirituales con un cuestionario validado por expertos y pilotaje con alfa de Cronbach > 0,75. Para los ejes temáticos y metodológicos de la intervención (cuidados espirituales) se revisó bibliografía sobre el tema, tuvieron en cuenta las necesidades de cuidados y niveles de ansiedad identificada. Se procesó la información con frecuencias absolutas, porcentajes, media, desviación típica, valor mínimo y máximo. Para contrastar hipótesis se utilizó la Prueba no paramétrica de rangos con signo de Wilcoxon. Para la relación entre necesidad de cuidado espiritual y evolución del nivel de ansiedad se utilizó Chi-cuadrada de Pearson (X2), con probabilidad de error del 5 por ciento. Resultados: El nivel de ansiedad situacional previo a la aplicación del cuidado espiritual fue de marcada a severa en 86,66 por ciento, aplicado el cuidado espiritual estuvo ausente en el 96,66 por ciento. Conclusión: La intervención con cuidados espirituales aplicada resultó efectiva en la disminución del nivel de ansiedad situacional en pacientes quirúrgicos estudiados(AU)
Introduction: People who should undergo surgical treatment present anxiety, which keeps them from reaching the operative period in optimal conditions. Spiritual care can be effective at times like this. Objective: To assess the effect of spiritual care on the level of situational anxiety in surgical patients. Methods: Quantitative pre-experimental research with pre- and post-test carried out in the Regional Hospital of Ayacucho, Peru, during March to May 2016. The population was made up of 123 surgical patients, of which 30 aged 24-57, with anxiety and willing to participate in the study were chosen. Anxiety was measured with the Zung test; spiritual needs, with a questionnaire validated by experts; and piloting, with Cronbach's alpha > 0.75. For the thematic and methodological axes of the intervention (spiritual care), a bibliography on the subject was reviewed, taking into account the care needs and levels of anxiety identified. The information was processed with absolute frequencies, percentages, mean, standard deviation, minimum and maximum values. The Wilcoxon signed rank test was used to test hypotheses. Pearson's chi-square (X2) was used for the relationship between need for spiritual care and evolution of anxiety level, with a probability of error of 5 percent. Results: The level of situational anxiety prior to the application of spiritual care was remarkable to severe in 86.66%; applied spiritual care was absent in 96.66 percent.. Conclusion: The intervention with spiritual care applied was effective in reducing the level of situational anxiety in the surgical patients studied.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Trastornos de Ansiedad/etiología , Atención de Enfermería , Cuidados Posoperatorios/métodos , Terapias Espirituales/métodosRESUMEN
Objective:To evaluate the ophthalmic service ability of county hospitals in China based on the improved DS evidence theory.Methods:Convenient sampling method was used to select the data of ophthalmology department of 9 county hospitals in eastern, central and Western China in 2019. The improved DS evidence theory method based on Mahalanobis distance weight coefficient was applied to evaluate the medical service ability, and the evaluation results were compared with the classical evidence theory method.Results:The regional development of ophthalmic service capacity in counties of China was uneven, and there were regional differences in the evaluation results of some indicators. Hospitals in the eastern region were generally leading in the evaluation of a number of indicators related to the amount of medical services. The numbers of inpatient operations, outpatient operations, bed turnover times, bed utilization rate, number of inpatients, number of outpatients, number of patients in the eastern region were 3.25, 1.60, 1.81, 1.61, 2.64, 2.63 and 4.47 times of the numbers of hospitals in western region. Compared with the classical evidence theory method, the analysis results of the improved DS evidence theory method were consistent with the actual business development of each hospital, and the evaluation results were credible, which could more effectively reduce the uncertainty in the evaluation results.Conclusions:Ophthalmic service ability of county hospitals in China needs to be continuously improved. Improved DS evidence theory can be adopted to make continuous evaluation.
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Objective:To introduce the improved "pull technique" and its preliminary application in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine.Methods:Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine has started to implement the "pull technique" since March 2018.After one patient suffered from postoperative tunnel infection, we′ve improved the operation method: after successful extubation, small incision was made at the tunnel entrance, and the skin was properly trimmed and sutured to close the tunnel entrance.Results:Until May 2020, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine has implemented the modified tube removal for 15 patients.During the follow-up period (0-25 months), there was no secondary infection or peritoneal effusion.Conclusion:For patients who meet the indications of "pull technique" , the improved "pull technique" is a trial method, which can reduce the risk of secondary infection and peritoneal effusion.
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From a regulatory perspective,drug quality consistency evaluation must concern different processes used for the same drug.In this study,an assessment strategy based on quality by design(QbD)was developed for population pharmaceutical quality evaluation.A descriptive analysis method based on QbD concept was first established to characterize the process by critical evaluation attributes(CEAs).Then quantitative analysis method based on an improved statistical process control(SPC)method was established to investigate the process indicators(PIs)in the process population,such as mean distri-bution,batch-to-batch difference and abnormal quality probability.After that rules for risk assessment were established based on the SPC limitations and parameters.Both the SPC parameters of the CEAs and the risk of PIs were visualized according to the interaction test results to obtain a better understanding of the population pharmaceutical quality.Finally,an assessment strategy was built and applied to generic drug consistency assessment,process risk assessment and quality trend tracking.The strategy demon-strated in this study could help reveal quality consistency from the perspective of process control and process risk,and further show the recent development status of domestic pharmaceutical production processes.In addition,a process risk assessment and population quality trend tracking provide data-based information for approval.Not only can this information serve as a further basis for decision-making by the regulatory authority regarding early warnings,but it can also reduce some avoidable adverse reactions.With continuous addition of data,dynamic population pharmaceutical quality is meaningful for emergencies and decision-making regarding drug regulation.
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ABSTRACT: Hypomagnesemia is a major cause of death in grazing beef cows in countries of the Southern Hemisphere such as Argentina, Australia and New Zealand. Here we review the literature on hypomagnesemia in beef cattle and describe an outbreak in Uruguay. The disease occurred in late autumn, affecting 6 to 11-year-old Aberdeen Angus and Hereford x Aberdeen Angus lactating multiparous cows in good body condition, grazing on natural grasslands that had been improved by fertilization and sowing of seeds of ryegrass and oat. Approximately 40 out of 225 cows were affected and 24 (10.7%) died. A presumptive diagnosis of hypomagnesemia was established based on sudden death, acute neuromuscular clinical signs, epidemiological data, and the response to Mg administration. The diagnosis was confirmed by detecting low Mg concentrations in serum (0.47-0.57mmol/L), vitreous humor (0.47-0.80mmol/L), aqueous humor (0.66mmol/L) and cerebrospinal fluid (0.59mmol/L). The largest component of the diet corresponding to fast-growing and exuberant forages of ryegrass and oat had high concentrations of K (3.48%), N (4.38%) and P (0.94%), suggesting secondary hypomagnesemia. In addition, the K/(Ca+Mg) ratio was 2.38 in forages of ryegrass and oat (reference value: 2.2), and 0.15 in the soil (reference value: 0.09), which represent risk factors for hypomagnesemia. In conclusion, hypomagnesemia is an important cause of mortality in beef cattle grazing improved natural grasslands in Uruguay and it can be easily prevented by correct seasonal Mg supplementation.
RESUMO: A hipomagnesemia é uma das principais causas de morte em vacas de corte em pastagem em países do Hemisfério Sul, como Argentina, Austrália e Nova Zelândia. Aqui, revisamos a literatura sobre hipomagnesemia em bovinos de corte e descrevemos um surto no Uruguai. A doença ocorreu no final do outono, afetando vacas Aberdeen Angus e Aberdeen Angus x Hereford de 6-11 anos de idade em boas condições corporais, lactantes, multíparas e pastando em campos naturais que foram melhorados com fertilização e plantio de azevém e aveia. Aproximadamente 40 de 225 vacas foram afetadas e 24 (10,7%) morreram. O diagnóstico presuntivo de hipomagnesemia foi estabelecido com base na morte súbita, sinais clínicos neuromusculares agudos, dados epidemiológicos e a resposta à administração de Mg. O diagnóstico foi confirmado pela detecção de baixos níveis de Mg no soro (0,47-0,57mmol/L), humor vítreo (0,47-0,80mmol/L), humor aquoso (0,66mmol/L) e líquido cefalorraquidiano (0,59mmol/L). O componente mais importante da dieta correspondia a pastagens de azevém e aveia de rápido crescimento, as quais apresentaram altas concentrações de K (3,48%), N (4,38%) e P (0,94%), que sugerem hipomagnesemia secundária. Além disso, a relação K/(Ca+Mg) foi de 2,38 em forragens de azevém e aveia (valor de referência: 2,2) e 0,15 no solo (valor de referência: 0,09), que representam fatores de risco para hipomagnesemia. Em conclusão, a hipomagnesemia é uma causa importante de mortalidade em gado de corte em pastagens naturais melhoradas no Uruguai e pode ser facilmente prevenida pela correta suplementação sazonal de Mg.