Discussion on Technical Evaluation of Tongue Diagnosis Equipment of Traditional Chinese Medicine / 中国医疗器械杂志

This study briefly introduces the tongue diagnostic equipment of traditional Chinese medicine. It analyzes and discusses the key points of technical evaluation of tongue diagnostic equipment from the aspects of product name, performance parameters, image processing functions, product use methods, clinical evaluation, etc. It analyzes the safety risks and effectiveness indicators of tongue diagnostic equipment, hoping to bring some help to the gradual standardization of tongue diagnostic equipment and the registration of enterprises.

Comparación entre el análisis automático y manual de 301 poligrafías respiratorias domiciliarias con ApneaLink / Comparison between automatic and manual scoring of 301 home respiratory polygraphs with ApneaLink device

Resumen Introducción: El síndrome de apnea obstructiva del sueño (SAOS) se asocia a aumento de morbimortalidad cardiovascular y metabólica, y a mala calidad de vida. Su diagnóstico y tratamiento eficaz mejora la salud individual y pública. Objetivo: evaluar concordancia entre análisis automático versus manual del dispositivo ApneaLink para diagnosticar y clasificar SAOS en pacientes con sospecha clínica. Material y Método: Evaluación retrospectiva de 301 poligrafías respiratorias del HOSCAR. Se mide correlación, acuerdo general y concordancia entre parámetros obtenidos manual y automáticamente usando coeficiente de Pearson, coeficiente de correlación intraclase y gráfico de Bland y Altman. Resultados: En 11,3% de casos el análisis automático interpreto erróneamente la señal de flujo. No hubo diferencias significativas entre índices de apnea-hipopnea automático (AHIa 18,9 ± 17,5) y manual (AHIm 20,8 ± 19,4) r + 0,97 (95% CI: 0,9571 a 0,9728; p < 0,0001) y tampoco entre la saturación mínima de oxígeno automática (82,1 ± 7,6) y manual (83,1 ± 6,8) r + 0,85 (95% CI: 0,8108 a 0,8766; p < 0,0001). No hubo buena correlación entre análisis automático y manual en clasificación de apneas centrales, r + 0,51 (95% CI: 0,4238 a 0,5942; p < 0,0001). Hubo subestimación de gravedad de SAOS por análisis automático: en 11% de casos. Conclusión: El diagnóstico entregado automáticamente por ApneaLink podría aceptarse sin confirmación manual adicional solamente en casos clasificados como severos. Para AHI menores se requeriría confirmación mediante análisis manual de experto.

Abstract Introduction: Obstructive sleep apnea syndrome (OSAS) is associated with increased cardiovascular and metabolic morbidity and mortality, and poor quality of life. Its effective diagnosis and treatment improve individual and public health. Aim: To evaluate concordance between automatic versus manual analysis of the ApneaLink device to diagnose and classify OSAS in patients with clinical suspicion. Material and Method: Retrospective evaluation of 301 respiratory polygraphs from HOSCAR. Correlation, general agreement and concordance between parameters obtained manually and automatically are measured using Pearson's coefficient, intraclass correlation coefficient, and Bland and Altman graph. Results: In 11.3% of cases, the automatic analysis misinterpreted the flow signal. There were no significant differences between automatic (AHIa 18.9 ± 17.5) and manual (AHIm 20.8 ± 19.4) apnea-hypopnea indices r + 0.97 (95% CI:0.9571 to 0.9728, p < 0.0001) and nor between automatic (82.1 ± 7.6) and manual (83.1 ± 6.8) minimum oxygen saturation r + 0.85 (95% CI: 0.8108 to 0.8766, p < 0.0001). There was no good correlation between automatic and manual analysis in the classification of central apneas, r + 0.51(95% CI:0.4238 to 0.5942, p < 0.0001). There was an underestimation of the severity of OSAS by automatic analysis in 11% of cases. Conclusion: The diagnosis delivered automatically by ApneaLink could be accepted without additional manual confirmation only in cases classified as severe. For minors AHI, confirmation through manual expert analysis would be required.

Reliability of shoulder rotation movement measured by the smartphone clinometer application / Confiabilidade da medida de movimento de rotação do ombro mensurada pelo aplicativo clinômetro para smartphone

Goniometry is widely used to measure range of motion (ROM), but requires skill and training. In this sense, smartphone apps appear as an alternative. The objective was to assess the reliability and validity of shoulder rotation measurements using a smartphone clinometer app. This study approved by Ethical and Research Committee of the University of Pernambuco. Thirty six (36) healthy and physically active adolescents and young adults participated in the study. In the measurement each volunteer performed external (ER) and internal (IR) rotation of the shoulder in the supine and side lying positions. The shoulder rotation ROM was measured by a goniometer and an application. ER and IR were measured in two days by two evaluators. Reliability was determined using intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change (MDC). Validity was assessed using Pearson's correlation coefficients. Both devices had excellent intra- and inter-examiner reliability levels in most evaluations. However, the goniometer showed moderate inter-examiner reliability in measuring the internal rotation performed in the lying position (ICC 0.61 to 0.67). The app showed inter-examiner reliability ranging from fair to moderate for the same measurements (ICC 0.35 to 0.61). Significant differences were observed between the values recorded by the two instruments for all measurements performed (p <0.001). A strong correlation was observed between measurements in the supine and side lying positions with the goniometer and a smartphone clinometer app (r> 0.85). The application presented excellent reliability levels as well as demonstrated a high correlation with the goniometer. However, the assessment of IR lying down position should be avoided. (AU)

A goniometria é muito usada para medir a amplitude de movimento (ADM), mas requer habilidade e treinamento. Nesse sentido, os aplicativos para smartphones aparecem como uma alternativa. O objetivo foi avaliar a confiabilidade e a validade das medidas de rotação do ombro usando um aplicativo clinômetro de smartphone. Este estudo foi provado pelo Comitê de Ética da Universidade de Pernambuco. Participaram do estudo trinta e seis (36) adolescentes e adultos jovens, saudáveis e fisicamente ativos. Na intervenção, cada voluntário realizou rotação externa (RE) e interna (RI) do ombro nas posições em supino e decúbito lateral. A ADM de rotação do ombro foi medida por um goniômetro e um aplicativo. RE e RI foram medidas em dois dias por dois avaliadores. A confiabilidade foi determinada usando coeficiente de correlação intraclasse (CCI), erro padrão de medição (EPM) e mudança mínima detectável (MMD). A validade foi avaliada usando os coeficientes de correlação de Pearson. Ambos os dispositivos apresentaram excelentes níveis de confiabilidade intra e interexaminadores na maioria das avaliações. No entanto, o goniômetro apresentou confiabilidade interexaminadores moderada na medição da rotação interna realizada na posição deitada (ICC 0,61 a 0,67). O aplicativo mostrou confiabilidade interexaminadores variando de ruim a moderada para as mesmas medidas (ICC 0,35 a 0,61). Diferenças significativas foram observadas entre os valores registrados pelos dois instrumentos para todas as medidas realizadas (p <0,001). Uma forte correlação foi observada entre as medidas nas posições supina e deitada de lado com o goniômetro e o aplicativo clinômetro para smartphone (r> 0,85). O aplicativo apresentou excelentes níveis de confiabilidade, bem como demonstrou uma alta correlação com o goniômetro. No entanto, a avaliação da RI na posição deitada deve ser evitada. (AU)

A notação logarítmica como opção de registro objetivo da estesiometria: um estudo piloto / THE LOGARITHMIC NUMBER AS AN OPTION OF OBJECTIVE REGISTRATION OF ESTESIOMETRY: A PILOT STUDY

Introdução: A Avaliação objetiva é um valioso recurso na pesquisa. Contudo, o estesiômetro provê informações por cores. Objetivo: Apresentar a conversão logarítmica dos valores nominais do estesiômetro como opção representativa de registro na avaliação de prejuízo tátil. Método: Estudo Piloto aprovado com parecer nº 1.337. 714, realizado de agosto de 2018 a julho de 2019. Valores nominais (gF) dos monofilamentos do estesiômetro foram convertidos em logaritmo, o procedimento serviu para o registro e o acompanhamento de pacientes cerebrovasculares em reabilitação (n=13), comparado ao controle (n=10), para notações de qualidade, acurácia e poder de inferências dos dados na representação do estado tátil. Statistical analysis performed by the GraphPad Prism 6.0 Program. Resultados: As opções numéricas trabalhadas conseguem representar a percepção da sensibilidade tátil, sendo que a conversão em logaritmo demonstra objetividade, sensibilidade, coerência e consistência para gerar mais inferências. Conclusão: A notação logarítmica para registro da sensibilidade é uma opção versátil de análise e interpretação dos dados na pesquisa em reabilitação.

Desafios na inocrporação de tecnologias de alta complexidade: estudo do PET-CT na perspectiva do plano de expansão da radioterapia / Challenges in the incorporation of high complexity technologies: PET-CT study in the perspective of radiotherapy expansion plan

Após a decisão pela incorporação de tecnologias na tabela de procedimentos no Sistema Único de Saúde (SUS), uma série de eventos pode prejudicar o efetivo acesso da população a tecnologias de alta complexidade, realçando uma dificuldade do SUS de executar localmente as estratégias definidas em âmbito federal. O objetivo deste estudo foi analisar os aspectos organizacionais pós-incorporação de tecnologias de alta densidade, em especial o caso do PET-CT (Tomografia por Emissão de Pósitron-Tomógrafo Computadorizado), identificando os principais desafios na implementação dessa tecnologia e avaliar a viabilidade de uso de soluções integradas a partir da experiência do Plano de Expansão da Radioterapia no SUS. Foram realizadas pesquisas nos sistemas informatizados do Ministério da Saúde e base de dados da Plataforma + Brasil. Foram coletadas as informações com as áreas técnicas e finalísticas do Ministério da Saúde e dados de registros sanitários na ANVISA. Discutiu-se que a solução integrada, como o Plano de Expansão da Radioterapia, pode ser alternativa real para a efetiva incorporação de tecnologias de alta complexidade.

Declaración de posición del Grupo de la Comisión Lancet de Hipertensión con respecto a la mejora mundial de las normas de exactitud para los dispositivos de medición de la presión arterial / Lancet Commission on Hypertension Group position statement on the global improvement of accuracy standards for devices that measure blood pressure / Posicionamento do Grupo da Lancet Commission on Hypertension sobre a melhoria global dos padrões de acurácia para aparelhos que medem a pressão arterial

Objetivos. El boletín de notas de México correspondiente al 2018 evalúa las oportunidades a disposición de la población infantil y joven mexicana para que puedan desarrollar niveles adecuados de actividad física y sueño, y disminuyan el sedentarismo.Métodos. El boletín es un sistema de vigilancia que recopila los datos obtenidos en las encuestas nacionales, censos, documentos gubernamentales, sitios web, literatura gris y estudios publicados con respecto al análisis de 16 indicadores en 4 categorías: comportamientos diarios, estado físico, entornos y fuentes influyentes, y estrategias e inversión. Los datos fueron cotejados con los puntos de referencia establecidos. A cada indicador se le asignó una calificación entre 1 y 10 (< 6 significa reprobado) o fue marcado como "incompleto" si los datos eran nulos o insuficientes. Resultados. Las calificaciones obtenidas para los comportamientos diarios fueron: actividad física en general: 4; participación en actividades deportivas organizadas: 5; juego activo: 3; modalidades de transporte activas: 5; sueño: 7; y sedentarismo: 3. El estado físico obtuvo un 7. Las calificaciones para los entornos y fuentes influyentes fueron: familiares y pares: "incompleto"; escuela: 3; comunidad y entorno: 4. Para las estrategias e inversión: estrategias gubernamentales: 6; entidades no gubernamentales: 2.Conclusiones. Las bajas calificaciones obtenidas en 11 de los 16 indicadores demuestran que las escuelas, las familias, las comunidades y el gobierno tienen que aunar esfuerzos para mejorar las oportunidades que tiene la población infantil y joven en México para desarrollar niveles de actividad física satisfactorios.(AU)

ABSTRACT The Lancet Commission on Hypertension identified that a key action to address the worldwide burden of high blood pressure (BP) was to improve the quality of BP measurements by using BP devices that have been validated for accuracy. Currently, there are over 3 000 commercially available BP devices, but many do not have published data on accuracy testing according to established scientific standards. This problem is enabled through weak or absent regulations that allow clearance of devices for commercial use without formal validation. In addition, new BP technologies have emerged (e.g. cuffless sensors) for which there is no scientific consensus regarding BP measurement accuracy standards. Altogether, these issues contribute to the widespread availability of clinic and home BP devices with limited or uncertain accuracy, leading to inappropriate hypertension diagnosis, management and drug treatment on a global scale. The most significant problems relating to the accuracy of BP devices can be resolved by the regulatory requirement for mandatory independent validation of BP devices according to the universally-accepted International Organization for Standardization Standard. This is a primary recommendation for which there is an urgent international need. Other key recommendations are development of validation standards specifically for new BP technologies and online lists of accurate devices that are accessible to consumers and health professionals. Recommendations are aligned with WHO policies on medical devices and universal healthcare. Adherence to recommendations would increase the global availability of accurate BP devices and result in better diagnosis and treatment of hypertension, thus decreasing the worldwide burden from high BP.(AU)

RESUMO A Comissão Lancet sobre Hipertensão Arterial identificou que uma iniciativa central para enfrentar a carga mundial da hipertensão arterial seria a melhoria na qualidade da mensuração da pressão arterial pelo uso aparelhos de pressão arterial validados quanto à acurácia. Atualmente, existem mais de 3 000 aparelhos de pressão arterial disponíveis comercialmente; entretanto, muitos não têm dados publicados sobre testes de acurácia realizados de acordo com padrões científicos estabelecidos. Este problema resulta de regulamentação fraca ou inexistente, o que permite a aprovação para uso comercial de dispositivos sem validação formal. Além disso, surgiram novas tecnologias de mensuração da pressão arterial (por exemplo, sensores sem algemas) sem consenso científico quanto aos padrões de acurácia. No conjunto, essas questões contribuem para a oferta generalizada de dispositivos de pressão arterial clínica e domiciliar com acurácia limitada ou incerta, levando a diagnóstico, gerenciamento e tratamento inadequados da hipertensão em escala global. Os problemas mais significativos relacionados com a acurácia dos dispositivos de pressão arterial podem ser resolvidos por regulamentação que imponha a obrigatoriedade de validação independente dos aparelhos de pressão arterial, de acordo com a norma universalmente aceita pela Organização Internacional de Normalização. Esta é uma recomendação fundamental para a qual existe uma necessidade internacional urgente. Outras recomendações essenciais incluem o desenvolvimento de padrões de validação especificamente para novas tecnologias de mensuração da pressão arterial e listas on-line de aparelhos com acurácia adequada que sejam acessíveis aos consumidores e profissionais de saúde. As recomendações estão alinhadas com as políticas da Organização Mundial da Saúde (OMS) sobre dispositivos médicos e atenção universal à saúde. A adesão às recomendações aumentaria a oferta global de dispositivos de pressão arterial com acurácia adequada e resultaria em melhor diagnóstico e tratamento da hipertensão arterial, diminuindo assim a carga mundial dessa doença.(AU)

Research on Quality Evaluation System of Ultrasound Diagnostic Equipment Maintenance / 中国医疗器械杂志

In order to improve the quality of medical equipment after-sales service quality and improve the quality of medical equipment maintenance, this paper discusses the establishment of an evaluation index system to evaluate the quality of ultrasonic diagnostic equipment. From the three aspects of maintenance results, maintenance process and maintenance coverage, the quality of the post-maintenance quality of hospital ultrasound diagnostic equipment manufacturers is objectively evaluated.

Freezing of Gait Detection System for Parkinson's Patients Based on Inertial Measurement Unit / 中国医疗器械杂志

In order to detect freezing of gait of Parkinson's patients automatically, a system based on inertial measurement unit to detect freezing of gait for Parkinson's patients is established. The two inertial measurement units are respectively fixed on the left and right ankles of the patient to be measured, the freezing index is calculated by windowed Fourier transform, the freezing threshold is calculated based on the freezing index during normal walking, and the freezing index and the freezing threshold are compared to complete the detection of freezing of gait. The experimental results show that the number of freezing of gait occurrences in Parkinson's patients is accurately detected, and it has high sensitivity and specificity, which can assist doctors to objectively assess the patient's condition.

Uso da estereofotogrametria para mensuração do volume da anatomia externa da face: revisão sistemática / Use of stereophotogrammetry for measuring the volume of external facial anatomy: a systematic review

Introdução: O registro fotográfico tem sido importante para diversas especialidades médicas como a Cirurgia Plástica. A fotografia em duas dimensões apresenta limitações para capturar profundidade e volume de estruturas outros instrumentos para avaliar essa alteração. Diversas tecnologias foram desenvolvidas para analisar objeto em três dimensões, sendo a estereofotogrametria uma tecnologia que utiliza a análise computadorizada de duas ou mais fotografias simultâneas do objeto para produzir um modelo geométrico em três dimensões. As vantagens da estereofotogrametria incluem menor custo, portabilidade, ausência de radiação e rapidez da captura das imagens. O objetivo deste trabalho foi realizar uma revisão bibliográfica avaliando o uso e a acurácia da estereofotogrametria para mensuração de volume de estruturas na face. Métodos: Foi realizada pesquisa nos bancos de dados Cochrane Library e Medline até maio de 2018 utilizando uma combinação de descritores Mesh e termos livres. Resultados: Foram obtidos inicialmente 2213 estudos observando a estratégia de busca. Seguindo os critérios de elegibilidade, foram selecionados 27 artigos, sendo 21 relatos de casos não randomizados e 6 ensaios clínicos randomizados. A qualidade metodológica dos estudos variou de 50 a 67%, segundo uma pontuação que vai de 0 a 100%. Conclusões: A estereofotogrametria é uma tecnologia promissora e tem sido cada vez mais utilizada para verificar variações de volume na face com alta acurácia e reprodutibilidade. Faltam estudos com melhor qualidade metodológica avaliando a acurácia e o uso da estereofotogrametria na avaliação de volume facial.

Introduction: Photographic documentation is important in several medical specialties, such as plastic surgery. Two-dimensional photography has limitations in capturing structure depth and volume, requiring other instruments to evaluate these changes. Several technologies have been developed for three-dimensional analysis of objects, of which stereophotogrammetry uses computerized analysis of two or more simultaneous photographs of the object to produce a three-dimensional geometric model. The advantages of stereophotogrammetry include lower cost, portability, absence of radiation, and speed of image capture. The aim of the present study was to perform a bibliographic review evaluating the use and accuracy of stereophotogrammetry for measuring the volume of facial structures. Methods: Using a combination of MeSH keywords and free terms, a search was performed in the Cochrane Library and MEDLINE databases. The search included all articles published on or before May 2018. Results: 2,213 studies were initially retrieved using this search strategy. Of these, 27 studies were selected based on the eligibility criteria, of which 21 were non-randomized case studies and 6 were randomized clinical trials. The methodological quality of the studies varied between 50 and 67%, on a grading scale from 0 to 100%. Conclusions: Stereophotogrammetry is a promising technology that is increasingly being used to check for facial volume variations with high accuracy and reproducibility. More studies with higher methodological quality are needed for evaluating the accuracy and use of stereophotogrammetry for facial volume evaluations.

Distribution of mammograms and mammography offering in relation to the parametric care of the Public Health Care System in Pernambuco / Distribuição dos mamógrafos e da oferta de mamografia em relação ao parâmetro assistencial do Sistema Único de Saúde em Pernambuco

Abstract Objective: to describe the distribution of available mammograms in the Sistema Único de Saúde (SUS) (Public Health Care System) and the mammography offering were carried out by this system, throughout the health regions in Pernambuco State, and compared them with the parametric care recommended by the Ministry of Health. Methods: this is a descriptive cross-sectional study that used secondary mammograms data in December 2016 by the Cadastro Nacional de Estabelecimentos de Saúde (National Registy on Health Establishments); and about mammography performed at SUS in 2016 by the Sistema de Informação Ambulatorial (Ambulatory Information System). The parametric care document No. 1.631/2015 was used as a comparability standard in relation to the distribution of the equipment and the mammography offering. Results: Pernambuco State presented approximately the double amount of mammograms and mammography was performed about 46% below the recommended parameter used in this study. All the health regions presented sufficient quantity of mammograms. However, the use of the installed capacity was less than 50% in all the health regions in the state. Conclusions: this study shows the need for a better use of the installed capacity for mammograms in Pernambuco State taken by the insufficient mammography offering and the poor distribution of the equipment in its territory.

Resumo Objetivo: descrever a distribuição dos mamógrafos disponíveis para o Sistema Único de Saúde (SUS) e da oferta de mamografias realizadas através desse sistema, por região de saúde em Pernambuco e compará-los aos parâmetros assistenciais preconizados pelo Ministério da Saúde. Métodos: Trata-se de um estudo transversal descritivo, que utiliza dados secundários sobre mamógrafos, em dezembro de 2016, através do Cadastro Nacional de Estabelecimentos de Saúde; e sobre mamografias realizadas pelo SUS, em 2016, através do Sistema de Informação Ambulatorial. Utilizou-se o parâmetro assistencial da Portaria N° 1631/2015 como padrão de comparabilidade em relação à distribuição dos equipamentos e da oferta de mamografia. Resultados: Pernambuco apresentou aproximadamente o dobro de mamógrafos e realizou aproximadamente 46% mamografias abaixo do que preconiza o parâmetro de necessidade utilizado nesse estudo. Todas as regiões de saúde apresentaram quantidade de mamógrafos suficiente. Contudo, a utilização da capacidade instalada foi menor que 50% em todas as regiões de saúde do estado. Conclusões: Esse estudo mostra a necessidade de uma melhor utilização da capacidade instalada dos mamógrafos em Pernambuco, tendo em vista a insuficiente oferta de mamografias e a má distribuição desses equipamentos em seu território.

Quality of tissue from punch biopsy forceps vs. round loop electrode in colposcopically directed biopsy: a randomized controlled trial / 부인종양

OBJECTIVE: To compare the quality of tissue from punch biopsy forceps (PB group) with round loop electrode (LE group) in colposcopically directed biopsy along with the evaluation of pain associated with each procedure. METHODS: Patients with abnormal cervical cytologic results and abnormal colposcopic findings were enrolled into a randomized trial into either a PB group or LE group. The quality of tissue was evaluated in regards to the size of tissue, site of tissue, and tissue damage. Each quality had 1 to 3 points and the sum of each quality contributed to the total tissue score that ranged from 3 to 9. Pain associated with each procedure was assessed by a visual analog scale (VAS). This was a clinical trial study and was registered at www.clinicaltrials.in.th (Identifier: TCTR20160404001). RESULTS: Ninety-six women who met all eligibility requirements were enrolled in the study. Forty-eight patients were randomly assigned to the PB group and 48 patients were randomized into the LE group. The characteristics of the patients were similar between the 2 groups with the exception of the median age. The median total tissue score was 8 points in the LE group which was more than the median of 7 points in the PB group with a statistically significant difference (p=0.014). However, the median VAS pain score in both groups was 3.4 (p=0.82). CONCLUSION: The quality of cervical tissues obtained from biopsy with a round loop electrode was better than the punch biopsy forceps with no difference in the level of pain.

Assessment of the accuracy of portable monitors for halitosis evaluation in subjects without malodor complaint. Are they reliable for clinical practice?

Abstract Halitosis is defined as a foul odor emanated from the oral cavity, with great impact in quality of life and social restraints. Recently, the use of Breath Alert™ in research increased significantly. Halimeter™, another portable device, is often used in clinical practice. Nevertheless, not many studies have verified the accuracy and compared the results of both devices simultaneously. Objective: To verify the accuracy of Breath Alert™ and Halimeter™ in patients without chief complaint of halitosis, using the organoleptic test (OT) as "gold standard." The second aim was to verify whether their concomitant use could enhance the diagnostic accuracy of halitosis. Material and Methods: A cross-sectional analytical study was performed. The quality of expired air of 34 subjects without chief complaint of halitosis was assessed. Two experienced examiners carried out the OT. Afterward, a third blinded examiner performed Halimeter™ (HT) and Breath Alert™ (BA) tests. Results: The OT identified halitosis in 21 subjects (62%). The area under the ROC curve (95% confidence interval) was 0.67 (0.48-0.85) and 0.54 (0.34-0.75) for HT and BA, respectively. The accuracy for HT and BA was 59% and 47%, respectively. The combined usage of HT and BA provided 11 positive results, being 9 subjects (43%) out of the total of 21 positive cases. Conclusions: Halimeter™ and Breath Alert™ were not able to diagnose halitosis in non-complainer subjects at the same level as the organoleptic examination, since their accuracy were low. Our results suggest that such portable devices are not reliable tools to assess halitosis and may neglect or misdiagnose a considerable number of patients in clinical practice.

Evaluation of tear film and meibomian gland function in dry eye patients using Keratograph 5M / 浙江大学学报·医学版

To assess the application of Keratograph 5M in evaluating tear film and meibomian gland function in patients with dry eye.A total of 144 eyes were recruited in the study, in which 72 eyes were from patients diagnosed with dry eye and 72 eyes were from healthy subjects. All subjects finished following tests or examinations:ocular surface disease index (OSDI) to evaluate eye symptoms; Keratograph 5M examination to obtain tear meniscus height (TMH), noninvasive tear break-up time (NIBUT) including first NIBUT (NIBUT-Fir) and average NIBUT (NIBUT-Ave), and infrared meibography; and fluorescein sodium staining to obtain fluorescein tearbreak-up time (FBUT).Dry eye group had higher OSDI score than healthy control group, but its TMH, NIBUT-Fir and NIBUT-Ave were lower than those in healthy control group (all<0.01). Total meiboscore in dry eye group was higher than that in healthy control group (<0.01), and it showed a significant correlation with NIBUT-Fir and NIBUT-Ave (=-0.449 and -0.398,<0.01), but no correlation with ages was observed (=0.031,>0.05). The NIBUT-Fir and NIBUT-Ave showed a significant correlation with FBUT (=0.833 and 0.727,<0.01).Keratograph 5M is a convenient, accurate and non-invasive method to assess the function of tear film and meibomian gland, and the new meibography scoring system can evaluate the function of meibomian gland objectively and succinctly.

Estrategias para la introducción de nuevos diagnosticadores en el Sistema Nacional de Salud / Strategies for the introduction of new diagnostics in the national health system

Introducción: los cambios continuos del entorno obligan a las empresas a vigilar constantemente sus productos, tecnologías y la preparación de sus directivos y empleados para adaptarse a las tendencias del mercado y fortalecer su prevalecía en el mismo. Las empresas deben contar con un sistema de información que favorezca la generación y transmisión de las ideas procedentes de empleados, proveedores, clientes, competidores o del análisis de mercado. Objetivo: reestructurar el Cuadro Básico de Diagnosticadores para los laboratorios de Química Clínica y Microbiología, pertenecientes a las instituciones del sistema de salud, acorde con las nuevas introducciones por la Empresa de Producción de Biológicos Carlos J. Finlay. Métodos: se aplicaron diferentes herramientas para identificar el posicionamiento y la vigencia que tiene la Empresa de Producción de Biológicos Carlos J. Finlay en el sistema de salud cubano. Se aplicó una encuesta validada en 181 centros asistenciales para determinar los posibles productos a incorporar. La metodología de trabajo agrupó 6 etapas. Resultados: se obtuvo que la Empresa Carlos J. Finlay, como principal productor del diagnóstico en Cuba, posee vigencia y posicionamiento, se identificaron todas las investigaciones analíticas que permitirán ofrecer un servicio de excelencia, la caracterización de los diagnosticadores por grado de importancia en cuanto a significado clínico, tecnología, factibilidad económica y demanda. La introducción de los productos evaluados y validados por especialistas del Grupo Nacional de Laboratorio cubrirá el diagnóstico esencial en 90 por ciento en Química Clínica y un 45 por ciento en Inmunoquímica en los centros asistenciales del sistema de salud cubano. Se confeccionó un programa para la introducción. Conclusiones: se evidenció el posicionamiento de la empresa en el Sistema Nacional de Salud, así como las potencialidades que la misma tiene para el desarrollo y asimilación de nuevas tecnologías(AU)

Introduction: the ongoing changes in the world scenario force the companies to permanently surveil their products, technologies and the preparation of their managers and employees in order to adapt to the market trends and to strengthen their prevalence there. The companies should have in place an information system favoring the generation and conveyance of ideas from employees, providers, clients, competitors or the market analyzis. Objectives: to restructure the Basic Group of Diagnostics for clinical chemistry and microbiology laboratories attached to the health care system institutions according to the new products introduced by Carlos J Finlay biologicals manufacturer enterprise. Methods: several tools were applied to identify the position and the validity that Carlos J. Finlay enterprise has in the Cuban health care system. The survey was validated in 181 medical assistance centers to determinte the possible products to be incorporated. The working methodology comprises 6 phases. Results: it was found out that this enterprise, as main manufacturer of diagnostics in Cuba, has validity and position in the market; all the analytical researches were identified, which will allow providing excellence service, characterization of diagnostics by level of importance in terms of clinical significance, technology, economic feasibility and demand. The introduction of the evaluated and validated products by the specialists of the national group of laboratories will cover 90 percent of the essential diagnosis in clinical chemistry and 45 percent in immunochemistry in the assistance centers of the Cuban health system. aprogram was designed to this end. Conclusions: it was confirmed that 'Carlos J Finlay" enterprise is positioned in the national health system as well as its potentialities for the development and assimilation of new technologies(AU)

Auditoria por resultados: uma proposta metodológica / Audit for results: a methodological proposal

Esta dissertação teve o objetivo de propor critérios para a criação da modalidade de Auditoria por Resultados para o Sistema Nacional de Auditoria (SNA), controle interno do SUS, com base nas ações realizadas pelo Departamento Nacional de Auditoria do SUS (Denasus), componente federal do SNA. Os três capítulos teóricos foram desenvolvidos apresentando, inicialmente, a auditoria como instrumento de gestão, com seu histórico, conceitos, evolução na administração pública e o papel da auditoria na governança pública e na organização do controle brasileiro. No capítulo seguinte, o trabalho centrou na auditoria do SUS, trazendo sua história, origens e evolução do SNA, além de sua situação atual e do seu componente central, o Denasus, com seus avanços e ações inovadoras na busca da melhoria do SUS. O terceiro capítulo teórico desenvolveu o referencial para a Auditoria por Resultados, dividido em três partes: uma base nas teorias e métodos da Administração por Resultados trazidos por Idalberto Chiavenatto; a distinção de auditoria nos processos e nos resultados e de aspectos de eficiência, eficácia e efetividade; e, conceituações para este tipo de auditoria, efetuando uma pesquisa na literatura quanto à Auditoria por Resultados, não encontrando nada nos órgãos de controle brasileiro, mas dois manuais europeus com o título de Auditoria de Resultados, baseados nas referências internacionais da auditoria operacional, a qual também o Tribunal de Contas da União (TCU) e o Denasus citam em seus manuais. Em seguida aos capítulos teóricos, um último capítulo trouxe as análises e a apresentação da proposta de uma Auditoria por Resultados para o SNA...

This work aimed to propose criteria for the creation of the Audit by Results modality for the National Audit System (SNA), SUS internal control, based on the actions taken by the National Audit of SUS Department (Denasus), federal component SNA. The three theoretical chapters were developed presenting initially the audit as a management tool, with its history, concepts, evolution in public administration and the role of audit in public governance and organization of the Brazilian control. In the next chapter, the work focused on the SUS audit, bringing its history, origins and evolution of the SNA, as well as their current situation and its central component, the Denasus, with its advances and innovative actions seeking to improve the SUS. The third chapter developed the theoretical reference for the Audit by Results, divided into three parts: one based on the theories and methods Administration by results brought by Idalberto Chiavenatto; the distinction of audit in the processes and results and considerations of efficiency, efficacy and effectiveness; and concepts for this type of audit, performing a literature search on the Audit by Results, finding nothing in the Brazilian control agencies, but two European books with the title of Audit of Results, based on international benchmarks of operational audit, the which also the Court of Auditors of the Union (TCU) and the Denasus put in their manuals. Following the theoretical chapters, one last chapter brought the analysis and the presentation of the proposal of an audit by results for the SNA. The analysis first involved identifying Denasus's audit contributions for changes in public health policies, selecting the Family's Health Strategy (ESF), the Brazil’s People's Pharmacy Program (PFPB) and Women's Health Policy, with the evaluation of mammography in the prevention of Breast Cancer...

Un microscopio proyector en el recuerdo de un estudiante / A projecting microscope in the memory of a dental student

Este artículo describe un microscopio que proyectaba preparados de histología sobre una pantalla, utilizando una fuente luminosa de gran intensidad por el arco voltaico.

Equipment-Based Image-Enhanced Endoscopy for Differentiating Colorectal Polyps

The use of colonoscopy for the screening and surveillance of colorectal cancer has increased. However, the miss rate of advanced colorectal neoplasm is known to be 2% to 6%, which could be affected by the image intensity of colorectal lesions. Image-enhanced endoscopy (IEE) is capable of highlighting lesions, which can improve the colorectal adenoma detection rate and diagnostic accuracy. Equipment-based IEE methods, such as narrow band imaging (NBI), Fujinon intelligent color enhancement (FICE), and i-Scan, are used to observe the mucosal epithelium of the microstructure and capillaries of the lesion, and are helpful in the detection and differential diagnosis of colorectal tumors. Although NBI is similar to chromoendoscopy in terms of adenoma detection rates, NBI can be used to differentiate colorectal polyps and to predict the submucosal invasion of malignant tumors. It is also known that FICE and i-Scan are similar to NBI in their detection rates of colorectal lesions. Through more effective and advanced endoscopic equipment, diagnostic accuracy could be improved and new treatment paradigms developed.

Diagnostic cast - a forgotten diagnostic tool

Dentists are challenged to create solutions for problems that patients present from chipped or missing teeth, a collapsed bite, or teeth that are irregular or misshapen. A clear diagnosis of the condition often is required for a proper treatment planning. The diagnostic cast helps the dentist to evaluate the condition of the patient's oral condition and for the diagnostic purposes. Casts may also be used as education tools for dentists as they explain characteristics of a patient's bite or particular dental needs. They can also show how a restoration will look when the work is complete