ABSTRACT
The three horizons model is a framework that helps manage an organization's innovation strategy. This model considers three aspects (horizons) that should be present in the institution and guide the development of new systems. Applied to medical science, the horizons are considered as paradigms that set the guidelines for clinical knowledge. New technologies can influence this model by causing disruptive changes. Horizon 1 (evidence-based medicine) reflects the current paradigm and emphasizes the aspect of continuous improvement needed to strengthen it, such as with the introduction of the GRADE (Grades of Recommendation Assessment, Development, and Evaluation) methodology. Evidence-based medicine has made it possible to stop performing harmful interventions like autologous bone marrow or stem cell transplantation in cancer treatment for women with early poor prognosis breast cancer or to discontinue the erroneous belief that children should not sleep on their backs to prevent sudden infant death syndrome. Horizon 2 (real-world evidence) refers to a new model in which innovation has generated new capabilities. This change makes it possible to correct weaknesses of the previous paradigm, as in the case of pragmatic clinical trials. Real-world evidence has been used to show that drugs such as tofacitinib are effective without using methotrexate as background or to demonstrate the efficacy of chemotherapy in older patients with stage II colon cancer. Horizon 3 (precision medicine) involves a disruptive innovation, leading to the abandonment of the traditional mechanistic model of medical science and is made possible by the appearance of major advances such as artificial intelligence. Precision medicine has been used to assess the use of retigabine for the treatment of refractory epilepsy or to define a genome-adjusted radiation dose using a biological model to simulate the response to radiotherapy, facilitate dose adjustment and predict outcome in breast cancer.
Subject(s)
Artificial Intelligence , Breast Neoplasms , Infant , Child , Humans , Female , Aged , Breast Neoplasms/therapyABSTRACT
Introducción: Desde diciembre de 2019, la nueva cepa del coronavirus 2, causante del síndrome respiratorio agudo severo (SARS-CoV-2), ha provocado una pandemia mundial. Los niños y los adolescentes infectados generalmente son asintomáticos y solo experimentan síntomas respiratorios leves. Sin embargo, se ha reportado, una nueva tendencia alarmante en las infecciones pediátricas por COVID-19, en las cuales los pacientes han llegado a presentar manifestaciones agravantes que han requerido de hospitalización, dejando secuelas importantes. Objetivo: Dar a conocer las manifestaciones orales asociadas al caso clínico de un paciente pediátrico contagiado por SARS-CoV-2, así como la rehabilitación estomatológica de mínima invasión. Presentación de caso clínico: Paciente masculino de 5 años, con antecedente de COVID-19, quien, en su estancia hospitalaria en el Instituto Nacional de Pediatría de México, presentó choque séptico refractario secundario SARS-COV-2 y falla orgánica múltiple. Se observaron lesiones en dorso lingual secundarias a la infección por COVID-19 las cuales eran asintomáticas. El paciente presentaba caries, y fue rehabilitado exitosamente cumpliendo medidas de bioseguridad, con materiales bioactivos y convencionales, estableciendo un excelenterapport. Conclusiones: El odontólogo pediatra debe diagnosticar las manifestaciones bucales del COVID-19, estableciendo protocolos adecuados de atención. El presente caso fue tratado exitosamente con una estrategia de rehabilitación oral efectiva y parámetros de prevención. Es importante reportar las manifestaciones orales por lo que se sugiere realizar seguimiento de estos hallazgos.
Introdução: Desde dezembro de 2019, a nova cepa do Coronavírus 2, que causa a síndrome respiratória aguda grave (SARS-CoV-2), causou uma pandemia global. Crianças e adolescentes infectados são geralmente assintomáticos ou apresentam apenas sintomas respiratórios leves. Entretanto, uma nova tendência de alarme tem sido relatada nas infecções pediátricas por COVID-19, nas quais os pacientes passaram a apresentar manifestações agravantes que precisaram de hospitalização, deixando sequelas significativas. Objetivos: Apresentar as manifestações orais associadas ao caso clínico de um paciente pediátrico infectado pela SRA-CoV-2, bem como a reabilitação estomatológica minimamente invasiva. Apresentação do caso clínico: Paciente do sexo masculino com 5 anos, com história de COVID-19, que durante sua internação hospitalar no Instituto Nacional de Pediatria do México, apresentou choque séptico refratário secundário ao SARS-COV2 e falha orgânica múltipla. Foram observadas lesões no dorso da língua secundárias à infecção por COVID-19, assintomáticas. Foi reabilitado com materiais bioativos e convencionais, estabelecendo um excelente relacionamento com o paciente. Conclusões: O estomatologista pediátrica deve diagnosticar as manifestações orais da COVID-19, estabelecendo protocolos de cuidados apropriados. O presente caso foi tratado com sucesso com uma estratégia eficaz de reabilitação oral e parâmetros de prevenção. É relevante mencionar as manifestações orais, por isso sugere-se o acompanhamento desses achados.
Introduction: Since December 2019, the new strain of coronavirus 2, which causes severe acute respiratory syndrome (SARS-CoV-2), has caused a global pandemic. Infected children and adolescents are generally asymptomatic and experience only mild respiratory symptoms. However, an alarming new trend has been reported in pediatric COVID-19 infections, in which patients have even presented aggravating manifestations that have required hospitalization, leaving significant sequelae. Objectives: To present the various oral manifestations associated with this case of a pediatric patient infected by SARS-CoV-2, as well as minimally invasive stomatological rehabilitation. Case presentation: A 5-year-old male patient, with a history of COVID-19, who during his hospital stay at the National Institute of Pediatrics of Mexico, presented refractory septic shock secondary to SARS-COV-2 and multiple organ failure. Lesions on the dorsum of the tongue were observed secondary to COVID-19 infection, which were asymptomatic. The patient presented caries, and was rehabilitated following biosafety measures, with bioactive and conventional materials, establishing an excellent rapport. Conclusions: The pediatric stomatologist's should diagnose the oral manifestations of COVID-19, establishing adequate care protocols. The present case was successfully treated with an effective oral rehabilitation strategy and prevention parameters. It is important to report oral manifestations, so it is suggested to follow up on these findings.
Subject(s)
Humans , Male , Child, Preschool , Oral Manifestations , COVID-19 , SARS-CoV-2 , COVID-19/complications , Multiple Organ FailureABSTRACT
OBJECTIVE: To analyze the association between the coverage by oral health teams in the Family Health Strategy (FHS-OH) and the use of dental services among 12-year-old adolescents in the state of Mato Grosso do Sul, Brazil, 2019. METHODS: This is a cross-sectional study involving school-based research, which adopted the use of dental services as its outcome. Structural equation modeling was used to test the association between covariates and the outcome. RESULTS: Of the 615 participants, 74.0% used dental services in the last three years. ESF-SB (oral health coverage by family health strategy, acronym in Portuguese) ≥50% was associated with a greater use of public dental services [standardized coefficient (SC) = 0.10 -95%CI 0.01;0.18], a lower use of these services for prevention (SC = -0.07 -95%CI -0.17;0.01) and higher unhealthy food consumption (SC = 0.19 -95%CI 0.11;0.26). CONCLUSION: Higher ESF-SB coverage was associated with a lower use of dental services for prevention and higher unhealthy food consumption. Teams must organize the access to oral health service and qualify the work process.
Subject(s)
Family Health , Oral Health , Adolescent , Brazil , Child , Cross-Sectional Studies , Dental Care , HumansABSTRACT
Objective: To analyze the association between the coverage of oral health teams in the Family Health Strategy (ESF-SB) and the use of dental services among adolescents aged 12 years in Mato Grosso do Sul, 2019. Methods: This is a cross-sectional study, involving school-based research. The outcome was the use of dental services. Structural equation models were performed to test the association of covariates with the use of services. Results: Of the 615 participants, 74.0% used dental services in the past three years. ESF-SB coverage ≥50% was associated with greater use of public dental services [Standardized Coefficient (SC) = 0.10 IC95% 0.01;0.18], greater use for treatment (SC = -0.07 IC95% 0.17;0.01), and greater consumption of unhealthy foods (SC = 0.19 IC95% 0.11;0.26). Conclusion: Greater coverage of ESF-SB was associated with greater use for treatments and greater inadequate food consumption by adolescents. Oral health teams must organize access and qualify the work process.
Objetivo: Analisar a associação entre a cobertura de equipes de saúde bucal na Estratégia Saúde da Família (ESF-SB) e a utilização de serviços odontológicos entre adolescentes de 12 anos, em Mato Grosso do Sul, Brasil, 2019. Métodos: Trata-se de um estudo transversal, cujo desfecho foi a utilização de serviços odontológicos. Modelos de equações estruturais foram construídos para testar a associação das covariáveis com o desfecho. Resultados: Dos 615 participantes, 74,0% utilizaram os serviços odontológicos nos últimos três anos. A cobertura de ESF-SB ≥50% associou-se a maior uso de serviços públicos [coeficiente padronizado (CP) = 0,10 IC95% 0,01;0,18], menor uso para prevenção (CP = -0,07 IC95% -0,17;0,01) e maior consumo de alimentos não saudáveis (CP = 0,19 IC95% 0,11;0,26). Conclusão: Maiores coberturas de ESF-SB associaram-se a menor utilização de serviços para prevenção e maior consumo alimentar não saudável. As equipes devem organizar o acesso e qualificar o processo de trabalho.
ABSTRACT
BACKGROUND: The evidence-based medicine (EBM) paradigm requires the development of health care professionals' skills in the efficient search of evidence in the literature, and in the application of formal rules to evaluate this evidence. Incorporating this methodology into the decision-making routine of clinical practice will improve the patients' health care, increase patient safety, and optimize resources use. OBJECTIVE: The aim of this study is to develop and evaluate a new tool (KNOWBED system) as a clinical decision support system to support scientific knowledge, enabling health care professionals to quickly carry out decision-making processes based on EBM during their routine clinical practice. METHODS: Two components integrate the KNOWBED system: a web-based knowledge station and a mobile app. A use case (bronchiolitis pathology) was selected to validate the KNOWBED system in the context of the Paediatrics Unit of the Virgen Macarena University Hospital (Seville, Spain). The validation was covered in a 3-month pilot using 2 indicators: usability and efficacy. RESULTS: The KNOWBED system has been designed, developed, and validated to support clinical decision making in mobility based on standards that have been incorporated into the routine clinical practice of health care professionals. Using this tool, health care professionals can consult existing scientific knowledge at the bedside, and access recommendations of clinical protocols established based on EBM. During the pilot project, 15 health care professionals participated and accessed the system for a total of 59 times. CONCLUSIONS: The KNOWBED system is a useful and innovative tool for health care professionals. The usability surveys filled in by the system users highlight that it is easy to access the knowledge base. This paper also sets out some improvements to be made in the future.
ABSTRACT
Objetivo: Analisar a associação entre a cobertura de equipes de saúde bucal na Estratégia Saúde da Família (ESF-SB) e a utilização de serviços odontológicos entre adolescentes de 12 anos, em Mato Grosso do Sul, Brasil, 2019. Métodos: Trata-se de um estudo transversal, cujo desfecho foi a utilização de serviços odontológicos. Modelos de equações estruturais foram construídos para testar a associação das covariáveis com o desfecho. Resultados: Dos 615 participantes, 74,0% utilizaram os serviços odontológicos nos últimos três anos. A cobertura de ESF-SB ≥50% associou-se a maior uso de serviços públicos [coeficiente padronizado (CP) = 0,10 - IC95% 0,01;0,18], menor uso para prevenção (CP = -0,07 - IC95% -0,17;0,01) e maior consumo de alimentos não saudáveis (CP = 0,19 - IC95% 0,11;0,26). Conclusão: Maiores coberturas de ESF-SB associaram-se a menor utilização de serviços para prevenção e maior consumo alimentar não saudável. As equipes devem organizar o acesso e qualificar o processo de trabalho.
Objetivo: Analizar la asociación entre la cobertura de los equipos de salud bucal en la Estrategia Salud de la Familia (ESF-SB) y el uso de servicios odontológicos en 12 años en Mato Grosso do Sul, 2019. Métodos: Este es un estudio transversal. El resultado fue el uso de servicios dentales. Se realizaron modelos de ecuaciones estructurales para asociación de covariables con el resultado. Resultados: De los 615 participantes, el 74,0% utilizó servicios dentales en los últimos tres años. La cobertura de ESF-SB ≥50% se asoció con mayor uso público [coeficiente estandarizado (CE) = 0,10 - IC95% 0,01;0,18], menor uso para prevención (CE = -0,07 - IC95% -0,17;0,01) y mayor consumo de alimentos no saludables (CE = 0,19 - IC95% 0,11;0,26). Conclusión: Mayor cobertura de ESF-SB se asoció con un menor uso para la prevención y un mayor consumo de alimentos no saludables. Los equipos de salud bucal deben organizar el proceso de trabajo.
Objective: To analyze the association between the coverage by oral health teams in the Family Health Strategy (FHS-OH) and the use of dental services among 12-year-old adolescents in the state of Mato Grosso do Sul, Brazil, 2019. Methods: This is a cross-sectional study involving school-based research, which adopted the use of dental services as its outcome. Structural equation modeling was used to test the association between covariates and the outcome. Results: Of the 615 participants, 74.0% used dental services in the last three years. ESF-SB (oral health coverage by family health strategy, acronym in Portuguese)≥50% was associated with a greater use of public dental services [standardized coefficient (SC) = 0.10 -95%CI 0.01;0.18], a lower use of these services for prevention (SC = -0.07 -95%CI -0.17;0.01) and higher unhealthy food consumption (SC = 0.19 -95%CI 0.11;0.26). Conclusion: Higher ESF-SB coverage was associated with a lower use of dental services for prevention and higher unhealthy food consumption. Teams must organize the access to oral health service and qualify the work process.
Subject(s)
Humans , Male , Female , Adolescent , National Health Strategies , Oral Health , Health Services Accessibility , Brazil , Cross-Sectional Studies , Dental CareABSTRACT
The influence of climatic variables on the dynamics of human malaria has been widely highlighted. Also, it is known that this mosquito-borne infection varies in space and time. However, when the data is spatially incomplete most popular spatio-temporal methods of analysis cannot be applied directly. In this paper, we develop a two step methodology to model the spatio-temporal dependence of malaria incidence on local rainfall, temperature, and humidity as well as the regional sea surface temperatures (SST) in the northern coast of Venezuela. First, we fit an autoregressive distributed lag model (ARDL) to the weekly data, and then, we adjust a linear separable spacial vectorial autoregressive model (VAR) to the residuals of the ARDL. Finally, the model parameters are tuned using a Markov Chain Monte Carlo (MCMC) procedure derived from the Metropolis-Hastings algorithm. Our results show that the best model to account for the variations of malaria incidence from 2001 to 2008 in 10 endemic Municipalities in North-Eastern Venezuela is a logit model that included the accumulated local precipitation in combination with the local maximum temperature of the preceding month as positive regressors. Additionally, we show that although malaria dynamics is highly heterogeneous in space, a detailed analysis of the estimated spatial parameters in our model yield important insights regarding the joint behavior of the disease incidence across the different counties in our study.
Subject(s)
Malaria/epidemiology , Humans , Humidity , Incidence , Markov Chains , Models, Statistical , Monte Carlo Method , Rain , Spatio-Temporal Analysis , Temperature , Venezuela/epidemiologyABSTRACT
The Andalusian Health Service is the public healthcare provider for 8.302.923 inhabitants in the South Spain. This organization coordinates primary and specialized care with an IT infrastructure composed by multiple Electronic Health Record Systems. According to the large volume of healthcare professionals involved, there is a need for providing a consistent management of information through multiple locations and systems. The HEMIC project aims to address this need developing and validating a methodology based on a software tool for standardizing information contained within EHR systems. The developed tool has been designed for supporting the participation of healthcare professionals the establishment of mechanisms for information governance. This research presents the requirements and designs for of a software tool focused on the adoption of recognized best practice in clinical information modeling. The designed tool has a Service Oriented Architecture that will be able to integrate terminology servers and repositories of clinical information models as part of the modeling process. Moreover, the defined tool organizes clinicians, IT developers and terminology experts involved in the modeling process in three levels to promote their coordination in the definition, specialization and validation of clinical information models. In order to ensure the quality of the developed clinical information models, the defined tool is based on the requirements defined in the ISO13972 Technical Specification.
Subject(s)
Electronic Health Records , Medical Records Systems, Computerized , Software , Computer Systems , Humans , SpainABSTRACT
Introducción: El síndrome de niño maltratado se define como toda forma de violencia, perjuicio o abuso físico o mental, descuido o trato negligente, mientras el niño se encuentra bajo el cuidado de sus padres, de un tutor o de cualquier otra persona en función de su superioridad física y/o intelectual. En más del 50% de los casos las lesiones se presentan en cabeza, cara y cuello. Es por eso que el odontólogo y especialmente el odontopediatra deben estar preparados para reconocer alguna forma de maltrato o negligencia con base en una historia clínica adecuada y una exploración intencionada ante la sospecha de síndrome de niño maltratado. Objetivo: Conocer los indicadores intraorales y extraorales que le permitan al odontopediatra reconocer los signos y contribuir en el diagnóstico como parte de un equipo multidisciplinario encargado de la atención de estos pacientes. Caso clínico: Paciente masculino de dos años cinco meses quien acude al Servicio de Urgencias del Instituto Nacional de Pediatría por presentar edema periorbitario, múltiples fracturas en extremidades e indicadores orofaciales que permitieron diagnosticar síndrome de niño maltratado. Conclusión: Considerando la frecuencia con que las estructuras orofaciales se ven involucradas en el síndrome de niño maltratado, existe un compromiso médico, ético y legal para que todos los dentistas y específicamente los odontopediatras intervengan en la prevención, detección, diagnóstico y tratamiento de este problema médico social.
Introduction: Battered child syndrome is defined as all forms of violence, prejudice or physical and mental abuse, carelessness or neglect inflicted on the child while under the care of his parents, tutors or any other person exerting physical and/or intellectual superiority. In over 50% of all cases lesions are found in the head and neck area. For that reason, dentists, especially pediatric dentists, must be aware to recognize all sorts of battering or neglect based on a suitably-taken clinical history, and focused exploration when suspicion of battered child syndrome is established. Objective: To be knowledgeable with BCS intra- and extra-oral indicators which might allow the pediatric dentist to recognize signs and contribute in the diagnosis as part of a multi-disciplinary team in charge of providing care to this type of patients. Clinical case: A two year, five month old male patient was brought to the National Pediatrics Institute afflicted with peri-orbital edema, multiple limb fractures and oral-facial indicators which suggested battered child syndrome diagnosis. Conclusion: Taking into consideration the frequency with which oral and facial structures are involved in battered child syndrome cases there is a medical, ethical and legal commitment for all dentists and specifically pediatric dentists, to intervene in prevention, detection, diagnosis and treatment of this medical and social problem.
ABSTRACT
We investigated the periodicity of Plasmodium vivax and P. falciparum incidence in time-series of malaria data (1990-2010) from three endemic regions in Venezuela. In particular, we determined whether disease epidemics were related to local climate variability and regional climate anomalies such as the El Niño Southern Oscillation (ENSO). Malaria periodicity was found to exhibit unique features in each studied region. Significant multi-annual cycles of 2- to about 6-year periods were identified. The inter-annual variability of malaria cases was coherent with that of SSTs (ENSO), mainly at temporal scales within the 3-6 year periods. Additionally, malaria cases were intensified approximately 1 year after an El Niño event, a pattern that highlights the role of climate inter-annual variability in the epidemic patterns. Rainfall mediated the effect of ENSO on malaria locally. Particularly, rains from the last phase of the season had a critical role in the temporal dynamics of Plasmodium. The malaria-climate relationship was complex and transient, varying in strength with the region and species. By identifying temporal cycles of malaria we have made a first step in predicting high-risk years in Venezuela. Our findings emphasize the importance of analyzing high-resolution spatial-temporal data to better understand malaria transmission dynamics.
Subject(s)
Malaria, Falciparum/epidemiology , Malaria, Vivax/epidemiology , Periodicity , Climate , Humans , Incidence , Venezuela/epidemiologyABSTRACT
El raquitismo hipofosfatémico resistente a la vitamina D está caracterizado por una hipofosfatemia persistente e hiperfosfaturia. Este disturbio metabólico causa una calcificación deficiente de las estructuras mineralizadas tales como en los huesos y dientes. Una de las alteraciones bucales más importantes de esta enfermedad es la recurrente formación de abscesos ''espontáneos'' afectando a múltiples dientes primarios, así como permanentes sin caries o trauma, relacionado con una mineralización deficiente de la dentina. Nosotros reportamos un caso de raquitismo hipofosfatémico resistente a la vitamina D en un paciente que reportó múltiples abscesos dentales y requirió tratamiento con pulpectomías, pulpotomías y coronas de acero cromo en molares y resinas en dientes anteriores. El objetivo del presente artículo es dar a conocer las características de este trastorno, el tratamiento y las consideraciones dentales.
Hypophosphatemic vitamin-D resistant rickets is characterized by persistent hypophosphatemia and hyperphosphaturia. This metabolic disorder causes deficient calcification of mineralized structures such as bones and teeth. One of the most important oral alterations elicited by this condition is the recurrent formation of ''spontaneous'' abscesses. These affect multiple caries or trauma to free primary o permanent teeth and are related to a deficient dentin mineralization. We report a case of hypophosphatemic vitamin-D resistant rickets in a patient who reported multiple dental abscesses and who required treatment consisting in pulpectomies, pulpotomies and chrome-steel crowns in molars and composite resin in anterior teeth. The aim of the present article was to raise awareness on the characteristics of this disorder, as well as its treatment and dental considerations.
Subject(s)
Minor Surgical Procedures/standards , Patient Satisfaction , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Primary Health CareABSTRACT
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Subject(s)
Humans , Male , Female , Child , Adult , Middle Aged , Aged , Patient Satisfaction/statistics & numerical data , Minimally Invasive Surgical Procedures/economics , Minimally Invasive Surgical Procedures/statistics & numerical data , Primary Health Care/statistics & numerical data , Primary Health Care/trends , Primary Health Care , Cross-Sectional Studies , Socioeconomic SurveyABSTRACT
A 17-year-old female patient presented with sequelae to ankylosis of the temporomandibular joint, which included vertical maxillary protrusion, anterior open bite, labial incompetence, micrognathia, undefined neck angle, facial asymmetry, Class II molar relationship, and Class III canine relationship. She presented with the following cephalometric and soft tissue data: SNA angle = 78 degrees, SNB angle = 70 degrees, incisor-nasion-point A = 11 degrees, incisor-nasion-point B = 33 degrees, Frankfort-mandibular plane angle = 43 degrees, occlusal plane = 25 degrees, subnasale-stomion = 20 mm, stomion superius-stomion inferius = 9 mm, stomion inferius-soft tissue menton = 30 mm, neck angle = 144 degrees, and chin projection = 10 mm. Orthognathic surgery and mandibular osteogenic distraction were employed, specifically Le Fort I osteotomy to decrease a vertical excess of 12 mm, augmentation genioplasty of 17 mm, and bilateral extraoral distractors of bidirectional vector for a 14-mm augmentation of the mandible. The result was satisfactory with minimal adverse complications.
