Management of lung diseases under ultrasound monitoring: potential to make bronchopulmonary dysplasia in preterm infants as an avoidable disease / 中国当代儿科杂志

Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in preterm infants. Despite significant progress in the understanding of its etiology, mechanisms, prevention, and treatment, the prognosis remains poor. BPD not only has a high mortality rate but also causes persistent respiratory, neurological, and cardiovascular impairments in survivors. The author's team has successfully prevented the occurrence of BPD by managing neonatal lung diseases under lung ultrasound monitoring for nearly 7 years, opening up a new approach in BPD prevention. This article provides a brief overview of the approach, aiming to facilitate further research and provide more scientifically sound management strategies to prevent or minimize the occurrence of BPD.

Ethical Thoughts on the Quality Evaluation of the Kidneys from Expanded Criteria Donors / 中国医学伦理学

In the case of extremely shortage of donor kidney sources, the number of Expanded Criteria Donors (ECD) with relatively poor kidney quality and transplantation effect is increasing. In order to alleviate the contradiction between supply and demand by using transplantable kidneys as much as possible and avoid the failure or poor effect of transplantation caused by poor quality kidneys, the quality assessment and evaluation criteria of ECD kidney have become a research hotspot in the field of kidney transplantation. This paper analyzed the possible ethical defects in the research process, and put forward some suggestions for the transplantation team to strictly follow the ethical principles of "no harm", "beneficial" and "informed consent", and the organ transplantation ethics committee to pay attention to the ethical review of the quality evaluation process of ECD donor kidney.

Research progress in liver transplantation for colorectal liver metastasis / 器官移植

Colorectal cancer is one of the common malignant tumors in China. Studies have shown that more than 50% of patients with colorectal cancer will experience metastasis. After systematic treatment, patients with resectable colorectal cancer could obtain favorable 5-year survival rate. However, patients with unresectable colorectal liver metastasis constantly obtain poor prognosis. In spite of the development of medical treatment, patients with unresectable colorectal liver metastasis can be treated by multiple approaches, such as interventional therapy combined with targeted therapy and immunotherapy, clinical efficacy is relatively low. Hence, clinicians divert extensive attention to liver transplantation. Liver transplantation, as an emerging treatment in recent years, is expected to improve clinical prognosis of patients with unresectable colorectal liver metastasis. In this article, research progress in liver transplantation for patients with unresectable colorectal liver metastasis was reviewed, mainly including the historical overview, recent results, prognostic factors, adaptation criteria, relationship with systemic treatment, liver source shortage and donor allocation, aiming to provide reference for liver transplantation for patients with colorectal liver metastasis.

Construction and Interpretation of Clinical Comprehensive Evaluation Index System for Chinese Patent Medicine Based on EVIDEM Framework / 中国实验方剂学杂志

ObjectiveTo establish the clinical comprehensive evaluation index system for Chinese patent medicine（CPM） based on Evidence and Value：Impact on DEcisionMaking（EVIDEM） framework， so as to promote the scientific， systematic and standardized implementation of clinical comprehensive evaluation of CPM. MethodThe clinical comprehensive evaluation index system was determined through literature review， semi-structured interview and Delphi method， and the weights of each index were clarified by analytic hierarchy process（AHP）. ResultThe recovery rates of both rounds of expert consultation were 100%， and the authority coefficient of experts was 0.90 and 0.905， respectively. Kendall's coordination coefficients（W） of the second- and third-level indicators in the first-round consultation were 0.320 and 0.283（P<0.001）， and in the second round were 0.411 and 0.351， respectively（P<0.001）. The finally constructed clinical comprehensive evaluation index system for CPM included 6 first-level indicators， 13 second-level indicators and 28 third-level indicators. Among the first-level indicators， the weights of effectiveness， safety， economy， innovation， suitability and accessibility were 37.34%， 32.68%， 11.85%， 5.87%， 5.79% and 6.47%， respectively. ConclusionThis study has constructed a universal clinical comprehensive evaluation index system for CPM， and the domain and criteria are introduced and interpreted in detail， which can provide reference and information for carrying out the clinical comprehensive evaluation of CPM， but it needs to be refined and improved in combination with the clinical practice of CPM for specialized diseases.

Comprehensive Clinical Evaluation of Yiqing Capsules in Treating Heat-toxin Syndrome / 中国实验方剂学杂志

ObjectiveTo systematically review the studies about Yiqing Capsules in the treatment of pharyngitis， tonsillitis， gingivitis， and oral ulcers with heat-toxin syndrome and clarify the advantages and therapeutic characteristics of Yiqing capsules， thus providing reference for the decision-making by relevant departments and clues for the clinical and basic research. MethodThe multi-criteria decision analysis （MCDA） model and CSC v2.0 were employed to comprehensively evaluate Yiqing capsules from multiple aspects. ResultThe serious adverse reactions in the spontaneous reporting system （SRS） monitoring data of Yiqing capsules included pruritus， rash， an ddiarrhea， all of which were relieved or cured， without aggravation or interhospital transfer for treatment. Literature data showed that the main clinical adverse reactions were abdominal pain， diarrhea， etc. Both acute toxicity and long-term toxicity tests showed good safety， and thus the safety of Yiqing capsules was rated as grade B. The results of Meta-analysis showed that Yiqing capsules used alone or in combination with other medicines outperformed Niuhuang Jiedu capsules or Western medicine in the treatment of pharyngitis， tonsillitis， gingivitis， and oral ulcers with heat toxin in terms of symptom alleviation， disappearance rate of main symptoms， and recurrence rate of aphtha. Pharmacological and pharmacodynamic studies showed that Yiqing capsules had antimicrobial， antiviral， and anti-inflammatory effects， with the effectiveness rated as grade B. The decision tree model was adopted to analyze the incremental cost-effectiveness ratio. With the threshold of 1 fold per capita GDP and the disappearing rate of pain in gingivitis as the indicator， Yiqing capsules had an economic advantage in the treatment of gingivitis due to heat-toxin compared with Niuhuang Jiedu capsules， and the incremental cost-effectiveness ratio was 0.39 yuan/%， which indicated acceptable cost， with the economy rated as grade B. Yiqing capsules can not only clear heat from Qi aspect but also purge blood fire， serving as the representative prescription of clearing and purging for heat-toxin syndrome. Considering the industrial service system and enterprise innovation， the comprehensive innovation of Yiqing capsules was rated as grade B. Generally， this product does not require personalized treatment plans and features convenient supply， storage， transportation， policy publicity， drug information standards， and easy operation for medical care and patients. The Chinese patent medicine information was complete and in line with national standards， and thus the suitability of Yiqing capsules was rated as grade A. With a low price and good availability and affordability， the accessibility of Yiqing capsules was rated as grade A. The Yiqing capsules prescription， Sanhuang Xiexin decoction， originated from ancient medical books， with rich real-world studies， and thus the traditional Chinese medicine characteristics of Yiqing capsules was rated as grade C. ConclusionThe clinical value of Yiqing capsules was rated as grade B from the "6+1" dimensions， suggesting that it could be conditionally converted into the relevant policy results of basic clinical drug management according to the procedure.

Evolution and innovation of preservation fluid for donor liver / 器官移植

Organ preservation fluid could mitigate cold ischemia injury and maintain normal function of the grafts. At present, how to reduce a series of injury caused by cold ischemia of donor liver and improve the preservation quality of grafts are the hot and challenging spots in this field. Currently, preservation fluid in clinical practice has not achieved ideal preservation effect, especially for the protection of marginal donor organs. In the context of severe donor shortage, the key solution is still to explore the optimal preservation protocol for donor liver to prevent grafts from cold ischemia injury. In this article, the mechanism of donor liver injury during cold ischemia, the classification and evolution of donor liver preservation fluid were summarized, the development direction and challenges of donor liver preservation fluid were discussed, aiming to provide novel ideas and references for the research and development of donor liver preservation fluid.

Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study

ABSTRACT BACKGROUND: The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use. OBJECTIVE: To estimate the incidence and factors associated with PIMs use in intensive care units. DESIGN AND SETTING: Historical cohort study was conducted in a high-complexity hospital in Brazil. METHODS: A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a "Patient Safety Project" database. A Chi-square test, Student's t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%. RESULTS: According to Beers' criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43). CONCLUSIONS: Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.

Resultados del aislamiento eléctrico de las venas pulmonares en pacientes menores y mayores de 70 años / Outcomes of pulmonary vein electrical isolation in patients younger than and older than 70 years

Resumen Introducción y objetivos: Comparar las características clínicas y los resultados de cohortes contemporáneas de pacientes menores y mayores de 70 años que han sido sometidos a ablación de fibrilación auricular (FA) mediante catéter. Métodos: Se llevó a cabo un estudio de cohortes retrospectivo en pacientes sometidos a ablación con catéter debido a la presencia de FA refractaria. Se realizó un seguimiento mínimo de 12 meses por paciente. Resultados: En el estudio se incluyeron un total de 239 pacientes sometidos a ablación de FA, de los cuales 171 (71,5%) pertenecían al grupo de edad < 70 años y 68 (28,5%) al grupo de edad > 70 años. La edad promedio de la población estudiada fue de 62,4 años (desviación estándar [DE] = 10,87). El grupo < 70 años presentó una edad promedio de 58,03 años (DE = 9,71), mientras que el grupo > 70 años tuvo una edad promedio de 73,4 años (DE = 3,05). Además, se observó una mayor prevalencia de FA paroxística en el grupo de pacientes menores de 70 años, mientras que en el grupo de pacientes mayores de 70 años se encontró una mayor prevalencia de FA persistente. Estas diferencias fueron estadísticamente significativas en ambos casos. Las tasas de recurrencia después del primer procedimiento de ablación fueron similares entre los dos grupos (21,43% en el grupo menor de 70 años frente a 23,53% en el grupo mayor de 70 años, p = 0,79). No se encontraron diferencias significativas en cuanto a complicaciones. El grupo menor de 70 años experimentó 18 complicaciones, mientras que el grupo mayor de 70 años tuvo 5 complicaciones, con un valor de p de 0,472. Conclusión: Los pacientes mayores de 70 años sometidos al primer procedimiento de ablación de FA por catéter presentan resultados clínicos similares a los pacientes menores de 70 años.

Abstract Introduction and objectives: The objective of this study is to compare the clinical characteristics and outcomes of contemporary cohorts of patients undergoing catheter ablation for atrial fibrillation (AF), stratified by age (< 70 years and ≥ 70 years). Methods: This retrospective cohort study included patients who underwent catheter ablation for refractory AF. The minimum follow-up duration per patient was 12 months. Results: A total of 239 patients were included in the study, with 171 (71.5%) in the < 70 years group and 68 (28.5%) in the ≥ 70 years group. The mean age of the study population was 62.4 years (SD 10.87). The < 70 years group had a mean age of 58.03 years (SD 9.71), while the ≥ 70 years group had a mean age of 73.4 years (SD 3.05). Furthermore, a higher proportion of paroxysmal AF was observed in patients < 70 years, whereas a higher proportion of persistent AF was found in patients ≥ 70 years. These differences were statistically significant. The recurrence rates after the initial ablation procedure were similar between the two groups (21.43% in the < 70 years group vs. 23.53% in the ≥ 70 years group, p = 0.79). Additionally, there were no significant differences in terms of complications. The < 70 years group experienced 18 complications, while the ≥ 70 years group had 5 complications (p = 0.472). Conclusion: The findings of this study suggest that patients aged 70 years and older who undergo their first catheter ablation procedure for AF demonstrate similar clinical outcomes compared to patients younger than 70 years.

Sustainability disclosure in the Ecuadorian banking sector: channels used, determining factors and type of information revealed

This study aimed to provide evidence on sustainability disclosure in the banking sector of Ecuador Using a descriptive-correlational approach, three key areas were examined: the most common reports for the disclosure of sustainability information, factors influencing banks' willingness to disclose, and the type of sustainability information being disclosed. Fisher's test and mean difference tests were employed to identify factors influencing banks' willingness to disclose sustainability information. Additionally, a content analysis was conducted to identify the main themes disclosed by banks regarding sustainability An index incorporating environmental, social, economic, and governance aspects was utilized for this analysis. The findings revealed low levels of disclosure, a higher prevalence of specialized reports, a positive association between willingness to disclose and organizational visibility, and a predominance of social dimension disclosure practices. These findings underscore the need to enhance disclosure standards and strengthen communication with stakeholders in Ecuador's banking sector. JEL CLASSIFICATION MI0, MI4; G2I

Este estudio buscó proporcionar evidencia sobre la divulgación de sostenibilidad en el sector bancario de Ecuador Mediante un enfoque descriptivo-correlacional se abordaron tres temáticas: los medios más utilizados para divulgar información de sostenibilidad, los factores que influyen en la disposición de los bancos a divulgar y el tipo de información sobre sostenibilidad que divulgan. Se utilizaron las pruebas de Fisher y de diferencia de medias para identificar los factores que influyen en la disposición de los bancos a divulgar información de sostenibilidad. De igual forma, se realizó un análisis de contenido para identificar los temas principales que divulgan los bancos sobre sostenibilidad. Para ello, se usó un índice que identificó aspectos ambientales, sociales, económicos y de gobernanza. Los resultados revelaron niveles bajos de divulgación, un mayor uso de informes especializados, una asociación positiva entre la disposición a divulgar y la visibilidad de la organización, y una predominancia de la divulgación de prácticas en la dimensión social. Estos hallazgos resaltan la necesidad de mejorar los estándares de divulgación y fortalecer la comunicación con los grupos de interés en el sector bancario de Ecuador. CLASIFICACIÓN JEL M10, M14; G21

Este estudo buscou fornecer evidências sobre a divulgação da sustentabilidade no setor bancário do Ecuador. Usando uma abordagem descritiva-correlacional, foram abordadas três questões: os meios mais comuns usados para divulgar informações sobre sustentabilidade, os fatores que influenciam a disposição dos bancos em divulgar e o tipo de informações sobre sustentabilidade que eles divulgam. O teste de Fisher e os testes de diferença de médias foram usados para identificar os fatores que influenciam a disposição dos bancos em divulgar informações sobre sustentabilidade. Da mesma forma, foi realizada uma análise de conteúdo para identificar os principais tópicos que os bancos divulgam sobre sustentabilidade. Isso foi feito por meio de um índice que identificou questões ambientais, sociais, econômicas e de governança. Os resultados revelaram baixos níveis de divulgação, um maior uso de relatórios especializados, uma associação positiva entre a disposição de divulgar e a visibilidade organizacional, e uma predominância de divulgação de práticas na dimensão social. Essas conclusões destacam a necessidade de melhorar os padrões de divulgação e fortalecer a comunicação com as partes interessadas no setor bancário do Ecuador. CLASSIFICAÇÃO JEL M10, M14; G21

When should a university student be allowed academic accommodations for attention-deficit/hyperactivity disorder? A position statement for a unified procedure for use in Brazil

In higher education, reasonable accommodations are increasingly made for students with a wide range of disabilities. However, rigorous assessment is paramount to ensure these students are supported while preventing ineligible students from gaining unfair advantages. In this context, we sought to identify under which circumstances a university student should be allowed academic accommodation for attention-deficit/hyperactivity disorder (ADHD) and to outline an evidence-based policy for use in Brazil based on the global experience. We reviewed the literature to acquire information on what documents are commonly required by disability services before accommodations for ADHD are provided (including detection of malingering) and scrutinized the eligibility criteria of leading universities worldwide. Finally, renowned experts in the field and national stakeholders were consulted. Despite an exhaustive search, we found no international standard for the assessment of students with ADHD who request academic accommodation; even renowned institutions worldwide differ in their approaches to granting accommodations on the grounds of ADHD. Therefore, we propose a unified set of nationwide criteria for Brazilian universities, which could be generalized internationally. Higher education institutions in Brazil and beyond may benefit from adoption of such criteria.

Patients´ satisfaction concerning direct anterior dental restoration

Abstract The objective of this study was to observe patients' satisfaction with their in-service direct anterior dental restorations and to compare it with clinical evaluation using FDI (Federation Dental International) criteria. Patients scored their own anterior dental restorations regarding satisfaction (satisfactory /dissatisfactory). If dissatisfaction was mentioned, then, they would be interviewed about the complaint. In the same session, the dental restorations were clinically evaluated by two dentists using FDI criteria (1-5 score) concerning esthetic, functional, and biological domains. Descriptive statistics were used for frequencies of scores attributed by patients and clinicians. In order to compare patients' to clinicians' frequencies, the Chi-square test was applied (p ≤ 0.05). A total of 106 restorations were evaluated by patients and clinicians. Patients reported 52.8% of restorations satisfactory and 47.8% dissatisfactory. Overall, clinicians reported the same restorations as 82,3% satisfactory and 17,6% dissatisfactory. Patients' most frequent complaints referred to color, followed by anatomical form, fracture of material and retention, and approximal anatomical form. Comparing patients' satisfaction and dissatisfaction rates to clinicians' evaluation per criteria, there was no difference regarding esthetics. The frequency of dissatisfactory restorations by clinicians was significantly lower when functional and biological properties were compared with patients' opinions. Direct anterior dental restorations were more frequently reported as satisfactory by patients and clinicians, being the main complaints related to esthetic issues. When clinicians and patients' evaluations were compared, it was observed that the frequencies of satisfactory restoration by patients and clinicians were similar regarding esthetic properties, and significantly different regarding functional and biological properties.

Resumo O objetivo deste estudo foi observar a satisfação dos pacientes com suas restaurações dentárias anteriores diretas e compará-las com a avaliação clínica do dentista usando os critérios FDI (Federation Dental International). Os pacientes pontuaram suas restaurações dentárias (n=106) anteriores em relação à satisfação (satisfatória / insatisfatória). Quando insatisfatória, ele foi entrevistado sobre a queixa. Na mesma sessão, as restaurações dentárias foram avaliadas clinicamente por dois dentistas utilizando os critérios FDI (escore 1-5) quanto aos aspectos estéticos, funcionais e biológicos. Estatística descritiva foi usada para frequências de escores atribuídos por pacientes e clínicos. Para comparar as frequências dos pacientes e dos clínicos, foi aplicado o teste Qui-quadrado (p ≤ 0,05). Os pacientes relataram suas restaurações como 52,8% satisfatórias e 47,8% insatisfatórias. Os clínicos reportaram as mesmas restaurações, 82,3% satisfatória e 17,6% insatisfatória. As queixas mais frequentes dos pacientes referiam-se à cor, seguida da forma anatômica, fratura e retenção do material e forma anatômica proximal. Comparando os índices de satisfação e insatisfação dos pacientes com os clínicos, não houve diferença em relação à estética. A frequência de restaurações insatisfatórias por dentistas foi significativamente menor quando as propriedades funcionais e biológicas foram comparadas com as opiniões dos pacientes. As restaurações foram mais frequentemente relatadas como satisfatórias pelos pacientes, sendo as principais queixas relacionadas a questões estéticas. Quando as avaliações dos clínicos e dos pacientes foram comparadas, observou-se que as frequências de restaurações satisfatórias por pacientes e clínicos foram semelhantes em relação às propriedades estéticas e significativamente diferentes em relação às propriedades funcionais e biológicas.

Sociodemographic and academic characteristics of the admission profile of students, faculty of dentistry, University of Costa Rica 2007-2014 / Características sociodemográficas y académicas del perfil de ingreso de estudiantes de la Facultad de Odontología de la Universidad de Costa Rica 2007-2014

The objective of this research was to determine some of the sociodemographic and academic characteristics of the students who entered the Dentistry career in the period 2007 to 2014. Data was collected from 673 student files. The variables considered were sex, admission age, marital status, children, nationality, place of origin, high school of origin, and admission exam score. The data was obtained from the database of the Student Applications System, the physical files, and the Supreme Electoral Tribunal of Costa Rica. Descriptive statistics were performed, establishing the absolute and relative frequency of the variables. The Mann-Whitney test was used to determine if there were statistically significant differences between the admission exam and the established sociodemographic variables (p<0,05, IC 95%). 68,4% of the students are female. The average age was 18.4 years (SD=2,41). 99,0% of the students are from Costa Rica. 99,3% were single and only 0,9% had children. The largest number of students entered through an admission exam (78.9%) and 50.7% studied at a public high school. Regarding the address, 77.9% of the subjects resided in the Greater Metropolitan Area. The average grade of the admission exam was 613,8 (SD=49,95). There was a statistically significant difference between the entrance exam grade and the different types of high schools of origin. The group of students who entered to train as Dentists at the University of Costa Rica from 2007 to 2014 was a population with an average age of entry of 18,4 years, Costa Rican, predominantly female, single, without children, from geographic areas within the Greater Metropolitan Area (GMA), graduated from public schools with an average admission exam grade of 612,2.

El objetivo de esta investigación fue determinar algunas de las características sociodemográficas y académicas de los estudiantes que ingresaron a la carrera de Odontología en el período 2007 al 2014. Se recopilaron los datos de 673 expedientes de los estudiantes. Las variables consideradas fueron: sexo, edad de ingreso, estado civil, hijos, nacionalidad, lugar de procedencia, colegio de procedencia y nota de examen de admisión. Los datos se obtuvieron de la base de datos del Sistema de Aplicaciones Estudiantiles (SAE), los expedientes físicos y del Tribunal Supremo de Elecciones de Costa Rica. Se realizó estadística descriptiva estableciendo la frecuencia absoluta y relativa de las variables. Se empleó el test de Mann Whitney para determinar si existían diferencias estadísticamente significativas entre el examen de admisión y las variables sociodemográficas establecidas (p<0,05, IC 95%). El 68,4% de los estudiantes pertenecen al sexo femenino. La edad promedio fue de 18,4 años (DS=2,41). El 99,0% de los discentes son de nacionalidad costarricense. El 99,3% eran solteros y sólo el 0,9% tenían hijos. La mayor cantidad de estudiantes ingresaron por examen de admisión (78,9%) y el 50,7% cursó sus estudios en un colegio público. Respecto al domicilio, el 77,9% de los sujetos residían en el Gran Área Metropolitana. El promedio de nota del examen de admisión fue de 613,8 (DS=49,95). Hubo una diferencia estadísticamente significativa entre la nota del examen de admisión y los diferentes tipos de colegios de procedencia. El grupo de estudiantes que ingresaron a formarse como Odontólogos en la Universidad de Costa Rica en el periodo de 2007 al 2014 fue una población con un promedio una edad de ingreso de 18,4 años predominantemente femenina, costarricense, soltera, sin hijos, proveniente de áreas geográficas dentro del Gran Área Metropolitana (GAM), egresadas de colegios públicos con un promedio de nota de examen de admisión de 612,2.

Al término de la primera implementación de la malla curricular innovada 2015. Cohorte de médicos egresados (2017-2023). FCM-UNA. Historia, fortalezas, debilidades y nuevos desafíos / At the end of the first implementation of the innovated 2015 curriculum cohort of graduating physicians (2017-2023). FCM-UNA. History, strengths, weaknesses and new challenges

En la Facultad de Ciencias Médicas egresó en el año 2023 la primera cohorte de médicos formados con el nuevo currículum, implementado desde del 2017 como resultado del Proyecto de Innovación Curricular (PIC) desarrollado en los 5 años previos. La finalidad fue transitar de un currículum tradicional a uno orientado a competencias, integrado, pertinente a las necesidades sanitarias del entorno, incorporando la semestralidad, los créditos académicos y el Rotatorio Clínico preprofesional supervisado. La integración curricular es uno de los referentes más importantes de esta innovación. Se pretende aquí iniciar una narrativa que pase el testimonio histórico de esta transformación y reconozca el compromiso colectivo demostrado con la formación de profesionales médicos de excelencia. Se incluye el marco histórico, las fases del PIC, los criterios curriculares implicados, los equipos humanos participantes, la estructura organizacional para la implementación, el resumen de la evaluación de medio término y el escenario actual, donde de la evaluación de la implementación es fundamental para retroalimentar el proceso y generar la mejora continua.

The Faculty of Medical Sciences graduated in 2023 the first cohort of physicians trained with the new curriculum, implemented since 2017 as a result of the Curricular Innovation Project (CIP) developed in the previous 5 years. The purpose was to transition from a traditional curriculum to one that is competency-oriented, integrated, relevant to the health needs of the environment, incorporating the semester, academic credits and the supervised pre-professional Clinical Rotation. Curricular integration is one of the most important references of this innovation. It is intended here to initiate a narrative that passes the historical testimony of this transformation and recognizes the collective commitment demonstrated with the formation of medical professionals of excellence. It includes the historical framework, the phases of the CIP, the curricular criteria involved, the human teams involved, the organizational structure for the implementation, the summary of the mid-term evaluation and the current scenario, where the evaluation of the implementation is fundamental to feed back the process and generate continuous improvement.

Appropriateness of drug usage in acute pediatric diarrhea – A prospective observational study

Background: Pediatric diarrhea is the 3rd foremost cause of childhood mortality all over the world. Although these are self-limiting, irrational antibiotic use and polypharmacy are prevalent in their treatment. Antimicrobial therapy is recommended in bacterial diarrhea and severely malnourished children only. Inappropriate use of drugs for the treatment of acute diarrhea can be minimized by adhering to standard guidelines. Aims and Objectives: The objectives of this study were as follows: (1) To evaluate the appropriateness of drug treatment in Acute Pediatric Diarrhea and (2) to assess the appropriateness of antibiotic treatment in diarrhea based on modified Kunin’s criteria. Materials and Methods: A prospective observational study was conducted for 12 months at the pediatric inpatient unit of Bidar Institute of Medical Sciences, Bidar. Prescriptions of 400 cases of acute diarrhea were evaluated for the appropriateness of drug usage using Indian Academy of Pediatrics (IAP) guidelines and modified Kunin’s criteria. Results: Among the 400 acute diarrhea cases, majority were male (54.75%) and below 5 years (58.25%). Oral rehydration solution (ORS) was given to 337 patients and IV fluids to 324 cases. About 55.5% patients were prescribed antibiotics. In 75.67% prescriptions, the antibiotic use was not necessary (modified Kunin’s criteria category V). Only 12.5% prescriptions adhered to IAP guidelines (2006), which included ORS and Zinc. About 54.5% patients were prescribed probiotics and 80% were prescribed antiemetics (ondansetron), which is not appropriate as per guidelines. Conclusion: Majority of patients were prescribed ORS, but only few were given zinc as an adjunctive therapy. Thus, we found that adherence to IAP 2006 guidelines was very low in our setup. Based on our observations, we suggest that prescribers should make use of standard treatment guidelines and choose appropriate drugs and their formulations so that irrational use of drugs can be minimized.

Evaluation of Microbiological Quality of Halal Beef Intended for Export from Khartoum State, Sudan

Aims: To evaluate halal criteria of beef microbiological quality intended for export in two slaughterhouses. Study Design: A cross-sectional study. Place and Duration of Study: Khartoum State, Sudan between August and November 2022. Methodology: Samples were collected by using the non-destructive dry swab method for microbiological quality sampling of beef and a standardized checklist to evaluate good manufacturing practices (GMPs) and good hygienic practices (GHPs). Restraining methods were categorized as “modern method” where the full inversion rotary casting box was used which resembled slaughterhouse “A” or “conventional method” where a large-sized hammer for blowing the skull was used and this resembled slaughterhouse “B”. A total of 80 male beef cattle were investigated after arrival in the lairages of the designated slaughterhouses. Forty carcasses from each slaughtering method were randomly chosen and swabbed. Results: The results revealed that halal criteria for the slaughtering methods in slaughterhouse (A) was 100%, while slaughterhouse (B) was 83.2%. Also, this study revealed poor personal hygiene as slaughterhouse A scored 53.2%, while slaughterhouse B scored 33.2% for personal hygiene evaluation. The mean total bacterial count (TBC) was found to be 4.556 x 10? cfu/ml and 5.53275 X 10? cfu/ml in slaughterhouses A and B, respectively with highly significant differences compared to the standard permissible limits (1x 10?cfu/ml) with p ?0.05, while there were no statistically significant differences (0.847) within slaughterhouses with p ?0.05. Furthermore, the mean total coliform count (TCC) was found to be 16.4795 X10²cfu/ml and 47.8670 X 10²cfu/ml in slaughterhouses A and B, respectively with a highly significant difference compared to the standard permissible limits (1x10²cfu/ml) with p ?0.05 and also with highly significant differences (0.000) between slaughterhouses themselves with p ?0.05. Conclusion: The study concluded that both slaughterhouses failed to meet the requirements of the various beef halal criteria.

41 cases of chronic obstructive pulmonary disease caused by occupational irritating chemicals / 中华劳动卫生职业病杂志

Objective: To analyze the case characteristics of Chronic obstructive pulmonary disease caused by occupational irritant chemicals (OI-COPD). To provide basis for revising its diagnostic criteria. Methods: From June to December 2021, we investigated the information of OI-COPD patients confirmed by Shandong Institute of Occupational Health and Prevention of Occupational Diseases, Guangxi Zhuang Autonomous Region Institute of Occupational Disease Prevention and Control, Qingdao Central Hospital affiliated to Qingdao University and other diagnostic institutions in the past five years, a total of 41 cases. The basic information of OI-COPD cases, occupational risk factors exposure information, medical history, smoking history and clinical symptoms were analyzed retrospectively. The measurement data were tested for normal distribution, which was described by x±s, and compared between groups by t test; Those who do not conform to the normal distribution are described by the median [M (Q(1), Q(3)) ] and analyzed by nonparametric test; The counting data were expressed in frequency and rate (% ), and the comparison between groups was tested. Results: Of the 41 cases, 33 were male and 8 were female. The age of the patient diagnosed with OI-COPD was (49.5±10.3) years old, and the minimum age was 30 years old; Among them, 8 patients had a definite long-term smoking history (more than 5 years) ; The exposure duration of occupational risk factors was (18.6±10.3) years, of which 3 patients had exposure duration of less than 5 years; The occupational risk factors leading to OI-COPD include acids and acid-forming compounds, bases, aldehydes, nitrogen oxides, chlorine and its compounds, etc. The exposure level of occupational risk factors is related to the degree of COPD airflow restriction (χ(2)=6.17, P <0.05). 18 patients with diagnosis age <50 years old were diagnosed as early-onset COPD. The incidence of respiratory symptoms in the early diagnosis COPD group was lower than that in the non-early diagnosis COPD group, and the FEV1% pred was significantly higher than that in the non-early diagnosis COPD group. The difference was statistically significant (P<0.01 ) . Conclusion: The exposure level of occupational risk factors may be the risk factor affecting the degree of COPD airflow restriction. With the increase of the exposure level of COPD patients, the proportion of respiratory symptoms will also increase accordingly.

Clinical comprehensive evaluation of Ruyi Zhenbao Pills in treatment of osteoarthritis / 中国中药杂志

This study evaluated the clinical effectiveness of Ruyi Zhenbao Pills in the treatment of osteoarthritis, aiming to clarify its clinical advantages and promote rational drug use and related policy transformation. Following the relevant standards in Guidelines for the Comprehensive Evaluation of Drugs in Clinical Practice and Technical Specifications for the Clinical Comprehensive Evaluation of Chinese Patent Medicine, comprehensive research and related data on Ruyi Zhenbao Pills in the treatment of osteoarthritis were collected in the dimensions of safety, effectiveness, economy, innovation, suitability, accessibility, and traditional Chinese medicine(TCM) cha-racteristics(referred to as the "6+1" dimensions). Through evidence-based medicine, questionnaire surveys, health technology assessment, pharmacoeconomic evaluation, and other methods, a multi-criteria decision analysis(MCDA) model and CSC v2.0 software were used to comprehensively evaluate the clinical value of Ruyi Zhenbao Pills. Spontaneous reporting system data on adverse reactions and literature data indicate that the adverse reactions of Ruyi Zhenbao Pills are mostly general adverse reactions, with no reports of se-rious adverse reactions. The known risks are small, and its safety is rated as class A. It has been shown to effectively relieve joint pain and restore joint function in the treatment of osteoarthritis. However, more high-quality, large-sample randomized controlled trials are needed to further validate its effectiveness, which is rated as class B. There is evidence supporting its economic viability, and its economic is rated as class B. It demonstrates good clinical innovation, innovative enterprise service system, and industrial innovation, and innovation is rated as class A. Medical professionals and patients have a favorable perception of the suitability of Ruyi Zhenbao Pills, and further improvement can be made in terms of convenience of administration and promotion to facilitate rational drug use by healthcare professionals and patients. Suitability is rated as class B. The drug has a favorable price level, availability, and affordability, and accessibility is rated as class A. Ruyi Zhenbao Pills are a classic Tibetan medicinal prescription with excellent TCM theoretical characteristics. However, further research is needed on its use in human studies. TCM characteristics are rated as class B. Based on the evaluation results of the "6+1" dimensions, the comprehensive clinical evaluation is rated as grade B. Ruyi Zhenbao Pills have good clinical value in the treatment of osteoarthritis, and it is recommended to undergo the necessary procedures for conditional transformation into a policy for the management of essential clinical drugs.

Clinical comprehensive evaluation of Xiangju Capsules in treatment of rhinosinusitis / 中国中药杂志

The articles involving Xiangju Capsules were retrieved, and qualitative research and quantitative research methods were combined to evaluate the evidence of the safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine( "6+1" dimensions) of this drug. Multi-criteria decision analysis(MCDA) model and CSC v2.0 software were used to comprehensively evaluate the clinical value of Xiangju Capsules in the treatment of rhinosinusitis and clarify the precise clinical positioning. The dimensions are graded A, B, C, or D. Multi-source safety evidence showed that the main adverse reactions were gastrointestinal reactions, rash, itching, dizziness, and headache. Based on the available studies, the risk is controllable and the safety is grade A. Meta-analysis showed that Xiangju Capsules + conventional western medicine could recover the Lund-Kennedy score, Lund-Mackay score, and CT score, relieve headache, nasal congestion, olfactory disturbance, and facial pain, with the effectiveness is grade B. The incremental cost-effectiveness ratio of Xiangju Capsules + conventional western medicine compared with conventional western medicine alone in the treatment of chronic rhinosinusitis was 263.71 yuan, about 0.82% of the per capita disposable income. The results of sensitivity analysis showed that the research results were relatively robust. Based on the assumption that the per capita disposable income in 2020 will be the threshold of patients' willingness to pay, it is more economical to use Xiangju Capsules + conventional western medicine. The drug belongs to grade A of the national medical insurance, with an average daily cost of 3.06 yuan, and the economy is grade B. This formula is modified from classic formulas and characteristic empirical formulas, be capable of improving immunity and preventing repeated attacks. It can be used for acute and chronic rhinitis-rhinosinusitis. It had a wide range of applicability, especially for the patients with head and face tenderness. Service innovation was reflected in the measures to guarantee supply, capacity, scalability, and coverage of grass-roots sales channels. The industrial innovation was improved through the management of medicinal resources, pharmaceutical industry, production technology, quality control, scientific research and development, and this formula won three national invention patents. Comprehensively, the innovation of Xiangju Capsules is grade B. According to the survey of 188 medical practitioners and 196 patients in 20 provinces, municipalities, and autonomous regions of China, the drug was characterized by easy preparation and administration, individualized medication, simple technology and management, convenient use, storage, and transport, and controllable adverse reactions, with the suitability is grade B. Xiangju Capsules showed the cost of 45.9 and 275.4 yuan for treatment of acute and chronic rhinitis-rhinosinusitis, respectively, being well affordable. It was sold in 35 000 medical institutions in China. The dosage form was suitable for transportation, storage, and grass-root application. With rich, sustainable, and available medicinal resources, the accessibility of Xiangju Capsules is grade A. This drug can be used for both acute and chronic rhinitis-rhinosinusitis, clearing heat and expelling pus, and strengthening the exterior to prevent relapse. After this drug was available on the market, over 4 000 cases were studied, with rich experience in human use accumulated, and characteristics of traditional Chinese medicine is grade B. Overall, the clinical value of Xiangju Capsules is class B. It is suggested that Xiangju Capsules should be used in accordance with the relevant policies of basic clinical drug administration to play its role.

Comprehensive Clinical Evaluation of Xueshuantong for Injection（Lyophilized） in Treatment of Acute Cerebral Infarction / 中国实验方剂学杂志

ObjectiveTo systematically review the existing studies on Xueshuantong for injection（lyophilized） in the treatment of acute cerebral infarction（ACI）， and to clarify the clinical value of Xueshuantong for injection（lyophilized） through comprehensive clinical evaluation， so as to promote clinical rational drug use and relevant policy transformation. MethodEvidence of Xueshuantong for injection（lyophilized） in terms of safety， effectiveness， economy， innovation， suitability， accessibility， traditional Chinese medicine（TCM） characteristics（6+1 dimensions） and information service was comprehensively collected. Evidence-based medicine， questionnaire survey， health technology assessment， pharmacoeconomic evaluation and other research methods were used， and the multi-criteria decision analysis model was used to measure each dimension， in order to comprehensively evaluate the clinical value of Xueshuantong for injection（lyophilized）. ResultSpontaneous reporting system， Meta-analysis of adverse reactions， and active safety monitoring study showed that the main adverse reactions of Xueshuantong for injection（lyophilized） were rash， pruritus， chest tightness， headache， dizziness and other general adverse reactions， the incidence of serious adverse reactions was judged to be rare， the known risk was small， the evidence was sufficient， and the safety evaluation was grade A. The results of Meta-analysis showed that Xueshuantong for injection（lyophilized） combined with conventional treatment for ACI was superior to conventional treatment in terms of improving neurological deficit score， improving daily activity score and clinical efficacy， and the effectiveness evaluation was grade B. The results of pharmacoeconomic evaluation showed that Xueshuantong for injection（lyophilized） combined with conventional treatment was relatively economic compared with conventional treatment alone， with the total clinical effective rate as the effect parameter， but the incremental effect was not significant， the economic evaluation was grade B. In addition to ACI and unstable angina of coronary heart disease， the drug also had good clinical efficacy in central retinal vein occlusion， and had a wider range of indications and awarded 16 patents， and its innovation evaluation was grade B. The suitability of medical personnel and patients was good without special technical and management requirements， and the suitability was evaluated as grade B. Xueshuantong for injection（lyophilized） had reasonable price， good affordability， certain prescription restrictions and general availability， the accessibility evaluation was grade B. Since the drug is an injection of effective parts of TCM， no grade evaluation of its TCM characteristics is conducted. The legal and non-legal information evaluation results of Xueshuantong for injection（lyophilized） showed that all the information was complete and in accordance with the requirements of national standards. Based on the grade scores of the 6 dimensions， the clinical comprehensive evaluation of Xueshuantong for injection（lyophilized） in the treatment of ACI was calculated as category B by CSC 2.0. ConclusionThe clinical value of Xueshuantong for injection（lyophilized） is good， and it is suggested that it can be directly translated into relevant policy outcomes for basic clinical medication management.