Effectiveness of Tocilizumab in COVID-19 patients with pneumonia: A systematic review

Background and Objective@#COVID-19 contributes significantly to global morbidity and mortality. Age-related comorbidities elevate the risk of severe cases. Studies have recently demonstrated that widely available medications, including tocilizumab (TCZ), can manage severe symptoms. However, its effectiveness is unclear, particularly among the older population. Therefore, this review aimed to evaluate TCZ’s efficacy in managing severe pneumonia in individuals aged 50 and older.@*Methods@#We systematically search several databases and gray literature including Web of Science, CINAHL, Academic Search Complete, PsycINFO, PsycArticles, SocINDEX, CENTRAL/Cochrane Library, PubMed/MEDLINE for original research articles in English across several study designs published in the year 2020-2022. A narrative synthesis was conducted to summarize the evidence. We employed the NIH quality assessment tool for observational cohort studies to evaluate risk of bias. Additionally, we utilized GRADE to appraise the certainty of evidence.@*Results@#Among 539 screened articles, only five studies met the selection criteria. Tocilizumab's impact on severe COVID-19 pneumonia revealed a diverse effect on mortality rate, with 29% in the TCZ group, and 40% in the controls died within 30 days of intubation (OR 0.61; 95% CI, 0.27-1.36). It is also reported that TCZ was not associated with mortality, despite faster decline in pulmonary function and prolonged fever. Hospital mortality in the TCZ group was significantly lower than in the controls, and age over 60 was the only significant risk factor. Moreover, administering TCZ reduced mechanical ventilation needs, with 82% extubated compared to 53% in controls. However, 45% in TCZ group was associated with a higher ventilator-associated pneumonia rate than in the untreated group which was 20% (P < 0.001). Despite this, TCZ-treated patients had shorter hospital stays.@*Conclusions@#The effects of tocilizumab on reducing mortality risk and improving the survival rate of COVID-19 patients with pneumonia remained inconclusive. Yet, the majority of results suggested that giving tocilizumab leads to shorter hospital stays, lowers the requirement for mechanical ventilation, and decreases the likelihood of ICU transfer. Tocilizumab is linked to the incidence of secondary infections; hence, this medication should be closely monitored for side effects.

Regime de Informação e tipologia documental no âmbito dos serviços de saúde: noções aplicadas à gestão da informação em hospitais federais do estado do Rio de Janeiro / Information Regime and documental typology in the field of health services: notions applied to information management in federal hospitals in the state of Rio de Janeiro / Régimen de Información y tipología documental en el ámbito de los servicios de salud: nociones aplicadas a la gestión de la información en los hospitales federales del estado de Río de Janeiro

Aborda a tipologia documental em sistemas de informação digitais, compreendendo-a como metadado essencial na estrutura de transferência da informação entre serviços, sistemas e redes de atenção e inovação à saúde. Por meio de pesquisa de campo com gestores de dois hospitais federais do Rio de Janeiro, realiza prospecção e análise da gestão de sistemas de informação digitais em saúde. Os resultados revelaram que o emprego do conceito de Regime de Informação e de seus componentes analíticos permite-nos obter uma visão dos recursos informacionais, tecnológicos, humanos e normativos do sistema nacional de saúde, que integram o Sistema Único de Saúde. Destaca a tipologia documental como um dos elementos constituintes dos sistemas de informação nos serviços dos hospitais, cujas interconexões e articulações expressam os aspectos seletivos e decisórios das práticas e ações de informação

It addresses the document typology in digital information systems, understanding it as essential metadata in the structure of information transfer between attention and innovation health services, systems and networks. Through field research with managers of two federal hospitals in Rio de Janeiro, it prospects and analyzes the management of digital health information systems. The results revealed that the use of the concept of Information System and of its analytical components allows us to obtain a vision of the informational, technological, human and normative resources of the national health system, which are part of the Unified Health System. It highlights the documentary typology as one of the constituent elements of information systems in hospital services, whose interconnections and articulations express the selective and decision-making aspects of information practices and actions

Aborda como objeto la tipología documental en los sistemas de información digital, entendiéndola como un metadato esencial en la estructura de transferencia de información entre servicios, sistemas y redes de atención e innovación en salud. A través de una investigación de campo con gerentes de dos hospitales federales de Río de Janeiro, prospecta y analiza la gestión de los sistemas digitales de información en salud. Los resultados revelaran que la utilización del concepto de Régimen de Información y de sus componen-tes analíticos permítenos obtener una visión de los recursos informacionales, tecnológicos, humanos y normativos del sistema nacional de salud, que integram el Sistema Único de Salud. Destaca la tipología documental como uno de los elementos constitutivos de los sistemas de información cuyas interconexiones y articulaciones expresan los aspectos selectivos y decisorios de las prácticas y acciones informativas reali-zadas en este dominio

Gestão de cuidados paliativos em domicílio: perspectivas de enfermeiros de um município do oeste do Paraná / Management of palliative care at home: perspectives of nurses from a municipality in the west of Paraná / Gestión de los cuidados paliativos en el domicilio: perspec- tivas de enfermeros de un municipio del oeste de Paraná

Introdução: O avanço tecnológico e as constantes mudanças mundiais para aumentar a qualidade de vida, e consequentemente o aumento da expectativa de vida, no entanto nem sempre isso é possível devido ao adoecimento crônico e o desencadeamento da necessidade de cuidados paliativos. Objetiva-se analisar sobre a gestão do cuidado paliativo em domicílio na perspectiva de enfermeiros de um município do oeste do paraná. Metodologia: trata-se de uma pesquisa exploratória, com abordagem qualitativa realizada com enfermeiros que atuam no Programa de Assistência e Internação Domiciliar (PAID) do município do Oeste do Paraná. A autorização para a realização da pesquisa foi solicitada junto à Secretaria Municipal de Saúde (SMS) do município pesquisado. Após autorização da (SMS e PAID) e aprovação do Comitê de Ética e Pesquisa da Unipar deu-se início a coleta de dados que aconteceu nos meses de setembro e outubro de 2022. Para análise dos dados, utilizou-se análise de conteúdo de Bardin. Principais Resultados foram organizados em cinco categorias: Os enfermeiros na gestão dos cuidados paliativos no domicílio; Ferramentas para a organização do cuidado paliativo no domicílio; A contribuição da família e do cuidador para atenção domiciliar; Desafios no trabalho com cuidados paliativos no domicílio; O trabalho em equipe como estratégia de gestão do cuidado na atenção domiciliar. Conclusões: O estudo evidenciou que os enfermeiros que atuam no Programa de Assistência e Internação Domiciliar são gestores dos cuidados paliativos no domicílio, tendo a equipe multiprofissional e a família como aliados e suporte em seu processo de trabalho direcionados ao indivíduo em cuidados paliativos e enfrentam desafios de diferentes naturezas em sua prática, sendo eles relacionados a aspectos como: a operacionalização da rotina de trabalho diante das diversas demandas do território local; ao campo de atuação e a rede deficitária de suporte ao paciente e a família; e de comunicação/acolhimento aos pacientes e familiares em um cenário que favorece a fragilidade emocional de todos os envolvidos nesse processo de cuidado.

Introduction: Technological advances and constant world changes to in- crease the quality of life, and consequently the increase in life expectancy, however this is not always possible due to chronic illness and triggering the need for palliative care.Ob- jective is to analyze the management of palliative care at home from the perspective of nurses in a municipality in western Paraná. Methodology: this is exploratory research, with a qualitative approach, carried out with nurses who work in the Home Assistance and Hospitalization Program (PAID) in the city of Western Paraná. Authorization to carry out the research was requested from the Municipal Health Secretariat (SMS) of the rese- arched municipality. After authorization from (SMS and PAID) and approval from Uni- par's Ethics and Research Committee, data collection began in September and October 2022. Bardin's content analysis was used for data analysis. Results were organized into five categories: Nurses managing palliative care at home; Tools for organizing palliative care at home; The contribution of the family and the caregiver to home care; Challenges in working with palliative care at home; Teamwork as a care management strategy in home care. Conclusions: The study showed that the nurses who work in the Home Assis- tance and Hospitalization Program are managers of palliative care at home, with the mul- tidisciplinary team and the family as allies and support in their work process, aimed at the individual in palliative care and facing challenges of different natures in their practice, being related to aspects such as: the operationalization of the work routine in face of the different demands of the local territory; the field of action and the deficient support network for the patient and family; and communication/welcoming patients and family members in a scenario that favors the emotional fragility of all those involved in this care process.

Introducción: Los avances tecnológicos y los constantes cambios mundiales para aumentar la calidad de vida, y en consecuencia el aumento de la esperanza de vida, sin embargo esto no siempre es posible debido a las enfermedades crónicas y desencade- nar la necesidad de cuidados paliativos.Objetivo es analizar la gestión de los cuidados paliativos en el hogar desde la perspec-tiva de las enfermeras de un municipio en el oeste de Paraná. Metodología: se trata de una investigación exploratoria, con abordaje cualita- tivo, realizada con enfermeros que actúan en el Programa de Asistencia Domiciliaria y Hospitalización (PAID) de la ciudad de Paraná Oeste. La autorización para la realización de la investigación fue solicitada a la Secretaría Municipal de Salud (SMS) del municipio investigado. Después de la autorización de (SMS y PAID) y de la aprobación del Comité de Ética e Investigación de la Unipar, se inició la recolección de datos en septiembre y octubre de 2022. Para el análisis de los datos se utilizó el análisis de contenido de Bardin. Los resultados fueron orga-nizados en cinco categorías: Enfermeras que gestionan los cuidados paliativos en el domicilio; Herramientas para organizar los cuidados paliativos en el domicilio; La contribución de la familia y del cuidador en la atención domiciliaria; Retos en el trabajo con cuidados paliativos en el domicilio; El trabajo en equipo como estrategia de gestión de los cuidados en la atención domiciliaria. Conclusiones: El estudio demostró que las enfermeras que trabajan en el Programa de Asistencia Domiciliaria y Hospitalización son gestoras de cuidados paliativos en el domicilio, con el equipo multi- disciplinar y la familia como aliados y apoyo en su pro-ceso de trabajo, dirigido al indi- viduo en cuidados paliativos y enfrentando desafíos de diferente naturaleza en su práctica, estando relacionados con aspectos como: la operacionalización de la rutina de trabajo frente a las diferentes demandas del territorio local; el campo de actuación y la deficiente red de apoyo al paciente y a la familia; y la comunicación/acogida de pacientes y famili- ares en un escenario que favorece la fragilidad emocional de todos los involucrados en este proceso de cuidados.

CHINA PH ARMACY Volume 33，Number 6，March 30，2022 Semimonthly Table of Contents Guideline for the evaluation of medicine list in Chinese med ical instituti ons / 中国药房

In order to improve the management level of medicine list of medical institutions in China ，and help medical institutions build a medicine list of medical institutions with reasonable drug use structure ，standardized adjustment procedures ， convenient operation and application and scientific evaluation methods ，so as to meet the needs of clinical rational drug use to the greatest extent ，with the support of the Pharmaceutical Care Professional Committee of the Chinese Pharmaceutical Association ， China-Japan Friendship Hospital and the First Affiliated Hospital of University of Science and Technology of China （Anhui Provincial Hospital ）jointly initiate and complete Guideline for the Evaluation of Medicine List in Chinese Medical Institutions jointly with a number of medical institutions. In strict accordance with the methodological requirements of World Health Organization standard guidelines ，based on the Delphi method ，the guideline formulation working group has constructed the quality evaluation index system and quantitative scoring table of medicine list management in medical institutions from the 5 dimensions of organization and management ，structure，adjustment，application and e valuation of the list. It is used to help medical institutions evaluate the quality of their medicine list management ，so asto play a positive role in the fine management of medicine list in medical institutions.

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

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

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

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

Animación interactiva en la administración segura de medicamentos / Interactive animation in secure administration of medications

Introducción: El objetivo de esta investigación fue fortalecer a estudiantes de enfermería en temática de la administración segura de medicamentos a través de una animación interactiva, orientado a maximizar el bienestar del sujeto de cuidado que requiera atención terapéutica en los diferentes servicios de salud. Metodología: Estudio cualitativo-cuantitativo (mixto), de cohorte transversal, con revisión de literatura en la primera fase y en la segunda fase ejecución cuasi experimental, aplicando consideraciones éticas como son: Validación de herramienta de recoleccion de datos pretest y postest por expertos. Resultados: La aplicabilidad de animación interactiva proporciona fortalecimiento en la percepción de los estudiantes de enfermería sobre la importancia de la adherencia en la práctica de manejo y la responsabilidad ético legal en administración segura de medicamentos en los servicios de salud. Aplicando en esta fase una herramienta tipo encuesta a estudiantes que cursan 8 semestres de enfermería en la jornada mañana y tarde. Resultados: se evidenció en la jornada mañana un 51.7% tenían conocimiento teórico y posterior a la socialización del video, el postest mejoró al 86.2%, en cuanto a la responsabilidad ético legal en el pretest un 62 % tenian adherencia a la ética en administración segura de medicamentos y que con el postest cambio a un 93 % mejorando la percepción de la adherencia a la ética en administración segura de medicamentos. En los resultados de estudiantes de la jornada tarde, el 52.6% tienen conocimiento teórico en el pre-test y con resultado del 89.4% en el post ­test; en cuanto a la responsabilidad ético legal se obtuvo en el pre-test un 68.4 % y un resultado en el post-test el 89.4%. Lo anteriormente descrito se mejoró con la animación interactiva, fortaleciendo los conocimientos teóricos y éticos en administración segura de medicamentos por vía intravenosa al sujeto que requiera atención terapéutica. Conclusión: Se concluye que la animación interactiva es un programa que ayuda a que la formación de enfermería reconozca y comprenda la labor y el deber de administrar tratamientos farmacológicos aplicando ética en la práctica de la misma, ya que el usuario que requiere un tratamiento tiene derecho a que se le proteja su integridad orgánica y sistémica. Adicionalmente, en relación al estudio realizado se evidencia que por medio de animación interactiva se logró fortalecer los conocimientos teóricos y prácticos en administración segura de medicamentos.

Introduction: The objective of this research was to strengthen the nursing staff in the safe administration of medicines through an interactive animation, oriented towards the welfare of the subject of care that requires therapeutic attention in the different health services. Methodology: Qualitative-quantitative cross-sectional study (mixed), with literature review in the first phase and in the second phase quasi-experimental execution, applying ethical considerations such as: Pre-test and post-test validation by experts. Results: The applicability of interactive animation provides strengthening in the perception of nursing staff about the importance of adherence in the practice of ethics in safe administration of medicines in health services. Applying in this part, the quantitative phase with quasi-experimental design type to the nursing student population of the University Foundation of the Andean Area, who study 8 semester and which is taken as a sample in the morning session 29 students and in the afternoon session 19 nursing students. Where it was evidenced in the day tomorrow with the students of nursing that 51.7% had theoretical knowledge and that with the realization of the posttest improved to 86.2%, as for the ethical ethical responsibility in the pretest 62% have adherence to the ethics in safe administration of medications and that with the post-test changed to 93% improving the perception of adherence to ethics in safe administration of medicines. In the pretest and posttest results made to the students of the afternoon session, 52.6% have theoretical knowledge in the pre-test and with a result of 89.4% in the post-test; in the part of ethical legal responsibility, 68.4% was obtained in the pre-test and 89.4% in the post-test. The above described was improved with interactive animation, strengthening the theoretical and ethical knowledge in safe administration of intravenous medications to the subject that requires therapeutic attention. Conclution: It is concluded that interactive animation is a program that helps the nursing profession know that it has the task and duty to administer pharmacological treatments applying ethics in the practice of the same, since the user that requires a treatment has the right to have its organic and systemic integrity protected. Additionally, in relation to the study carried out, it is evident that through interactive animation, the theoretical and practical knowledge in safe drug administration was strengthened.

Research progress on the core competence of head nurses / 中国基层医药

With the rapid development of economy and society and the progress of health care,the requirements of the head nurses＇core competence are also changing.The head nurse,as the manager of nursing work ,has gradually raised the requirements on the head nurse in the new era.The development of core competence is the basic requirement of the head nurse,which is of vital importance to the development of the head nurse.This paper introduces the requirements of head nurse ,the role of head nurse,the core competence of head nurse and the methods to cultivate the core competence of head nurse in the new era.

Potencial de vazão ambiental: método participativo para estimar vazão ambiental em rios na Amazônia / Potential of environmental flow: participatory method for determining environmental flow in hydropower's reservoirs in Amazon rivers

RESUMO O potencial de vazão ambiental (PVA) é um método alternativo de estimativa de vazão por considerar principalmente as características ecológicas, econômicas e culturais das bacias hidrográficas, reduzindo erros de estimativa na avaliação de impactos ambientais para implantação ou operação de usinas hidrelétricas (UHEs). O objetivo desta pesquisa foi adaptar a metodologia do PVA para grandes bacias da Amazônia usando abordagem holística. A metodologia de estimativa do PVA foi adaptada às bacias hidrográficas dos rios Tocantins, no Pará, Jari, no Amapá e Pará, e Araguari, no Amapá, em fase de operação e/ou instalação de UHEs. Os resultados sugerem que, nos rios Tocantins e Araguari, ambos sob influência de barramentos em operação, o parâmetro mais relevante do PVA foi o estresse hídrico. Diante dos impactos diretos dessas UHEs, a vazão é elevada e suficiente para manter o ecossistema ou a diversidade aquática durante o ano. Contudo, a resposta do método na bacia hidrográfica do rio Jari indicou o parâmetro dependência econômica como o mais crítico, já que o rio é intensamente utilizado para a locomoção pelos moradores do Pará e Amapá e, dessa forma, o cálculo da vazão por método não adequado comprometeria essa tão importante função do rio. Concluiu-se que o método PVA é uma ferramenta alternativa interessante à gestão de grandes bacias por ser flexível, adaptável e principalmente por permitir a participação dos agentes envolvidos nos processos decisórios.

ABSTRACT The potential of environmental flow (PVA) is an alternative method to estimate the flow as it mainly considers the ecological, economic and cultural characteristics of the basins, reducing estimation errors in the assessment of environmental impacts for deployment or operation of hydroelectric power plants (HPPs). The aim of this research was to adapt the PVA methodology for Amazon's large basins using holistic approach. The methodology for estimating the PVA was adapted to the watersheds of the rivers Tocantins, in Pará, Jari, in Amapá and Pará, and Araguari, in Amapá, under operation and/or final installation of HPPs. The results suggest that, in the Tocantins and Araguari rivers, both under the influence of dams in operation, the most relevant parameter of PVA was water stress. Taking into account the direct impact of these HPPs, the flow rate is high enough to keep the ecosystem or aquatic diversity during the whole year. However, the response of the PVA in the Jari river basin, in the ultimate construction phase, the most relevant parameter was the economic dependence, because the priority is the fluvial transport, and, in this way, estimating the flow by a non-adequate method would jeopardize this very important function. We concluded that the PVA method is an interesting tool for managing large basins, because it is flexible, adaptable and especially allowing the participation of the agents involved in the decision making processes.

Rapid Healing and Remodeling Process of Pediatric Seat-Belt Fracture without Surgical Treatment / 대한신경손상학회지

Pediatric seat-belt fracture is a rare condition, and its management has not been well defined. The authors report a case of pediatric Chance fracture that was managed conservatively and that demonstrated rapid bone healing. A 7-year-old boy presented with back pain after a motor vehicle accident. Plain lumbar spine radiography, three-dimensional computed tomography (CT), and magnetic resonance imaging revealed a seat-belt fracture type C (classified by Rumball and Jarvis), and the patient's condition was managed conservatively. The patient started to ambulate with a brace 2 weeks after the injury. Spine CT performed 100 days after the injury revealed a remodeled fracture, and dynamic radiography did not show any evidence of instability or kyphotic deformity. We suggest that if there are no neurological deficits or severe deformities, then a pediatric seat-belt fracture should be managed conservatively, because the bone healing process is far more rapid in children than it is in adults and because of possible growth problems after surgery.

Retrospective Analysis of Stroke at Acute Stage Treated by Traditional Chinese Medicine Clinical Pathway / 广州中医药大学学报

Objective To evaluate the effect for stroke(cerebral infarction)at acute stage intervened by traditional Chinese medicine(TCM) clinical pathway. Methods A retrospective analysis was carried out in the patients before and after intervention by TCM clinical pathway during the year of 2013-2016. The outcomes included the entrance rate,completion percentage,aberration rate,severity,hospitalization time,and hospitalization fee as well as functional prognosis 30 d after discharge. Results A total of 792 cases was included,241 cases admitted in the year of 2013, 191 in the year of 2014, 135 in the year of 2015, and 225 in the year of 2016. In the year of 2014-2016,the entrance rate,completion percentage,hospitalization time,hospitalization fee,critical case percentage,and gender constituent ratio were steadily(P > 0.05). Modified Rankin Scale(mRS)for short-term functional prognosis mRS 0 ~ 2 percentage and aberration rate in the year of 2016 were superior to those in the year of 2014 and 2015(P < 0.05). Functional improvement on discharge day 30 in the year of 2014-2016 was superior to that in the year of 2013(P < 0.05). The hospitalization time and hospitalization fee in the year of 2014-2016 were a liffle higher than those in the year of 2013(P < 0.05), showing no obvious increase. Conclusion The application of TCM clinical pathway can make the diagnosis and treatment procedure of stroke at acute stage standardized,enhance the therapeutic effect,achieve or even exceed the goal of manage scheme.

How to Develop and Manage the Policies of Hospital / 现代医院

According to laws and regulations , rules and relevant standards , combined with the actual condition of our hospital, to develop the hospital management policies of covering the whole process of medical care , and to update in time, which is the basis of ensuring the quality of medical care .Our hospital standardized the management of the policies , designed a unified process from the formulation , review, approval, issuance, revision, abolishment of the hospital management poli-cies, and supervised and implemented effectively , in order to achieve the sustainable development of hospital management policies standardly , integrally , dynamically .

The st udy on the influence of implementation of the Regulations on Hygienic Manaegment in Public Places on hygienic inspection management in public places in Hongkou District of Shanghai / 上海预防医学

Objective To investigate the influences and effects on hygienic inspection management in public places after the implementation of the Regulations on Hygienic Management in Public Pl aces ( hereinafter referred to as Regulations ) . Methods Data of hygienic management and administrative penalty in public places of Hongkou District from 2009 to 2013 were analyzed and investigated.Further-more, questionnaires and individual interviews were surveyed among 10%of proprietors and 250 employees in public places of Hongkou District. Results After the implementation of Regulatinos, administrative punishments for violators were more strictly .Meanwhile proprietors in public places fulfilled the added specific hygienic management requirements of the Rgeulations conscientiously.Moreover, the legal aware-ness was enhanced gradually. Conclus ion The proprietors and employee in public places lack a basic knowledge of the Regulations.Therefore, it is recommended that more intensive efforts should be made to study, publicize and implement the Regulations through various channels.Legal awareness and supervise consciousness of the proprietors and employee should be intensified, respectively.Meanwhile, their own management should be normalized.Furthermore, the professional quality, the abilities of administration by law and the level of supervision and law enforcement of health supervisors should be improved , respectively.Thus the enduring hygienic management system of the public places will be established.

Observatorio de Discapacidad de Colombia / The Colombian Observatory of Disability / Observatório de Deficiência da Colômbia

La Dirección de Epidemiología y Demografía (ded) y la Oficina de Promoción Social del Ministerio de Salud y Protección Social (msps), dando cumplimiento a las competencias y obligaciones de seguimiento, evaluación y gestión del conocimiento establecidas para el sector salud y desde el rol de esta cartera como rector del Sistema Nacional de Discapacidad (snd), ha priorizado el Observatorio de Discapacidad de Colombia como un instrumento técnico para la formulación, desarrollo y evaluación de acciones de inclusión social para la población con discapacidad en el marco del Sistema Nacional de la Discapacidad y el cumplimiento de la Convención sobre los Derechos de las Personas con Discapacidad. El propósito de este artículo es describir la experiencia del Ministerio de Salud y Protección Social en la implementación del Observatorio de Discapacidad de Colombia, describiendo las actividades de planeación, mejoramiento y estructuración requeridas, así como la recolección sistemática, el análisis e interpretación de datos e información sobre la situación de discapacidad en el país.

The Direction of Epidemiology and Demography (DED) and the Social Promotion Office of the Ministry of Health and Social Protection (MSPS), in compliance with the responsibilities and duties of monitoring, assessing and managing the knowledge in the health sector and as the Director of the National System of Disability (SND), has prioritized the Observatory of Disability of Colombia as a technical instrument for the formulation, development and assessment of the actions of social inclusion for people with disabilities within the framework of the National System of Disability and in compliance with the Convention on the Rights of people with Disabilities. The purpose of this paper is to describe the experience of the Ministry of Health and Social Protection in the implementation of the Observatory of Disability of Colombia. The paper describes the required planning, improvement and structuring activities as well as the systematic gathering, analysis and interpretation of data and information on the situation of disability in Colombia.

A Direção de Epidemiologia e Demografia (DED) e o Escritório de Promoção Social do Ministério da Saúde e Assistência Social (MSPS), dando cumprimento às competências e obrigações de seguimento, avaliação e gestão do conhecimento estabelecidas para a área da saúde e desde o papel desta carteira como Reitor do Sistema Nacional de Deficiência (SND), tem priorizado o Observatório de Deficiência da Colômbia como um instrumento técnico para a formulação, desenvolvimento e avaliação de ações de inclusão social para a população com deficiências no quadro do Sistema Nacional da Deficiência e o cumprimento da Convenção sobre os Direitos das Pessoas com Deficiências. O intuito deste artigo é descrever a experiência do Ministério da Saúde e Assistência Social na implementação do Observatório de Deficiência da Colômbia, descrevendo as atividades de planejamento, melhoria e estruturação necessárias, bem como a coleta sistemática, a análise e interpretação de dados e informação sobre a situação de deficiência no país.

Diagnosis and treatment of type 2 diabetes mellitus in children and adolescents / 中华实用儿科临床杂志

With the obesity epidemic,children and adolescents with type 2 diabetes mellitus(T2DM)signifi-cantly increased throughout the world,screening and diagnosis of T2DM in the high - risk population is very important. In addition to lifestyle modification,the recommended optimal pharmacologic treatment of children and adolescents with T2DM is Metformin and Insulin. To reduce the risk of cardiovascular diseases,should fully understand the comorbidities and complications of T2DM,and take better assessment and management.

PROBLEMS AND COUNTERMEASURES EXISTINGIN HOSPITAL RATIONAL MEDICATIO-NEVALUATION / 现代医院

The rational prescription evaluation is important for improving the medical quality and ensuring prescription safety.For the last few years, the health authorities have issued a series of files in order to regulate clini-cal medical conducts, and reduce the irrational prescription.Hospitals are also paying more attention to the rational medicine evaluation.The evaluation is likely to be doubted and resisted for the difference of evaluation personnel, e-valuation personnel quality and evaluation criterion.Therefore, the smooth development of hospital rational prescrip-tion evaluation need to adopt effective management measures, which is connected with responsibilities, guaranteed by rewards and punishments and based on actualities, and establish various evaluation management mechanism to ensure continuous correction and updating at work.

Application of PDCA cycle to improve hand hygiene compliance among health care workers / 中国感染控制杂志

Objective To improve hand hygiene compliance among health care workers(HCWs)through continu-ous quality improvement,and effectively reduce the incidence of healthcare-associated infection(HAI).Methods Continuous quality improvement was performed by adopting plan-do-check-action(PDCA)cycle,all HCWs were trained,hand hygiene was stressed,periodical and random checking was conducted.Results After the implementa-tion of PDCA cycle,the acknowledge rate of hand hygiene enhanced from 48.00% to 63.99%;hand hygiene com-pliance rate enhanced from 65.11% to 82.40%,the difference were both significant(χ2=12.75,259.65,respective-ly,both P<0.05).The daily consumption of instant hand antiseptic per 1 000 bed day increased obviously,which was 2.95-fold of pre-implementation.Conclusion Continuous quality improvement through PDCA cycle can effec-tively improve hand hygiene compliance rate of HCWs.

Enfermagem e gerenciamento da situação de saúde na estratégia de saúde da família / Nursing and health management situation in family health strategy / Enfermería y gestión de la situación de la salud en la estrategia de salud familiar

O gerenciamento em enfermagem configura-se em um instrumento para potencializar a análise e avaliação do trabalho, além de intervir no processo saúde-doença da população. O presente estudo tem o objetivo de analisar a compreensão dos enfermeiros que atuam na Estratégia de Saúde da Família sobre o relatório de Situação de Saúde e Acompanhamento das Famílias. Trata-se de uma pesquisa qualitativa com enfermeiras que atuam na Estratégia de Saúde da Família da zona rural do município de Russas (CE). Embora informem a importância do Relatório para a construção de indicadores, as profissionais não usufruem da coleta sistemática de dados para o planejamento das ações de saúde. Concluiu-se que o Relatório SSA2, dentre outros utilizados na dinâmica de trabalho da ESF, pode ser utilizado como instrumento fundamental para direcionar o planejamento das ações em saúde, pois pode desencadear estratégias para fortalecer projetos de intervenção na comunidade.

The nursing management sets up an instrument for enhancing the analysis and evaluation of the work, as well as intervening in the health-disease process of the population. The present study aims to analyze the understanding of nurses working in the Family Health Strategy Report on the Situation Monitoring of Health and Families. This is a qualitative research with nurses who work in the Family Health Strategy (FHS) of the rural municipality of Russian (CE), Brazil. Although the importance of the Report for the construction of indicators is claimed, the professionals do not enjoy the systematic collection of data for planning of health actions. It could be concluded that the Report SSA2, among others used in the working dynamics of the FHS can be used as a key tool to direct the planning of health actions as it can trigger strategies to strengthen community intervention projects.

La gestión de enfermería se configura en un instrumento para mejorar el análisis y la evaluación del trabajo, además de intervenir en el proceso de salud-enfermedad de la población. El presente estudio tiene como objetivo analizar la comprensión de los enfermeros que trabajan en la Estrategia de Salud Familiar sobre el informe de la Situación de la Salud y el Acompañamiento de las Familias. Es una investigación cualitativa con enfermeras que trabajan en la Estrategia de Salud Familiar en la zona rural del municipio de Russas (CE). A pesar de que ellas informan sobre la importancia del informe para la construcción de indicadores, las profesionales no disponen de la recolecta sistemática de datos para la planificación de las acciones de salud. Se concluye que el informe SSA2, entre otros utilizados en la dinámica de trabajo de la ESF, puede ser utilizado como una herramienta clave para orientar la planificación de las acciones de salud desencadenando, de esta forma, estrategias para fortalecer los proyectos de intervención comunitaria.

Standardization of Malignancies report in General Hospital promoted by combination of training and management / 中华医学科研管理杂志

Objective To explore appropriate management of cancer report for general hospital and analyze the effect.Methods Based on the requirements of cancer report for general hospital that formulated by the health administrative departments,we set the rule and process of malignancy report.We clear the responsibilities of reporting and the management,strengthen the training of malignancies report,make regular supervision and evaluation,and gradually use information live system to monitor malignancies report.Results In 2006-2010,the number of reports of malignancy in our general hospital has a upward trend.The false negative rate and delaying rate decreased year by year.The pass rate of the report card increased year by year,and the difference was statistically significant (＜0.05).With the increase of the rate of training for malignancies report,rate of timely report increased significantly.Conclusion General hospitals should use their own conditions to the development of scientific and operational report management systems and processes for malignancies.Attention should be paid to the combine of training and management and the gradual standardizing of the malignancies reporting.

Newer insights in teledermatology practice.

The study and practice of dermatology care using interactive audio, visual, and data communications from a distance is called teledermatology. A teledermatology practice (TP) provides teleconsultation as well tele-education. Initially, dermatologists used videoconference. Convenience, cost-effectiveness and easy application of the practice made "store and forward" to emerge as a basic teledermatology tool. The advent of newer technologies like third generation (3G) and fourth generation (4G) mobile teledermatology (MT) and dermatologists' interest to adopt tertiary TP to pool expert (second) opinion to address difficult-to-manage cases (DMCs) has resulted in a rapid change in TP. Online discussion groups (ODGs), author-based second opinion teledermatology (AST), or a combination of both are the types of tertiary TP. This article analyzes the feasibility studies and provides latest insight into TP with a revised classification to plan and allocate budget and apply appropriate technology. Using the acronym CAP-HAT, which represents five important factors like case, approach, purpose, health care professionals, and technology, one can frame a TP. Store-and-forward teledermatology (SAFT) is used to address routine cases (spotters). Chronic cases need frequent follow-up care. Leg ulcer and localized vitiligo need MT while psoriasis and leprosy require SAFT. Pigmented skin lesions require MT for triage and combination of teledermoscopy, telepathology, and teledermatology for diagnosis. A self-practising dermatologist and national health care system dermatologist use SAFT for routine cases and a combination of ASTwith an ODG to address a DMC. A TP alone or in combination with face-to-face consultation delivers quality care.