The COVID-19 Vaccines Evaluation Program: Implementation, Management, and Experiences, 2021-2023.

In 2021, China's domestically produced coronavirus disease 2019 (COVID-19) vaccines received approval from regulatory bodies and were administered worldwide. Due to a low number of infections within China during that period, it became imperative to evaluate the vaccines' real-world effectiveness through international studies. To facilitate this, China CDC launched the COVID-19 Vaccines Evaluation Program (COVEP). This program formed research collaboration agreements with health institutes across five World Health Organization regions, addressing key questions about vaccine performance through ten cooperative agreements. The findings from COVEP projects reinforced confidence, both domestically and globally, in the effectiveness of the vaccines produced in China. Moreover, the outcomes observed internationally were frequently mirrored by later studies conducted within China. COVEP thus pioneered a novel approach for fostering cross-national research collaborations, addressing significant public health issues and exemplifying a framework for international cooperation. This approach is in line with the strategic objectives and other development efforts of China CDC's national disease control and prevention initiatives.

A Hybrid Methodology for the Evaluation of Clinical Practice in Final-Year Nursing Students.

(1) Background: Clinical practice constitutes a scenario where the student approaches reality. The pedagogical relationship that is built between the nurse, the tutors and the student becomes important. And this requires intentional and reflective accompaniment. The principal objective was to design a hybrid-learner-centered training model requiring reflection and acquisition of specific skills. (2) Methodology: This was a prospective observational study using an intentional sample of 87 students. A hybrid model based on a dynamic virtual forum and Individual Improvement Plan (IIP) was constructed, evaluated using a self-completed questionnaire with a Likert scale. (3) Results: A model of accompaniment to the practices was built that allows for unifying a work plan. A transversal activity IIP was designed. A discussion forum was incorporated for each subject tutor. The analysis of the questionnaire showed that learning assessment, tutorials, virtual forums, self-assessment and satisfaction statistically differed. (4) Conclusions: The model allows students to be accompanied to acquire skills, knowledge, and attitudes and to develop critical thinking, as well as to improve the teaching quality of the practices of the Curriculum of the Nursing degree and to achieve their own competences through student-centered methodologies. This study was not registered.

Neuropsychological features in RASopathies: A pilot study on parent training program involving families of children with Noonan syndrome.

Noonan syndrome (NS) is a clinical variable multisystem disorder caused by mutations in genes encoding proteins involved in the RAS/mitogen-activated protein kinase signaling pathway. NS is characterized by a distinctive facies, short stature, and congenital heart defects. Psychomotor delay, learning difficulties, and social deficits are also common. Furthermore, behavioral and attention problems can be reckoned as a key symptom in NS, with functioning resembling the patterns observed in attention deficit hyperactivity disorder (ADHD). The complex behavioral phenotype has great impact on the quality of life and raises demanding management issues also for patients' families. Parent management training (PMT) is recommended as first-line treatment for ADHD; however, no study has been performed to test the efficacy of PMT in NS, thus far. The aim of this pilot study is the implementation and evaluation of a PMT dedicated to NS families. Parents of seven children with NS were recruited and underwent to a 10-session PMT. Three different questionnaires were administered to both parents: Conners Parent Rating Scales, Parenting Stress Index Short Form (PSI-SF), and Alabama Parenting Questionnaire (APQ). Our findings on this first small cohort of families indicate that positive perception and satisfaction about the child and the interaction with him increased in mothers after the intervention, as measured respectively by PSI-SF difficult child (DC) and PSI-SF parent-child dysfunctional interaction (PCDI), while mothers' level of stress decreased after the PMT, as indicated by PSI-SF total scores. Furthermore, APQ positive parenting, which measures behaviors of positive relationship with the child, increased in mothers after the intervention. Statistical analysis on fathers' questionnaires did not show significant differences after the PMT sessions. This pilot study suggests that PMT is a promising intervention for parents of NS children with behavioral and ADHD symptoms. Changes in mothers' attitudes and distress indicate that behaviorally oriented programs may help parents to manage with NS phenotype.

Case-based, asynchronous sleep education outcomes among primary care nurse practitioner students.

STUDY OBJECTIVES: Primary care nurse practitioners (NPs) receive little sleep education in graduate programs but are often first-line providers for patients presenting with sleep-related symptoms. A pre-/postevaluation study was conducted using asynchronous, case-based sleep education modules in a cohort of primary care NP students enrolled in a single academic institution's nursing master's degree program. METHODS: Six virtual, case-based modules addressed adult sleep health and disorders, prioritized based on prevalence and primary care presentation. Kirkpatrick Training Evaluation Model guided outcome selection. Descriptive and paired comparative analyses were conducted. RESULTS: Participants were first-year NP students (n = 149; 88% female; 82% ≤ 35 years of age) in an adult primary care program that included psychiatric/mental health track. Participants reacted positively to course delivery methods and content. Insomnia was endorsed by 87% as most relevant to practice with healthy sleep (88%) and obstructive sleep apnea (50%) also frequently endorsed as practice relevant. Posttest knowledge scores significantly improved for all modules (P < .001). Self-rated confidence for future practice application was high. CONCLUSIONS: This novel asynchronous, virtual curriculum met Kirkpatrick levels 1 and 2 (positive reaction and knowledge transfer) in NP students who predicted an impact on their practice (Kirkpatrick level 3). Studies are needed to assess the benefits of increasing primary care NP knowledge in sleep medicine on quality of care and access to care (Kirkpatrick level 4). Future use of this novel sleep curriculum in other professional curricula, new-to-sleep clinical researchers, and practicing primary care providers may further potentiate care quality and sleep care access. CITATION: Sawyer AM, Saconi B, Lyons MM, et al. Case-based, asynchronous sleep education outcomes among primary care nurse practitioner students. J Clin Sleep Med. 2022;18(10):2367-2376.

Controlled underdilation using novel VIATORR® controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation.

BACKGROUND & AIMS: Smaller 8-mm diameter transjugular intrahepatic portosystemic shunts (TIPS) appear to be more beneficial than larger 10-mm TIPS stent-grafts, but lack the ability for secondary dilation in cases of clinical ineffectiveness. Underdilated VIATORR® TIPS stent grafts (VTS) expand passively, whereas novel VIATORR Controlled Expansion (VCX) stent grafts do not. This study evaluated the impact on survival of underdilated VCX compared with VTS in patients with decompensated cirrhosis. METHODS: This was a prospective case-control study including patients with cirrhosis receiving TIPS using 10-mm VCX underdilated to 8 mm. Patients with cirrhosis receiving 10-mm VTS underdilated to 8 mm were matched for age, sex, indication for TIPS, and liver function. RESULTS: A total of 114 patients (47 VCX, 47 VTS, and 20 fully dilated VCX/VTS) were included. After TIPS implantation, underdilated VCX diameter was 8.0 (7.8-9.2) mm at a median time of 359 (87-450) days, compared with VTS at 9.9 (9.7-10.0) mm (p <0.001). The portosystemic pressure gradient immediately after TIPS procedure and after 7 days did not change significantly in VCX [mean 9.4 (± 0.8) vs. 10.4 (± 0.7) mmHg, p = 0.115). Hospital readmission rates for hepatic encephalopathy were 23% (n = 11) vs 51% (n = 24) for VCX and VTS (p <0.001), respectively. Patients with VCX had significantly lower rates of large-volume paracentesis (n = 5 [11%] vs. n = 10 [21%], p = 0.017) and heart failure (n = 1 [2%] vs. n = 7 [15%], p = 0.015). One-year mortality for underdilated VCX and VTS was 15% (n = 7) and 30% (n = 14) and, for fully dilated VCX/VTS, was 45% (n = 9) (log-rank p = 0.008), respectively. CONCLUSIONS: This study demonstrated that VCX stent grafts underdilated to 8 mm do not passively expand to nominal diameter and suggests reduced hospital readmissions because of hepatic encephalopathy, uncontrolled ascites, and heart failure, and improved 1-year survival compared with underdilated VTS. LAY SUMMARY: Transjugular intrahepatic portosystemic shunt (TIPS) improves survival in selected patients with liver cirrhosis and acute variceal bleeding or refractory ascites. Smaller 8-mm diameter TIPS stent grafts appear to improve patient outcome compared with larger 10-mm diameter stent grafts. Novel VIATORR® Controlled Expansion (VCX) stent grafts facilitate safe and stable underdilation to 8 mm of large 10-mm diameter stent grafts with improved patient outcome (survival, hepatic encephalopathy, ascites and heart failure) compared with legacy VIATORR TIPS stent graft (VTS). Thus, the use of underdilated VCX could preserve heart function. CLINICAL TRIALS REGISTRATION: The study is registered at Clinicaltrials.govNCT03628807.

Knowledge production in Iranian cardiovascular research centers: A way to reduce the burden of disease.

BACKGROUND: According to the World Health Organization (WHO), non-communicable diseases (NCDs) including cardiovascular diseases (CVDs) will be responsible for almost 70% of all deaths in 2020. Therefore, knowledge production to find suitable ways to prevent, diagnosis, and effectively cover this disease in research centers is mandatory. Therefore, the present study is carried out with the aim to examine the results of studies performed in three years in Iranian cardiovascular centers. METHODS: Iranian cardiovascular research centers with more than three years of activity from 2015 to 2017 were evaluated. Research output, international collaboration, high quality publication, total citation, and average h-index (H) were evaluated and scored. RESULTS: 23 cardiovascular diseases research centers (CVDRCs) related to 15 universities of Medical Sciences (UMSs) were evaluated. The mean and standard deviation (SD) of age of the research activities in CVDRCs was 11.47 ± 8.60 years. Based on the research ranking, the first three centers were Isfahan Cardiovascular Research Center, Iran, Tehran Heart Center, and Shaheed Rajaei Cardiovascular Medical and Research Center, Iran, respectively, all of which have independent budget line. However, there is not any CVD research center in some provinces such as Zanjan, Kurdistan, Lorestan, and Arak, Iran. CONCLUSION: Mission oriented research activities in Iranian cardiovascular research centers may be effective in reducing the burden of CVDs. Moreover, establishment of CVD research centers in high risk areas may be useful.

[Analysis of the situation, evaluation and improvement proposals of the Preventive Activities and Health Promotion Program (PAPPS)]. / Análisis de la situación, evaluación y propuestas de mejora del Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS).

OBJECTIVE: To analyze the situation, evaluation and proposals for improvement of the Preventive Activities and Health Promotion Program (PAPPS). MATERIAL AND METHODS: A qualitative study of situation analysis was carried out for the evaluation of the PAPPS in 2 phases: 1) Generation of ideas and collection of information through a DAFO matrix, using 2 types of criteria: internal (strengths and weaknesses), and external (threats and opportunities); 2) Prioritization of the improvement proposals collected. Selection of participants: Key informants were identified taking into account their relationship and knowledge of the PAPPS program. All members of the PAPPS, expert groups and members with past participation were included, as well as the coordinators, including the autonomous leaders of the PAPPS. Two invitations to participate in the study were sent: the first from December 29, 2017 to February 11, 2018, and the second from January 10 to 23, 2019. The information was obtained from a questionnaire designed to be self-completed. RESULTS AND CONCLUSIONS: A total of 73 subjects answered the questionnaire. 35% of the participants were members of the PAPPS working groups, followed by family doctors from other areas, with 20.5%. The order of prioritization of the improvement proposals was as follows: 1) Unify recommendations with other semFYC working groups; 2) Prepare lists with "Recommendations not to do" from the point of view of prevention; 3) Incorporate PAPPS in the political agenda; 4) Greater coordination and interaction between groups with common competences; 5) Teaching in undergraduate and teaching units; 6) Review, update and dissemination of the program in Primary Care.

Women exposure to household air pollution after an improved cookstove program in rural San Luis Potosi, Mexico.

The state government of San Luis Potosí (SLP), Mexico implemented an improved cookstove (ICS) program in rural areas. As part of the comprehensive program evaluation, we compared fine particulate material (PM2.5) concentrations in kitchens and patios in treated (TH), and non-treated households (NTH), and analyzed pollutant levels according to patterns of fuels and devices use reported by the women. A panel study was conducted in 728 households (357 TH and 371 NTH) in three regions of SLP including two sampling rounds in 2015-16. Data on exposure determinants, ICS conditions and cooking practices were collected. Daily PM2.5 in kitchen and patio was measured in a subsample. The average treatment effect was estimated using the double difference method. We constructed a mixed linear model to estimate PM2.5 levels for the entire study sample and obtained personal exposure according to time-activity logs. NTH had lower socioeconomic status compared to TH. The average daily PM2.5 concentrations in NTH compared to TH were 155.2 and 92.6 µg/m3 for kitchen and 35.4 and 39.8 µg/m3 for patio, respectively. PM2.5 levels showed significant regional differences but no significant treatment effect. In many cases, the ICS was added to previous open fire and LPG use (stacking). The household size, kitchen ventilation, relative humidity, temperature and the ratio of indoor/outdoor PM2.5 concentration were significant predictors of kitchen PM2.5 levels. The daily PM2.5 personal exposure was significantly reduced using ICS in good conditions or LPG (57 µg/m3) compared to the traditional open fire (86 µg/m3). This study strengthens the evidence on the potential daily PM2.5 exposure reduction for women using an ICS in good conditions or LPG, displacing the polluting open fire. Comprehensive strategies tailored to the sociocultural context of the communities are needed to implement clean energy programs that achieve adoption and sustained use of ICS or LPG.

Evaluating an Advance Care Planning Curriculum: a Lecture, a Game, a Patient, and an Essay.

PURPOSE: Curricula on advance care planning are commonly absent or inadequate in the majority of medical schools. This study assessed an advance care planning mini-curriculum involving a lecture, an end-of-life conversation game, a patient encounter during which students facilitated completion of an advance directive, and a subsequent reflective essay. METHODS: This convergent, mixed methods study used a pre-post, longitudinal design. Confidence having end-of-life conversations was assessed at three timepoints. A linear mixed effects model compared mean confidence at the three timepoints. Focus groups and open-ended questionnaires (analyzed using content analysis) explored student perceptions of the curricula. RESULTS: Sixty-nine of 149 students completed the questionnaires; 18 students participated in the focus groups. Confidence scores increased by 10.3 points (+ 4.2 post-lecture/game; + 6.1 post-patient assignment/essay; p < 0.001 for all timepoints). Students felt the game (1) was a good "starting point" for learning to initiate end-of-life conversations; (2) fostered internal and external reflections about advance care planning; and (3) allowed exploration of the complexities of end-of-life discussions. Qualitative exploration suggested that high-level learning-interpreted through the lens of Bloom's taxonomy-occurred. CONCLUSION: Mixed methods data suggest that the advance care planning mini-curriculum effectively increased student confidence having end-of-life conversations. Qualitative analyses revealed student learning covering all of tiers of Bloom's taxonomy.

Evaluación curricular proceso para mantener la calidad y pertinencia de los programas de educación / Curricular evaluation, process to keep the quality and relevance of education programs

Objetivo: Evidenciar la congruencia del enfoque de cuidado de salud a la familia que plantea el programa de Enfermería y lo evidenciado en la teoría y la práctica, a través de la evaluación curricular. Materiales y Métodos: Es un estudio cualitativo, interpretativo. Utiliza el modelo de Stake o evaluación comprensiva que se desarrolla por medio de una matriz de descripción y una matriz de juicio. Análisis documental. Observación directa de la situación a evaluar. Resultado: Permitió identificar la congruencia del enfoque planteado y la realidad en la teoría y la práctica, así como las fortalezas del programa y las oportunidades para mejorar y poner en marcha un plan de mejoramiento. Conclusión: La evaluación curricular es imperativo para fortalecer y consolidar los procesos académicos en busca de altos niveles de calidad en la educación superior que aseguren la pertinencia y calidad de un programa, alcanzando certificación de acreditación.

Objective: Demonstrate the congruence of the health care approach for the family outlined by the Nursing program and what is shown in theory and practice, through curricular evaluation. Materials and Methods: This is a qualitative, interpretative study. Based on the Stake model or comprehensive evaluation developed through a description matrix and a judgment matrix. Documentary analysis. Direct observation of the situation to be evaluated. Result: It allowed the identification of congruence of the proposed approach and reality in theory and practice, as well as the program's strengths and opportunities to improve and implement an improvement plan. Conclusion: Curricular evaluation is imperative to strengthen and consolidate academic processes in search of high levels of quality in higher education that ensure the relevance and quality of a program, achieving accreditation certification.

Using Rapid Improvement Events for Disaster After-Action Reviews: Experience in a Hospital Information Technology Outage and Response.

The use of after-action reviews (AARs) following major emergency events, such as a disaster, is common and mandated for hospitals and similar organizations. There is a recurrent challenge of identified problems not being resolved and repeated in subsequent events. A process improvement technique called a rapid improvement event (RIE) was used to conduct an AAR following a complete information technology (IT) outage at a large urban hospital. Using RIE methodology to conduct the AAR allowed for the rapid development and implementation of major process improvements to prepare for future IT downtime events. Thus, process improvement methodology, particularly the RIE, is suited for conducting AARs following disasters and holds promise for improving outcomes in emergency management. Little CM , McStay C , Oeth J , Koehler A , Bookman K . Using rapid improvement events for disaster after-action reviews: experience in a hospital information technology outage and response. Prehosp Disaster Med. 2018;33(1):98-100.

Utilization of Functional Exercises to Build Regional Emergency Preparedness among Rural Health Organizations in the US.

Rural communities face barriers to disaster preparedness and considerable risk of disasters. Emergency preparedness among rural communities has improved with funding from federal programs and implementation of a National Incident Management System. The objective of this project was to design and implement disaster exercises to test decision making by rural response partners to improve regional planning, collaboration, and readiness. Six functional exercises were developed and conducted among three rural Nebraska (USA) regions by the Center for Preparedness Education (CPE) at the University of Nebraska Medical Center (Omaha, Nebraska USA). A total of 83 command centers participated. Six functional exercises were designed to test regional response and command-level decision making, and each 3-hour exercise was followed by a 3-hour regional after action conference. Participant feedback, single agency debriefing feedback, and regional After Action Reports were analyzed. Functional exercises were able to test command-level decision making and operations at multiple agencies simultaneously with limited funding. Observations included emergency management jurisdiction barriers to utilization of unified command and establishment of joint information centers, limited utilization of documentation necessary for reimbursement, and the need to develop coordinated public messaging. Functional exercises are a key tool for testing command-level decision making and response at a higher level than what is typically achieved in tabletop or short, full-scale exercises. Functional exercises enable evaluation of command staff, identification of areas for improvement, and advancing regional collaboration among diverse response partners. Obaid JM , Bailey G , Wheeler H , Meyers L , Medcalf SJ , Hansen KF , Sanger KK , Lowe JJ . Utilization of functional exercises to build regional emergency preparedness among rural health organizations in the US. Prehosp Disaster Med. 2017;32(2):224-230.

Analysis of esophagogastric cancer patients enrolled in the National Cancer Institute Cancer Therapy Evaluation Program sponsored phase 1 trials.

BACKGROUND: In phase 1 trials, an important entry criterion is life expectancy predicted to be more than 90 days, which is generally difficult to predict. The Royal Marsden Hospital (RMH) prognostic score that is determined by lactate dehydrogenase level, albumin level, and number of metastatic sites of disease was developed to help project patient outcomes. There have been no systematic analyses to evaluate the utility of the RMH prognostic score for esophagogastric cancer patients. METHODS: All nonpediatric phase 1 oncology trials sponsored by the National Cancer Institute Cancer Therapy Evaluation Program that began between 2001 and 2013 were considered in this review. RESULTS: Of 4722 patients with solid tumors, 115 patients were eligible for our analysis; 54 (47 %) with cancer of the esophagus, 14 (12 %) with cancer of the esopagogastric junction, and 47 (41 %) with stomach cancer. Eighty-six patients (75 %) had a good RMH prognostic score (0 or 1) and 29 patients (25 %) had a poor RMH prognostic score (2 or 3). Disease control rates were significantly different between patients with good and poor RMH prognostic scores (49 % vs 17 %; two-sided Fisher's exact test P = 0.004). The median treatment duration and overall survival for good and poor RMH prognostic score patients were significantly different (median treatment duration 2.1 months vs 1.2 months respectively, P = 0.016; median overall survival 10.9 months vs 2.1 months respectively, P < 0.001). In the multivariate analysis, age (60 years or older), Eastern Cooperative Oncology Group performance status (2 or greater), and the RMH prognostic score (2 or 3) were significant predictors of poor survival. CONCLUSIONS: The RMH prognostic score is a strong tool to predict the prognosis of esophagogastric cancer patients who might participate in a phase 1 trial.

Desempeño del kit ELISA chagas IICS V.1 para el diagnóstico de la enfermedad de chagas / ELISA chagas test IICS V.1 evaluation for the diagnosis of chagas disease

En Paraguay, el tamizaje serológico para la enfermedad de Chagas en bancos de sangre es necesario, por lo cual es importante un método diagnóstico con alta sensibilidad. El ELISA Chagas test IICS V.1 es un ELISA indirecto sensibilizados con antígeno soluble de epimastigote de T.cruzide la cepa Ypsilon. El objetivo del presente trabajo fue evaluar el desempeño del ELISA Chagas test IICS V.1 en comparación con kits comerciales, ademásanalizar los resultados de la evaluación externa e interna de calidad del kit. En este estudio observacional de prueba diagnóstica se analizaron 56 muestras de suerospositivos y negativos para antígenos de Trypanosoma cruzi, testados por el ELISA BiosChile, obteniéndose una concordancia excelente entre el ELISA Chagas test IICS V.1y los kits comerciales: Chagatest ELISA-Wiener, con Índice kappa: 0,89 IC de 95% (0,76-1) y Test ELISA para Chagas III-Grupo BiosChile con Índice kappa: 0,92 IC 95% (0,82-1).En la evaluación externa de calidad realizada por la Fundação Pró-Sangue/Hemocentro de São Paulo, Brasil en el periodo 2001 al 2012 se analizaron 450 muestras: 372 negativas y 78 positivas para T. cruzi, obteniéndose en dicha evaluación la calificación "A" que indica ausencia de falsos positivos y negativos. Además, en el mismo periodo los valores del control interno se encontraron dentro del rango permitido de ±2DS. Los resultados obtenidos en el estudio demuestran la alta calidad de este test de producción nacional, que sumado al bajo costo del mismo, pueden ser utilizados en trabajos de campo, donde no necesita de instrumentación y las lecturas pueden realizarse a simple vista, constituyendo una herramienta válida y útil para el apoyo al diagnóstico de la enfermedad de Chagas.

In Paraguay, the serological screening for Chagas disease is mandatory in pregnant women and blood banks, therefore a high sensitivity diagnostic method is required. The aimof this study was to evaluate the ELISA Chagas test IICS V.1 by comparison with commercial kits and to analyze the external and internal quality evaluation results. In this descriptive observational study, 56 seropositive and seronegative to Trypanosoma cruzisamples were analyzed, obtaining an excellent concordance between the ELISA Chagas test IICS V.1 and these commercial kits: Chagatest ELISA-Wiener, Argentina (kappa index:0.89) and Test ELISA Chagas III-Grupo Bios, Chile (kappa index: 0.92).In the externalquality assessment carried out by the Fundação Pró-Sangue /Blood Center of São Paulo,Brazil in the period 2001 to 2012, 450 samples were analyzed: 372 seronegative and 78seropositive for T. cruzi. In this evaluation, an “A” score was obtained indicating theabsence of false positives and negatives. Additionally, in the same period of time theinternal control values were within the accepted range of ± 2SD, with a confidence intervalof 95%. The results obtained in the present study demonstrate the high quality of this locally produced test which added to its low cost, making it a valid and useful tool tosupport the diagnosis of Chagas disease.

Rede de Atenção à Saúde Auditiva: perspectiva do usuário / Hearing Health Care Network: the perspective of the user / Red de Atención a la Salud Auditiva: opinión del paciente

Introdução: a análise da satisfação da pessoa com deficiência auditiva com a atenção à saúde é de suma importância. Objetivo: descrever a satisfação dos usuários da Rede de Atenção à Saúde Auditiva quanto às condições de assistência, acesso e utilização dos serviços. Método: estudo observacional descritivo transversal composto por 228 usuários de Serviços de Saúde Auditiva. A coleta de dados foi realizada em 34 municípios das microrregiões de Sete Lagoas e Curvelo em Minas Gerais por meio da aplicação de roteiro estruturado. Resultados: a avaliação da satisfação teve resultado superior a 80% em todos os itens avaliados. Além disso, mais de dois terços dos entrevistados relataram que recomendariam o serviço de saúde para outras pessoas. Contudo, apenas metade dos entrevistados relatou ter sido orientado sobre a importância do retorno ao serviço de Saúde Auditiva. Conclusão: o estudo revelou que a maioria dos usuários relatou estar satisfeito com a rede e a assistência prestada, bem como tiveram suas expectativas atendidas. O instrumento proposto atendeu aos objetivos, pois possibilitou a mensuração da satisfação dos usuários da Rede de Saúde Auditiva.

Introduction: analysis of the satisfaction of the person with hearing impairment to health care is of paramount importance. Purpose: to describe the satisfaction of the users of the Hearing Health Care Network regarding the conditions of assistance, access and use of the services. Methods: cross-sectional observational study with random sample stratified by municipality composed of 228 users of Hearing Health Services. The data collection was performed in 34 municipalities of the micro regions of Sete Lagoas and Curvelo in Minas Gerais, Brazil, through the application of structured script consisting of five themes (identification, socioeconomic data, user perception about their inclusion in the Hearing Health Network, evaluation of the access conditions, expectation, perception and use of the service and objective evaluation of the user satisfaction). Results: the evaluation of the satisfaction had a result higher than 80% in all assessed items. Moreover, more than two thirds of the respondents reported that they would recommend the health service to others. However, only half of the respondents reported to be advised about the importance of the follow up by the Hearing Health Service. Conclusion: the study revealed that most of the users reported to be satisfied with the network and the assistance as well as to have their expectations met. The proposed instrument has met the purposes because it made possible to measure the satisfaction of the users of the Hearing Health Network.

Introducción: el análisis de la satisfacción de la persona con discapacidad auditiva sobre la atención a la salud es de suma importancia. Objetivo: Describir la satisfacción de los usuarios de la Red de Atención a la Salud Auditiva con las condiciones de asistencia, acceso y utilización de los servicios. Método: Estudio observacional y transversal realizado con 228 usuarios de los Servicios de Salud Auditiva. La recolección de datos se llevó a cabo en 34 municipios de microrregiones de Sete Lagoas e Curvelo en Minas Gerais por la aplicación de cuestionario estructurado. Resultados: La evaluación de la satisfacción tubo resultado superior a los 80% para todos los aspectos evaluados. Además, más de dos tercios de los encuestados reportaron que recomendarían el servicio de salud a otras personas. Sin embargo, sólo la mitad de los encuestados reportó haber sido advertido de la importancia del retorno al Servicio Salud Auditiva. Conclusión: El estudio reveló que la mayoría de los usuarios informó estar satisfecho con la red y la asistencia recibida y tuvo sus expectativas satisfechas. El instrumento propuesto cumplió los objetivos, ya que hizo posible la medición de la satisfacción de los usuarios de la Red de Salud Auditiva.

Identifying weaknesses in undergraduate programs within the context input process product model framework in view of faculty and library staff in 2014.

PURPOSE: Objective of this research is to find out weaknesses of undergraduate programs in terms of personnel and financial, organizational management and facilities in view of faculty and library staff, and determining factors that may facilitate program quality-improvement. METHODS: This is a descriptive analytical survey research and from purpose aspect is an application evaluation study that undergraduate groups of selected faculties (Public Health, Nursing and Midwifery, Allied Medical Sciences and Rehabilitation) at Tehran University of Medical Sciences (TUMS) have been surveyed using context input process product model in 2014. Statistical population were consist of three subgroups including department head (n=10), faculty members (n=61), and library staff (n=10) with total population of 81 people. Data collected through three researcher-made questionnaires which were based on Likert scale. The data were then analyzed using descriptive and inferential statistics. RESULTS: Results showed desirable and relatively desirable situation for factors in context, input, process, and product fields except for factors of administration and financial; and research and educational spaces and equipment which were in undesirable situation. CONCLUSION: Based on results, researcher highlighted weaknesses in the undergraduate programs of TUMS in terms of research and educational spaces and facilities, educational curriculum, administration and financial; and recommended some steps in terms of financial, organizational management and communication with graduates in order to improve the quality of this system.

Beyond the dose-limiting toxicity period: Dermatologic adverse events of patients on phase 1 trials of the Cancer Therapeutics Evaluation Program.

BACKGROUND: Dermatologic adverse events (AEs) can be key determinants of overall drug tolerability and of the maximum tolerated and recommended phase 2 doses in phase 1 trials. The authors present the largest dedicated analysis of dermatologic AEs on phase 1 trials to date. METHODS: Data from a prospectively maintained database of patients with solid tumors who were enrolled onto Cancer Therapeutics Evaluation Program (CTEP)-sponsored phase 1 trials of cytotoxic or molecularly targeted agents (MTAs) from 2000 to 2010 were analyzed. Cumulative incidence, site, and type of drug-related dermatologic AEs were described and compared. The timing of worst drug-related dermatologic AEs was summarized. RESULTS: In total, 3517 patients with solid tumors and 6165 unique, drug-related dermatologic AEs were analyzed, including 1545 patients on MTA-only trials, 671 on cytotoxic-only trials, and 1392 on combination MTA and cytotoxic trials. Of 1270 patients who had drug-related dermatologic events, the timing of the worst AE was as follows: 743 (cycle 1), 303 (cycle 2), and 224 (cycle 3 or later). Although the cumulative incidence of grade ≥3 drug-related AEs increased to 2.4% by cycle 6, it was only 1.6% at the end of cycle 1. The cumulative incidence of drug-related AEs was highest in patients who received MTA-only therapy (P < .001) and differed by dose level (P < .001). In patients who received MTA-only therapy, drug-related AEs were most common for combination kinase inhibitor-containing therapy (P < .001). CONCLUSIONS: A substantial proportion of drug-related dermatologic AEs occur after the traditional dose-limiting toxicity monitoring period of phase 1 clinical trials. Future designs should account for late toxicities.

Identifying weaknesses in undergraduate programs within the context input process product model framework in view of faculty and library staff in 2014 / 한국의학교육

PURPOSE: Objective of this research is to find out weaknesses of undergraduate programs in terms of personnel and financial, organizational management and facilities in view of faculty and library staff, and determining factors that may facilitate program quality-improvement. METHODS: This is a descriptive analytical survey research and from purpose aspect is an application evaluation study that undergraduate groups of selected faculties (Public Health, Nursing and Midwifery, Allied Medical Sciences and Rehabilitation) at Tehran University of Medical Sciences (TUMS) have been surveyed using context input process product model in 2014. Statistical population were consist of three subgroups including department head (n=10), faculty members (n=61), and library staff (n=10) with total population of 81 people. Data collected through three researcher-made questionnaires which were based on Likert scale. The data were then analyzed using descriptive and inferential statistics. RESULTS: Results showed desirable and relatively desirable situation for factors in context, input, process, and product fields except for factors of administration and financial; and research and educational spaces and equipment which were in undesirable situation. CONCLUSION: Based on results, researcher highlighted weaknesses in the undergraduate programs of TUMS in terms of research and educational spaces and facilities, educational curriculum, administration and financial; and recommended some steps in terms of financial, organizational management and communication with graduates in order to improve the quality of this system.

Development of an Online Toolkit for Measuring Performance in Health Emergency Response Exercises.

INTRODUCTION: Exercises that simulate emergency scenarios are accepted widely as an essential component of a robust Emergency Preparedness program. Unfortunately, the variability in the quality of the exercises conducted, and the lack of standardized processes to measure performance, has limited the value of exercises in measuring preparedness. METHODS: In order to help health organizations improve the quality and standardization of the performance data they collect during simulated emergencies, a model online exercise evaluation toolkit was developed using performance measures tested in over 60 Emergency Preparedness exercises. The exercise evaluation toolkit contains three major components: (1) a database of measures that can be used to assess performance during an emergency response exercise; (2) a standardized data collection tool (form); and (3) a program that populates the data collection tool with the measures that have been selected by the user from the database. The evaluation toolkit was pilot tested from January through September 2014 in collaboration with 14 partnering organizations representing 10 public health agencies and four health care agencies from eight states across the US. Exercise planners from the partnering organizations were asked to use the toolkit for their exercise evaluation process and were interviewed to provide feedback on the use of the toolkit, the generated evaluation tool, and the usefulness of the data being gathered for the development of the exercise after-action report. RESULTS: Ninety-three percent (93%) of exercise planners reported that they found the online database of performance measures appropriate for the creation of exercise evaluation forms, and they stated that they would use it again for future exercises. Seventy-two percent (72%) liked the exercise evaluation form that was generated from the toolkit, and 93% reported that the data collected by the use of the evaluation form were useful in gauging their organization's performance during the exercise. Seventy-nine percent (79%) of exercise planners preferred the evaluation form generated by the toolkit to other forms of evaluations. CONCLUSION: Results of this project show that users found the newly developed toolkit to be user friendly and more relevant to measurement of specific public health and health care capabilities than other tools currently available. The developed toolkit may contribute to the further advancement of developing a valid approach to exercise performance measurement.

El proceso de autoevaluación en las instituciones universitarias pedagógicas: Una estrategia para su mejora / The self- evaluation process in the pedagogical university institutionsA strategy for its improvement

Fundamento: La calidad de los servicios educacionales constituye uno de los retos que enfrenta hoy la Educación Superior en Cuba, razón por la que la autoevaluación institucional es un instrumento esencial para la mejora de los procesos universitarios. Objetivo: Diseñar e implementar una estrategia de mejora para certificar la calidad en la Universidad de Ciencias Pedagógicas de Sancti Spíritus. Metodología: Se utilizó la investigación acción, que se corresponde con un enfoque metodológico predominantemente cualitativo. Resultados: Se aplicó una estrategia de mejora centrada en una visión integradora de los procesos sustantivos y contextualizados a las características de esta institución universitaria; las acciones se dirigieron a elevar la cultura de la calidad de los agentes participantes y aproximar los procesos universitarios a los estándares establecidos. Se minimizaron las debilidades y se aprovecharon las fortalezas en función del perfeccionamiento de los procesos sustantivos de la universidad. Conclusiones: La implementación de la propuesta en la Universidad Pedagógica contribuyó a alcanzar la categoría de acreditación de Institución Calificad.

Background: The quality of the educational services constitutes one of the challenges that face today the high education level in Cuba, a reason for which the institutional self-evaluation is an essential instrument to improve the university process. Objective: To design and implement a strategy of improving the registered quality in the science pedagogical university from Sancti Spiritus. Methodology: The action research was used in correspondence with a methodological approach mainly in quality. Results: An improving strategy was applied in an integrated vision of the contextualized and substantive processes to the characteristic of this university institution, the actions were gather to increase the agents and to approximate the university processes to the established standards. Were minimized the weakness in function of the improvement of the substantives processes of the university. Conclusions: The implementation of the proposal in the university contributed to enrich the accreditation category in the registered institution.