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BACKGROUND: As digital technologies and especially artificial intelligence (AI) become increasingly important in health care, it is essential to determine whether and why potential users intend to use related health information systems (HIS). Several theories exist, but they focus mainly on aspects of health care or information systems, in addition to general psychological theories, and hence provide a small number of variables to explain future behavior. Thus, research that provides a larger number of variables by combining several theories from health care, information systems, and psychology is necessary. OBJECTIVE: This study aims to investigate the intention to use new HIS for decisions concerning short- and long-term medical treatments using an integrated approach with several variables to explain future behavior. METHODS: We developed an integrated theoretical model based on theories from health care, information systems, and psychology that allowed us to analyze the duality approach of adaptive and nonadaptive appraisals and their influence on the intention to use HIS. We applied the integrated theoretical model to the short-term treatment using AI-based HIS for surgery and the long-term treatment of diabetes tracking using survey data with structured equation modeling. To differentiate between certain levels of AI involvement, we used several scenarios that include treatments by physicians only, physicians with AI support, and AI only to understand how individuals perceive the influence of AI. RESULTS: Our results showed that for short- and long-term treatments, the variables perceived threats, fear (disease), perceived efficacy, attitude (HIS), and perceived norms are important to consider when determining the intention to use AI-based HIS. Furthermore, the results revealed that perceived efficacy and attitude (HIS) are the most important variables to determine intention to use for all treatments and scenarios. In contrast, abilities (HIS) were important for short-term treatments only. For our 9 scenarios, adaptive and nonadaptive appraisals were both important to determine intention to use, depending on whether the treatment is known. Furthermore, we determined R² values that varied between 57.9% and 81.7% for our scenarios, which showed that the explanation power of our model is medium to good. CONCLUSIONS: We contribute to HIS literature by highlighting the importance of integrating disease- and technology-related factors and by providing an integrated theoretical model. As such, we show how adaptive and nonadaptive appraisals should be arranged to report on medical decisions in the future, especially in the short and long terms. Physicians and HIS developers can use our insights to identify promising rationale for HIS adoption concerning short- and long-term treatments and adapt and develop HIS accordingly. Specifically, HIS developers should ensure that future HIS act in terms of HIS functions, as our study shows that efficient HIS lead to a positive attitude toward the HIS and ultimately to a higher intention to use.
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BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating symptom experienced by cancer survivors. Despite the burden of CIPN-related symptoms, interventions remain limited. OBJECTIVES: This narrative review seeks to propose a framework for CIPN predisposing, precipitating, and perpetuating factors (3Ps), which will provide a foundation for future research and clinical interventions aimed at mitigating CIPN-related symptoms and morbidity. METHODS: A comprehensive literature search was performed using PubMed, guided by keywords related to "chemotherapy-induced peripheral neuropathy." Studies were limited to those with full text available in English. RESULTS: Predisposing factors outlined in this framework, such as older age and comorbid conditions, can be used to identify patients who have a higher risk of developing CIPN. The major precipitating factor of CIPN is the delivery of chemotherapy to peripheral nerves, which may be mitigated via cryotherapy or compression therapy during chemotherapy. Perpetuating factors can offer insight into psychological, cognitive, and behavioral modifications that could be treatment targets for CIPN management. CONCLUSION: The proposed 3P model can guide the development of effective interventions for CIPN by suggesting modifiable psychological and behavioral treatment targets that may mitigate the impact of CIPN for cancer patients.
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With the aim of describing the activities of nurses in mobile home palliative care teams in the Brussels Region, the study Nursing practices in palliative care in Brussels outpatient mobile teams took the cultural intermediary model as its theoretical framework. This model is based on in-depth research into the history of the nursing discipline. This article provides an overview of this European conceptual model, its integration into a descriptive study, and highlights some of its contributions.
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Cuidados Paliativos , Humanos , Cuidados Paliativos/organização & administração , Modelos de Enfermagem , Enfermagem de Cuidados Paliativos na Terminalidade da VidaRESUMO
Introduction: There are very few scholastic studies applying a theory-driven methodology to analyse the employment of teledentistry in clinical practice by the Saudi dental community. The objective of this research was to predict the employment of teledentistry in clinical practice by the Saudi dental community using the UTAUT (Unified Theory of Acceptance and Use of Technology) model. Methods: A countrywide survey was executed from November 2022 to April 2023 among the dental community (pre-graduate students, graduates, post-graduate students, general dentists, and specialist dentists) involved in clinical practice. The survey employed the UTAUT model, which has four fundamental constructs: performance expectancy (PE), effort expectancy (EE), social influence (SI) and facilitating conditions (FC). These constructs are known to impact the user's behavioural intention (BI). The four fundamental constructs were independent, and BI was the dependent variable. A Likert scale with five scores was used to record each variable. Descriptive statistics were used to describe all the constructs. Cronbach's alpha scores were used to measure the inner consistency of the Likert scale. Simple linear regression and multiple linear regression were used to determine the correlation between all the constructs and the overall model's prediction. The Statistical Package for the Social Sciences was applied for analysis. The study had 80% power and an alpha threshold of .05. Results: The electronic survey was sent to 3000 participants, out of whom 2143 responded (response rate = 71.43%). PE (R2= 26%, p < .01) was the most significant predictor of the Saudi dental community BI to employ teledentistry in clinical practice, followed by SI (R2= 24%, p < .01), EE (R2= 19%, p < .01) and FC (R2= 6%, p < .01). With statistically significant predictive power, the UTAUT model explained 32% of the variance in the BI (R2= 0.32, p < .01). Conclusions: Each UTAUT construct and the entire model were significantly correlated with the employment of teledentistry in clinical practice by the Saudi dental community. PE had the most salient correlation, followed by SI, EE and FC. The participants have perceived the benefits of teledentistry, increasing the future likelihood of its utilisation. The Saudi government could consider the UTAUT constructs to promote teledentistry in tandem with Vision 2030.
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Background: Evidence revealed that, 60% of deaths in the underdeveloped nations are linked to adoption of unhealthy lifestyles. The Trans-theoretical Model (TTM) has been considered a useful interventional approach in smoking cessation, drug addiction and weight control. However, its effectiveness in improving changes in dietary pattern, physical activity and alcohol consumption has not been reported. Purpose: The study aimed at evaluating the effectiveness of the TTM-based health education intervention in the promotion of lifestyle changes among adults with metabolic syndrome. Methods: This was an experimental design where 352 participants with metabolic syndrome were allocated to intervention and control groups. The participants were randomly assigned to receive either standard CVD care or a TTM stage-based lifestyle modification intervention for 12-months. Lifestyle patterns were assessed at baseline and endpoint. The mean difference of the subtotal TTM concept scores between pre and post intervention was evaluated using paired t-test. The chi-square test of independence was used to detect between group differences in the categorical data. Results: Most of the participants were in the pre-action stage of change for their dietary intake patterns and physical activity habits at the baseline assessment with no difference between the groups. The intervention group's total level of change toward adopting a healthy lifestyle was markedly (p < 0.001) improved than the control group at the endpoint. The mean scores for the intervention group's stage of change, self-efficacy, and pros and cons of decisional balance all improved significantly (p < 0.001) from the baseline. The mean scores for the control group's pros and cons of decisional balance and stage of change also considerably (p < 0.05) improved from baseline to the endpoint. Conclusion: The TTM- based health education intervention was effective in improving the participants' lifestyles that includes diet and physical activity. Health care providers, particularly nurses should implement TTM staged-matched educational intervention for individuals who are at risk for cardiovascular diseases.
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Purpose: Construct an exercise intervention program for patients with sarcopenic obesity. Material and Methods: Based on the COM-B theoretical model and evidence-based principles, the program was constructed using qualitative methods of literature analysis and Delphi method. The Delphi panel consisted of 15 experts from the fields of clinical medicine, rehabilitation medicine, medical technology, and nursing. Results: Fifteen experts were consulted, and the consultation recovery rate was 100%; the authority coefficient of the 1st round was 0.83, with coefficients of variation ranging from 0.00 to 0.27, and importance scores ranging from (4.13±1.13) to (5±0); the authority coefficient of the 2nd round was 0.82, with coefficients of variation ranging from 0.00 to 0.20, and importance scores ranging from (4.53±0.64) to (5±0); Kendall's harmony coefficient was 0.102, 0.115, respectively, and the differences were statistically significant(P < 0.05). The constructed exercise intervention program for patients with sarcopenic obesity included 4 primary indicators, 12 secondary indicators, and 28 tertiary indicators. Conclusion: The constructed exercise intervention program for patients with sarcopenic obesity is scientific, feasible and generalizable, and can provide useful reference for related personnel to develop exercise programs for patients with sarcopenic obesity.
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Técnica Delphi , Terapia por Exercício , Obesidade , Sarcopenia , Humanos , Obesidade/terapia , Terapia por Exercício/métodos , Sarcopenia/reabilitação , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , AdultoRESUMO
The article addresses Brazil's return to the Hunger Map in 2022 during the COVID-19 pandemic. After public policies in 2014-2015, food insecurity worsened from 2016 onwards, intensifying during the pandemic. Social inequality, unemployment, informality and family changes contributed to the worsening. The research used hypothetical-deductive models, based on two national surveys and regional studies. The process involved formulating hypotheses, reviewing the literature, deducing predictions and identifying variables. Two general hypotheses were formulated, relating the pandemic to worsening inequalities and introducing new sociodemographic variables. Contextual variables and impact mechanisms of the pandemic were identified. Contextual and individual consequences include food insecurity, health impacts and widening inequalities. The intersection between food insecurity and social inequalities highlights the need for comprehensive public policies. The rise in food insecurity during the pandemic has had significant implications and will require a long-term, sustainable approach. The proposed theoretical model, represented by a DAG, points out paths and causal relationships between events, highlighting the complexity of the scenario. The study concludes that, in addition to trends prior to the pandemic, the health emergency introduced crucial variables for understanding food insecurity in Brazil. The hypothetical-deductive theoretical model offers a more accurate understanding of the causes and effects of the pandemic.
O artigo aborda o retorno do Brasil ao Mapa da Fome em 2022 durante a pandemia de COVID-19. Após políticas públicas em 2014-2015, a insegurança alimentar piorou a partir de 2016, intensificando-se na pandemia. A desigualdade social, desemprego, informalidade e mudanças familiares contribuíram para o agravamento. A pesquisa utilizou modelos hipotético-dedutivos, baseados em dois inquéritos nacionais e estudos regionais. O processo envolveu formulação de hipóteses, revisão da literatura, dedução de previsões e identificação de variáveis. Duas hipóteses gerais foram formuladas, relacionando a pandemia agravando desigualdades e introduzindo novas variáveis sociodemográficas. Foram identificadas variáveis contextuais e mecanismos de impacto da pandemia. As consequências contextuais e individuais incluem insegurança alimentar, impacto na saúde e ampliação das desigualdades. A interseção entre insegurança alimentar e desigualdades sociais destaca a necessidade de políticas públicas abrangentes. O aumento da insegurança alimentar durante a pandemia teve implicações significativas e exigirá abordagem sustentável a longo prazo. O modelo teórico proposto, representado por um DAG, aponta caminhos e relações causais entre eventos, destacando a complexidade do cenário. O estudo conclui que, além das tendências anteriores à pandemia, a emergência sanitária introduziu variáveis cruciais para o entendimento da insegurança alimentar no Brasil. O modelo teórico hipotético-dedutivo oferece uma compreensão mais precisa das causas e efeitos da pandemia.
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Insights into key properties of biochar with a fast adsorption rate and high adsorption capacity are urgent to design biochar as an adsorbent in pollution emergency treatment. Machine learning (ML) incorporating classical theoretical adsorption models was applied to build prediction models for adsorption kinetics rate (i.e., K) and maximum adsorption capacity (i.e., Qm) of emerging contaminants (ECs) on biochar. Results demonstrated that the prediction performance of adaptive boosting algorithm significantly improved after data preprocessing (i.e., log-transformation) in the small unbalanced datasets with R2 of 0.865 and 0.874 for K and Qm, respectively. The surface chemistry, primarily led by ash content of biochar significantly influenced the K, while surface porous structure of biochar showed a dominant role in predicting Qm. An interactive platform was deployed for relevant scientists to predict K and Qm of new biochar for ECs. The research provided practical references for future engineered biochar design for ECs removal.
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Carvão Vegetal , Aprendizado de Máquina , Carvão Vegetal/química , Adsorção , Cinética , Modelos Teóricos , Poluentes Químicos da ÁguaRESUMO
Mobile phone dependence (also known as internet dependence, MPD), defined as a problematic behavior characterized by excessive use or intermittent craving to use a mobile phone, results in various social, behavioral, and affective problems in daily life. In sports, MPD is directly related to the physical and mental health and sports performance of athletes. The individual and environmental factors, neurobiological mechanisms and theoretical models of MPD affecting athletic performance were analyzed by reviewing previous studies, aiming to construct effective training and development protocols to prevent and control the occurrence of MPD in athletes. At present, athletic performance can be affected by MPD through individual factors and environmental factors. The neurobiological mechanisms between the two are based on the brain reward system and microwave radiation from mobile phones, with athletic performance being restricted by alterations in the corresponding brain regions. Relevant theoretical models mainly include the social cognitive model of self-regulation and the integrative model of self-control, which explain the interrelationship between MPD and athletic performance from the perspectives of athletes' self-regulation and self-control, respectively. As an emerging phenomenon, the influence pathways and mechanisms by which MPD affects athletic performance need to be further investigated. A longitudinal perspective should be adopted to trace the dynamic impact relationship between the two, and developing relevant theoretical frameworks from an interdisciplinary research perspective should be valuable for providing theoretical support for coaches and sports administrators to formulate scientific training protocols and thus improve the mental health of athletes.
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Objective: to explore the influences of a trans-theoretical model-based diet nursing intervention on sarcopenia and quality of life in maintenance hemodialysis patients. Methods: the clinical data of 243 patients with maintenance hemodialysis (MHD) admitted to our hospital from January 2019 to August 2020 were retrospectively analyzed. A 1:1 orientation score matching (PSM) method was adopted, and patients with different intervention methods were matched based on gender, age, education time, dialysis age, body mass index, underlying diseases, annual income, and whether they were malnourished. Finally, 82 cases were included in the control group (routine nursing and dietary guidance) and 80 cases in the intrevention group (dietary nursing intervention based on the trans-theoretical model), respectively. Results: After PSM, 82 cases in the control group and 80 cases in the intrevention group were included in the study. After the intervention, the incidence of sarcopenia, the extracellular water rate (ECF/TBF) value, and the malnutrition rate of the intrevention group were lower than those of the control group (p < 0.05); the scores of self-care, facing difficulties, potassium intake management, salt intake management, fluid restriction management, the levels of serum albumin, prealbumin and transferrin were all higher than those of the control group (p < 0.05); the SF-36 Concise Health Scale score of the intrevention group was higher than that of the control group (p < 0.05). The 1-year survival rate in the intrevention group (95.00 %) was higher than that in the control group (85.37 %) (p < 0.05). Conclusion: a TTM-based diet nursing intervention can help improve the dietary management behavior of MHD patients, prevent malnutrition, reduce the incidence of sarcopenia, and improve their quality of life and survival rate.(AU)
Objetivo: explorar el impacto de las intervenciones de enfermería dietética basadas en el modelo transteórico sobre la sarcopenia y la calidadde vida en pacientes en hemodiálisis de mantenimiento.Método: se analizaron retrospectivamente los datos clínicos de 243 pacientes con hemodiálisis de mantenimiento (MHD) ingresados en nuestrohospital de enero de 2019 a agosto de 2020. Se utilizó el método de emparejamiento de la puntuación direccional 1: 1 (PSM) para emparejar alos pacientes con diferentes métodos de intervención en función del sexo, la edad, el tiempo de educación, la edad de diálisis, el índice de masacorporal, la enfermedad subyacente, los ingresos anuales y la desnutrición. Finalmente, 82 casos fueron incluidos en el grupo de control (atenciónrutinaria y orientación dietética) y 80 en el grupo de intervención (intervención dietética basada en el modelo transteórico).Resultados: después del PSM, 82 casos fueron incluidos en el grupo de control y 80 casos en el grupo de observación. Después de la intervención,la incidencia de sarcopenia, los valores de agua extracelular (ecf/tbf) y la tasa de desnutrición del grupo de observación fueron menores que enel grupo de control (p < 0,05); autocuidado, afrontamiento de dificultades, manejo de la ingesta de potasio, manejo de la ingesta de sal, manejode restricción de líquidos, niveles de albúmina sérica, y tanto la prealbúmina como la transferrina fueron mayores que en el grupo de control(p < 0,05). La puntuación de la escala de salud concisa SF-36 en el grupo de observación fue mayor que la del grupo de control (p < 0,05), y latasa de supervivencia a un año en el grupo de observación (95,00 %) fue mayor que en el grupo de control (85,37 %) (p < 0,05).Conclusión: las intervenciones de atención dietética basadas en el TTM ayudan a mejorar el comportamiento de manejo dietético de los pacientescon MHD, a prevenir la desnutrición, a reducir la incidencia de sarcopenia y a mejorar la calidad de vida...(AU)
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Humanos , Masculino , Feminino , Diálise Renal , Qualidade de Vida , Sarcopenia , Dietoterapia , Ciências da Nutrição , Serviço Hospitalar de Nutrição , Estudos RetrospectivosRESUMO
The eating habits of adolescents are often inadequate, with high consumption of unhealthy foods and low consumption of healthy foods. It is necessary to design and implement effective interventions to improve eating habits at this age and evaluate their feasibility, acceptability, and effectiveness. The use of theories for behavior change in health interventions favors the adoption of healthy behaviors. Due to this, the objective was set to determine the feasibility, acceptability, and effect on food consumption of a new educational nutritional intervention program for adolescents based on the Social Cognitive Theory (SCT) and supported by the Trans-theoretical Model (TTM) and identify areas of improvement in study design and intervention for future larger-scale studies. A pilot study of a cluster randomized controlled trial was conducted in adolescents of both sexes, 12 to 15 years of age, students from a public secondary school in Tonala, Jalisco, Mexico. The results show that a nutritional education intervention for adolescents, based on SCT and supported by the TTM, is feasible, acceptable, and with positive results in the modification of the consumption of ultra-processed foods, vegetables/fruits, and water. This pilot study identified some aspects that could be improved to enhance the effectiveness of the interventions in future studies.
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Evaporative emission is an important source of vehicle pollutant emission and volatile organic compounds (VOCs), causing serious environmental pollution. Carbon canisters are used to store fuel vapor in evaporative emission control (EVAP) system, but canisters are prone to saturation, leading to the direct release of fuel vapor into the atmosphere. Therefore, accurate estimation of fuel vapor generation is crucial for EVAP system. Gasoline evaporation rate is mainly influenced by vapor-liquid interface area, gasoline saturated vapor pressure, filling level and temperature. The quantitative relation between different parameters and gasoline evaporation rate has rarely been reported, and a gasoline evaporative emission estimation model suitable for China needs to be proposed urgently. In this study, gasoline evaporative emission tests have been carried out in VT-SHED, and the effects of vapor-liquid interface area, filling level and temperature on gasoline evaporative emissions have been analyzed under the premise of consistent gasoline temperature and ambient temperature. Some valuable conclusions are obtained. The results show that different from expectation, gasoline evaporative emissions are not positively correlated with the vapor-liquid interface area. There is an approximately exponential relationship between the headspace volume and gasoline evaporative emissions. The widely used Reddy equation and Hata equation underestimate the gasoline vapor generation in China. Based on China VI test program and gasoline, accurate estimation of mass transfer coefficient has been conducted, and a new semi-empirical estimation model for vapor generation has been proposed. The model can accurately estimate the fuel evaporation of vehicles in China, providing guidance for the matching and optimization of EVAP system.
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AIM: The aim of this study was to evaluate the effect of motivational interviewing based on the trans-theoretical model promoting physical activity in older adults. METHODS: A randomized controlled trial study was conducted with 117 older adults (intervention group: 58, and control group: 59) between April and November 2019. The data were collected via a questionnaire, trans-theoretical model scales, the Physical Activity Scale for the Elderly, the Katz Activities of Daily Living scale and a pedometer. The 24-week intervention consisted of regular motivational interviewing. The control group received usual care at the family health centre. RESULTS: Following the intervention, the Intervention Group showed significant improvements Exercise Processes of Change Scale, Exercise Self-Efficacy Scale and Perceived Benefits of the Decisional Balance Scale for Exercise. There was a significant difference between the groups in terms of stages of change. In the Intervention Group, 81.5% were in the contemplation stage in the pre-test, while in the post-test, 70.4% had transitioned to the action stage. In contrast, in the control group, 62.5% were in the contemplation stage initially, but in the post-test, only 9.3% had reached the action stage. The mean number of step counts increased significantly in favour of the Intervention Group, as did the Physical Activity Scale for the Elderly total score. CONCLUSION: The trial indicated that after the trans-theoretical model-based motivational interviewing, the stages of change among the older adults improved, as did their exercise behaviours. It is recommended that the trans-theoretical model and motivational interviewing be used by nurses to improve healthy lifestyle stage behaviours in older adults.
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Entrevista Motivacional , Humanos , Idoso , Papel do Profissional de Enfermagem , Atividades Cotidianas , Exercício Físico , Modelos TeóricosRESUMO
A lattice-filled multicellular square tube features a regular cross-sectional shape, good energy consumption, and good crashworthiness, which is suitable for the design of energy absorbers in various protection fields such as automobiles, aerospace, bridges, etc. Based on the super folding theory, two reference planes are set to refine the energy consumption zone of the super folding element in this study. The energy consumption calculation of convex panel stretching is involved, and the critical crushing force formula is introduced in this study. Meanwhile, the calculation method from a single-cell square tube to a multicellular thin-walled square tube is extended and the structural optimization is investigated, in which the NSGAII algorithm is used to obtain the Pareto front (PF) of the crashworthiness performance index of the square multicellular tubes, the Normal Boundary Intersection (NBI) method is adopted to select knee points, and the influence of different cross-sectional widths on the number, as well as the thickness, of cells are discussed. This study's results indicate that the theoretical value is consistent with that obtained from the numerical simulation, meaning that the improved theoretical model can be applied to predict the crashworthiness of multicellular square cross-sectional tubes. Also, the optimization method and study results proposed in this study can provide a reference for the design of square lattice multicellular tubes.
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Large thin-walled pipes are particularly suitable for oil and gas transport and auxiliary pipes in cold areas or deep sea-beds. At present, the rounding and straightening processes are completed independently, and the theoretical model for roller-shape design is analyzed only in a single direction. To solve this problem, a theoretical model for roller-shape design of three-roller continuous and synchronous adjusting straightness and ovality process for large thin-walled pipes is established. The established model is verified by numerical simulation and experimental research using 304 stainless steel pipes. The results show that the three roller-shape design schemes, including three-section, four-section and five-section, proposed based on the theoretical model, can obtain qualified formed pipes. Based on the model, the residual ovality, residual straightness and maximum residual stress of the three roller-shape schemes are discussed. The residual straightness can reach within 0.2%, and the residual ovality can reach within 1%. It verifies the applicability of the model and the feasibility of the process. The model can provide a theoretical basis for presetting the process parameters and optimizing the roller-shape.
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BACKGROUND AND OBJECTIVE: Self-expanding polymer braided stents are expected to replace metallic stents in the treatment of Peripheral Arterial Disease, which seriously endangers human health. To restore the patency of blocked peripheral arteries with different properties and functions, the radial supporting capacity of the stent should be considered corresponding to the vessel. A theoretical model can be established as an effective method to study the radial supporting capacity of the stent which can shorten the stent design cycle and realize the customization of the stent according to lesion site. However, the classical model developed by Jedwab and Clerc of radial force is only limited to metallic braided stents, and the predictions for polymer braided stents are deviated. METHODS: In this paper, based on the limitation of the J&C model for polymer braided stents, a modified radial force model for polymer braided stents was proposed, which considered the friction between monofilaments and the torsion of the monofilaments. And the modified model was verified by radial force tests of polymer braided stents with different structures and monofilaments. RESULTS: Compared with the J&C model, the proposed modified model has better predictability for the radial force of polymer braided stents that prepared with different braided structure and polymer monofilaments. The root mean squared error of modified model is 0.041±0.026, while that of the J&C model is 0.246±0.111. CONCLUSIONS: For polymer braided stents, the friction between the polymer monofilaments and the torsion of the monofilaments during the radial compression cannot be ignored. The radial force prediction accuracy of the modified model considering these factors was significantly improved. This work provides a research basis on the theoretical model of polymer braided stents, and improves the feasibility of rapid personalized customization of polymer braided stents.
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Modelos Teóricos , Polímeros , Humanos , StentsRESUMO
BACKGROUND: Organizations face diverse contexts and requirements when updating and maintaining their portfolio, or pool, of systematic reviews or clinical practice guidelines they need to manage. We aimed to develop a comprehensive, theoretical framework that might enable the design and tailoring of maintenance strategies for portfolios containing systematic reviews and guidelines. METHODS: We employed a conceptual approach combined with a literature review. Components of the diagnostic test-treatment pathway used in clinical healthcare were transferred to develop a framework specifically for systematic review and guideline portfolio maintenance strategies. RESULTS: We developed the Portfolio Maintenance by Test-Treatment (POMBYTT) framework comprising diagnosis, staging, management, and monitoring components. To illustrate the framework's components and their elements, we provided examples from both a clinical healthcare test-treatment pathway and a clinical practice guideline maintenance scenario. Additionally, our literature review provided possible examples for the elements in the framework, such as detection variables, detection tests, and detection thresholds. We furthermore provide three example strategies using the framework, of which one was based on living recommendations strategies. CONCLUSIONS: The developed framework might support the design of maintenance strategies that could contain multiple options besides updating to manage a portfolio (e.g. withdrawing and archiving), even in the absence of the target condition. By making different choices for variables, tests, test protocols, indications, management options, and monitoring, organizations might tailor their maintenance strategy to suit specific contexts and needs. The framework's elements could potentially aid in the design by being explicit about the operational aspects of maintenance strategies. This might also be helpful for end-users and other stakeholders of systematic reviews and clinical practice guidelines.
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Guias de Prática Clínica como Assunto , Revisões Sistemáticas como Assunto , Humanos , Revisões Sistemáticas como Assunto/métodos , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normasRESUMO
Tetracycline (TC) is a widely used antibiotic, and evaluating its interaction with humic substances (HS) that act as a complexing agent in the environment is essential to understanding the availability of this contaminant in the environment. This study evaluated the interaction between HS and TC using different spectroscopic techniques, theoretical studies, and biological assays simulating environmental conditions. TC interacts with HS, preferably by electrostatic forces, with a binding constant of 9.2 × 103 M-1 (30 °C). This process induces conformational changes in the superstructure, preferably in the HS, like protein fraction. Besides, studies using the 8-anilino-1-naphthalene sulfonate (ANS) probe indicated that the antibiotic alters the hydrophobicity degree on HS's surface. Synchronized fluorescence shows that the TC interaction occurs preferentially with the protein-like fraction of soil organic matter (KSV = 26.28 ± 1.03 M-1). The TC epitope was evaluated by 1H NMR and varied according to the pH (4.8 and 9.0) of the medium, as well as the main forces responsible for the stabilization of the HS-TC complex. The molecular docking studies showed that the formation of the HS-TC complex is carried out spontaneously (ΔG = -7.1 kcal mol-1) and is stabilized by hydrogen bonds and electrostatic interactions, as observed in the experimental spectroscopic results. Finally, biological assays indicated that HS influenced the antimicrobial activity of TC. Thus, this study contributed to understanding the dynamics and distribution of TC in the environment and HS's potential in the remediation of antibiotics of this class in natural systems, as these can have adverse effects on ecosystems and human health.
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Ecossistema , Substâncias Húmicas , Humanos , Substâncias Húmicas/análise , Simulação de Acoplamento Molecular , Adsorção , Antibacterianos/farmacologia , Antibacterianos/química , Tetraciclina/químicaRESUMO
INTRODUCTION: Opioid-related overdose fatalities are rising despite the increased accessibility of take-home naloxone (THN). Targeted implementation strategies are needed to improve the distribution of naloxone. This study investigates the effectiveness of a short video targeting pharmacists that addresses implementation barriers. METHODS: A pre-post, mixed methods design was adopted to examine the effect of a brief behaviour change intervention (an educational video informed by the capability, opportunity, motivation affecting behaviour (COM-B) model), on factors affecting pharmacists' implementation of THN in Western Australia. Paired samples t-tests for were used to investigate intentions, knowledge, skill, confidence, feasibility, appropriateness, acceptability, attitudes, anticipated patient reactions, social support and implementation climate. Structural equation modelling examined the associations between constructs and to test the proposed mediation of motivation on capability and opportunity affecting intentions to discuss and provide THN. RESULTS: We analysed data from 102 participants. At follow-up and after all participants had viewed the video, participants had significantly improved intentions, skill, confidence, anticipated reactions, social support and perceptions that THN implementation was feasible, appropriate and acceptable. No significant differences were seen for attitudes, knowledge or implementation climate. The proposed mediation effect of motivation on the associations between opportunity and intentions and capability and intentions was not supported. DISCUSSION AND CONCLUSIONS: A short video directly targeting identified implementation barriers has the ability to improve key influences in the provision of THN. Dissemination of information to community pharmacists is a challenge. Implementation strategies addressing knowledge and targeting other levels of influence on intentions and behaviour are required.
Assuntos
Motivação , Overdose de Opiáceos , Humanos , Farmacêuticos , Intenção , Escolaridade , Naloxona/uso terapêuticoRESUMO
BACKGROUND: Temporomandibular joint (TMJ) overloading is considered a primary cause of temporomandibular joint disorders (TMD). Accordingly, craniomaxillofacial structural parameters affect the loading situation in the TMJ. However, no effective method exists for quantitatively measuring the loading variation in human TMJs. Clinical statistics, which draws from general rules from large amounts of clinical data, cannot entry for exploring the underlying biomechanical mechanism in craniomaxillofacial system. The finite element method (FEM) is an effective tool for analyze the stress and load on TMJs for several cases in a short period of time; however, it is difficult to generalize general patterns through calculations between different cases due to the different geometric characteristics and occlusal contacts between each case. METHODS: (1) This study included 88 subjects with 176 unilateral data to measure angle (α) of the distance to the plane of occlusion. The bone destruction score was evaluated for clinical statistics. To rule out effects of the potential factors and ensure the generality of the study, one participant with no obvious bone destruction was selected as the standard case for establishing the three-dimensional (3D) theoretical model and FEM. (2) Three groups of forces, including biting, muscles and joint reaction forces on mandible, were adopted to establish a 3D theoretical model. (3) By modifying the sagittal α and coronal three types of deviation angle (φ) of the original model, nine candidate models were obtained for the FEM studies. RESULTS: (1) The static equilibrium equations, were used to establish a 3D theoretical model for describing the loading of the TMJ. The theoretical model was validated by monotonously modifying the structural parameter in comparison to two-dimensional theoretical models reported previously; (2) The force on the TMJ gradually decreased with α, and this trend was validated by both clinic statistics and FEM results; (3) The effects of the three types of deviation angle were different. The results of the case where only rotating biting forces were considered was consistent with clinical statistics, indicating that the side with lower α experiences higher TMJ load. (4) Changing the unilateral proportionality coefficients of biting and muscle force produced opposite effects, wherein the effects of the muscle force were stronger than those of the biting forces. CONCLUSIONS: A negative correlation was observed between the joint load and α. Among the three types of asymmetric deformities, occlusal deviations were the primary factors leading to TMD. Unilateral occlusion can result in a greater load on the ipsilateral joint and should be avoided when using the side corresponding to the TMD. This study provides a theoretical basis for the biomechanical mechanism of TMD and also enables the targeted mitigation and treatment of TMD through structural modification.