Tabla de la normalidad de las pruebas psicométricas para el diagnóstico de encefalopatía hepática subclínica en la población Dominicana / Score of normality psychometric tests for the diagnosis of subclinical hepatic encephalopathy in the Dominican Population

Introducción: La encefalopatía hepática mínima (EHM), es una enfermedad definida por la existencia de varias alteraciones neurofisiológicas, indetectables a la exploración neurológica y el examen clínico. Dentro de las estrategias diagnosticas para la EHM se contemplan las pruebas psicométricas (PHE), pero para su aplicación es indispensable la estandarización previamente en la población de estudio. Objetivo: El estudio se propuso determinar la tabla de la normalidad de las PHE para diagnosticar la encefalopatía hepática subclínica en una muestra de la población dominicana. Método: Se realizó un estudio descriptivo, prospectivo y transversal en un hospital de referencia nacional. Se analizaron 134 personas clasificados por grupos de edades (18-70 años de edad) y años de escolaridad. Se diseñó una tabla de 5x5. Se estudió la influencia de la edad, sexo, uso de espejuelo y de los años de escolarización en el rendimiento de cada uno de las PHE, para lo cual se utilizaron las siguientes pruebas estadísticas: análisis de varianza (ANOVA), prueba t de Student y regresión lineal. Resultado: La escolaridad y la edad fueron variables determinantes en el desempeño de las 5 pruebas psicométricas. Pero, la correlación univariable de la edad con el desempeño de la prueba TMS no hubo diferencias intra e inter grupos estadísticamente significativas (p>0.171). Conclusión: se confecciono la fórmula de predicción de resultados de los test psicométricos. Ninguno sobrepasó el punto de corte de la puntuación que oscila entre los -4 y los +2 puntos.

Introduction: Minimal hepatic encephalopathy (MHE) is a disease defined by the existence of several neurophysiological alterations, undetectable by neurological examination and clinical examination. Among the diagnostic strategies for EHM, psychometric tests (PHE) are contemplated, but for their application, prior standardization in the study population is essential. Objective: The study will need to determine the normality table of PHE to detect subclinical hepatic encephalopathy in a sample of the Dominican population. Method: A descriptive, prospective and cross-sectional study was carried out in a national reference hospital. 134 people classified by age groups (18-70 years of age) and years of schooling were analyzed. A 5x5 board is recommended. The influence of age, sex, use of glasses and years of schooling on the performance of each one of the PHEs was studied, for which the following statistical tests were used: analysis of variance (ANOVA), Student's t test and linear regression. Result: Schooling and age were determining variables in the performance of the 5 psychometric tests. But, the univariate coincidence of age with the performance of the TMS test, there were no statistically significant intra and inter group differences (p>0.171). Conclusion: the formula for predicting the results of the psychometric tests was made. None exceeded the cut-off point of the score that oscillates between -4 and +2 points.

Pediatric Infectious Diseases Milestones: A Step in the Right Direction to Evaluate Subspecialty Learners.

We share the work of the ACGME Pediatric Infectious Diseases Working Group in creating the Pediatric Infectious Diseases-Specific Milestones and discuss key considerations that lead to the reformation of competencies to better assess learners in Pediatric Infectious Diseases.

Use of vinasse and coffee waste as chelating agent of photo-Fenton landfill leachate treatment.

This research studies the use of vinasse (VS) coming from Pisco and caffeic acid (Caa) from solid coffee waste as chelating agents of this process, to carry out a photo-Fenton process using UVc lamps of 254-nm wavelength for 60 min, at the natural pH of the landfill leachate (8.9). Without the chelating agent, there was a removal of UV 254 and COD of 54.2% and 54.7%, respectively, when the photo-Fenton reaction was carried out at pH 3; at pH 6, the removal of UV 254 and COD was 13.1% and 39.2%, respectively, and at pH 8.9, the elimination of UV 254 and COD was 10.8% and 16.1%, respectively. When Caa was used in the landfill leachate (LL) for the photo-catalytic processes carried out at pH 8.9, a removal of 24.1%, 43.0%, and 47.4% of UV 254 was obtained using 5 mg/L, 50 mg/L, and 100 mg/L of Caa. The removal of UV 254 was 27.3%, 30.7%, and 36.3% using 5 mg/L, 50 mg/L, and 100 mg/L of VS, respectively, and the removal of COD was 32.2%, 35.4%, and 39.2% using 5 mg/L, 50 mg/L, and 100 mg/L of VS, respectively. When Caa was used in the LL at pH 8.9, the concentration of total Fe went from 37.5 to 33.2, from 40.2 to 36.8, and from 45.2 to 42.1, using 5 mg/L, 50 mg/L, and 100 mg/L of caffeic acid, respectively. Using VS in the LL at pH 8.9, the concentration of total Fe along the run went from 35.1 to 32.2, from 39.4 to 34.8, and from 42.1 to 40.2, using 5 mg/L, 50 mg/L, and 100 mg/L of VS, respectively. As a result of these processes, it was noted that the use of Caa and VS increases the solubility of Fe at a higher pH.

Sistema CAD/CAM en la confección de prótesis totales dentales / The CAD/CAM system in the fabrication of total dental prostheses

La técnica CAD/CAM es un sistema que ha facilitado los procesos de toma de impresiones totales e incorpora registros intraorales y requisitos apropiados para lograr bases protésicas adecuadas, lo cual permite óptimos resultados en clínica dental, como son el ahorro de tiempo y la comodidad para el especialista y el paciente, razones que llevan al profesional estomatológico a dar el paso hacia una odontología digital. El objetivo del estudio fue analizar el sistema CAD/CAM en la confección de prótesis totales dentales. La búsqueda se realizó en las bases de datos Google Scholar, Pubmed y Scopus, intentando responder a la pregunta orientadora: ¿Cuáles son los aspectos más significativos para el sistema CAD/CAM en la confección de prótesis totales dentales? Como resultados, se pudo interpretar que, consiguiendo registros tridimensionales producidos en un escáner, se proporciona una mejor adaptación de estructuras respecto a los métodos convencionales, por lo que induce estética y precisión, que son factores importantes en la odontología. Se concluyó que el sistema CAD/CAM disminuye el margen de error humano y conduce a mayores éxitos odontológicos, al brindar un mejor soporte para la toma decisiones y conseguir mejores resultados estéticos y funcionales en las prótesis totales de los pacientes(AU)

The CAD/CAM technique is a system that has facilitated the process of taking total impressions and incorporates intraoral records and appropriate requirements to achieve adequate prosthetic bases, which allows optimal results in the dental clinic, such as time savings and comfort for the specialist and the patient, reasons that lead the dental professional to take the step towards digital dentistry. The objective of the study was to analyze the CAD/CAM system in the fabrication of total dental prostheses. The search was carried out in Google Scholar, Pubmed and Scopus databases, trying to answer the guiding question: What are the most significant aspects for the CAD/CAM system in the manufacture of total dental prostheses? As results, it was possible to interpret that, by obtaining three-dimensional records produced in a scanner, it provides a better adaptation of structures compared to conventional methods, thus inducing esthetics and precision, which are important factors in dentistry. It was concluded that the CAD/CAM system reduces the margin of human error and leads to greater dental success by providing better support for decision making and achieving better esthetic and functional results in the total prostheses of patients(AU)

Rapidly Evolving and Fatal Miliary Tuberculosis and COVID-19 Infection in an Infant.

Tuberculosis (TB) and SARS-CoV-2 (COVID-19) are two important infectious diseases causing morbidity and mortality worldwide. Active TB infection can stimulate host immune responses and together with COVID-19, may lead to cytokine storm and immune dysregulation leading to multi-organ failure. We present a rare case of both miliary tuberculosis and SARS-CoV-2 co-infection in an infant who was a 6-month-old previously healthy term boy. He had persistent cough and congestion, became severely ill, and was brought to the emergency department. He was found to be COVID-19 positive by PCR test. Laboratory studies showed pancytopenia, elevated inflammatory markers, and an abnormal coagulation profile with coagulopathy. He developed strokes, severe sepsis, and electrolyte abnormalities, and declined rapidly within 6 days. Autopsy examination showed multifocal micro-abscesses in multiple organs, which on microscopic examination showed necrotic foci teeming with Mycobacteria and were culture positive for M. tuberculosis Neuropathological examination showed infarction in the right middle and posterior cerebral artery territories. This patient helps illuminate some immunological and pathological aspects of two co-occurring infectious diseases and the susceptibility for the development of fatal complications with SARS-CoV-2 infection in the pediatric population.

Human papillomavirus vaccine effectiveness by number of doses: Updated systematic review of data from national immunization programs.

BACKGROUND: Human papillomavirus (HPV) vaccines were first licensed as a three-dose series. Two doses are now widely recommended in some age groups; there are data suggesting high efficacy with one dose. We updated a systematic literature review of HPV vaccine effectiveness by number of doses in observational studies. METHODS: We searched Medline and Embase databases from January 1, 2007, through September 29, 2021. Data were extracted and summarized in a narrative synthesis. We also conducted quality assessments for bias due to selection, information, and confounding. RESULTS: Overall, 35 studies were included; all except one were conducted within the context of a recommended three-dose schedule. Evaluations were in countries that used bivalent HPV vaccine (seven), quadrivalent HPV vaccine (27) or both (one). Nine evaluated effectiveness against HPV infection, ten anogenital warts, and 16 cervical abnormalities. All studies were judged to have moderate or serious risk of bias. The biases rated as serious would likely result in lower effectiveness with fewer doses. Investigators attempted to control for or stratify by potentially important variables, such as age at vaccination. Eight studies evaluated impact of buffer periods (lag time) for case counting and 10 evaluated different intervals between doses for two-dose vaccine recipients. Studies that stratified by vaccination age found higher effectiveness with younger age at vaccination, although differences were not all formally tested. Most studies found highest estimates of effectiveness with three doses; significant effectiveness was found among 28/29 studies that evaluated three doses, 19/29 that evaluated two doses, and 18/30 that evaluated one dose. Some studies that adjusted or stratified analyses by age at vaccination found similar effectiveness with three, two and one doses. CONCLUSION: Observational studies of HPV vaccine effectiveness have many biases. Studies examining persons vaccinated prior to sexual activity and using methods to reduce sources of bias are needed for valid effectiveness estimates.

Immunohistochemistry, Quality Control, and Principles of Validation in the Central Nervous System.

The conventional hematoxylin and eosin stain (H&E) is vital for the histological diagnosis but the role of immunohistochemistry (IHC) in the central nervous system is undeniable. Immunohistochemical techniques detect antigens in tissue sections by immunological and chemical reactions. This chapter reviews the preanalytic, analytic, and postanalytic phases of immunohistochemistry, as well as the principles of quality control and validation.

Relación entre características sociodemográficas y estadios de la enfermedad de Alzheimer desde una perspectiva enfermera / Relationship between Sociodemographic Characteristics and Stages of Alzheimer's disease from Nursing Perspective

Introducción: Los cambios demográficos de las últimas décadas favorecen el incremento de personas mayores, este panorama muestra aumento de enfermedades no transmisibles, entre las más frecuentes está la enfermedad de Alzheimer. Los pacientes que la padecen requieren cuidados de enfermería en la atención primaria de salud. Objetivo: Establecer la relación entre características sociodemográficas y estadios de la enfermedad de Alzheimer desde una perspectiva enfermera. Métodos: Estudio descriptivo correlacional en 81 pacientes con enfermedad de Alzheimer, del Policlínico Docente "Julio Antonio Mella" del municipio Guanabacoa, La Habana, Cuba, durante abril-mayo del 2018. Las variables estudiadas fueron: edad, sexo, estadio de la enfermedad, estado civil y nivel educacional. La información se obtuvo del cuestionario sociodemográfico y clínico. Se utilizó frecuencia absoluta, porcentaje, media y desviación estándar para la edad; se comprobó la relación del estadio de la enfermedad con variables sociodemográficas con la prueba coeficiente de correlación de Pearson. Resultados: Pacientes con edad media de 79,22 años; 63,00 por ciento, mujeres; 45,70 por ciento, viudos(as); 64,20 por ciento con escolaridad de secundaria terminada; 63,00 por ciento en estadio moderado de la enfermedad. Se evidenció correlación negativa y positiva entre el estadio de la enfermedad y las características sociodemográficas; con niveles de significancia del 0,01 y 0,05. Conclusiones: Predominaron los pacientes con enfermedad de Alzheimer en el estadio moderado de la enfermedad, femeninas, viudas, con nivel educacional de secundaria terminada y una edad media de 79,22 años. Se identificó correlación entre el estadio de la enfermedad y las características sociodemográficas de los pacientes(AU)

Introduction: The demographic changes of the last decades favor the increase of the elderly; this panorama shows an increase in non-communicable diseases, among the most frequent is Alzheimer's disease. Patients who suffer from it require nursing care in primary health care. Objective: To establish the relationship between sociodemographic characteristics and stages of Alzheimer's disease from a nursing perspective. Methods: Descriptive correlational study in 81 patients with Alzheimer's disease were carried out at Julio Antonio Mella Teaching Polyclinic in Guanabacoa municipality, Havana, Cuba, from April to May 2018. The variables studied were age, sex, stage of the disease, marital status and schooling level. We took information from the sociodemographic and clinical questionnaire. Absolute frequency, percentage, mean and standard deviation for age were used; the relationship of the stage of the disease with sociodemographic variables was verified with the Pearson correlation coefficient test. Results: We found a predominance of patients with mean age of 79.22 years; 63.00 percent, women; 45.70 percent, widowers; 64.20 percent with secondary schooling completed; 63.00 percent in moderate stage of the disease. A negative and positive correlation was evidenced between the stage of the disease and the sociodemographic characteristics; and significance levels of 0.01 and 0.05. Conclusions: Patients with Alzheimer's disease prevailed in the moderate stage of the disease, female, widowed, with high school education level and mean age of 79.22 years. A correlation was identified between the stage of the disease and the sociodemographic characteristics of the patients(AU)

A Snapshot of Current US Medical School Off-Ramp Programs-a Way to Leave Medical School with Another Degree.

Although most students finish medical school, those who do not frequently have no obvious programmatic alternatives. In recent years, a growing number of medical schools have been developing "off-ramp" programs to help such learners. We surveyed 12 medical schools with off-ramp programs to understand their characteristics and challenges. Differences existed between programs but most were deemed helpful to the students and institutions they served. Advantages included the opportunity to acknowledge the students' hard work, increase career opportunities, and reduce debt. Understanding and promoting such programs will assist students for whom medical school does not represent the optimal career path.

Long-term operation of a permeable reactive barrier with diffusive exchange.

In this study, we evaluate the long term operation of a bench-scale reactor which simulates a permeable reactive barrier with sulfidic diffusive exchange (SDES PRB) to treat acid mine drainage (AMD), considering that treatment costs are very sensitive to the useful life for passive reactors. Its functioning was evaluated for a much longer period of 591 days compared to previous SDES PRB studies, with two influents simulating moderately and highly acid groundwater contaminated by AMD. First, we fed water amended with 200 mg/L Zn2+ and 3300 mg/L SO42- at pH 4.9; and after, water with 450 mg/L Fe2+, 100 mg/L Zn2+, 10 mg/L Ni2+, 5 mg/L Cu2+ and 3600 mg/L SO42- at pH 2.5. Biologically produced sulfide and alkalinity were enough to remove both metals and acidity (~99%) from the moderately acidic water, while with the highly acidic water, they resulted in significant removal of the metals reaching up to 87% and 79% of total Fe and Zn, respectively. Furthermore, no inhibitory effect was apparent, as the sulfate reduction rates in the two experiments did not vary significantly (averages close to 0.2 mol/m3-d), despite the much higher acidity and metal load in the second case. Hence, the SDES PRB protected the microbial consortium from metal toxicity and acidity in the long-term, and thus is suitable for remediation of AMD contaminated groundwater with high concentrations of metals, extending the operational range of conventional biological PRBs. Furthermore, an economic evaluation shows that SDES costs can be competitive with the costs of conventional chemical precipitation if the enhanced reactivity that SDES technology offers is realized.

Teoría de Kristen M. Swanson vinculada al cuidado del cuidador principal de pacientes con enfermedad de Alzheimer / Kristen M. Swanson Theory linked under the care to the principal caregiver of patient with Alzheimer disease

Introducción: La enfermedad de Alzheimer es causa frecuente de demencia, esta tiene impacto social y económico para los pacientes, los sistemas de salud y las familias, lo cual provoca que los enfermos sean atendidos por familiares, amigos o vecinos, que no siempre son personas capacitadas y se les denomina cuidadores informales. Objetivo: Exponer la vinculación de la teoría de Kristen M. Swanson al cuidado del cuidador principal de pacientes con enfermedad de Alzheimer. Métodos: Revisión bibliográfica descriptiva para un análisis crítico reflexivo de contenido de artículos originales, artículos de revisión, libros de la especialidad y tesis de grado. Las palabras clave identificadas en DeCS y operadores booleanos utilizados fueron: "enfermedad de Alzheimer" OR "demencia" AND "cuidadores" AND "teoría de enfermería". La búsqueda fue realizada en las bases de datos SciELO (Scientific Electronic Library Online) y el motor de búsqueda Google académico, desde mayo hasta junio del 2019. Se consideró como criterio de inclusión los artículos publicados en idioma español e inglés y los disponibles a texto completo en las bases de datos seleccionadas. Se utilizó el diagrama de flujo (PRISMA) para contribuir a la formulación de la estrategia de búsqueda. Conclusiones: Se expuso la teoría de los cuidados de Kristen M. Swanson, representante de la escuela de la interacción, su vínculo en el cuidado del paciente con enfermedad de Alzheimer, así como su posible vinculación en otros contextos en los que se desempeña el personal de enfermería. Se constató la carencia en el contexto cubano de estudios sustentados en esta teoría(AU)

Introduction: Alzheimer's disease is frequent cause of dementia; this has a great social and economic impact for the patients, the health's systems and the families; that which causes that the sick persons are assisted by relatives, friends or neighbors that are not always qualified people and they are denominated informal caregivers. Objective: to present Kristen M. Swanson theory to the principal caregivers care of patient suffering from Alzheimer's disease. Methods: a descriptive bibliographic review was carried out for a critical reflexive analysis of the content of original and review articles, books of the specialty and grade thesis. The keywords identified in DeCS and Boolean operators used: "Alzheimer diseases" OR "dementia" AND "caregivers" AND "nursing theory" The search was carried out in the SciELO (Scientific Electronic Library Online) and the search motor academic Google database, from May until June of the 2019. It was considered as inclusion criteria articles published in Spanish and English language and, the available ones to complete text in the selected databases. The flow chart (PRISMA) was used to contribute to the formulation of the search strategy. Conclusions: the theory of caring of Kristen M. Swanson was presented, representative of the interaction school, its linking in the Alzheimer disease patient's care, as well as its possible link in other contexts in those that the nursing personnel works. It was confirmed the deficient in the Cuban context of studies sustained in this theory(AU)

Meaning of well-being of older institutionalized persons in abandonment situation.

OBJECTIVE: To understand the meaning of well-being of older persons in situation of abandonment. METHODS: a qualitative phenomenological study, carried out in a nursing home in Tepic, Nayarit, from 2017 to 2019. Intentional sampling with 12 older persons aged 60 and above. Data collection occurred by phenomenological interview. The ethical criteria of the General Health Law were respected. Participants signed the Informed Consent Form. Data analysis took place through phenomenological analysis. RESULTS: four themes have emerged: 1. Living Activities of Daily Living; 2. Attention to physical needs; 3. Coexistence; 4. Spirituality experience. CONCLUSION: for older persons, living institutionalized implies a process of adaptation and transformation to their context and state of life, restructuring their needs that provide well-being. It is important to approach these scenarios to establish ways of experiencing aging that favor a full quality of life.

Murine Typhus Outbreak Presenting as Multisystem Inflammatory Syndrome in Children During SARS-CoV-2 Pandemic.

Multisystem inflammatory syndrome in children is a severe illness associated with the SARS-CoV-2 pandemic that possesses features overlapping with other pediatric diseases causing systemic inflammation. Significant diagnostic and treatment uncertainty remain, and clinicians should maintain a broad differential when evaluating patients for multisystem inflammatory syndrome in children, as antibiotic-susceptible infections such as murine typhus may present similarly.

Integrated probabilistic risk assessment in sites contaminated with arsenic and lead by long-term mining liabilities in San Luis Potosi, Mexico.

Mining environmental liabilities (MEL) in San Luis Potosi are the result of more than 450 years of mining activity, which has contaminated the soil mainly with arsenic (As) and lead (Pb) in several areas. Risk assessments are used to estimate the possibility of the occurrence of adverse effects on human health or on ecological receptors; and the most accessible way of performing them is through probabilistic estimates such as the Latin Hypercube Sampling (LHS) model. Therefore, the aim of this study was to carry out an Integrated Probabilistic Environmental Risk Assessment (IPERA) for the estimation of health risks in infants and rodents. The mean concentrations of As and Pb in soil were significantly higher (p<0.05) in all contaminated sites than in their respective reference sites. Villa de la Paz was the site with the highest mean concentration of As (1374 mg/kg), while Charcas was the one with the highest level of Pb (12,929 mg/kg). The Hazard Quotient (HQ) was calculated and Villa de la Paz had the highest values of As in both rodents (11.994) and children (39.32), and Charcas showed the highest values of Pb in both (24.971 and 31.668 for rodents and children respectively). The cumulative hazard Index (HI) reveals there is a very significant health risk due to As and Pb exposure for both rodents and children in contaminated areas of these mining communities.

Perinatal HIV-1 Infection in an Extremely Low Birth Weight Infant.

There is limited guidance on how to treat extremely premature infants with HIV infection. This can lead to delay of antiretroviral therapy initiation adversely affecting magnitude of HIV reservoir and disease progression. We report perinatal HIV-1 infection in an extremely low birth weight infant born at 24 5/7 weeks of gestation. Treatment challenges, viral dynamics and clinical outcomes are described.

Health Disparities Past the Classroom: The Impact of Frontier Medicine on Students.

In 2000, the Liaison Committee on Medical Education issued a standard for cultural competence for medical students, stating the necessity of understanding different belief systems and cultures and how biases can affect health care and perpetuate health disparities. While many programs travel overseas to address this standard, our study evaluated an in-state, study-away, service-learning mission trip program's efficacy of improving cultural competence and awareness of health disparities, as well as facilitating the ease of participation for students. Our overall goal was to provide a rich field opportunity in our own backyard that would allow students to visit a foreign environment without leaving the country, simultaneously eliminating the financial burden that comes with international travel and to expose the students to health disparities through partnership with local community centers and clinics present in the frontier region of southwest Texas (2016 - 2018). Post-trip assessments revealed that students were surprised by the disparities found within the state and gained a better understanding of community need. Subsequently, students revealed the desire to pursue careers that administer care to underserved populations and to improve their Spanish language skills. We concluded that this program increased awareness of cultural competency comparable to study-abroad programs. Post-trip evaluations were helpful in assessing change and impact on the students' cultural and health disparities awareness.

Medical Spanish Standardization in U.S. Medical Schools: Consensus Statement From a Multidisciplinary Expert Panel.

Medical Spanish (MS) education is in growing demand from U.S. medical students, providers, and health systems, but there are no standard recommendations for how to structure the curricula, evaluate programs, or assess provider performance or linguistic competence. This gap in medical education and assessment jeopardizes health care communication with Hispanic/Latino patients and poses significant quality and safety risks. The National Hispanic Health Foundation and University of Illinois College of Medicine convened a multidisciplinary expert panel in March 2018 to define national standards for the teaching and application of MS skills in patient-physician communication, establish curricular and competency guidelines for MS courses in medical schools, propose best practices for MS skill assessment and certification, and identify next steps needed for the implementation of the proposed national standards. Experts agreed on the following consensus recommendations: (1) create a Medical Spanish Taskforce to, among other things, define educational standards; (2) integrate MS educational initiatives with government-funded research and training efforts as a strategy to improve Hispanic/Latino health; (3) standardize core MS learner competencies; (4) propose a consensus core curricular structure for MS courses in medical schools; (5) assess MS learner skills through standardized patient encounters and develop a national certification exam; and (6) develop standardized evaluation and data collection processes for MS programs. MS education and assessment should be standardized and evaluated with a robust interinstitutional medical education research strategy that includes collaboration with multidisciplinary stakeholders to ensure linguistically appropriate care for the growing Spanish-speaking U.S. population.

Adherence stages measured by patient-reported outcome instruments in adults with asthma: a scoping review.

Objective: Individuals who are adherent to their asthma inhaled maintenance medication: (1) initiate their treatment (take the first dose); (2) implement it (take it as per prescribed dosing regimen); and persist with it (take it for the entire prescribing period). To avoid unnecessary hospitalizations and costs, patient adherence should be routinely assessed. To this end, we aimed to identify patient-reported outcome instruments (PROs) used for measurement of patient adherence to inhaled maintenance medication in asthmatic adults and to report on the adherence stage that these instruments measured. Data sources: We conducted a scoping review of six databases. Study selection: We searched for studies in which PROs were used to measure patient adherence to inhaled maintenance medication in asthmatic participants aged ≥18 years. We extracted and synthesized data in order to list the available PROs and to report the adherence stages that these instruments measured. Results: We included 186 studies (87 PROs). Among all 87 instruments, none were found to measure all three adherence stages. We found that 1 measured initiation, 2 evaluated initiation and implementation, 74 assessed implementation, 7 measured implementation and persistence. The most used instrument (n = 41 studies or 22%) was the Self-Reported Medication-Taking Scale, which was found to assess implementation only. Conclusion: Our results suggest that no single PRO exists to measure initiation, implementation and persistence with asthma inhaled maintenance medication. Results from this review could therefore guide the development or refinement of PROs that would aim to measure all three adherence stages.