Abriendo puertas para la vida: Programa de prevención de conductas suicidas a través de docentes Gatekeepers / Opening doors to life: A suicidal behavior prevention program involving Gatekeeper teachers / Abrindo portas para a vida: Programa de prevenção ao comportamento suicida por meio de professores Gatekeepers

Introducción: El suicidio es la tercera causa de muerte de jóvenes entre 15 y 19 años. Ante esto, los ambientes escolares pueden favorecer el fomento de la salud mental de los adolescentes, permitir la identificación temprana de factores de riesgo y aportar en la prevención de conductas suicidas. Una de las estrategias de prevención es el entrenamiento de "gatekeepers". Objetivo: Determinar el efecto del programa "Abriendo Puertas para la Vida" sobre conocimientos, actitudes y prácticas en prevención de conductas suicidas en un grupo de profesores de secundaria de una institución educativa de San Juan de Pasto, Colombia. Materiales y métodos: Estudio preexperimental, con un grupo de intervención y medidas pre y pos-seguimiento. Participaron nueve docentes voluntarios durante dos jornadas de formación. Resultados: Se identificaron cambios positivos en conocimientos, actitudes y prácticas de los participantes entre pretest y postest, en la mayoría de las subdimensiones evaluadas; sin embargo, tres años después, estos cambios se mantuvieron tan solo en conocimientos sobre las conductas suicidas y en actitudes hacia la prevención. Conclusión: El programa "Abriendo Puertas para la Vida" evidenció efectividad y pertinencia, sin embargo, el mantenimiento de sus efectos requiere de acciones de seguimiento y acompañamiento a los docentes formados.

Introduction: Suicide is the third cause of death in young people aged between 15 to 19 years. Thus, school environments can promote mental health of adolescents through early identification of risk factors and prevention of suicidal behaviors. One prevention strategy is the training of "gatekeepers". Objective: To determine the impact of the "Opening Doors to Life" program on the knowledge, attitudes, and practices regarding prevention of suicidal behavior in a set of high school teachers from an educational institution in San Juan de Pasto, Colombia. Materials and methods: A pre-experimental study with an intervention group and pre- and post-follow-up measurements. Nine volunteer teachers participated during two training sessions. Results: Positive changes regarding knowledge, attitudes, and practices of the participants during pretest and posttest were observed for the majority of evaluated sub-dimensions. However, after three years, the positive measures prevailed only for knowledge about suicidal behavior and attitudes toward prevention. Conclusion: The "Opening Doors to Life" program showed effectiveness and relevance. However, maintaining its impact requires follow-up actions and support of trained teachers.

Introdução: O suicídio é a terceira causa de morte de jovens entre 15 e 19 anos. Diante disso, os ambientes escolares podem promover a promoção da saúde mental em adolescentes, permitir a identificação precoce de fatores de risco e contribuir para a prevenção do comportamento suicida. Uma das estratégias de prevenção é a formação de "gatekeepers". Objetivo: Determinar o efeito do programa "Abrindo Portas para a Vida" nos conhecimentos, atitudes e práticas na prevenção do comportamento suicida em um grupo de professores do ensino médio de uma instituição educacional em San Juan de Pasto, Colômbia. Materiais e métodos: Estudo pré-experimental, com grupo de intervenção e medidas pré e pós-acompanhamento. Nove professores voluntários participaram durante dois dias de treinamento. Resultados: Foram identificadas mudanças positivas nos conhecimentos, atitudes e práticas dos participantes entre o pré-teste e o pós-teste, na maioria das subdimensões avaliadas; porém, três anos depois, essas mudanças se mantiveram apenas no conhecimento sobre comportamentos suicidas e atitudes frente à prevenção. Conclusão: O programa "Abrindo Portas para a Vida" mostrou efetividade e relevância, porém, a manutenção de seus efeitos requer ações de acompanhamento e apoio a professores capacitados.

Prevalence and reasons for referrals to the Endodontics Specialty Clinic at the Piracicaba Dental School

Abstract Dental referrals to the Endodontics Specialty Clinic (ESC) are routine owing to the complexity of endodontic treatments. To obtain a better prognosis for treatment, students/dentists must perceive their technical limits. This study sought to investigate the referrals of patients to the ESC from different clinics of the Piracicaba Dental School, State University of Campinas - SP, Brazil, and check: a) the demographic profile of patients and the most commonly affected tooth; b) the clinic with the largest number of referrals; c) the reasons for referrals; d) the complexity of the cases; e) and the difficulty in assessing the referred cases based on the classification provided by the American Association of Endodontists (AAE) and Souza-Filho. The study sample consisted of patients' electronic dental referral records from February 2015 to June 2019. A total of 1,707 patients were referred to the ESC during the study period, and 62.4% were female. Lower molars were the most frequently involved teeth (34.8%), and 60.7% of the cases were referred due to the presence of root curvature. The AAE classification showed prevalence of highly difficult cases (71.3%), whereas Souza-Filho classification demonstrated a high rate of class III cases (85.8%). This study highlights the difficulties encountered by undergraduate students before or during endodontic treatments, reinforcing the need for clear criteria for selecting cases appropriate for each education level, thus improving endodontic treatment prognosis.

The decision-making skills of Brazilian physical therapists for patients with red flags / Capacidade da tomada de decisão dos fisioterapeutas brasileiros para pacientes com bandeiras vermelhas

ABSTRACT BACKGROUND AND OBJECTIVES: The red flags screening purpose is to ensure that signs and symptoms that raise suspicion of serious diseases are being considered during the assessment, assisting physical therapists in their clinical decision process. Brazilian physical therapists are autonomous and can act as first contact professionals in the management of musculoskeletal disorders, therefore, they need to know how to recognize, screen and refer patients with red flags for better therapeutic management. The objectives of this study were to verify whether Brazilian physical therapists can recognize and manage patients who presented red flags, compare professionals' skills regarding different academic degree levels and clinical experience and identify which factors can influence the results. METHODS: A cross-sectional and quantitative research was conducted, collected from an online questionnaire. The target audience consisted of Brazilian physical therapists who have clinical experience in the management of patients with musculoskeletal disorders. Participants filled demographic data and made clinical decisions based on six clinical cases created by the authors, based on the literature, and reviewed by three experts. Data were analyzed using descriptive statistics, the Chi-square test of independence and logistic regression. RESULTS: The study analyzed 384 answers from Brazilian physical therapists with clinical experience in musculoskeletal conditions. Brazilian physical therapists, in general, have not shown to be able to properly recognize and manage the clinical cases involving red flags, with 23.2% of the sample performing appropriate management for medical conditions, 53.9% for emergency conditions and 61.8% for medical conditions with associated musculoskeletal dysfunction. More years of clinical experience and post-professional education did not positively influence the outcomes. Higher academic degrees (Doctorate) can influence positively on the management of non-emergency medical conditions. CONCLUSION: Brazilian physical therapists who work with patients with musculoskeletal disorders perform poorly in identifying red flags in hypothetical clinical cases.

RESUMO JUSTIFICATIVA E OBJETIVOS: O objetivo da triagem de bandeiras vermelhas é garantir que sinais e sintomas que levantam suspeitas de doenças graves sejam considerados durante a avaliação, auxiliando os fisioterapeutas no seu processo de decisão clínica. Os fisioterapeutas brasileiros são autônomos e podem atuar como profissionais de primeiro contato no manejo de distúrbios musculoesqueléticos, portanto, precisam saber reconhecer, rastrear e encaminhar pacientes com bandeiras vermelhas para melhor manejo terapêutico. Os objetivos deste estudo foram verificar se os fisioterapeutas brasileiros conseguem reconhecer e tratar pacientes que apresentavam bandeiras vermelhas, comparar as habilidades dos profissionais com diferentes níveis de formação acadêmica e experiência clínica e identificar quais fatores podem influenciar os resultados. METHODS: Uma pesquisa transversal e quantitativa foi realizada, coletada através de um questionário online. O público-alvo consistiu em fisioterapeutas brasileiros com experiência clínica no manejo de pacientes com disfunções musculoesqueléticas. Os participantes preencheram dados demográficos e tomaram decisões clínicas com base em seis casos clínicos criados pelos autores, com base na literatura, e revisados por três especialistas. Os dados foram analisados por estatísticas descritivas, pelo teste qui-quadrado de independência e por regressão logística. RESULTADOS: Foram analisadas 384 respostas de fisioterapeutas brasileiros com experiência clínica em disfunções musculoesqueléticas. Os fisioterapeutas brasileiros, em geral, não demonstraram ser capazes de reconhecer e manejar adequadamente os casos clínicos envolvendo bandeiras vermelhas, com 23,2% da amostra realizando manejo adequado para condições médicas, 53,9% para condições de emergência e 61,8% para condições médicas com disfunção musculoesquelética associada. Mais anos de experiência clínica e educação pós-profissional não influenciaram positivamente os resultados. Graus acadêmicos mais elevados (Doutorado) podem influenciar positivamente no manejo de condições médicas não emergenciais. RESULTADOS: Foram analisadas 384 respostas de fisioterapeutas brasileiros com experiência clínica em disfunções musculoesqueléticas. Os fisioterapeutas brasileiros, em geral, não demonstraram ser capazes de reconhecer e manejar adequadamente os casos clínicos envolvendo bandeiras vermelhas, com 23,2% da amostra realizando manejo adequado para condições médicas, 53,9% para condições de emergência e 61,8% para condições médicas com disfunção musculoesquelética associada. Mais anos de experiência clínica e educação pós-profissional não influenciaram positivamente os resultados. Graus acadêmicos mais elevados (Doutorado) podem influenciar positivamente no manejo de condições médicas não emergenciais. CONCLUSÃO: Fisioterapeutas brasileiros que atuam com pacientes com disfunções musculoesqueléticas apresentam um mau desempenho na identificação de bandeiras vermelhas em casos clínicos hipotéticos.

Asociación entre utilización de Guía de Referencia Clínica a Ortodoncia y derivación pertinente

Objetivo Los Servicios de Salud en Chile tienen una demanda insatisfecha en ortodoncia y muchas de las interconsultas no son pertinentes. Buscando una solución, el Servicio de Salud Metropolitano Norte (SSMN) implementó la "Guía de Referencia Clínica Ortodoncia (GRCO) para Servicios Públicos de Salud". El objetivo de este estudio fue evaluar si existe asociación entre utilizar GRCO y pertinencia en derivaciones a Ortodoncia realizadas por odontólogos de Atención Primaria. Materiales y Métodos Se realizó un estudio observacional analítico en 167 pacientes derivados por odontólogos que utilizaron la GRCO y 167 pacientes derivados por odontólogos que no la utilizaron. Una especialista en ortodoncia evaluó pertinencia en la derivación. Los datos se analizaron mediante la prueba de chi-cuadrado, y la prueba t-test. Resultados De los odontólogos que usaron la guía solo un 3% de sus derivaciones fueron no pertinentes, mientras que aquellos que no la usaron, tuvieron un 54% de derivaciones no pertinentes (p <0,001). Odontólogos que no usan la GRCO presentan 38 veces más probabilidad de realizar una derivación no pertinente. (OR 38,8; IC 14,9 - 125,9). Conclusión El uso de Guía de Referencia Clínica a Ortodoncia se asocia fuertemente con la pertinencia en la derivación de pacientes a la especialidad ortodoncia.

Objective. Health Services in Chile have an unsatisfied demand in orthodontics and the largest waiting list for dental specialties, with many of the referrals being irrelevant. Seeking a solution, the North Metropolitan Health Service (SSMN) implemented the "Orthodontic Clinical Referral Guideline (GRCO) for Public Health Services", to define the appropriateness of referrals. The objective of this study was to assess whether there is an association between the GRCO and the appropriateness of orthodontic referrals made by Primary Health Care dentists of the SSMN. Materials and methods. An analytical observational study was carried out in 167 patients referred by dentists who used the GRCO and 167 patients referred by dentists who did not use it. A calibrated orthodontic specialist assessed the relevance of the referral. The data was analyzed using the chi-square test, and the t-test. Results. Only 3% of the referrals made by dentists who used the GRCO were inappropriate, compared to 54% of those who did not use it. Dentists who do not use the GRCO are 38 times more likely to make an inappropriate referral than those who adhere to the GRCO (OR 38.8; CI 14.9 - 125.9) Conclusion. The use of the Orthodontic Clinical Referral Guideline is strongly associated with appropriateness in referring patients to the orthodontic specialty.

Características clínicas en pacientes atendidos en una unidad de psiquiatría de emergencia en un hospital general de Perú

Introducción. En los últimos 10 a 20 años, la psiquiatría de emergencia ha experimentado un progreso constante en cuanto a la prestación de servicios altamente especializados y enfocados en el paciente. Este aumento global refleja desafíos en accesibilidad y calidad de atención. En el contexto peruano, la legislación de salud mental y múltiples directrices clínicas orientan la prestación de servicios, no obstante, la insuficiencia de datos representa una barrera significativa para la toma de decisiones informadas. Objetivo. Examinar y reportar las características sociodemográficas y clínicas de los pacientes evaluados en la Unidad de Psiquiatría de Emergencia del Hospital Nacional Guillermo Almenara Irigoyen (HNGAI), de Lima, Perú, y analizar la naturaleza de los cuadros sintomatológicos y sindrómicos. Métodos. Estudio descriptivo, transversal. Se estudiaron las interconsultas recibidas por la Unidad de Psiquiatría de Emergencia del HNGAI, entre julio y diciembre del 2022. Se aplicó un análisis factorial de los síntomas. Resultados. En 1037 pacientes vistos en interconsulta, la edad promedio fue 41,15 ± 23,52 años. El 65,2 % fueron mujeres. La tasa de derivación fue de 1,18 %. Los trastornos más frecuentes fueron los del humor (27,8 %); los síntomas más frecuentes fueron el afecto ansioso (47,3 %), insomnio (38,8 %) y ánimo depresivo (32,6 %). Con respecto al tratamiento, el más usado fueron los antipsicóticos (50,4 %). El análisis factorial exploratorio de los síntomas mostró siete factores o componentes sindrómicos importantes: psicótico, delirium, depresivo-suicida, obsesivo-compulsivo, negativo, apático, ansioso. Conclusión. El paciente típico de esta muestra fue mujer al inicio de su cuarta década de vida. Los trastornos del humor y los síntomas ansiosos fueron los más comunes. El análisis factorial exploratorio mostró la presencia de siete síndromes. Es necesario incrementar la recopilación sistemática de datos e inversión en investigación en psiquiatría de emergencia, todo con la finalidad de mejorar la atención que se brinda a estos pacientes.

Introduction. In the last 10 to 20 years, emergency psychiatry has undergone consistent progress in providing highly specialized and patient-focused services. This global advancement reflects challenges in accessibility and quality of care. In the Peruvian context, mental health legislation and various clinical guidelines guide service provision; however, the lack of data constitutes a significant barrier to informed decision-making. Objective. The objective of this study was to examine and report the sociodemographic and clinical characteristics of patients evaluated at the Emergency Psychiatry Unit of the National Guillermo Almenara Irigoyen Hospital (HNGAI) in Lima, Peru, and analyze the nature of the symptomatic and syndromic profiles present. Methods. This was a descriptive, cross-sectional study. Interconsultations received by the Emergency Psychiatry Unit of HNGAI between July and December 2022 were analyzed. A factorial analysis of symptoms was conducted. Results. Out of a total of 1037 patients seen in interconsultation, the mean age was 41.15 ± 23.52 years. 65.2% of the patients were female. The referral rate was 1.18%. Mood disorders (27.8%) were the most frequent diagnoses, with anxious affect (47.3%), insomnia (38.8%), and depressive mood (32.6%) being the most common symptoms. Antipsychotics (50.4%) were the most used treatment modality. Exploratory factor analysis of symptoms revealed the presence of seven important syndromic factors: psychotic, delirium, depressive-suicidal, obsessive-compulsive, negative, apathetic, and anxious. Conclusion. The typical patient in this sample was a female in the early forties. Mood disorders and anxious symptoms were the most prevalent. Exploratory factor analysis identified the presence of seven syndromes. There is a need to increase systematic data collection and investment in emergency psychiatry research to enhance the care provided to these patients.

Identificação de demandas psicológicas em pacientes atendidos por interconsulta: divergências na percepção de médicos e psicólogos / Identification of psychological demands in patients seen by inter-consultation: differences in physicians' and psychologists' perceptions

O adoecimento e a necessidade de internação hospitalar podem implicar em prejuízo psicológico ao paciente. Neste sentido, o trabalho em equipes multiprofissionais configura-se como uma importante ferramenta para oferecer atenção integral à saúde. A interconsulta psicológica se caracteriza por um atendimento breve e focado, solicitado pela equipe responsável pelo cuidado do paciente, no qual o psicólogo propõe condutas em conjunto com a equipe de saúde. O objetivo deste estudo foi comparar as demandas psicológicas identificadas pelo médico no pedido de interconsulta, com as demandas avaliadas pelo psicólogo no primeiro atendimento a pacientes hospitalizados em um hospital universitário de nível terciário. Os dados foram obtidos no prontuário médico, categorizados pelos pesquisadores segundo o método quantitativo-interpretativo e analisados em termos de frequência e porcentagem pelo teste de McNemar e grau de concordância entre os avaliadores pelo Coeficiente de Concordância de Kappa. Cento e quatro pedidos de interconsulta realizados entre março de 2017 e março de 2018 foram avaliados, com predominância de pacientes do sexo feminino (59,8), com mais de 50 anos (63%) e profissionalmente inativos (61,9%). A maioria das solicitações teve origem na clínica médica (80,8%) e em paciente com quadro crônico (52,9%). Os resultados encontrados foram descritos em 11 categorias. Notou-se que houve maior concordância entre os cuidadores no reconhecimento de sintomas emocionais como justificativa de intervenção psicológica, o que encontrou correspondência com a literatura científica disponível. Observaram-se discordâncias na percepção de demandas entre os profissionais, especialmente sobre sofrimento emocional relacionado a dificuldades na compreensão do diagnóstico e/ou tratamento, pouco suporte familiar/social, problemas de adaptação à internação hospitalar e problemas emocionais não relacionados à doença. Conclui-se que a perspectiva multiprofissional é uma estratégia importante para promover atenção integral ao paciente, tendo a interconsulta como possibilidade efetiva, e que a abordagem do paciente apresenta diferentes perspectivas, vinculadas aos saberes de cada componente da equipe. Destaca-se a necessidade de investir na formação para a identificação e manejo de problemas de ordem emocional, comunicação e bom relacionamento médico-paciente, e observação de aspectos da história individual que possam contribuir para o bom desfecho do tratamento. Também, mostra-se importante que a for-mação acadêmica instrumentalize os profissionais para o trabalho em equipe multiprofissional, o que requer habilidades de comunicação, sensibilidade e compreensão sobre a complementaridade dos sabere (AU).

Falling ill and the need for hospitalization may imply psychological damage to the patient. In this sense, the work in multi-professional teams is configured as an important tool to offer integrated health care. The psychological in-ter-consultation is characterized by a brief and focused service requested by the team responsible for the patients' care, in which the psychologist proposes practices together with the health team. This study aimed to compare the psychological demands identified by the physician in the inter-consultation request, with the demands evaluated by the psychologist in the first assistance to patients hospitalized in a tertiary-level university hospital. The data were obtained from the medical records, categorized by the researchers according to the quantitative-interpretative method, and analyzed in terms of frequency and percentage by McNemar's test and degree of agreement between the evaluators by the Kappa Coefficient of Agreement. 104 inter-consultation requests made between March 2017 and March 2018 were evaluated, with a predominance of female patients (59.8), over 50 years of age (63%), and professionally inactive (61.9%). Most requests originated from the medical clinic (80.8%) and a patient with a chronic condition (52.9%). The results found were described in 11 categories. It was noted that there was greater agreement among caregivers in recognition of emotional symptoms as a justification for psychological intervention, which found correspondence with the available scientific literature. Disagreements were noted in the perception of demands among professionals, especially regarding emotional suffering related to difficulties in understanding the diagnosis and/or treatment, little family/social support, problems of adaptation to hospitalization, and emotional problems unrelated to the disease. We conclude that the multi-professional perspective is an important strategy to promote integral attention to the patient, with inter-consultation as an effective possibility, and that the approach to the patient presents different perspectives linked to each team component's knowledge. The need to invest in training for emotional problem identification and management, communication and a good doctor-patient relation-ship, and aspects of the individual history that can contribute to a good treatment outcome is emphasized. Also, it is important that academic training equips professionals to work in a multi-professional team, which requires communication skills, sensitivity, and an understanding of the complementarity of knowledge (AU).

Geographical Health District and Distance Traveled Influence on Clinical Status at Admission of Patients with Gestational Trophoblastic Disease / A influência do distrito de saúde e da distância viajada sobre o estado clínico na apresentação de pacientes com doença trofoblástica gestacional

Abstract Objective To assess the potential relationship of clinical status upon admission and distance traveled from geographical health district in women with gestational trophoblastic disease (GTD). Methods This is a cross-sectional study including women with GTD from the 17 health districts from the São Paulo state (I-XVII), Brazil, referred to the Botucatu Trophoblastic Disease Center (specialized center, district VI), between 1990 and 2018. At admission, hydatidiform mole was assessed according to the risk score system of Berkowitz et al. Gestational trophoblastic neoplasia was evaluated using the International Federation of Gynecology and Obstetrics / World Health Organization (FIGO/WHO) staging/risk score. Data on demographics, clinical status and distance traveled were collected. Multiple regression analyses were performed. Results This study included 366 women (335 hydatidiform mole, 31 gestational trophoblastic neoplasia). The clinical status at admission and distance traveled significantly differed between the specialized center district and other districts. Patients referred from health districts IX (β = 2.38 [0.87-3.88], p = 0.002) and XVI (β = 0.78 [0.02-1.55], p = 0.045) had higher hydatidiform mole scores than those from the specialized center district. Gestational trophoblastic neoplasia patients from district XVI showed a 3.32 increase in FIGO risk scores compared with those from the specialized center area (β = 3.32, 95% CI = 0.78-5.87, p = 0.010). Distance traveled by patients from districts IX (200km) and XVI (203.5km) was significantly longer than that traveled by patients from the specialized center district (76km). Conclusion Patients from health districts outside the specialized center area had higher risk scores for both hydatidiform mole and gestational trophoblastic neoplasia at admission. Long distances (>80 km) seemed to adversely influence gestational trophoblastic disease clinical status at admission, indicating barriers to accessing specialized centers.

Resumo Objetivo Avaliar a possível relação entre estado clínico na apresentação e distância percorrida a partir do distrito de saúde em mulheres com doença trofoblástica gestacional. Métodos Estudo transversal incluindo mulheres com doença trofoblástica gestacional dos 17 distritos de saúde do estado de São Paulo (I-XVII), Brasil, encaminhadas ao Centro de Doenças Trofoblásticas de Botucatu (distrito VI), entre 1990 e 2018. Na admissão, avaliaram-se mola hidatiforme pelo sistema de pontuação de risco de Berkowitz et al. e neoplasia trofoblástica gestacional pelo escore de risco/estadiamento Federação Internacional de Ginecologia e Obstetrícia / Organização Mundial da Saúde (FIGO/OMS). Coletaram-se dados demográficos, clínicos e distância percorrida e análises de regressão múltipla foram realizadas. Resultados Este estudo incluiu 366 mulheres (335 mola hidatiforme, 31 neoplasia trofoblástica gestacional). O estado clínico na apresentação e distância percorrida diferiram significativamente entre o centro especializado e demais distritos. Nas pacientes encaminhadas pelos distritos IX (β = 2,38 [0,87-3,88], p = 0,002) e XVI (β = 0,78 [0,02-1,55], p = 0,045), os escores de mola hidatiforme foram maiores que no centro especializado. As pacientes com neoplasia trofoblástica gestacional do distrito XVI apresentaram escores FIGO 3,32 vezes maior que no centro especializado (β = 3,32, 95% CI = 0,78-5,87, p = 0,010). A distância percorrida pelas pacientes dos distritos IX (200km) e XVI (203,5km) foi significativamente maior do que a percorrida pelas pacientes do centro especializado (76km). Conclusão Pacientes de distritos de saúde fora da cobertura do centro especializado apresentaram escores de risco mais alto para mola hidatiforme e para neoplasia trofoblástica gestacional na admissão. Longas distâncias (>80 km) pareceram influenciar negativamente o estado clínico da doença trofoblástica gestacional na apresentação, indicando barreiras no acesso a centros especializados.

Frecuencia de referencias ambulatorias injustificadas, en base a diagnósticos no pertinentes, realizadas a un hospital peruano de tercer nivel / Frequency of unjustified ambulatory referrals bases on no pertinent diagnosis sent to a third level Peruvian hospital

Objetivo: Determinar la frecuencia y describir las características de referencias injustificadas, en base a diagnósticos no pertinentes, enviadas al servicio de consulta externa adultos de un hospital de tercer nivel. Material y métodos: Estudio transversal, observacional y descriptivo, realizado en el Hospital Cayetano Heredia (HCH) en el periodo abril a diciembre del 2019. Se utilizaron los datos del aplicativo "REFCON" con una población de 99 891 referencias. Para la variable "justificación de la referencia", se utilizó un listado de diagnósticos que no deberían derivarse a hospitales de la DIRIS Lima Norte. Adicionalmente, se estudiaron las variables de edad, sexo, grupo etario, especialidad de destino, categoría del EESS de origen, distrito de origen, y diagnóstico del grupo de referencias injustificadas. Se utilizó estadística descriptiva. Resultados: La frecuencia de referencias injustificadas fue de 8,4 %. El 34,2 % fue de pacientes adultos; el 65,8 %, de adultos mayores; y el 67 %, de pacientes mujeres Las especialidades con más referencias injustificadas fueron cardiología, geriatría, medicina interna, medicina familiar y neurología. Los diagnósticos injustificados más frecuentes fueron hipertensión esencial, lumbago no especificado y cefalea. Conclusiones: La frecuencia de referencias injustificadas al HCH por diagnósticos no pertinentes fue 8,4 %, tasa similar a otros dos estudios, pese a la emisión de una lista de diagnósticos que no deberían derivarse a hospitales de la DIRIS Lima Norte.

SUMMARY Objective: To determine the frequency and to describe the characteristics of unjustified ambulatory referrals bases on no pertinent diagnosis done at an adult outpatient clinic of a third level Peruvian hospital. Methods: A cross-sectional study was carried-out from April to December 2019 at Hospital Cayetano Heredia. Data were extracted from REFCON with a population of 99 891 referrals. To justify the reference, a list of diagnosis that does not require referral was used. In addition, variables such as age, sex, specialty of destination, category of EESS, district of origin and diagnosis of the unjustified referral. Descriptive statistics was used. Results: the frequency of unjustified referrals was 8.4%; 34.2% comprised the adult population; 65.8% were elder and 67% were female. Specialties with more unjustified referrals were geriatrics, internal medicine, family medicine and neurology. The most common unjustified diagnosis was essential hypertension, nonspecific low back pain and headache. Conclusions: Despite of socializing a list of unjustified referral diagnosis a frequency of 8,4% remain in this category, which is like results from two previous studies.

Attitudes and beliefs of argentinian medical oncologists regarding palliative care referral / Actitudes y creencias de los médicos oncólogos argentinos sobre la derivación a cuidados paliativos

Abstract Introduction: Local evidence suggests insufficient access to palliative care (PC) for advanced cancer patients. The objective was to investigate the attitudes and beliefs of Argentinian medical oncologists regarding PC referral of their patients. Methods: All medical oncologists listed in the main national Clinical Oncology Associations (N = 831) were invited to participate in a telephone survey. Results: Fifty nine percent (N = 489) completed the survey. Most reported being informed about the scopes of PC (83%) and having accessible PC service/specialists (71%). However, 53% did not work collaboratively, and 55% exceptionally or never referred their patients. Oncologists who usually referred their patients did so mainly due to uncontrolled pain (67%) or absence of curative treatment (48%). Only 19% supported early-referral criteria. Those who exception ally referred their patients argued that PC was not meaningful/beneficial/a priority (78%) or that they preferred to handle the patient's problems by themselves (55%). End-of-life care (33%) and improvement in quality of life (32%) were stated as primary benefits of PC for cancer patients. Addressing psychological aspects was consid ered the least important item (2%). Having an accessible PC service (P = 0.002) and being well informed about PC (P = 0.008) were associated with frequent referral. Having ≤10 years or >30 years from graduation were associated with exceptional or no referral (P = 0.012 and 0.001, respectively). Discussion: Oncologists report awareness of the potential advantages of PC and have accessible PC services, but rarely refer patients. They mainly use late-referral criteria. Younger and older age are negatively associated with referral. More research is needed to improve the referral rate and timing of cancer patients to PC.

Resumen Introducción: La evidencia local sugiere un acceso insuficiente a los cuidados paliativos (CP) para los pacien tes con cáncer avanzado. El objetivo fue investigar las actitudes y creencias de médicos oncólogos argentinos respecto de la derivación de sus pacientes a CP. Métodos: Todos los médicos oncólogos registrados en las principales Asociaciones Nacionales de Oncología Clínica (N = 831) fueron invitados a participar en una encuesta telefónica. Resultados: El 59% (N = 489) completó la encuesta. La mayoría informó estar informado sobre los alcances de CP (83%) y tener especialistas/servicios de CP acce sibles (71%). Sin embargo, el 53% no trabajaba de forma colaborativa y el 55% excepcionalmente o nunca derivaba a sus pacientes. Los oncólogos que habi tualmente derivan a sus pacientes lo hacen principalmente por dolor no controlado (67%) o ausencia de trata miento curativo (48%). Solo el 19% mencionó criterios de derivación temprana. Aquellos que excepcionalmente derivan a sus pacientes argumentaron que los CP no era significativos, beneficiosos o prioritarios (78%) o que preferían manejar los problemas del paciente por sí mismos (55%). La atención al final de la vida (33 %) y la mejora de la calidad de vida (32 %) se señalaron como los principales beneficios de los CP para los pacientes con cáncer. El abordaje de los aspectos psicológicos fue el ítem menos señalado (2%). Tener un servicio de CP accesible (P= 0,002) y estar bien informado sobre CP (P = 0,008) se asociaron con la derivación frecuente. Tener ≤10 años o >30 años desde la graduación se asoció con una derivación excepcional o nula (P = 0,012 y 0,001, respectivamente). Discusión: Los oncólogos refieren conocer las ventajas potenciales de los CP y tienen servicios de CP accesibles, pero rara vez derivan pacientes. Utilizan principalmente criterios de derivación tardía. Las edades más jóvenes y mayores se asocian negativamente con la derivación. Se necesita más investigación para mejorar la tasa y momento de derivación de los pacientes con cáncer a CP.

Consultas a urgencia y valores espirométricos tras el reemplazo de salmeterol/fluticasona por budesonida/formoterol en pacientes con asma moderada a grave / Emergency consultations and spirometric values after replacement of salmeterol/fluticasone with budesonide/formoterol in patients with moderate to severe asthma

El asma se caracteriza por su impacto deletéreo que incluye gran coste económico para el sistema de salud. En pacientes con asma mal controlada a pesar del tratamiento, se propone un régimen de mantenimiento con corticoides inhalados y formoterol. El objetivo del presente estudio observacional retrospectivo fue evaluar las modificaciones espirométricas tras el cambio del medicamento controlador en pacientes con asma moderada a severa asistidos en el Hospital Clínico de Magallanes de Punta Arenas, así como también cuantificar la modificación en el número de exacerbaciones graves (consulta a un servicio de urgencia y/u hospitalización por asma). Participaron 61 adultos con asma moderada a severa (mediana de edad: 60 años [rango: 21-87], mujeres: 69,4%; comorbilidad atópica/alérgica: 79%; otras comorbilidades: 46,8%) en los que se cambió el tratamiento con fluticasona/salmeterol 250/25 μg por budesónida/formoterol 160/4,5 μg. No se observaron cambios significativos en los índices espirométricos tras el cambio. Con el tratamiento inicial, el 46,9% presentó ≥ 1 visita a urgencias (total: 50 consultas). Tras el cambio por budesonida/formoterol, el 21% requirió al menos una visita a urgencias (total: 14 consultas; p < 0,01). La proporción de pacientes con ≥ 2 consultas a urgencias fue de 19,7% con el tratamiento basal y de 1,6% tras el cambio a budesonida/formoterol (p < 0,01). No se observaron diferencias significativas en la cantidad de hospitalizaciones. En este estudio del mundo real de pacientes con asma moderada a grave, el cambio del tratamiento a budesonida/formoterol se asoció con reducción significativa de las consultas a urgencias, a pesar de no detectarse cambios de significación estadística en los índices espirométricos habituales.

Asthma is characterized by its deleterious impact, including a high cost to the healthcare system. In patients with poorly controlled asthma despite treatment, a maintenance regimen of inhaled corticosteroids and formoterol is proposed. The aim of this retrospective, observational study was to evaluate the spirometric changes after switching the controller medication in patients with moderate to severe asthma attended in our institution ("Hospital Clínico de Magallanes"), as well as the variation in the number of severe exacerbations (consultation to an emergency department and/or hospitalization for asthma). Sixty-one adults with moderate to severe asthma (median age: 60 years-old [range: 21-87], women: 69.4%; atopic/allergic comorbidity: 79%; other comorbidities: 46.8%) in whom treatment with fluticasone/salmeterol 250/25 μg was switched to budesonide/formoterol 160/4.5 μg participated in our study. No significant changes in spirometric parameters were observed after the replacement treatment. With the initial treatment, 46.9% patients presented ≥ 1 visit to the emergency department (total: 50 visits). After the switch to budesonide/formoterol, 21% required at least one emergency department visit (total: 14 consultations; p < 0.01). The proportion of patients with ≥ 2 emergency department visits was 19.7% with baseline treatment and 1.6% after switching to budesonide/formoterol (p < 0.01). No significant differences were observed in the number of hospitalizations. In this real-world study of moderate to severe asthma patients, switching to budesonide/formoterol was associated with a significant reduction in emergency department visits, despite no statistically significant changes in the usual spirometric parameters.

A survey of patients' satisfaction with referral in a class A tertiary hospital / 预防医学

Objective@# To investigate patients' satisfaction rate towards referral in a class A tertiary hospital, so as to provide the evidence for promoting the highly efficient implementation of referral. @*Methods @#The gender, age, type of referral, referral efficiency and referral cost of patients receiving referral services in 2021 were collected through the interconnected intelligent hierarchical diagnosis and treatment collaborative platform of Henan Provincial People's Hospital. Patients' awareness and recognition of the two-way referral system were investigated using questionnaire surveys, and factors affecting patients' satisfaction with referral were identified using a multivariable logistic regression model.@* Results@# A total of 1 268 patients receiving referral services were surveyed, including 576 men (45.43%) and 692 women (54.57%), and the respondents were predominant at ages of 18 years and older (935 cases, 73.74%). There were 535 cases with overdue referral (42.19%) and 1 157 cases with free referrals (91.25%). There were 749 cases that were aware of the two-way referral system (59.07%), and 587 cases recognized the two-way referral system (46.29%). There were 975 patients with a satisfactory attitude towards referral, with a satisfaction rate of 76.89%. There were 1 030 cases (81.23%) that considered fluent communication of referral information, with a 78.54% satisfaction rate towards referral; 569 cases (44.87%) that considered simple referral procedures, with an 81.37% satisfaction rate towards referral, and 797 cases that were satisfied with the services provided by the referred medical staff (62.85%), with a 79.42% satisfaction rate towards referral. Multivariable logistic regression analysis showed that non-overdue referrals (OR=1.846, 95%CI: 1.411-2.414), free referrals (OR=1.815, 95%CI: 1.188-2.773), awareness of the two-way referral system (OR=0.624, 95%CI: 0.472-0.826), recognition of the two-way referral system (OR=1.621, 95%CI: 1.235-2.129) were factors affecting the satisfaction with referral.@*Conclusions@# The satisfaction rate towards referral was 76.89% among the study patients, and the awareness and recognition of the two-way referral system, referral efficiency and convenience are factors affecting the satisfaction with referral.

Current status and future prospects of the model integrating medicine with health regimens for elderly care under the multilevel referral healthcare system / 中华老年医学杂志

Along with population aging in China, the spectrum of chronic diseases in the elderly is constantly evolving, and the demand for different types of elderly care is increasing steadily.The healthcare infrastructure constitutes the cornerstone of elderly care.In order to further improve the elderly care system and the medical service model, this paper analyzes the current status of the model integrating medicine with health regimens for elderly care under the multilevel referral healthcare system and puts forward suggestions for future development.

Evaluation of application effect of two-way referral service in the referral and treatment of coronary disease / 中华健康管理学杂志

Objective:To evaluate the effect of two-way referral service in referral and treatment of patients with coronary disease.Methods:A non-randomized controlled study was used, 80 patients with coronary disease who were referred to the First Affiliated Hospital of Xinjiang Medical University through the fast referral channel, also called green referral channel (GRC) of telemedicine service mode from January 2021 to January 2022 were selected as the GRC referral group. A propensity score was used to match 110 patients from the same period with coronary disease who were referred to this hospital through conventional medical channels and had similar basic conditions such as age, gender, region and medical insurance type as the conventional referral group. The differences in disease severity, referral time, hospitalization cost and other indicators were compared using t-test, χ2 test and nonparametric test between the two groups, and the satisfaction of the GRC referral group was investigated. Results:The proportion of patients with heart function grade Ⅲ (NYHA grading), heart failure, atrial fibrillation and interventional therapy in the GRC referral group was significantly higher than conventional referral group (all P<0.05). The total referral time and bed waiting time of patients in the GRC referral group were significantly shorter than conventional referral group [14.16 (9.62, 25.61) vs 34.39 (28.51, 49.68) h, 2.13 (0.83, 6.64) vs 24.58 (20.27, 27.68) h] ( Z=8.465, 9.172, all P<0.001). The hospitalization cost, surgical treatment cost and material cost in GRC referral group were significantly higher than conventional referral group [24 755 (11 559, 56 521) vs 14 700 (9 375, 29 534) CNY, 6 013 (2 096, 8 256) vs 2 562 (2 044, 6 154) CNY, 12 093 (1 267, 35 689) vs 1 329 (826, 16 125) CNY] ( Z=2.814, 2.917, 3.353, all P<0.05), and the diagnosis cost was significantly lower than conventional referral group [4 878 (3 628, 6 847) vs 5 719 (4 228, 7 639) CNY] ( Z=2.323, P<0.05). In the GRC referral group, the satisfaction rates with referral process, visit time and patient experience were all above 90%. Conclusion:Two-way referral service based on telemedicine has a good application effect in the referral and treatment of patients with coronary disease.

Downward referral willingness of rehabilitation patients in an urban medical group and its influencing factors / 中国康复理论与实践

ObjectiveTo investigate the willingness of rehabilitation patients within an urban medical group to accept downward referrals and analyze the influencing factors. MethodsFrom June to October, 2023, a survey was conducted using a simple random sampling method among neurological and orthopedic rehabilitation patients in hospitals within a specific urban medical group. The 2013 version of the Andersen Model was employed to construct a theoretical framework for the willingness of rehabilitation patients to accept downward referrals and influencing factors. Within this framework, a questionnaire was designed using a 5-point Likert scale, comprising three sections including personal characteristics, environmental features and healthcare service utilization choices, totaling 23 questions. A preliminary survey was conducted, and the questionnaire had underwent reliability and validity testing. ResultsA total of 350 questionnaires were collected, with 314 valid questionnaires. The willingness of rehabilitation patients to accept downward referrals was found to be associated with age, rehabilitation specialties, rehabilitation phases, previous experiences with downward referrals, awareness of and perceptions regarding bidirectional referral policies, and understanding and opinions about the urban medical group (χ2 > 7.755, P < 0.05). The primary influencing factors were rehabilitation specialties, rehabilitation phases, previous experiences with downward referrals and perceptions of the necessity of bidirectional referral policies (P < 0.05). ConclusionRehabilitation specialties, rehabilitation phases, previous experiences with downward referrals and perceptions of the necessity of bidirectional referral policies are the primary factors that influenced the willingness of rehabilitation patients to accept downward referrals. We should formulate targeted and focused improvement measures based on the specific circumstances and key influencing factors of rehabilitation patients within the urban medical group regarding their willingness to accept downward referrals. Continuously enhancing the proportion of patients willingness to accept downward referrals is essential for the effective implementation of bidirectional referral for rehabilitation patients.

Assessing Inter-rater Reliability of the Dental Practicality Index and the American Association of Endodontists Endodontic Case Difficulty Assessment Form among Undergraduates

@#Dental Practicality Index (DPI) and American Association of Endodontists Endodontic Case Difficulty Assessment (AAECDA) form potentially can guide clinicians in making clinical decisions and triaging in large practices and academic settings. Nonetheless, the reliability and validity should be evaluated before institution-wide implementation. This study aimed to evaluate the inter-rater reliability of the DPI and AAECDA forms. Ten randomly selected, trained students rated 25 cases with both forms. The itemby- item inter-rater and overall reliability were estimated with Gwet’s agreement coefficient (AC2) and intraclass correlation coefficient (ICC), respectively. The association between clinical decisions and the scores was analysed with the Generalised Estimating Equation. The inter-rater reliability of DPI was generally very good (AC2 = 0.81–1.00), except context (good; AC2 = 0.718; 95% confidence interval [CI] = 0.575–0.861). The inter-rater reliability of AAECDA was generally very good (AC2 = 0.81–1.00) and good (AC2 = 0.61–0.80), except the radiographic appearance of the canal(s) (fair; AC2 = 0.424, 95% CI = 0.263–0.585). Moderate overall inter-rater reliability of AAECDA (ICC = 0.53, 95% CI = 0.38–0.70) and DPI (ICC = 0.62, 95% CI = 0.48–0.77) was observed. Referral to an endodontist was positively associated with AAECDA score (odds ratio [OR] = 1.323, 95% CI = 1.145–1.52, p < 0.001). The decision of tooth extraction was positively associated with the DPI score (OR = 1.983, 95% CI = 1.539–2.555; p < 0.001). In conclusion, DPI and AAECDA are methods with moderate inter-rater reliability when used among dental students.

Mobile application-based oximetry: a potential toolfor appropriate referral of patients with respiratory symptoms examined via telemedicine

ABSTRACT Objective To calculate the positive likelihood ratio to determine whether telemedicine is able to optimize referral to the emergency department. Methods Unicenter study with 182 consecutive patients admitted to Hospital Israelita Albert Einstein due to respiratory symptoms. All patients were submitted to oxygen saturation measurement using the standard method Welch Allyn finger device vital sign monitor and a 2-minute evaluation (Binah.ai mobile application). The reproducibility of oxygen saturation measurements made with both methods was investigated using interclass correlation coefficients and analysis of dispersion. Bland-Altman plots were constructed and kappa concordance coefficients used to examine data normality. Accuracy was also estimated. Results Oxygen saturation measurement differences between methods were ≤2% in more than 85% of cases. The mean difference (bias) between methods was near zero (0.835; Bland-Altman analysis). Oxygen saturation measurements made using the Binah.ai mobile application had an average ability to detect patients with altered oxygen saturation levels compared to the conventional method (ROC analysis). The positive likelihood ratio of the mobile application was 6.23. Conclusion Mobile applications for oxygen saturation measurement are accessible user-friendly tools with moderate impact on clinical telemedicine evaluation of patients with respiratory symptoms, and may optimize referral to the emergency department.

Características Clínicas e Manejo de Pacientes Avaliados por Teleconsulta Cardiológica na Região Brasileira com Maior Número de Cidades Isoladas / Clinical Features and Management of Patients Assessed by Cardiology Teleconsultation in the Brazilian Region with the Highest Number of Isolated Cities

Resumo Fundamento As doenças cardiovasculares são a principal causa de morte no mundo. Regiões brasileiras geograficamente remotas e de baixa renda carecem de consultas especializadas. Não se tem conhecimento total acerca do manejo por telemedicina dessa população por parte de cardiologistas. Objetivos Analisar a teleconsulta cardiológica na região brasileira com maior número de municípios isolados. Métodos Entre fevereiro de 2020 e outubro de 2021, pacientes da Região Norte do Brasil avaliados por médicos generalistas locais foram encaminhados para avaliação cardiológica por telemedicina. Foram analisados os motivos do encaminhamento, dados demográficos, histórico clínico, exames físicos, exames complementares, medicamentos e prescrições pré e pós-telemedicina (considerou-se p<0,05 como estatisticamente significativo). Resultados Analisamos 653 pacientes. A taxa de frequência foi de 85,7% (53,1% do sexo feminino, idade média: 54,2±6,5 anos). Os principais motivos de encaminhamento foram sintomas cardiovasculares (58,1%) e fatores de risco entre pacientes assintomáticos (13,3%). Apenas 12,6% apresentava alguma doença diagnosticada. A maioria dos pacientes havia passado por exame físico e eletrocardiogramas regulares. Poucos tinham exames complementares recentes. A prescrição de bloqueadores dos receptores da angiotensina (BRA), bloqueadores dos canais de cálcio e estatinas aumentou significativamente, enquanto a de digoxina, betabloqueadores não cardíacos e ácido acetilsalicílico (AAS) diminuiu na primeira teleconsulta. A maioria dos exames complementares solicitados era de baixa complexidade e custo: eletrocardiograma (28,2%), radiografia de tórax (14%), ecocardiograma (64,5%) e exames de sangue (71,8%). Para 2,1% dos pacientes, foram indicadas intervenções, e 8% recebeu alta após a primeira consulta. Conclusão A teleconsulta cardiológica sob demanda contribui para a otimização do tratamento das doenças cardíacas. A maioria dos pacientes foi encaminhada com diagnósticos sindrômicos sem exames complementares prévios. A avaliação especializada solicitada geralmente estava disponível localmente e com baixo custo, mas impedia a alta precoce. Capacitação local poderia otimizar o encaminhamento.

Abstract Background Cardiovascular diseases are the leading cause of adult mortality. Geographically remote and low-income Brazilian regions lack specialized consultations. The telemedicine management of this population by cardiologists is not fully known. Objectives To analyze cardiology teleconsultation in the Brazilian region with the highest number of isolated cities. Methods From February 2020 to October 2021, patients from the North Region of Brazil evaluated by local general practitioners were referred for cardiological evaluation by telemedicine. Referral reasons, demographics, clinical history, physical examinations, tests, medications, and prescriptions pre- and post-telemedicine were analyzed (p<0.05 was considered statistically significant). Results We analyzed 653 patients. The attendance rate was 85.7% (53.1% female, mean age: 54.2±6.5 years). The main reasons for referral were cardiovascular symptoms (58.1%) and risk factors among asymptomatic patients (13.3%). Only 12.6% had a diagnosed disease. Most patients had regular physical examinations and electrocardiograms. Few had recent complementary tests. The prescription of angiotensin receptor blockers (ARBs), calcium channel blockers and statins was significantly increased, while that of digoxin, noncardiac beta-blockers and acetylsalicylic acid (ASA) was decreased at the first teleconsultation. Most of the tests requested were of low complexity and cost: electrocardiogram (28.2%), chest X-ray (14%), echocardiogram (64.5%) and blood tests (71.8%). For 2.1% of patients, interventions were indicated, and 8% were discharged after the first consultation. Conclusion On-demand cardiology teleconsultation contributes to heart disease treatment optimization. Most patients were referred with syndromic diagnoses without previous complementary tests. The specialist workup requested was usually available locally and at a low cost but precluded early discharge. Local training could optimize the referral.

Cuidados paliativos: la visión del neurólogo en Uruguay / Palliative care from a neurologist's perspective in Uruguay / Cuidados paliativos: a visão do neurologista no Uruguai

Introducción: los cuidados paliativos (CP) han incluido en su abordaje patologías no oncológicas, sin embargo los criterios de inclusión de pacientes con enfermedades neurológicas avanzadas es aún un desafío. Objetivo: conocer la percepción de los neurólogos, residentes y posgrados sobre los CP. Método: se aplicó una encuesta en línea, ad hoc. Se exploró la percepción del profesional en cuatro áreas: experiencia de trabajo conjunto, enfermedades neurológicas pasibles de CP, criterios de derivación y autopercepción de la formación en CP. Resultados: se obtuvieron 60 respuestas, 73% de los neurólogos tenían más de 5 años de ejercicio. El 83% de los encuestados refirió haber compartido pacientes con profesionales de CP, el 87% afirmó que su experiencia fue positiva o muy positiva. El 53% consideró que la esclerosis lateral amiotrófica siempre debe recibir CP y alrededor de 80% evaluó la derivación de otras enfermedades sólo en etapas avanzadas. El principal criterio de derivación evocado fue la toma de decisiones anticipadas (66%), independientemente de los años de ejercicio. En relación a la autopercepción de la capacitación en el manejo del paciente con enfermedad neurológica avanzada al final de la vida, el 62% se percibió muy capacitado o aceptablemente capacitado. Conclusión: en esta primera aproximación de la perspectiva de los neurólogos del Uruguay con respecto a los CP, se destaca la necesidad de desarrollar guías de derivación y estrategias de trabajo conjunto para la asistencia integral de pacientes con enfermedades neurológicas pasibles de ser beneficiados por el enfoque de cuidados paliativos.

Introduction: palliative care (PC) has included non-oncologic conditions among its scope although inclusion criteria for patients with advanced neurological diseases continues to be challenging. Objective: to learn about the perception of neurologists, residents and postgraduates on palliative care. Method: an online, ad hoc survey was conducted. The survey explored the perception of professional in four areas: work experience in collaborative work, neurological conditions that could qualify for PC, criteria for referral and self-perception of palliative care training. Results: 60 replies were obtained. 73% of participants in the survey were neurologists with over 5 years of practice. 83% of surveyed physicians stated they had shared patients with PC professionals; 87% affirmed their experience had been positive or very positive. 53% found amyotrophic lateral sclerosis must receive PC in all cases and 80% considers the appropriateness of referring patients with other conditions only in advanced stages of the disease. The main criteria for referral mentioned was the making of anticipated decisions (66%), regardless of the years of practice. As to their self-perception of training in the handling of patients with advanced neurological disease at the end of life, 62% see themselves as very well prepared or satisfactorily prepared. Conclusions: in this first approach to the perspective of neurologists in Uruguay on palliative care, we stand out the need to create referral guidelines and strategies for collaborative work for the comprehensive handling of patients with neurological conditions that could qualify for benefiting from palliative care.

Introdução: os cuidados paliativos (CP) têm incluído patologias não oncológicas na sua abordagem; no entanto os critérios de inclusão para doentes com doenças neurológicas avançadas ainda são um desafio. Objetivo: conhecer a percepção de neurologistas, residentes e pós-graduandos de neurologia sobre os CP. Método: foi aplicado um questionário online, ad hoc. A percepção do profissional foi explorada em quatro áreas: experiência de trabalho conjunto, doenças neurológicas susceptíveis ao CP, critérios de encaminhamento e autopercepção da capacitação em CP. Resultados: foram obtidas 60 respostas sendo 73% neurologistas com mais de 5 anos de prática. 83% dos entrevistados relataram ter compartilhado pacientes com profissionais de CP; 87% afirmam que sua experiência foi positiva ou muito positiva. 53% consideraram que a Esclerose Lateral Amiotrófica deve sempre receber CP e cerca de 80% avaliaram o encaminhamento de outras doenças apenas em estágios avançados. O principal critério de encaminhamento evocado foi a tomada de decisão precoce (66%), independentemente dos anos de prática. Em relação à autopercepção de capacitação no manejo de pacientes com doença neurológica avançada na fase final da vida, 62% percebem-se altamente capacitados ou com treinamento aceitável. Conclusão: nesta primeira aproximação à perspectiva dos neurologistas uruguaios sobre os CP, destaca-se a necessidade de desenvolver guias de encaminhamento e estratégias de trabalho conjunto para o atendimento integral de pacientes com doenças neurológicas que possam se beneficiar da abordagem de cuidados paliativos.

Ebola outbreak in Guinea, 2021: Clinical care of patients with Ebola virus disease

Background: Experience from the Zaire Ebolavirus epidemic in the eastern Democratic Republic of the Congo (2018­2020) demonstrates that early initiation of essential critical care and administration of Zaire Ebolavirus specific monoclonal antibodies may be associated with improved outcomes among patients with Ebola virus disease (EVD). Objectives: This series describes 13 EVD patients and 276 patients with suspected EVD treated during a Zaire Ebolavirus outbreak in Guinea in 2021. Method: Patients with confirmed or suspected EVD were treated in two Ebola treatment centres (ETC) in the region of N'zérékoré. Data were reviewed from all patients with suspected or confirmed EVD hospitalised in these two ETCs during the outbreak (14 February 2021 ­ 19 June 2021). Ebola-specific monoclonal antibodies, were available 2 weeks after onset of the outbreak. Results: Nine of the 13 EVD patients (age range: 22­70 years) survived. The four EVD patients who died, including one pregnant woman, presented with multi-organ dysfunction and died within 48 h of admission. All eight patients who received Ebola-specific monoclonal antibodies survived. Four of the 13 EVD patients were health workers. Improvement of ETC design facilitated implementation of WHO-recommended 'optimized supportive care for EVD'. In this context, pragmatic clinical training was integrated in routine ETC activities. Initial clinical manifestations of 13 confirmed EVD patients were similar to those of 276 patients with suspected, but subsequently non confirmed EVD. These patients suffered from other acute infections (e.g. malaria in 183 of 276 patients; 66%). Five of the 276 patients with suspected EVD died. One of these five patients had Lassa virus disease and a coronavirus disease 2019 (COVID-19) co-infection. Conclusion: Multidisciplinary outbreak response teams can rapidly optimise ETC design. Trained clinical teams can provide WHO-recommended optimised supportive care, including safe administration of Ebola-specific monoclonal antibodies. Pragmatic training in essential critical care can be integrated in routine ETC activities. Contribution: This article describes clinical realities associated with implementation of WHO-recommended standards of 'optimized supportive care' and administration of Ebola virus specific treatments. In this context, the importance of essential design principles of ETCs is underlined, which allow continuous visual contact and verbal interaction of health workers and families with their patients. Elements that may contribute to further quality of care improvements for patients with confirmed or suspected EVD are discussed.

Determinants and outcomes of low birth weight among newborns at a Tertiary Hospital in Zambia: A retrospective cohort study

Aim: This study aimed to assess determinants and outcomes of LBW among newborns at a tertiary hospital. Settings and Design: Retrospective cohort study at Women and Newborn Hospital in Lusaka Zambia. Subjects and Methods: We reviewed delivery case records and neonatal files between January 1, 2018, and September 30, 2019, for newborns admitted to the neonatal intensive care unit. Statistical Analysis Used: Logistic regression models were used to establish determinants of LBW and describe the outcomes. Results: Women living with human immunodeficiency virus infection were more likely to deliver LBW infants (adjusted odds ratio [AOR] = 1.46; 95% confidence interval [CI]: 1.16­1.86). Other maternal determinants of LBW were; increased parity (AOR = 1.22; 95% CI: 1.05­1.43), preeclampsia (AOR = 6.91; 95% CI: 1.48­32.36), and gestational age <37 weeks compared to 37 weeks or more (AOR = 24.83; 95% CI: 13.27­46.44). LBW neonates were at higher odds of early mortality (AOR = 2.16; 95% CI: 1.85­2.52), developing respiratory distress syndrome (AOR = 2.96; 95% CI: 2.53­3.47), and necrotizing enterocolitis (AOR = 1.66; 95% CI: 1.16­2.38) than neonates with a birth weight of 2500 g or more. Conclusions: These findings underscore the importance of effective maternal and neonatal interventions to reduce the risk of morbidity and mortality for neonates with LBW in Zambia and other similar settings.