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Evaluation of the quality of platelet concentrates obtained in a Peruvian hospital. 评估在秘鲁一家医院获得的血小板浓缩物的质量。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-21 DOI: 10.5867/medwave.2024.05.2776
Jair Huamani-Chacchi, Fernando Soncco-Llulluy, Jaime Rosales-Rimache

Introduction: Platelet concentrates are blood products obtained from donor's blood, and their conservation must be subject to a strict quality control process to guarantee a safe and high-performance product in treating diseases that require their use.

Methods: We designed a cross-sectional study to determine the total compliance rate in platelet concentrates obtained in the blood bank of the Cayetano Heredia Hospital in Lima during November and December of 2019. The Buffy method Coat obtained the platelet concentrates, and parameters such as platelet count and residual leukocytes, pH, and swirling effect were evaluated according to the National Hemotherapy and Blood Bank Program criteria.

Results: The platelet count had a mean of 6.66 ± 3.94 x 10¹⁰/µL, the platelet concentrates had a mean of 56.30 ± 6.22 mL, and all, without exception, had the presence of the Swirling phenomenon. The pH had a mean of 7.64 ± 0.15, while the leukocyte count had a mean of 4.22 ± 3.51 x 10⁷/µL. Regarding compliance by the parameters evaluated, it was evident that the platelet and leukocyte count had moderate compliance rates of 43.6% and 24.1%, while the pH and swirling effect had rates of 100% in both cases. The total compliance rate was 54.9% (95% confidence interval: 46.0 to 63.5).

Conclusions: The compliance rate of platelet concentrates is moderate, and it is necessary to implement a process of continuous quality improvement in the blood bank.

引言血小板浓缩物是从献血者血液中提取的血液制品,其保存必须经过严格的质量控制过程,以保证在治疗需要使用血小板浓缩物的疾病时获得安全、高效的产品:我们设计了一项横断面研究,以确定 2019 年 11 月和 12 月期间在利马卡耶塔诺-埃雷迪亚医院血库获得的血小板浓缩物的总合格率。根据国家血液治疗和血库计划标准,采用巴菲法 Coat 获得血小板浓缩液,并对血小板计数和残留白细胞、pH 值和漩涡效应等参数进行评估:血小板计数的平均值为 6.66 ± 3.94 x 10¹⁰/µL,血小板浓缩物的平均值为 56.30 ± 6.22 mL,无一例外都出现了漩涡现象。pH 值平均为 7.64 ± 0.15,白细胞计数平均为 4.22 ± 3.51 x 10⁷/µL。关于评估参数的符合率,血小板和白细胞计数的符合率分别为 43.6% 和 24.1%,属于中等水平,而 pH 值和漩涡效应的符合率均为 100%。总符合率为 54.9%(95% 置信区间:46.0 至 63.5):血小板浓缩物的合格率一般,血库有必要实施持续质量改进流程。
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引用次数: 0
Multicentric reticulohistiocytosis revealing a ductal breast cancer in situ: A case report with dermoscopic and histopathological findings. 显示导管原位乳腺癌的多中心网状组织细胞增生症:一例皮肤镜和组织病理学发现的病例报告。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-19 DOI: 10.5867/medwave.2024.05.2914
Sofía Palma Peña, Gabriel Neely Erdos, Catalina Buchroithner Haase, Claudio Pinto Viguera

Multicentric reticulohistiocytosis is a rare non-Langerhans cell histiocytosis of unknown etiology. It is classified as multicentric because of multisystem involvement. The disease predominantly affects the skin and joints, but visceral involvement is possible. Multiple erythematous-brownish, pruritic nodules and papules on the face, hands, neck, and trunk are characteristic. It is associated with autoimmune diseases, or malignant neoplasms are seen in 20% to 30% of patients with multicentric reticulohistiocytosis. The diagnosis is based on histopathology of affected tissues. As it is an underreported disease, there is no standardized treatment. A case of multicentric reticulohistiocytosis is reported as a paraneoplastic manifestation of ductal breast cancer, being successfully treated with no recurrence after two years of follow-up. Few cases of multicentric reticulohistiocytosis associated with breast cancer have been reported in the literature.

多中心网状组织细胞增生症是一种病因不明的罕见非朗格汉斯细胞组织细胞增生症。它之所以被归类为多中心性,是因为它涉及多个系统。该病主要累及皮肤和关节,但也可能累及内脏。面部、手部、颈部和躯干出现多发性红褐色瘙痒性结节和丘疹是其特征。多中心网状组织细胞增多症与自身免疫性疾病有关,20% 到 30% 的多中心网状组织细胞增多症患者会出现恶性肿瘤。诊断依据是受影响组织的组织病理学。由于该病报告率低,因此没有标准化的治疗方法。有报告称,一例多中心网状组织细胞增生症是乳腺导管癌的副肿瘤性表现,经过成功治疗,随访两年后未再复发。与乳腺癌相关的多中心网状组织细胞增多症的文献报道很少。
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引用次数: 0
Efficiency and comparability of using new evidence platforms for updating recommendations: Experience with a type-2 diabetes guideline in Colombia. 使用新证据平台更新建议的效率和可比性:哥伦比亚 2 型糖尿病指南的经验。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-17 DOI: 10.5867/medwave.2024.05.2781
Juan Carlos Villar, Luz Angela Torres López, Anamaría Muñoz Flórez, Angela Manuela Balcázar, Laura Parra-Gómez, Edgar Camilo Barrera

Introduction: Updating recommendations for guidelines requires a comprehensive and efficient literature search. Although new information platforms are available for developing groups, their relative contributions to this purpose remain uncertain.

Methods: As part of a review/update of eight selected evidence-based recommendationsfor type 2 diabetes, we evaluated the following five literature search approaches (targeting systematic reviews, using predetermined criteria): PubMed for MEDLINE, Epistemonikos database basic search, Epistemonikos database using a structured search strategy, Living overview of evidence (L.OVE) platform, and TRIP database. Three reviewers independently classified the retrieved references as definitely eligible, probably eligible, or not eligible. Those falling in the same "definitely" categories for all reviewers were labelled as "true" positives/negatives. The rest went to re-assessment and if found eligible/not eligible by consensus became "false" negatives/positives, respectively. We described the yield for each approach and computed "diagnostic accuracy" measures and agreement statistics.

Results: Altogether, the five approaches identified 318 to 505 references for the eight recommendations, from which reviewers considered 4.2 to 9.4% eligible after the two rounds. While Pubmed outperformed the other approaches (diagnostic odds ratio 12.5 versus 2.6 to 5.3), no single search approach returned eligible references for all recommendations. Individually, searches found up to 40% of all eligible references (n = 71), and no combination of any three approaches could find over 80% of them. Kappa statistics for retrieval between searches were very poor (9 out of 10 paired comparisons did not surpass the chance-expected agreement).

Conclusion: Among the information platforms assessed, PubMed appeared to be more efficient in updating this set of recommendations. However, the very poor agreement among search approaches in the reference yield demands that developing groups add information from several (probably more than three) sources for this purpose. Further research is needed to replicate our findings and enhance our understanding of how to efficiently update recommendations.

简介更新指南建议需要进行全面而有效的文献检索。尽管有新的信息平台可供开发小组使用,但它们对这一目的的相对贡献仍不确定:方法:作为对 2 型糖尿病的八项循证建议进行回顾/更新的一部分,我们评估了以下五种文献检索方法(以系统回顾为目标,使用预定标准):MEDLINE的PubMed、Epistemonikos数据库基本搜索、使用结构化搜索策略的Epistemonikos数据库、Living overview of evidence (L.OVE)平台和TRIP数据库。三位审稿人独立将检索到的参考文献分为肯定符合条件、可能符合条件或不符合条件。所有审稿人都认为属于同一 "肯定 "类别的参考文献被标记为 "真正的 "阳性/阴性。其余参考文献则进行重新评估,如果一致认为符合/不符合条件,则分别成为 "假 "阴性/阳性。我们描述了每种方法的结果,并计算了 "诊断准确性 "指标和一致性统计:结果:五种方法共为八项建议确定了 318 至 505 篇参考文献,经过两轮审查后,审查员认为其中 4.2% 至 9.4% 符合条件。虽然 Pubmed 的表现优于其他方法(诊断几率比 12.5 对 2.6 至 5.3),但没有任何一种搜索方法能返回所有建议的合格参考文献。单独检索最多只能找到所有符合条件的参考文献的 40%(n = 71),而任何三种方法的组合都无法找到超过 80% 的参考文献。检索之间的 Kappa 统计结果非常不理想(10 次配对比较中有 9 次没有超过机会预期的一致性):结论:在所评估的信息平台中,PubMed 在更新这组建议方面似乎更有效率。结论:在评估的信息平台中,PubMed 在更新这套建议书方面似乎更有效率。然而,由于各种搜索方法在参考产量方面的一致性非常差,因此开发小组需要为此目的添加来自多个(可能超过三个)来源的信息。我们需要进一步研究,以复制我们的发现,并加深我们对如何有效更新建议的理解。
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引用次数: 0
Letter to the editor on "education on pain disciplines in physical therapy in Chile: In need of change". 致编辑的信,主题为 "智利物理治疗中的疼痛学科教育:需要改变"。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-10 DOI: 10.5867/medwave.2024.05.2907
Felipe Ponce-Fuentes, Joaquín Salazar-Méndez, Iván Cuyul-Vásquez
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引用次数: 0
Exploratory analysis on payment mechanisms to Community Mental Health Centers in Chile using mixed grounded theory. 运用混合基础理论对智利社区心理健康中心的支付机制进行探索性分析。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-04 DOI: 10.5867/medwave.2024.05.2920
Olga Toro-Devia, Rubén Alvarado, Mercedes Jeria, Denise Razzouk, Luis Salvador-Carulla

Introduction: Research on psychiatric deinstitutionalization has neglected that reforms in this field are nested in a health system that has undergone financial reforms. This subordination could introduce incentives that are misaligned with new mental health policies. According to Chile's National Mental Health Plan, this would be the case in the Community Mental Health Centers (CMHC). The goal is to understand how the CMHCpayment mechanism is a potential incentive for community mental health.

Methods: A mixed quantitative-qualitative convergent study using grounded theory. We collected administrative production data between 2010 and 2020. Following the payment mechanism theory, we interviewed 25 payers, providers, and user experts. We integrated the results through selective coding. This article presents the relevant results of mixed selective integration.

Results: Seven payment mechanisms implemented heterogeneously in the country's CMHC are recognized. They respond to three schemes subject to rate limits and prospective public budget. They differ in the payment unit. They are associated with implementing the community mental health model negatively affecting users, the services provided, the human resources available, and the governance adopted. Governance, management, and payment unit conditions favoring the community mental health model are identified.

Conclusions: A disjointed set of heterogeneously implemented payment schemes negatively affects the community mental health model. Formulating an explicit financing policy for mental health that is complementary to existing policies is necessary and possible.

导言:有关精神病院去机构化的研究忽视了这一领域的改革是嵌套在已进行财政改革的卫生系统中的。这种从属关系可能会引入与新的心理健康政策不一致的激励机制。根据智利国家心理健康计划,社区心理健康中心(CMHC)就属于这种情况。我们的目标是了解社区精神健康中心的支付机制如何成为社区精神健康的潜在激励机制:方法:采用基础理论进行定量-定性混合研究。我们收集了 2010 年至 2020 年间的行政生产数据。根据支付机制理论,我们采访了 25 位支付方、提供方和用户专家。我们通过选择性编码对结果进行了整合。本文介绍了混合选择性整合的相关结果:结果:我们确认了在该国医疗健康中心异质性实施的七种支付机制。它们响应了三种受费率限制和预期公共预算约束的计划。它们的支付单位各不相同。它们与社区精神健康模式的实施相关联,对使用者、所提供的服务、可用的人力资源以及所采取的治理方式产生了负面影响。结论:结论:一套杂乱无章的支付方案对社区精神卫生模式产生了负面影响。制定明确的精神卫生筹资政策,对现有政策进行补充,是必要的,也是可行的。
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引用次数: 0
International migration, food insecurity, and mental health: A scoping review protocol. 国际移民、粮食不安全与心理健康:范围界定审查协议。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-30 DOI: 10.5867/medwave.2024.04.2802
Alice Blukacz, Báltica Cabieses, Catalina Huerta, Amelia A Lake, Jo Smith, Emma L Giles, Faye Deane

Introduction: Food insecurity is a global priority that has been found to negatively impact mental health, increasing the risk of mental disorders and severe mental illness. International migrants may face food insecurity throughout their migratory cycle due to a range of risk factors, such as poor transit conditions, precarious employment, financial pressure, discrimination, and lack of availability and access to culturally relevant food, among others. Although there are multiple reviews on migration, food insecurity, and health in general, no scoping review has been conducted on food insecurity among international migrants focusing on mental health.

Objective: To investigate the available evidence on food insecurity and mental health among international migrants.

Methods: A search of scientific literature in English, Spanish, French, Italian, and Portuguese published since 2013 will be performed in the Web of Science, PubMed, Medline, APA PsycArticles, Cinahl, and ASSIA databases, including grey literature available in Google Scholar. Two authors will independently review titles, abstracts, and full texts before extracting data from publications complying with the eligibility criteria. Extracted data will be descriptively mapped according to emerging thematic categories.

Expected results: The review will contribute to identifying what is known about international migration, food insecurity, and mental health, gaps in the literature, opportunities for specific research subtopics, and how food insecurity and mental health can be linked in the existing literature.

导言:粮食不安全是一个全球优先事项,已被发现会对心理健康产生负面影响,增加精神障碍和严重精神疾病的风险。由于一系列风险因素,如恶劣的过境条件、不稳定的就业、经济压力、歧视、缺乏文化相关食物的供应和获取途径等,国际移民在整个移徙周期中都可能面临粮食不安全问题。尽管对移民、粮食不安全和一般健康问题进行了多次综述,但尚未对国际移民的粮食不安全问题进行以心理健康为重点的范围综述:调查有关国际移民中粮食不安全和心理健康的现有证据:将在 Web of Science、PubMed、Medline、APA PsycArticles、Cinahl 和 ASSIA 数据库中搜索 2013 年以来发表的英文、西班牙文、法文、意大利文和葡萄牙文科学文献,包括谷歌学术中的灰色文献。两位作者将独立审阅标题、摘要和全文,然后从符合资格标准的出版物中提取数据。提取的数据将根据新出现的主题类别进行描述性映射:该综述将有助于确定有关国际移民、粮食不安全和心理健康的已知信息、文献中的空白、特定研究子课题的机会,以及如何在现有文献中将粮食不安全和心理健康联系起来。
{"title":"International migration, food insecurity, and mental health: A scoping review protocol.","authors":"Alice Blukacz, Báltica Cabieses, Catalina Huerta, Amelia A Lake, Jo Smith, Emma L Giles, Faye Deane","doi":"10.5867/medwave.2024.04.2802","DOIUrl":"https://doi.org/10.5867/medwave.2024.04.2802","url":null,"abstract":"<p><strong>Introduction: </strong>Food insecurity is a global priority that has been found to negatively impact mental health, increasing the risk of mental disorders and severe mental illness. International migrants may face food insecurity throughout their migratory cycle due to a range of risk factors, such as poor transit conditions, precarious employment, financial pressure, discrimination, and lack of availability and access to culturally relevant food, among others. Although there are multiple reviews on migration, food insecurity, and health in general, no scoping review has been conducted on food insecurity among international migrants focusing on mental health.</p><p><strong>Objective: </strong>To investigate the available evidence on food insecurity and mental health among international migrants.</p><p><strong>Methods: </strong>A search of scientific literature in English, Spanish, French, Italian, and Portuguese published since 2013 will be performed in the Web of Science, PubMed, Medline, APA PsycArticles, Cinahl, and ASSIA databases, including grey literature available in Google Scholar. Two authors will independently review titles, abstracts, and full texts before extracting data from publications complying with the eligibility criteria. Extracted data will be descriptively mapped according to emerging thematic categories.</p><p><strong>Expected results: </strong>The review will contribute to identifying what is known about international migration, food insecurity, and mental health, gaps in the literature, opportunities for specific research subtopics, and how food insecurity and mental health can be linked in the existing literature.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"24 4","pages":"e2802"},"PeriodicalIF":1.2,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Methodological considerations in the study of perceived discrimination at work and its association with workers health and occupational outcomes: A scoping review. 工作中感知到的歧视及其与工人健康和职业结果的关系研究中的方法考虑:范围综述。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-22 DOI: 10.5867/medwave.2024.04.2910
Gonzalo Bravo, Alejandra Fuentes-Garcia, María Arriagada, Héctor Castellucci

Introduction: Perceived workplace discrimination is a complex phenomenon involving unfair treatment in the workplace based on personal characteristics such as age, ethnicity, gender, or disability. The objective of this study is to explore the association of perceived workplace discrimination with health and occupational outcomes.

Methods: Following the PRISMA-ScR guidelines and the Joanna Briggs Institute methodology, a scoping review of articles published between 2000 and 2022 was conducted in databases such as Pubmed, Scopus, and PsyInfo. Inclusion criteria focused on studies exploring perceived workplace discrimination among workers, excluding those on patients, students, or the general population, and articles not written in English or Spanish.

Results: Of the 9,871 articles identified, 102 met the criteria and were analyzed. Research showed a progressive increase in the study of perceived workplace discrimination, with a majority of studies in North America and Europe and a predominance of cross-sectional designs. Most studies did not clearly define the concept of perceived workplace discrimination nor report the psychometric characteristics of the measurement instruments. A significant association was found between perceived discrimination and negative outcomes in workers' mental and physical health, as well as a negative impact on job satisfaction and an increase in absenteeism. Additionally, sociodemographic characteristics such as race/ethnicity, gender, and age influenced the perception of discrimination.

Conclusions: This review confirms that perceived workplace discrimination significantly impacts the health and job satisfaction of workers, with particular detriment in minorities and women. Despite an increase in research over the last two decades, there remains a lack of consistency in the definition and measurement of the phenomenon. Most studies have used cross-sectional designs, and there is a notable absence of research in the Latin American context.

导言:感知到的工作场所歧视是一种复杂的现象,涉及工作场所中基于年龄、种族、性别或残疾等个人特征的不公平待遇。本研究旨在探讨感知到的工作场所歧视与健康和职业结果之间的关系:按照 PRISMA-ScR 指南和乔安娜-布里格斯研究所(Joanna Briggs Institute)的方法,在 Pubmed、Scopus 和 PsyInfo 等数据库中对 2000 年至 2022 年间发表的文章进行了范围界定。纳入标准主要是探讨工人感知到的工作场所歧视的研究,不包括以病人、学生或普通人群为对象的研究,也不包括非英语或西班牙语撰写的文章:在确定的 9871 篇文章中,有 102 篇符合标准并进行了分析。研究表明,对感知到的工作场所歧视的研究在逐步增加,大多数研究在北美和欧洲进行,并且以横断面设计为主。大多数研究没有明确界定感知到的职场歧视的概念,也没有报告测量工具的心理测量特征。研究发现,感知到的歧视与工人身心健康的负面结果、对工作满意度的负面影响以及缺勤率的增加之间存在重要关联。此外,种族/民族、性别和年龄等社会人口特征也会影响对歧视的感知:本综述证实,感知到的工作场所歧视会严重影响工人的健康和工作满意度,尤其是对少数群体和女性不利。尽管在过去二十年中,相关研究不断增加,但对这一现象的定义和测量仍缺乏一致性。大多数研究都采用了横断面设计,而且明显缺乏针对拉丁美洲的研究。
{"title":"Methodological considerations in the study of perceived discrimination at work and its association with workers health and occupational outcomes: A scoping review.","authors":"Gonzalo Bravo, Alejandra Fuentes-Garcia, María Arriagada, Héctor Castellucci","doi":"10.5867/medwave.2024.04.2910","DOIUrl":"https://doi.org/10.5867/medwave.2024.04.2910","url":null,"abstract":"<p><strong>Introduction: </strong>Perceived workplace discrimination is a complex phenomenon involving unfair treatment in the workplace based on personal characteristics such as age, ethnicity, gender, or disability. The objective of this study is to explore the association of perceived workplace discrimination with health and occupational outcomes.</p><p><strong>Methods: </strong>Following the PRISMA-ScR guidelines and the Joanna Briggs Institute methodology, a scoping review of articles published between 2000 and 2022 was conducted in databases such as Pubmed, Scopus, and PsyInfo. Inclusion criteria focused on studies exploring perceived workplace discrimination among workers, excluding those on patients, students, or the general population, and articles not written in English or Spanish.</p><p><strong>Results: </strong>Of the 9,871 articles identified, 102 met the criteria and were analyzed. Research showed a progressive increase in the study of perceived workplace discrimination, with a majority of studies in North America and Europe and a predominance of cross-sectional designs. Most studies did not clearly define the concept of perceived workplace discrimination nor report the psychometric characteristics of the measurement instruments. A significant association was found between perceived discrimination and negative outcomes in workers' mental and physical health, as well as a negative impact on job satisfaction and an increase in absenteeism. Additionally, sociodemographic characteristics such as race/ethnicity, gender, and age influenced the perception of discrimination.</p><p><strong>Conclusions: </strong>This review confirms that perceived workplace discrimination significantly impacts the health and job satisfaction of workers, with particular detriment in minorities and women. Despite an increase in research over the last two decades, there remains a lack of consistency in the definition and measurement of the phenomenon. Most studies have used cross-sectional designs, and there is a notable absence of research in the Latin American context.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"24 4","pages":"e2910"},"PeriodicalIF":1.2,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Key factors in the choice of appropriate outcomes for clinical trials. 为临床试验选择适当结果的关键因素。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-15 DOI: 10.5867/medwave.2024.04.2790
Carlos Cabrera-Ubilla, Vicente Nuñez-Galleguillos, Javier Bracchiglione, Roberto Garnham, Ignacio Pérez

Health research is the foundation of medical knowledge and healthcare system recommendations. Therefore, choosing appropriate outcomes in studies of therapeutic interventions is a fundamental step in producing evidence and, subsequently, for decision-making. In this article, we propose three key factors for the choice of outcomes: the inclusion of patient-reported outcomes, since they focus on the patient's perception of their health status and quality of life; the consideration of clinically relevant outcomes, which are direct measurements of the patient's health status and, therefore, will be decisive in decision-making; and the use of core outcome sets, a tool that standardizes the measurement and interpretation of outcomes, facilitating the production and synthesis of appropriate evidence for the evidence ecosystem. The correct choice of outcomes will help health decision-makers and clinicians deliver appropriate patient-centered care and optimize the use of resources in healthcare and clinical research.

健康研究是医学知识和医疗保健系统建议的基础。因此,在治疗干预研究中选择适当的结果是产生证据的基本步骤,也是决策的基本步骤。在本文中,我们提出了选择结果的三个关键因素:纳入患者报告的结果,因为这些结果侧重于患者对其健康状况和生活质量的感知;考虑临床相关结果,因为这些结果是对患者健康状况的直接测量,因此在决策中起决定性作用;使用核心结果集,这是一种对结果的测量和解释进行标准化的工具,有助于为证据生态系统提供和综合适当的证据。正确选择结果将有助于卫生决策者和临床医生提供以患者为中心的适当护理,并优化医疗保健和临床研究资源的使用。
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引用次数: 0
Daily compliance of the ABCDEF liberation bundle for patients in the intensive care unit: A retrospective descriptive study 重症监护室病人的捆绑治疗:回顾性描述研究。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-09 DOI: 10.5867/medwave.2024.04.2795
Felipe Muñoz-Muñoz, Jaime Leppe, Felipe González-Seguel, Ana Castro-Ávila

Introduction: Implementing the ABCDEF bundle has demonstrated improved outcomes in patients with critical illness. This study aims to describe the daily compliance of the ABCDEF bundle in a Chilean intensive care unit.

Methods: Retrospective observational study of electronic clinical records of nursing, physiotherapy, and medical professionals who cared for patients over 18 years of age, admitted to an intensive care unit for at least 24 hours, with or without mechanical ventilation. Daily bundle compliance was determined by considering the daily records for each element: Assess pain (element A), both spontaneous awakening trials (element B1) and spontaneous breathing trials (element B2), choice of sedation (element C), delirium assessment (element D), early mobilization (element E), and family engagement (element F).

Results: 4165 registered bundle elements were obtained from nursing (47%), physiotherapy (44%), and physicians (7%), including 1134 patient/days (from 133 patients). Elements E and C showed 67 and 40% compliance, while D, A, and B2 showed 24, 14 and 11%, respectively. For B1 and F, 0% compliance was achieved. Compliance was higher in patients without mechanical ventilation for A and E, while it was similar for D.

Conclusions: Early mobilization had the highest compliance, while spontaneous awakening trials and family engagement had absolute non-compliance. Future studies should explore the reasons for the different degrees of compliance per bundle element in clinical practice.

介绍:实施 ABCDEF 套件已证明可改善危重症患者的治疗效果。本研究旨在描述智利一家重症监护病房对 ABCDEF 套件的日常遵守情况:方法:对护理 18 岁以上、入住重症监护病房至少 24 小时、使用或不使用机械通气的患者的护理、物理治疗和医疗专业人员的电子临床记录进行回顾性观察研究。日常捆绑护理的合规性是通过对每项内容的日常记录来确定的:评估疼痛(要素 A)、自发唤醒试验(要素 B1)和自发呼吸试验(要素 B2)、镇静剂选择(要素 C)、谵妄评估(要素 D)、早期动员(要素 E)和家属参与(要素 F):从护理(47%)、物理治疗(44%)和医生(7%)处获得了 4165 个注册捆绑要素,其中包括 1134 个患者/日(来自 133 名患者)。要素 E 和 C 的符合率分别为 67% 和 40%,而 D、A 和 B2 的符合率分别为 24%、14% 和 11%。B1 和 F 的依从性为 0%。在没有机械通气的患者中,A 和 E 的顺应性更高,而 D 的顺应性与之相似:结论:早期动员的依从性最高,而自发唤醒试验和家属参与的依从性绝对较低。未来的研究应探讨临床实践中各捆绑要素依从性程度不同的原因。
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引用次数: 0
Protocol for a systematic mapping review of surgical and pharmacological interventions for the treatment of trigeminal neuralgia. 关于治疗三叉神经痛的手术和药物干预措施的系统性绘图审查协议。
IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-08 DOI: 10.5867/medwave.2024.04.2759
Dominga Ladevig, Valentina Veloso, Camila Ávila-Oliver
<p><strong>Introduction: </strong>Trigeminal neuralgia is a painful neuropathic disorder characterized by sudden electric shock-like pain that significantly impacts patients' quality of life. Multiple treatment alternatives are available, including medical and surgical options but establishing the optimal course of action can be challenging. To enhance clinical decision-making for trigeminal neuralgia treatment, it is imperative to organize, describe and map the available systematic reviews and randomized trials. This will help identify the best treatment alternatives supported by evidence and acknowledge potential knowledge gaps where future research is needed.</p><p><strong>Objective: </strong>This systematic mapping review aims to provide up-to-date evidence on the different surgical and pharmacological treatment alternatives used for trigeminal neuralgia.</p><p><strong>Methods: </strong>A search will be systematically conducted on the Epistemonikos database to identify potentially eligible systematic reviews. Additionally, a search will be made in PubMed, CENTRAL, and EBSCO to identify randomized controlled trials assessing pharmacological and surgical treatment interventions for trigeminal neuralgia. Two independent reviewers will screen and select the studies. Data on the different treatment alternatives and reported outcomes in the included studies will be extracted using standardized forms. Following extraction, descriptive statistical methods will be used to analyze the data. The final output of this study will include an evidence map that will illustrate the connections between different treatments and their respective outcomes, providing a clear depiction of the evidence landscape.</p><p><strong>Expected results: </strong>This study expects to map, describe and assess the methodological quality of the available systematic reviews and trials on pharmacological interventions and neurosurgical procedures for treating trigeminal neuralgia. It will present the results in an evidence map that organizes the available evidence based on their different interventions and outcomes. This evidence map will serve as a visual tool to assist healthcare professionals and patients to understand evidence-based treatment options and their implications for managing this medical condition.</p><p><strong>Introducción: </strong>La neuralgia del trigémino es un trastorno neuropático doloroso caracterizado por un dolor súbito y agudo, similar a una descarga eléctrica, que impacta significativamente en la calidad de vida. Dada la variedad de tratamientos disponibles, médicos y quirúrgicos, es crucial organizar y mapear la evidencia proveniente de revisiones sistemáticas y ensayos clínicos para orientar las decisiones clínicas. Esto permite identificar tratamientos respaldados por evidencia y señalar áreas de investigación futura.</p><p><strong>Objetivo: </strong>El propósito de esta revisión sistemática de mapeo es proporcionar una visión actualizada de la evide
导言:三叉神经痛是一种神经痛性疾病,其特点是突发性电击样疼痛,严重影响患者的生活质量。目前有多种治疗方法可供选择,包括药物治疗和手术治疗,但确定最佳治疗方案可能具有挑战性。为了加强三叉神经痛治疗的临床决策,必须对现有的系统综述和随机试验进行整理、描述和绘图。这将有助于确定有证据支持的最佳治疗方案,并确认未来需要研究的潜在知识缺口。方法:将在 Epistemonikos 数据库中系统地进行检索,以确定可能符合条件的系统性综述。此外,还将在 PubMed、CENTRAL 和 EBSCO 中进行检索,以确定评估三叉神经痛药物和手术治疗干预措施的随机对照试验。两名独立审稿人将对研究进行筛选。将使用标准化表格提取纳入研究的不同治疗方案和报告结果的数据。提取后,将使用描述性统计方法对数据进行分析。本研究的最终成果将包括一份证据图谱,该图谱将说明不同治疗方法及其各自结果之间的联系,从而提供一份清晰的证据图谱。预期成果:本研究将对现有的关于治疗三叉神经痛的药物干预和神经外科手术的系统综述和试验进行图谱绘制、描述和方法学质量评估。研究将以证据地图的形式呈现研究结果,该地图将根据不同的干预措施和结果对现有证据进行整理。该证据图将作为一种可视化工具,帮助医护人员和患者了解循证治疗方案及其对控制这种病症的影响:三叉神经痛是一种神经痛性疾病,其特点是突发性、剧烈、电击样疼痛,严重影响生活质量。鉴于现有的药物和手术治疗方法多种多样,因此对系统综述和临床试验中的证据进行整理和绘图以指导临床决策至关重要。本系统综述图谱的目的是提供有关治疗三叉神经痛的各种手术和药物治疗方案的现有证据的最新概览。方法:将对 Epistemonikos 数据库进行系统检索,以确定潜在的系统综述。此外,还将在 PubMed、CENTRAL 和 EBSCO 中搜索评估三叉神经痛药物和手术治疗干预的随机临床试验。两名独立审稿人将对研究进行筛选。将使用标准化表格提取所纳入研究中报告的不同治疗方案和结果的数据。提取后,将使用描述性统计方法对数据进行分析。本研究的最终成果将包括一份证据图谱,其中说明了不同治疗方法及其各自结果之间的联系,清晰地呈现了证据状况。预期成果:从本系统图谱中提取的成果包括识别和描述治疗三叉神经痛的不同替代方法,包括药物治疗和手术治疗。此外,我们还计划在随机临床试验和系统综述的基础上绘制证据图谱,有条理地展示不同干预措施及其结果之间的证据。该证据图将作为一种可视化工具,帮助医护人员和患者更好地了解有证据支持的治疗方案及其对该病症的治疗效果。
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