Las funciones ejecutivas: su significado y aplicación clínica / Executive functions: meaning and clinical application

Las funciones ejecutivas generalmente se conceptualizan como un conjunto de procesos generales de control de orden superior que trabajan juntos para dirigir y gestionar las funciones cognitivas, emocionales y conductuales, especialmente durante la resolución activa de problemas. Su disfunción es frecuente de ser detectada como comorbilidad de otros trastornos del neurodesarrollo, causa o efecto? La detección precoz de la disfunción ejecutiva y su abordaje terapéutico temprano, mejora el pronóstico global madurativo en el periodo infantojuvenil. Esta sucinta revisión de las funciones ejecutivas intenta resaltar su importancia para el pediatra y su mirada de los trastornos del neurodesarrollo (AU)

Executive functions are typically understood as a set of general higher-order control processes that collectively direct and manage cognitive, emotional, and behavioral functions, especially during active problem solving. Their dysfunction is often detected as a comorbidity of other neurodevelopmental disorders; cause or effect? Early detection of executive dysfunction and a prompt therapeutic approach improves the overall developmental prognosis in childhood and adolescence. This brief review of executive functions aims to highlight their importance for the pediatrician and his/her view of neurodevelopmental disorder (AU)

Economic burden of acute myeloid leukemia on patients in a resource-limited tertiary hospital in the Philippines

ABSTRACT Introduction: The remission induction treatment for acute myeloid leukemia (AML) has remained unchanged in the resource-limited setting in the Philippines. AML treatment consists of induction chemotherapy followed by high dose consolidation chemotherapy or allogeneic hematopoietic stem cell transplantation. In the Philippines, the Filipino household bears the burden of health care cost of hospitalization expenditure. Insights into the treatment costs becomes an essential requirement as these guides the allocation of resources to scheme health programs. Method: This study involved a retrospective cohort analysis of AML patients who underwent treatment for AML. Review of the statements of account per admission per patient during treatment for remission induction, consolidation, relapsed and refractory disease and best supportive care from 2017 to 2019. Of the 251 eligible patients, 190 patients were included. Result: The mean healthcare expenditure for remission induction chemotherapy (Phase 1) was US $2, 504.78 (Php 125,239.29). While 3 to 4 cycles of consolidation chemotherapy cost an average of US $3,222.72 (Php 162,103.20). For patients who had relapsed and refractory disease, an additional mean cost of US $3,163.32 (Php 159,115.28) and US $2, 914.72 (Php 146,610.55) were incurred, respectively. The average cost of palliative care was US $1,687.00 (Php 84,856.59). Conclusion: The cost of chemotherapy and other therapeutics bear most of the weight of the direct healthcare cost. The cost of AML treatment represents a significant economic burden for patients and the institution. The cost increases as patients proceed through subsequent lines of treatment for induction failure. Existing subsidy for health insurance benefits could still be improved for appropriate source allocation of resources.

The impact of patients with generalized anxiety disorder in the Brazilian Private Healthcare System: a claim database study with expert's perspective / O impacto de pacientes com transtorno de ansiedade generalizada no Sistema Único de Saúde: um estudo de base de sinistros com a perspectiva de especialistas

This study describes the healthcare resource use and costs associated with anxiety assessing claim database outcomes and expert opinion from the perspective of the Brazilian Private Healthcare System. A retrospective analysis of the Orizon database was conducted, containing claims data of anxiety patients reported in Private Healthcare Systems (2015-2017) according to the ICD-10 code (F40 or F41 and their subtypes). Further, a 3-hour online meeting brought together five anxiety and Health Insurance Companies experts to discuss their perspectives. The total cost of the 18,069 patients identified in the database was BRL 490 million: related to medical appointments (2%), exams (16%), emergency room (5%), and others (77%). The mean number of appointments was 5.1 in a 4-year period, performed by 61% of the patients. Approximately 2,595 visits were made to psychiatrists by 923 patients, and 95% underwent at least one examination (100.6 examinations per patient, on average). The identification of anxiety patients and their corresponding burden is challenging to estimate. The higher impact is related to the frequency of healthcare use before the diagnosis than the treatment itself. These outcomes may help plan and implement adequate healthcare programs for patients with anxiety.

Este estudo descreve o uso de recursos de saúde e os custos relacionados à ansiedade associando resultados de uma base de dados administrativa e opinião de especialistas na perspectiva do Sistema Privado de Saúde Brasileiro. Foi realizada uma análise retrospectiva da base de dados da Orizon de pacientes com ansiedade em atendimento hospitalizar ou ambulatorial no Sistema Privado de Saúde (2015 - 2017) com o código CID-10 (F40 ou F41 e os seus subtipos), adicionalmente promovemos uma reunião online de 3 horas com cinco especialistas em ansiedade e em seguros de saúde para discutir as suas perspectivas. O custo total dos 18.069 pacientes identificados no banco de dados foi de R$ 490 milhões, relacionados a consultas médicas (2%), exames (16%), pronto-socorro (5%) e outros (77%). A média de consultas foi de 5,1 em um período de 4 anos, realizadas por 61% dos pacientes. Aproximadamente 2.595 visitas foram feitas a psiquiatras por 923 pacientes, e 95% realizaram pelo menos um exame (média de 100,6 exames por paciente. É desafiador identificar e estimar o impacto da doença no Sistema Privado de Saúde Brasileiro. O impacto maior está relacionado à frequência de uso de serviços de saúde antes do diagnóstico, em comparação com o próprio tratamento. Esses resultados podem ajudar a planejar e implementar programas de saúde adequados para pacientes com ansiedade.

Immediate effect of small-angle Tui-Pushing and An-Pressing anti-rotation bone-setting manipulation in improving the treatment of braces for adolescent idiopathic scoliosis / 针灸推拿医学（英文版）

Objective: To observe the immediate effect of small-angle Tui-Pushing and An-Pressing anti-rotation bone-setting manipulation in improving the correction of braces for adolescent idiopathic scoliosis. Methods: A total of 50 cases of adolescent idiopathic scoliosis were selected and given brace correction first. The whole spine anteroposterior and lateral radiographs were taken, the Cobb angle was measured, and the visual analog scale (VAS) score of pain caused by brace wearing was recorded. After removal of the brace, small-angle Tui-Pushing and An-Pressing anti-rotation bone-setting manipulation was performed once. After treatment, the same brace was put on again to take a whole spine anteroposterior radiograph, the Cobb angle was measured, and the VAS score was recorded. The changes in Cobb angle and VAS score after manipulation were compared, and the immediate efficacy was evaluated. Results: After the manipulation, the Cobb angle was significantly smaller than that before treatment (P<0.01) and the VAS score was significantly lower than that before treatment (P<0.01). Conclusion: Small-angle Tui-Pushing and An-Pressing anti-rotation bone-setting manipulation can improve the immediate efficacy of brace in treating adolescent idiopathic scoliosis and relieve the pain caused by brace wearing at the same time.

Scientific unknown-base in medical field: Supporting problem-oriented priority setting in basic research / 中华医学科研管理杂志

Objective:The present study delves into the realm of scientific unknowns, which serve as the primary representation of major scientific challenges and often give rise to subversive, non-consensus, and high-risk scientific problems. Addressing this pivotal aspect, we focus on the development of scientific unknown identification methods and tool platforms to provide essential data support for priority setting of basic research through a problem-oriented approach. Such efforts are imperative for managing the scientific and technological innovation system within the context of demands and problem-solving.Methods:While numerous knowledge bases have been established in the medical field, there remains a notable lack of focus on the unknown base. The paper synthesizes relevant literature and existing research, amalgamating the methodological paradigm of scientific big data research with text mining. This integration facilitates comprehensive interpretations and enlightening insights concerning the concept, identification methods, and construction of an unknown-base.Results:By systematically analyzing the concept of scientific unknowns, we present a recognition method based on cognitive state and logical rules. Furthermore, we discuss a classification framework and realization path for scientific unknowns from the dimensions of attribute, relationship, and disease, thereby providing foundational insights for the construction of a medical unknown database.Conclusions:Notably, the research on unknowns in medical science transcends disciplinary boundaries, encompassing the confluence of information science, data science, medical informatics, and science and technology management. As such, this paper seeks to expound upon the significance and application scenarios of unknown research in science, furnishing valuable ideas and references for scholars in the field.

Research on the reform of position setting and performance evaluation in medical research institutes under the background of institute integration / 中华医学科研管理杂志

Objective:To explore the collaborative innovation development mechanism of hospitals and research institutes, fully integrate the institute personnel with hospitals, and conduct classified management and performance appraisal, promoting the integrated development of hospitals and research institutes.Methods:The idea of personnel classification, the establishment of an integrated research team, and technical team groupings and service directions were determined through key informant interviews, research ability and technical strength surveys, and other research methods; The performance appraisal scheme of research teams were established by using literature analysis and optimization and Delphi expert investigation; The platform team assessment programs were established by qualitative research methods.Results:Built a position setting framework for research institutes, formed hospital-institute integrated research teams around the hospital's clinical advantageous disciplines with researchers and clinical staff, set up platform teams based on existing equipment and technicians′ specialties, established a performance appraisal scheme for research teams based on Science and Technology Evaluation Metrics(STEM), determined a full-dimensional comprehensive performance evaluation scheme for the technology platforms based on service volume and quality.Conclusions:This study formulated a set of position setting and performance evaluation schemes that fit with the current situation of municipal research institutes, and explored a new scientific research cooperation mechanism of resource sharing, team co-construction, and technology sharing, which can provide a certain reference value for the reform of other medical research institutes.

Normalized spectral settings in light- and myopia-related experimental studies / 中华实验眼科杂志

There are more and more studies investigating the influence of spectral difference on myopia, but the settings of light sources are different in each study.As a physical quantity, light can be measured radiometrically, mainly to detect the energy properties of light.As a psychological and physical quantity, the light should be measured photometrically to detect the degree of light perception of the organism.Different optical measuring tools measure based on the response curve of the photoelectric conversion device.The essence of the light source spectrum setting in the experiment is to control the sensitivity of organisms to light.Therefore, special attention should be paid to the influence of light source setting differences when interpreting similar experimental results.When setting the light in animal experiments, it is necessary to consider the differences in the absorption curve of the animal's photosensitive pigment and the curve of the animal's spectral light efficiency.It is also suggested that a radiometer should be used to unify the photon flux density consistent among different groups based on 200-300 lx light intensity.In this paper, the normalization of spectral settings in experiments related to light and myopia was reviewed.

Introduction to Health Research Priority Setting Methods and Application Recommendations of Methods in Field of Traditional Chinese Medicine / 中国实验方剂学杂志

Health research priority setting， based on the existing disease burden or healthcare needs， screens out specific areas or topics with relatively high research priority by scientific and systematic methods， and optimizes the allocation of health resources by influencing healthcare decision-making， so as to alleviate the imbalance between regional or global health and development. Many developed countries have carried out related research and practical work on different scales， and the World Health Organization （WHO） attaches great importance to the transformation and application of relevant achievements in developing countries. As the largest developing country in the world， China's research in this field started relatively late， and only a small number of scholars have carried out part of the localization methodology research and practice according to the specific national conditions. However， health research priority setting has not yet attracted the attention of large-scale research institutions or government organizations in China. Although the priority setting is rarely mentioned in the research on traditional Chinese medicine （TCM）， the research and decision-making on the diseases responding specifically to TCM can also be regarded as the practical work of exploring the priority of TCM. Policymakers have a sense of priority support in the "priority of TCM research"， but the decisions from the top design are mainly based on the consensus reached by high-level think tanks. There is a lack of extensive research， and moreover， the data of multiple stakeholders are not included. Therefore， it is urgent to introduce appropriate priority setting methods to solve the problem of transparency and scientificity in the decision-making process. Given the perspective of the specific implementation， the present study introduced three international priority setting methods， i.e.， the James Lind Alliance and Priority Setting Partnerships（JLAPSP，）the Child Health and Nutrition Research Initiative（CHNRI）， and the Council on Health Research and Development （COHRED）， and presented relevant recommendations on how to apply them in the research of TCM， which is expected to provide references for the local research.

A invenção de um setting on-line para atendimento psicológico remoto / The invention of an online environment for remote psychological care / La invención de un entorno en línea para la atención psicológica remota

Com o advento da covid-19, foi declarado estado de emergência de saúde pública e decretadas medidas de isolamento e distanciamento social para conter a propagação da doença. O Conselho Federal de Psicologia, considerando a importância do acolhimento seguro durante a pandemia, publicou a Resolução CFP nº 4/2020, permitindo que serviços psicológicos aconteçam de maneira remota. O presente estudo visa, através do Método da Cartografia, apresentar a construção de um setting on-line para intervenções grupais e os desafios na oferta de acolhimento e atendimento remoto. Foram ofertados grupos terapêuticos, por meio da plataforma Google Meet, para estudantes da Universidade Federal Rural do Rio de Janeiro. Um diário de bordo foi produzido para acompanhar as forças que atravessavam e constituíam o território e a experiência grupal remota. Compreendemos que o território-espaço-grupal-on-line era composto pelo espaço virtual em que nos reuníamos, pelos espaços individuais de cada integrante e pelas forças que os atravessavam. Observamos que nem sempre os participantes dispunham de um lugar privado, mas estiveram presentes no encontro com câmeras e áudios abertos e/ou fechados e/ou através do chat da videochamada. A participação no grupo funcionou como alternativa no momento de distanciamento social, sendo uma possibilidade para o atendimento psicológico em situações de dificuldade de encontros presenciais; entretanto, se mostrou dificultada em diversos momentos, pela falta de equipamentos adequados e instabilidade na internet, fatores que interferiram nas reuniões e impactaram na possibilidade de falar e escutar o que era desejado.(AU)

With the advent of COVID-19, a state of public health was declared, and measures of isolation and social distance to contain the spread of the disease was decreed. The Federal Council of Psychology, considering the importance of safe reception during the pandemic, published CFP Resolution No. 4/2020, allowing psychological services to happen remotely. This study narrates, via the Cartography Method, the experience of inventing an Online Setting for group reception. Therapeutic groups were offered, via Google Meet Platform, to students at the Federal Rural University of Rio de Janeiro. A logbook was produced to accompany the forces that crossed and constituted the territory and the remote group experience. We understand that the territoryspace-group-online was composed by the virtual-space that we gathered, by the individualspaces of each member and by the forces that crossed them. We observed that the participants did not always have a private place, but they were present at the meeting with open and/or closed cameras and audio and/or through the video call chat. Participation in the group worked as an alternative at the time of social distancing, being a possibility for psychological care in situations of difficulty in face-to-face meetings, however, it proved to be difficult at various times, due to the lack of adequate equipment and instability on the internet, factors that interfered in meetings and impacted the possibility of speaking and listening to what was desired.(AU)

La llegada de la COVID-19 produjo un estado de emergencia de salud pública, en el que se decretaron medidas de confinamiento y distanciamiento físico para contener la propagación de la enfermedad. El Consejo Federal de Psicología, considerando la importancia de la acogida segura durante la pandemia, publicó la Resolución CFP nº 4/2020, por la que se permite la atención psicológica remota. Este estudio tiene por objetivo presentar, mediante el método de la Cartografía, la elaboración de un escenario en línea para la intervención grupal y los desafíos en la oferta de acogida y atención remota. Grupos terapéuticos se ofrecieron, en la plataforma Google Meet, a estudiantes de la Universidad Federal Rural de Río de Janeiro. Se elaboró un diario para acompañar a las fuerzas que atravesaron y constituyeron el territorio y la experiencia remota del grupo. Entendemos que el territorio-espacio-grupo-en línea estaba compuesto por el espacio-virtual que reunimos, por los espacios individuales de cada integrante y por las fuerzas que los atravesaban. Observamos que los participantes no siempre tenían un lugar privado y que estaban presentes en la reunión con cámaras y audio abiertos y/o cerrados y/o por el chat de la videollamada. La participación en el grupo funcionó como una alternativa en el momento del distanciamiento físico y revela ser una posibilidad de atención psicológica en situaciones de dificultad en los encuentros presenciales, sin embargo, se mostró difícil en varios momentos, ya sea por la falta de medios adecuados o por inestabilidad en Internet, factores que interferían en las reuniones e impactaban en la posibilidad de hablar y escuchar lo que se deseaba.(AU)

Chemical analysis of mineral trioxide agregate mixed with hyaluronic acids as an accelerant

Abstract Mineral trioxide aggregate (MTA) has many clinical applications in dentistry; the main drawback is the long setting. The main objective is to investigate and compare the chemical effect of using two commercially available hyaluronic acid hydrogels (HA) instead of distilled water for mixing MTA as an accelerant of setting time. Materials and method: Test materials were divided into three groups; Group 1: (control) mixing MTA with distilled water supplied by the manufacturer; Group 2: mixing MTA with a hybrid cooperative complex of high and low molecular weight HA (Profhilo®); Group 3: mixing MTA with High molecular weight / non-cross-linked HA (Jalupro®). Mixing time, and setting time (initial and final) were determined, Fourier-transform infrared spectroscopy, Energy-dispersive X-ray spectroscopy, Field emission Scanning Electron Microscopy, and X-ray diffraction were performed. Results: mixing time, initial, and final setting time for (MTA + HA) groups were significantly different and lower in comparison to the control group (p < 0.05). This study revealed higher expression of calcium silicate hydrate and calcium hydroxide expression with higher Ca release in the MTA + HA group than the control group. Conclusion: commercially available HA demonstrated better chemical properties when used as a mixing medium for MTA. The Mixing and setting time for MTA + HA group were significantly shorter than those of the control group were. Thus, commercially available HA can be used as a mixing medium for MTA.

Resumo O agregado de trióxido mineral (MTA) tem muitas aplicações clínicas em odontologia, mas a principal desvantagem é a longa presa. O objetivo principal é investigar e comparar o efeito químico do uso de dois hidrogéis de ácido hialurônico (HA) disponíveis comercialmente em vez de água destilada para misturar o MTA como um acelerador do tempo de presa. Materiais e método: Os materiais de teste foram divididos em três grupos: Grupo 1: (controle) misturando o MTA com água destilada fornecida pelo fabricante; Grupo 2: misturando o MTA com um complexo cooperativo híbrido de HA de alto e baixo peso molecular (Profhilo®); Grupo 3: misturando o MTA com HA de alto peso molecular/não reticulado (Jalupro®). Foram determinados o tempo de mistura e o tempo de presa (inicial e final), a espectroscopia de infravermelho com transformada de Fourier, a espectroscopia de raios X com dispersão de energia, a microscopia eletrônica de varredura com emissão de campo e a difração de raios X. Resultados: o tempo de mistura, o tempo de presa inicial e final dos grupos (MTA + HA) foram significativamente diferentes e menores em comparação com o grupo de controle (p < 0,05). Esse estudo revelou maior expressão de silicato de cálcio hidratado e expressão de hidróxido de cálcio com maior liberação de Ca no grupo MTA + HA do que no grupo de controle. Conclusão: a HA disponível comercialmente demonstrou melhores propriedades químicas quando usada como meio de mistura para o MTA. O tempo de mistura e de presa do grupo MTA + HA foi significativamente menor do que o do grupo de controle. Portanto, a HA disponível comercialmente pode ser usada como meio de mistura para o MTA.

Performance des explorations cliniques et de l'échographie mammaire dans le diagnostic des tumeurs bénignes du sein en milieu peu équipé d'Afrique subsaharienne / Performance of clinical investigations and breast ultrasound in the diagnosis of benign breast tumors in low-resource settings in sub-Saharan Africa

Contexte et objectif. Malgré leur fréquence élevée, très peu d'études ont été menées sur les tumeurs bénignes du sein (TBS) en Afrique subsaharienne. L'objectif de la présente étude a été d'évaluer la valeur diagnostique des explorations clinique et échographique mammaire des TBS en milieu peu équipé. Méthodes. Il s'agissait d'une étude documentaire, sur les TBS suivies aux Cliniques Universitaires de Kinshasa, entre janvier 2016 et décembre 2021. La valeur diagnostique des explorations clinique et échographique mammaire des TBS (sensibilité, spécificité, valeur prédictive négative VPN, VPP, coefficient Kappa) a été calculée en prenant pour référence la découverte anatomopathologique des pièces biopsiques. Résultats. Au total, 81 dossiers de TBS ont été colligés. Le Fibroadénome 58 (71,6 %), la Maladie fibrokystique (MFK) 15 (18,5 %), l'Adénome tubuleux 6(7,4 %), la Tumeur Phyllode (TP) 1(1,2 %) et le kyste 1(1,2 %) étaient les tumeurs diagnostiquées à l'anatomopathologie, après tumorectomies. A l'examen clinique, la capacité diagnostique des TBS autres que le Fibroadénome était nulle. La spécificité, la VPN et le coefficient kappa étaient respectivement, de 60,0 %, 39,1 % et 32,2 % pour le diagnostic du Fibroadénome. L'échographie mammaire était faite dans 98,6 % tandis que la mammographie seulement dans 11,1 % des cas. La majorité des tumeurs étaient classées Breast Imaging reporting and Data system (BIRADS) 2 (70,0 %). La spécificité, la VPN et le coefficient kappa étaient respectivement, de 80,6 %, 40,9 % et 39,0 % pour le Fibroadénome, et de 84,4 %, 66,7 % et 1,9 % pour la MFK. La TP était classée BIRADS3. Conclusion. L'échographie mammaire très réalisée, est très performante dans la classification BIRADS des TBS; les cliniciens exerçant en milieu peu équipé peuvent donc sans équivoque suivre les recommandations sur la prise en charge des tumeurs classées BIRADS2 et BIRADS3 à l'échographie, bien que sa performance en ce qui concerne le diagnostic différentiel de ces tumeurs soit moindre.

Depression and Burnout among Health Extension Workers in Ethiopia: A Cross-Sectional Study

BACKGROUND: Depression and burnout are common among healthcare workers (HCWs) and negatively affect their well being and the quality of the service they provide. However, the burden of depression and burnout among health extension workers (HEWs) in Ethiopia and their relationship has not been documented well. The objective of this study was to estimate the prevalence of depression and burnout among HEWs in Ethiopia and to investigate the relationship between these conditions. MATERIALS AND METHODS: We used a cross-sectional study design and collected data from 584 rural and 581 urban HEWs in Ethiopia, as part of the 2019 national health extension program assessment. The Patient Health Questionnaire (PHQ-9) and Burnout Self-Test were used to screen HEWs for depression and burnout, respectively. We used descriptive statistics to estimate the magnitude of depression and burnout, and logistic regression to examine their relationship. RESULT: Based on PHQ-9 cutoff scores of 10, the prevalence of major depression was 16.5% among rural and 8.9% among urban HEWs, whereas burnout risk was 39.8% among rural and 12.6% among urban HEWs. The odds of having depression among HEWs with burnout risk was relatively higher compared to those without burnout risk [For rural HEWs, the adjusted odds ratio (AOR) is 11.88 at a 95% confidence interval (CI; 5.27, 26.80), and for urban HEWs, the AOR is 11.49 at a 95% CI (5.35, 24.63)]. CONCLUSION: The prevalence of depression and burnout is high among HEWs in Ethiopia, with a significant rural­urban difference, and burnout is a significant predictor of depression. Mental health interventions that enable prevention, early detection, and management are needed especially for rural HEWs who are in charge of preventive health service delivery for the disadvantaged rural communities

Conservative treatment of supination and external rotation for type Ⅲ and Ⅳankle fracture by bone setting / 中国骨伤

OBJECTIVE@#To explore curative effect of conservative treatment of supination-lateral rotation (SER) with type Ⅲ and Ⅳ ankle fracture by bone setting technique.@*METHODS@#From January 2017 to December 2019, 64 patients diagnosed with SER with type Ⅲ and Ⅳ ankle fracture were treated with manipulative reduction and conservative treatment (manipulation group) and surgical treatment with open reduction and internal fixation (operation group), 32 patients in each group. In manipulation group, there were 17 males and 15 females, aged from 15 to 79 years old with an average of (51.42±13.68) years old;according to Lauge-Hansen classification, there were 8 patients with supination external rotation type Ⅲ and 24 patients with type Ⅳ. In operation group, there were 13 males and 19 females, aged from 18 to 76 years old with an average of (47.36±15.02) years old;7 patients with type Ⅲ and 25 patients with type Ⅳ. Displacement of ankle fracture was measured by Digimizer software, and compared before treatment, 3 and 12 months after treatment between two groups. Lateral medial malleolus displacement, lateral medial malleolus displacement, lateral malleolus displacement, lateral malleolus displacement, lateral malleolus contraction displacement and posterior malleolus displacement were measured and compared between two groups. Mazur score was used to evaluate ankle joint function.@*RESULTS@#All patients were followed up from 12 to 36 months with an average of (17.16±9.36) months. There were statistical differences in lateral medial malleolus displacement, lateral medial malleolus displacement, lateral malleolus displacement, lateral malleolus displacement, lateral malleolus contraction displacement and posterior malleolus displacement in manipulation group before and after reduction(P<0.05). Compared with operation group, there were no statistically significant differences in lateral malleolus shift, lateral malleolus shift, lateral malleolus contraction shift(P>0.05), while there were statistically significant differences in lateral malleolus shift, posterior malleolus shift up and down (P<0.05). Mazur scores of ankle joint at 3 months after treatment in manipulation group and operation group were 68.84±13.08 and 82.53±7.31, respectively, and had statistical differences(P<0.05), while there was no difference in evaluation of clnical effect(P>0.05). There were no differences in Mazur score and evaluation of clnical effect between two groups at 12 months after treatment (P>0.05).@*CONCLUSION@#Bone setting technique could effectively correct lateral displacement of medial malleolus, lateral displacement of medial malleolus, lateral displacement of lateral malleolus and lateral contraction displacement of lateral malleolus in supination lateral rotation type Ⅲ and Ⅳ ankle fracture, and has good long-term clinical effect, which could avoid operation for some patients and restore ankle function after fracture.

Expert knowledge-based strategies for ventilator parameter setting and stepless adaptive adjustment / 生物医学工程学杂志

The setting and adjustment of ventilator parameters need to rely on a large amount of clinical data and rich experience. This paper explored the problem of difficult decision-making of ventilator parameters due to the time-varying and sudden changes of clinical patient's state, and proposed an expert knowledge-based strategies for ventilator parameter setting and stepless adaptive adjustment based on fuzzy control rule and neural network. Based on the method and the real-time physiological state of clinical patients, we generated a mechanical ventilation decision-making solution set with continuity and smoothness, and automatically provided explicit parameter adjustment suggestions to medical personnel. This method can solve the problems of low control precision and poor dynamic quality of the ventilator's stepwise adjustment, handle multi-input control decision problems more rationally, and improve ventilation comfort for patients.

Discussion on Development Status of Traditional Chinese Medicine Dispensing Granules and Survival Strategy of Enterprises / 中国实验方剂学杂志

As an important complementary form of decoction pieces of traditional Chinese medicine（TCM）， TCM dispensing granules has the advantages of being free of decoction， easy to take， easy to carry and easy to be dispensed， which greatly improves the capacity of emergency services of TCM and is more in line with the needs of modern society. With the end of the pilot project of TCM dispensing granules， the market has been fully liberalized， the competition has been intensified， and it is in the transition period of switching between the new standard and the old one， and there are some problems such as the shortage of varieties， the change of specifications and the difference of quality， and the production enterprises are facing new opportunities and challenges. Based on this， the authors intend to systematically sort out the policies and regulations， enterprise layout and standard formulation since the pilot of TCM dispensing granules. In view of the problems in the post-pilot stage and from the perspective of survival and development of enterprises， it is suggested that enterprises should establish a quality control system for the whole industry chain of TCM dispensing granules to reduce process costs and increase enterprise competitiveness， further increase the investment in scientific research， overcome the key technical problems of difficult varieties， actively and orderly promote the research of national standards， in order to ensure the integrity of clinical formula varieties， and establish and improve the efficacy evaluation mechanism of TCM dispensing granules， build a consistency evaluation system between TCM dispensing granules and decoction pieces. Government departments should strengthen the guidance， fully mobilize the enthusiasm of scientific research institutions， enterprises and hospitals， and explore the establishment of "government-industry-study-research-application" mode to promote the development of TCM dispensing granule industry.

Establecimiento de metas como técnica motivacional en deportistas / Estabelecimento de metas como técnica motivadora para esportistas / Setting goals as a motivational technique in athletes

RESUMEN Introducción: El establecimiento de metas es un proceso fundamental en el entrenamiento deportivo y puede ser utilizado como una técnica motivacional en el deporte para manejar los recursos psicológicos del deportista y el equipo en aras de potenciar la cohesión y lograr sus aspiraciones. Objetivo: Analizar la pertinencia de la aplicación de un programa de intervención psicológica sustentado en el establecimiento de metas como técnica motivacional en el equipo femenino categoría 13-14 años de Polo Acuático de la Escuela de Iniciación Deportiva Escolar Eide "Marcelo Salado", de Villa Clara, Cuba. Materiales y métodos: La metodología empleada incluye diversos métodos y técnicas de investigación de naturaleza cuantitativa y cualitativa. Se utilizaron el análisis ssíntesis, observación, entrevista, cuestionario de establecimiento de metas, técnica de completamiento de frases, el cuestionario de estilo de dirección, la triangulación y el preexperimento. Se calcularon medidas descriptivas de posición como la media y la moda. Se utilizó la prueba de hipótesis no paramétrica de rangos señalados de Wilcoxon para comprobar si los cambios antes y después de la intervención eran significativos. Resultados: Los datos susceptibles de medición fueron procesados estadísticamente mediante el software SPSS para Windows versión 17.0 Los resultados demuestran la influencia del programa de intervención aplicado para el mejoramiento del establecimiento de metas del equipo. Conclusiones: Valoran la contribución de la aplicación del programa de intervención psicológica, en el establecimiento de metas de manera más objetivas, claras y comprensibles en las deportistas y en el desarrollo de la esfera motivacional al utilizar las potencialidades del trabajo del equipo deportivo como grupo.

SÍNTESE Introdução: O estabelecimento de metas é um processo fundamental no treinamento esportivo e pode ser usado como uma técnica motivacional no esporte para administrar os recursos psicológicos do atleta e da equipe, a fim de aumentar a coesão e alcançar suas aspirações. Objetivo: analisar a relevância da aplicação de um programa de intervenção psicológica baseado no estabelecimento de metas como técnica motivacional na equipe de pólo aquático feminina de 13-14 anos da Escuela de Iniciación Deportiva Escolar Eide "Marcelo Salado", em Villa Clara, Cuba. Materiais e métodos: a metodologia empregada inclui vários métodos e técnicas de pesquisa de natureza quantitativa e qualitativa. Foram utilizadas análise-síntese, observação, entrevista, questionário de estabelecimento de metas, técnica de preenchimento de frases, questionário de estilo de gestão, triangulação e pré-experimentação. Foram calculadas medidas descritivas de posição, tais como média e modo. O teste de hipóteses Wilcoxon não paramétrico assinado foi usado para testar se as mudanças antes e depois da intervenção eram significativas. Resultados: Os dados mensuráveis foram processados estatisticamente usando o software SPSS para Windows versão 17.0. Os resultados demonstram a influência do programa de intervenção aplicado na melhoria da definição das metas da equipe. Conclusões: a contribuição da aplicação do programa de intervenção psicológica no estabelecimento de metas mais objetivas, claras e compreensíveis para as atletas e no desenvolvimento da esfera motivacional, utilizando o potencial do trabalho da equipe esportiva como um grupo.

ABSTRACT Introduction: Goal setting is a fundamental process in sports training and can be used as a motivational technique in sports to manage the resources of the athlete and the team in order to enhance cohesion and achieve their aspirations. Objective: To analyze the relevance of the application of a psychological intervention program based on the establishment of goals as a motivational technique in the women's team category 13-14 years of Water Polo of the School of Sports Initiation School Eide " Marcelo Salado", of Villa Clare, Cuba. Materials and methods: The methodology used includes various research methods and techniques of a quantitative and qualitative nature. Analysis-synthesis, observation, interview, goal setting questionnaire, sentence completion technique, management style questionnaire, triangulation and pre-experiment were used. Descriptive measures of position such as the mean and mode were calculated. The Wilcoxon signed ranks nonparametric hypothesis test was used to test whether the changes before and after the intervention were significant. Results: The measurable data were statistically processed using the SPSS software for Windows version 17.0. The results demonstrate the influence of the intervention program applied to improve the team's goal setting. Conclusions: They value the contribution of the application of the psychological intervention program, in the establishment of goals in a more objective, clear and understandable way in the athletes and in the development of the motivational sphere when using the potentialities of the work of the sports team as a group.

Initial Immunomodulation and Outcome of Children with Multisystem Inflammatory Syndrome Related to COVID-19: A Multisite Study from India

Objective To determine the outcomes in children with MIS-C receiving diferent immunomodulatory treatment. Methods In this multicentric, retrospective cohort study, data regarding treatment and outcomes of children meeting the WHO case defnition for MIS-C, were collected. The primary composite outcome was the requirement of vasoactive/inotropic support on day 2 or beyond or need of mechanical ventilation on day 2 or beyond after initiation of immunomodulatory treatment or death during hospitalization in the treatment groups. Logistic regression and propensity score matching analyses were used to compare the outcomes in diferent treatment arms based on the initial immunomodulation, i.e., IVIG alone, IVIG plus steroids, and steroids alone. Results The data of 368 children (diagnosed between April 2020 and June 2021) meeting the WHO case defnition for MIS-C, were analyzed. Of the 368 subjects, 28 received IVIG alone, 82 received steroids alone, 237 received IVIG and steroids, and 21 did not receive any immunomodulation. One hundred ffty-six (42.39%) children had the primary outcome. On logistic regression analysis, the treatment group was not associated with the primary outcome; only the children with shock at diagnosis had higher odds for the occurrence of the outcome [OR (95% CI): 11.4 (5.19–25.0), p<0.001]. On propensity score matching analysis, the primary outcome was comparable in steroid (n=45), and IVIG plus steroid (n=84) groups (p=0.515). Conclusion While no signifcant diference was observed in the frequency of occurrence of the primary outcome in diferent treatment groups, data from adequately powered RCTs are required for defnitive recommendations.

Tecnologias de informação e comunicação na clínica psicanalítica: desafios / Information and Communication Technologies in the Psychoanalytic Clinic: Challenges / Tecnologías de información y comunicación en la clínica psicoanalítica: desafíos

O progresso tecnológico modificou as formas de inte-ração entre os indivíduos. A psicanálise, enquanto método de investigação de processos mentais, resguarda pressupostos teóricos e técnicos, ao mesmo tempo que considera as mudanças sociais de cada época. O presente estudo visou investigar as possíveis implicações do uso de mídias digitais, tais como celulares e aplicativos co-mo WhatsApp e Skype, na relação transferencial entre paciente e psicanalista. Assim, o objetivo foi verificar como as tecnologias de informação e comunicação são percebidas e utilizadas por profissionais, no contexto da clínica psicanalítica pré-pandemia da covid-19. A pes-quisa foi realizada com a utilização do método clínico-qualitativo e os dados foram examinados a partir da técnica de análise de conteúdo. Participaram oito psicana-listas brasileiros, os quais foram entrevistados a partir de um roteiro semidirigido, no período de 2018 a 2019. Os resultados apontaram que as tecnologias adentraram os consultórios, tornando-se parte do trabalho analítico. Os profissionais entrevistados manifestaram oposições frente aos novos dispositivos no exercício da clínica psicanalítica, ressaltando diferenças entre contatos pre-senciais e virtuais. Porém, consideraram que a relação transferencial, fundamental para o trabalho psicanalítico, mantém-se independentemente de o setting ser presencial ou digital. Finalmente, verificou-se certa flexibilização no uso de tecnologias de informação e comunicação com os pacientes em situações emergenciais, possibilitando refletir, inclusive, sobre o impacto da pandemia no mo-do de praticar o atendimento na clínica psicanalítica.

Technological progress has modified the interactions between individuals. Psychoanalysis, as a method of investigating mental processes, safeguards theoreti-cal and technical assumptions while considering the social changes of each era. The present study aimed to investigate the possible implications of the use of digital media, such as cellphones and apps, such as WhatsApp and Skype, in the transference relation between patient and psychoanalyst. Thus, the objective was to investigate how information and communication technologies are perceived and used by professionals in the context of the psychoanalytic clinic previous to the covid-19 pandemic. The research was conducted using the clinical-qualitative method. The data were analyzed using the content analysis technique. Eight Brazilian psychoanalysts participated, who were in-terviewed based on a semi-directed script from 2018 to 2019. The results showed that technologies entered the clinics, becoming part of the analytical work. The interviewed professionals expressed opposition to the new devices in the practice of the psychoanalytic clin-ic, highlighting differences between face-to-face and virtual contacts. However, they considered that the transferential relation, fundamental for psychoanalytic work, remains regardless of whether the setting is face-to-face or digital. Finally, there was a certain flexibility in the use of information and communication technol-ogies with patients in emergency situations, enabling the reflection on the impact of the pandemic on how attendance is practiced in the psychoanalytic clinic.

El progreso tecnológico modificó las formas de interacción entre los individuos. El psicoanálisis, como método de investigación de los procesos mentales, protege supuestos teóricos y técnicosal mismo tiempo que considera los cambios sociales de cada época. El presente estudio tuvo como objetivo investigar las posibles implicaciones del uso de medios digitales, como teléfonos celulares y aplicaciones como WhatsApp y Skype, en la relación transferencial entre paciente y psicoanalista. Así, el objetivo fue investigar cómo las tecnologías de la información y la comunicación son percibidas y utilizadas por los profesionales, en el contexto de la clínica psicoanalítica pre pandemia covid-19. La investigación se llevó a cabo utilizando el método clínico-cualitativo y los datos fueron analizados mediante la técnica de análisis de contenido. Participaron ocho psicoanalistas brasileños, que fueron entrevistados a partir de un guion semidirigido, del 2018 a 2019. Los resultados mostraron que las tecnologías entraron en los consultorios, convirtiéndose en parte del trabajo analítico. Los profesionales entrevistados expresaron oposición a los nuevos dispositivos en la práctica de la clínica psicoanalítica, destacando diferencias entre los contactos presenciales y virtuales. Sin embargo, consideraron que la relación transferencial, fundamental para el trabajo psicoanalítico, se mantiene independientemente de que el setting sea presencial o digital. Finalmente, hubo cierta flexibilidad en el uso de las tecnologías de la información y la comunicación con pacientes en situaciones de emergencia, lo que permitió reflexionar, incluso, sobre el impacto de la pandemia en la forma de practicar la asistencia en la clínica psicoanalítica.

MANAGEMENT OF TUBERCULOSIS PATIENT IN A DENTAL SETTING IN INDIA- A REVIEW

Tuberculosis (TB) still continues to be endemic in various regions of the world, including in India and needs surveillance, clinical assessment, testing, contact tracing, confirmation of diagnosis with supervised or in-supervised treatment regimens for an effective eradication. Tuberculosis is responsible for the death of every third AIDS patient in India and accounts for about a quarter of the global tuberculosis burden. The ministry reiterated their commitment to eliminating tuberculosis in the country by 2025. This article gives dentists an overview of the guidelines' recommendations that are applicable to most outpatient dental settings.

El concepto del confort en el cuidado de enfermería / The Concept of Comfort in Nursing Care

Introducción: Para enfermería, el confort es un objetivo de cuidado en los múltiples escenarios del actuar disciplinario, lleva a la formulación de teorías con perspectiva holística y logra aplicar el confort desde una mirada física, psicoespiritual, ambiental y social. Objetivo: Identificar los atributos del concepto confort entendido por enfermería en los diferentes escenarios de cuidado. Métodos: Revisión integrativa, con estrategia de búsqueda: "Confort" AND "Nursing", en las bases de datos Scopus, Google Académico, BVS, EBSCO, Cochrane, Ovid y Medline. Los criterios de elegibilidad fueron: estudios primarios, a texto completo, publicados entre 2009-2019, en español, inglés y portugués. Se utilizó el diagrama prisma para el análisis crítico de diseños experimentales, revisiones y cualitativos, se emplearon las plantillas del Critical Appraisal Skills Programme (Caspe). Para los demás diseños se aplicaron las listas de chequeo del Joanna Briggs Institute, quedaron incluidos 16 artículos. Conclusión: El confort está ligado a temas que enmarcan la realidad física, social, psíquica y ambiental de la persona, determinado por los atributos: 1. Alivio físico del dolor mediante intervenciones farmacológicas y de elementos externos en contacto con el cuerpo. 2. Soporte social con cercanía de los familiares, lo que facilita la adaptación al ambiente hospitalario y reduce la ansiedad. 3. Relaciones con el personal sanitario de acompañamiento y acceso a información sobre la condición del paciente. 4. Ambiente adaptado para favorecer la recuperación y alivio. 5. Descanso que incluye reposo y sueño, generando alivio; y 6. Salud mental con alivio de ansiedad, estrés y adecuada recuperación mental(AU)

Introduction: For nursing, comfort is a care-related objective in the multiple settings of professional performance; it leads to the formulation of theories with a holistic perspective and manages to be applied from a physical, psychospiritual, environmental and social point of view. Objective: To identify the attributes of the concept of comfort understood by nursing in different care settings. Methods: Integrative review carried out in the Scopus, Google Scholar, VHL, EBSCO, Cochrane, Ovid and Medline databases, using the following search strategy: "Comfort" AND "Nursing". The eligibility criteria considered primary studies, full texts, published between 2009 and 2019, in Spanish, English or Portuguese. The PRISMA diagram was used for the critical analysis of experimental, review and qualitative studies, using the templates of the Critical Appraisal Skills Program (Caspe). For the other designs, the checklists of the Joanna Briggs Institute were applied and sixteen articles were included. Conclusion: Comfort is related to issues that enclose the physical, social, psychic and environmental reality of a person, determined by the following attributes: physical relief of pain through pharmacological interventions and external elements in contact with the body; social support with the closeness of family members, which facilitates adaptation to the hospital environment and reduces anxiety; relationships with the accompanying health personnel and access to information on the patient's condition; an adapted environment to favor recovery and relief; rest including sleep and generating relief; and mental health with relief of anxiety, stress and adequate mental recovery(AU)