The effect of interprofessional simulation practice on collaborative learning: A randomized controlled trial.

This study examined the effect of simulation on readiness for collaborative practice and learning using a randomized-controlled trial design that used the same education protocol with interprofessional and uniprofessional groups. The sample consisted of 43 students from four different majors. The students were assessed with the Readiness for Interprofessional Learning Scale, and a care plan measurement instrument. The interprofessional group showed a small increase (0.1 ± 0.43; p = .02) in readiness for teamwork and collaboration; the uniprofessional group showed a smaller increase for teamwork and collaboration (0.04 ± 0.31; p = .04) and for patient-centred care (0.0 ± 0.35; p = .01). The enriching work of interprofessional learning was evident within the care plan activity, suggesting that interprofessional simulation is an effective learning method for interprofessional education.

Geometry effect in multi-step crossflow microfluidic devices for red blood cells separation and deformability assessment.

The efficient separation of blood components using microfluidic systems can help to improve the detection and diagnosis of several diseases, such as malaria and diabetes. Therefore, a novel multi-step microfluidic device, based on passive crossflow filters was developed. Three different designs were proposed, fabricated and tested in order to evaluate the most suitable geometry to perform, simultaneously, blood cells separation and cell deformability measurements. All the proposed geometries include a main channel and three sequential separation steps, all comprised of symmetrical crossflow filters, with multiple rows of pillars, to reduce the amount of red blood cells (RBCs) flowing to the outlets of the microfluidic device (MD). Sets of hyperbolic constrictions located at the outlets allow the assessment of cells deformability. Based on the proposed geometries, the three correspondent MD were evaluated and compared, by measuring the RBCs velocities, the cell-free layer (CFL) effect through the microchannels and by quantifying the amount of RBCs at the outlets. The results suggest that the proposed MD 3 configuration was the most effective one for the desired application, due to the formation of a wider CFL. As a result, a minor amount of RBCs flow through the hyperbolic contraction at the third separation level of the device. Nevertheless, for all the proposed geometries, the existence of three separation levels shows that it is possible to achieve a highly efficient cell separation. If needed, such microdevices have the potential for further improvements by increasing the number of separation levels, aiming the total separation of blood cells from plasma.

Propuesta teórica para tratar los aspectos conductuales de la incontinencia urinaria.

Theoretical model for treating behavioural aspects of urinary incontinence SINOPSIS This reflective article presents a theoretical model of behavioural evaluation and intervention for women with urinary incontinence. Nola Pender's health promotion model (HPM) was used as a reference to develop this proposal. Behavioural measures were identified to build the model: constipation control, bladder training, urination position, reduction of irritating drinks, water intake, and pelvic floor muscle training. Next, specific actions were defined to investigate and intervene on certain behavioural aspects: previous related behaviour, personal factors, benefits, and obstacles regarding the proposed action, perceived self-efficacy, feelings related to the expected behaviour and the proposed action, interpersonal and situational influences, commitment to the action plan, competitive demands, and health promotion behaviour. The model proposed by the authors could help nurses to guide the conversation between them and the patient to modify certain behavioural aspects, to develop an achievable plan and, thus, enhance the achievement of the goals established for the treatment of urinary incontinence.

Sinopsis Este artículo de reflexión presenta un modelo teórico de evaluación e intervención conductual para mujeres con incontinencia urinaria (IU). El Modelo de Promoción de Salud de Nola Pender, enfermera estadounidense, fue usado como referencia para desarrollar la propuesta. Se identificaron medidas conductuales para construir el modelo: control del estreñimiento, entrenamiento vesical, posición para orinar, reducción de bebidas irritantes, ingesta de agua, y entrenamiento muscular del suelo pélvico. Luego, se definieron acciones determinadas para investigar e intervenir sobre ciertos aspectos conductuales: comportamiento previo relacionado, factores personales, beneficios y obstáculos percibidos acerca de la acción propuesta, autoeficacia percibida, sentimientos relacionados con el comportamiento esperado y la acción propuesta, influencias interpersonales y situacionales, compromiso con el plan de acción, exigencias competitivas, y comportamiento de la promoción de la salud. El modelo propuesto por los autores podría ayudar a enfermeros y enfermeras a orientar la conversación entre ellos y el paciente para modificar determinados aspectos conductuales, con el fin de elaborar un plan alcanzable y, así, potenciar el logro de las metas establecidas para el tratamiento de la IU.

An interprofessional international research collaboration: exploration of key opportunities and challenges.

Interprofessional research has made substantive progress in Brazil over the past decade, in line with globalization and the worldwide expansion of university international relationships. This sustained growth of interprofessional research in many other countries around the world has been increasingly reported in the literature. Interprofessional international research involves interactions and exchanges between researchers from different countries with different professional and disciplinary backgrounds who collaborate to undertake scholarly work. The benefits of interprofessional international research are many and varied. In this paper, we explore the opportunities and challenges related to interprofessional international research collaboration while reflecting on our personal experiences of a study focused on interprofessional collaboration in primary care which spanned two countries - Brazil and UK. A key element in our international research has been regular discussion, negotiation, and agreement. Collectively, these elements have helped to ensure that our international empirical work can be sustained.

Investigating the nature of interprofessional collaboration in primary care across the Western Health Region of Brasília, Brazil: A study protocol.

Primary care can provide a supportive context for the development of interprofessional collaborative practice owing to its nature and dynamics. In Brazil, a number of practice changes have already occurred to primary care, notably the implementation of the Family Health Strategy which promoted interprofessional collaboration (IPC). In Brasilia, a new arrangement was implemented in 2016 that focused on an expansion of primary healthcare. However, it is not clear how these reforms will affect the nature of IPC or the delivery of patient care. The article presents a study protocol which describes a study that aims to explore the nature of IPC in the context of primary care in the Western Health Region of Brasilia. A sequential mixed methods design will be used to gather both quantitative and qualitative data. Initially, we will translate, cross-culturally adapt, and validate an IPC scale for a survey of primary care teams. We will then undertake a series of focus groups with a purposeful sample of team members to explore the results from the survey. Quantitative data will be analysed with descriptive and multivariate statistics. A content analysis will be undertaken with the focus group data. We expect that the results will illuminate a range of elements linked to IPC in primary care as well as identify areas for improving IPC skills, patient safety, quality of care, and healthcare outcomes in this clinical context.

A simple microfluidic device for the deformability assessment of blood cells in a continuous flow.

Blood flow presents several interesting phenomena in microcirculation that can be used to develop microfluidic devices capable to promote blood cells separation and analysis in continuous flow. In the last decade there have been numerous microfluidic studies focused on the deformation of red blood cells (RBCs) flowing through geometries mimicking microvessels. In contrast, studies focusing on the deformation of white blood cells (WBCs) are scarce despite this phenomenon often happens in the microcirculation. In this work, we present a novel integrative microfluidic device able to perform continuous separation of a desired amount of blood cells, without clogging or jamming, and at the same time, capable to assess the deformation index (DI) of both WBCs and RBCs. To determine the DI of both WBCs and RBCs, a hyperbolic converging microchannel was used, as well as a suitable image analysis technique to measure the DIs of these blood cells along the regions of interest. The results show that the WBCs have a much lower deformability than RBCs when subjected to the same in vitro flow conditions, which is directly related to their cytoskeleton and nucleus contents. The proposed strategy can be easily transformed into a simple and inexpensive diagnostic microfluidic system to simultaneously separate and assess blood cells deformability.

Microglia P2Y6 receptors mediate nitric oxide release and astrocyte apoptosis.

BACKGROUND: During cerebral inflammation uracil nucleotides leak to the extracellular medium and activate glial pyrimidine receptors contributing to the development of a reactive phenotype. Chronically activated microglia acquire an anti-inflammatory phenotype that favors neuronal differentiation, but the impact of these microglia on astrogliosis is unknown. We investigated the contribution of pyrimidine receptors to microglia-astrocyte signaling in a chronic model of inflammation and its impact on astrogliosis. METHODS: Co-cultures of astrocytes and microglia were chronically treated with lipopolysaccharide (LPS) and incubated with uracil nucleotides for 48 h. The effect of nucleotides was evaluated in methyl-[3H]-thymidine incorporation. Western blot and immunofluorescence was performed to detect the expression of P2Y6 receptors and the inducible form of nitric oxide synthase (iNOS). Nitric oxide (NO) release was quantified through Griess reaction. Cell death was also investigated by the LDH assay and by the TUNEL assay or Hoechst 33258 staining. RESULTS: UTP, UDP (0.001 to 1 mM) or PSB 0474 (0.01 to 10 µM) inhibited cell proliferation up to 43 ± 2% (n = 10, P <0.05), an effect prevented by the selective P2Y6 receptor antagonist MRS 2578 (1 µM). UTP was rapidly metabolized into UDP, which had a longer half-life. The inhibitory effect of UDP (1 mM) was abolished by phospholipase C (PLC), protein kinase C (PKC) and nitric oxide synthase (NOS) inhibitors. Both UDP (1 mM) and PSB 0474 (10 µM) increased NO release up to 199 ± 20% (n = 4, P <0.05), an effect dependent on P2Y6 receptors-PLC-PKC pathway activation, indicating that this pathway mediates NO release. Western blot and immunocytochemistry analysis indicated that P2Y6 receptors were expressed in the cultures being mainly localized in microglia. Moreover, the expression of iNOS was mainly observed in microglia and was upregulated by UDP (1 mM) or PSB 0474 (10 µM). UDP-mediated NO release induced apoptosis in astrocytes, but not in microglia. CONCLUSIONS: In LPS treated co-cultures of astrocytes and microglia, UTP is rapidly converted into UDP, which activates P2Y6 receptors inducing the release of NO by microglia that causes astrocyte apoptosis, thus controlling their rate of proliferation and preventing an excessive astrogliosis.

Medication errors in a public hospital in Brazil.

This article describes the analysis of the frequency, type and risk factors relating to errors in the preparation and administration of medications in patients admitted to a public hospital in Brasilia Federal District, Brazil, which serves a population of approximately 500,000 inhabitants. Patients are commonly affected and harmed by medication errors, almost half of which are preventable. This is a cross-sectional, descriptive and exploratory study conducted in a clinical medicine unit. Direct observations were made by eight nurse technicians. The type of error, the type of drug involved and associated risk factors were analysed. Relationships between the occurrence of errors and risk factors were studied with logistic regression models. Of the 484 observed doses, 69.5% errors occurred during drug administration, 69.6% during the preparation stage, 48.6% were timing errors, 1.7% were dose-related errors and 9.5% were errors of omission. More than one error was detected in 34.5% of occasions. Unlabelled drugs increased the risk of timing errors by a factor of 13.72. Interruptions in preparation increased the risk of errors by a factor of 3.75. Caring for a larger number of patients (8-9) increased the risk of timing errors by a factor of 8.27. The research shows the need to manage the risk of medication errors in their real-life contexts by interposing safety barriers between the hazards and potential errors.

Advances in Microfluidic Systems and Numerical Modeling in Biomedical Applications: A Review.

The evolution in the biomedical engineering field boosts innovative technologies, with microfluidic systems standing out as transformative tools in disease diagnosis, treatment, and monitoring. Numerical simulation has emerged as a tool of increasing importance for better understanding and predicting fluid-flow behavior in microscale devices. This review explores fabrication techniques and common materials of microfluidic devices, focusing on soft lithography and additive manufacturing. Microfluidic systems applications, including nucleic acid amplification and protein synthesis, as well as point-of-care diagnostics, DNA analysis, cell cultures, and organ-on-a-chip models (e.g., lung-, brain-, liver-, and tumor-on-a-chip), are discussed. Recent studies have applied computational tools such as ANSYS Fluent 2024 software to numerically simulate the flow behavior. Outside of the study cases, this work reports fundamental aspects of microfluidic simulations, including fluid flow, mass transport, mixing, and diffusion, and highlights the emergent field of organ-on-a-chip simulations. Additionally, it takes into account the application of geometries to improve the mixing of samples, as well as surface wettability modification. In conclusion, the present review summarizes the most relevant contributions of microfluidic systems and their numerical modeling to biomedical engineering.

Polydimethylsiloxane Surface Modification of Microfluidic Devices for Blood Plasma Separation.

Over the last decade, researchers have developed a variety of new analytical and clinical diagnostic devices. These devices are predominantly based on microfluidic technologies, where biological samples can be processed and manipulated for the collection and detection of important biomolecules. Polydimethylsiloxane (PDMS) is the most commonly used material in the fabrication of these microfluidic devices. However, it has a hydrophobic nature (contact angle with water of 110°), leading to poor wetting behavior and issues related to the mixing of fluids, difficulties in obtaining uniform coatings, and reduced efficiency in processes such as plasma separation and molecule detection (protein adsorption). This work aimed to consider the fabrication aspects of PDMS microfluidic devices for biological applications, such as surface modification methods. Therefore, we studied and characterized two methods for obtaining hydrophilic PDMS surfaces: surface modification by bulk mixture and the surface immersion method. To modify the PDMS surface properties, three different surfactants were used in both methods (Pluronic® F127, polyethylene glycol (PEG), and polyethylene oxide (PEO)) at different percentages. Water contact angle (WCA) measurements were performed to evaluate the surface wettability. Additionally, capillary flow studies were performed with microchannel molds, which were produced using stereolithography combined with PDMS double casting and replica molding procedures. A PDMS microfluidic device for blood plasma separation was also fabricated by soft lithography with PDMS modified by PEO surfactant at 2.5% (v/v), which proved to be the best method for making the PDMS hydrophilic, as the WCA was lower than 50° for several days without compromising the PDMS's optical properties. Thus, this study indicates that PDMS surface modification shows great potential for enhancing blood plasma separation efficiency in microfluidic devices, as it facilitates fluid flow, reduces cell aggregations and the trapping of air bubbles, and achieves higher levels of sample purity.

Purinergic modulation of norepinephrine release and uptake in rat brain cortex: contribution of glial cells.

The pathogenesis of psychiatric and neurodegenerative diseases is often associated with a deregulation of noradrenergic transmission. Considering the potential involvement of purinergic signaling in the modulation of noradrenergic transmission in the brain cortex, this study aimed to identify the P2Y receptor subtypes involved in the modulation of neuronal release and neuronal/glial uptake of norepinephrine. Electrical stimulation (100 pulses at 5 Hz) of rat cortical slices induced norepinephrine release that was inhibited by ATP and ADP (0.01-1 mM), adenosine 5'-O-(2-thiodiphosphate) (ADPßS, 0.03-0.3 mM), and UDP (0.1-1 mM). The effect of ADPßS was mediated by P2Y1 receptors and possibly by A1/P2Y1 heterodimers since it was attenuated by the A1 receptor antagonist DPCPX and by the P2Y1 receptor antagonist MRS 2500 but was resistant to the effect of adenosine deaminase (ADA). UDP inhibited norepinephrine release through activation of P2Y6 receptors, an effect that was abolished by the P2Y6 receptor antagonist MRS 2578 and by DPCPX, indicating that it depends on the formation and/or release of adenosine and activation of A1 receptors. Supporting this hypothesis, the inhibitory effect of UDP was also prevented by inhibition of ectonucleotidases, by ADA and was attenuated by the inhibitor of nucleoside transporter 6-[(4-nitrobenzyl)thio]-9-ß-d-ribofuranosylpurine (NBTI). Additionally, the inhibitory effect of UDP was attenuated when norepinephrine uptake 1 or 2 was inhibited. In astroglial cultures, ADPßS and UDP increased norepinephrine uptake mainly by activation of P2Y1 and P2Y6 receptors, respectively. The results indicate that neuronal and glial P2Y1 and P2Y6 receptors may represent new targets of intervention to regulate noradrenergic transmission in CNS diseases.

How is Integration Defined and Measured, and what Factors Drive Success in Brazil? An Integrative Review.

Introduction: Integration in health and care can improve quality and outcomes, but it is challenged by expansion of medical knowledge, social pressures on patient needs, and demands to deliver critical information. In Latin American and in other lower and middle-income countries integrated care remains in development. This paper examined the available literature on integrated care to understand how Latin American countries identify and measure integration, and what factors influence success. Methods: This integrative literature review included systematic searches in Global Health, PubMed, SciELO and BVSPsi databases for articles on integrated care in Spanish, Portuguese, and English in the period from January of 1999 to December 2020. The articles were screened for selection and assessed independently by five reviewers that used the inclusion criteria of papers about integration in health care systems. The sample excluded articles that did not deal with the integration of health care, which addressed issues related to public health campaigns, programs to control endemics and epidemics, reports on the experience of implementing health services, health promotion guidelines, food safety, oral health, and books evaluation. Results: 24 articles were included: qualitative (75%), quantitative (12,5%), and mixed-method research (4%) published between 2000 and 2017. All studies were undertaken in Brazil, and two of them were also conducted in Latin American countries. In 15 articles there was an interchangeable use between concepts of integration of services and integrated care, while nine studies did not define integration. Barriers to integration included absence of shared understanding of knowledge among members of interprofessional teams, lack of clarity on professional roles, missing consensus on a definition and measurement of integrated care, power struggles between professionals, poor institutional support, insufficient team preparation and training and unequal valuation of professions by society. Conclusion: Several types of integration and factors contributing to the success of implementation of integrated care in various contexts in Brazil were identified. The concept of integration reflected the varied local and regional realities including different health settings and levels of health and care, suggesting a need for further clarifications on its objective and components especially in LMIC contexts.

Fourier Transform Infrared (FTIR) Spectroscopy to Analyse Human Blood over the Last 20 Years: A Review towards Lab-on-a-Chip Devices.

Since microorganisms are evolving rapidly, there is a growing need for a new, fast, and precise technique to analyse blood samples and distinguish healthy from pathological samples. Fourier Transform Infrared (FTIR) spectroscopy can provide information related to the biochemical composition and how it changes when a pathological state arises. FTIR spectroscopy has undergone rapid development over the last decades with a promise of easier, faster, and more impartial diagnoses within the biomedical field. However, thus far only a limited number of studies have addressed the use of FTIR spectroscopy in this field. This paper describes the main concepts related to FTIR and presents the latest research focusing on FTIR spectroscopy technology and its integration in lab-on-a-chip devices and their applications in the biological field. This review presents the potential use of FTIR to distinguish between healthy and pathological samples, with examples of early cancer detection, human immunodeficiency virus (HIV) detection, and routine blood analysis, among others. Finally, the study also reflects on the features of FTIR technology that can be applied in a lab-on-a-chip format and further developed for small healthcare devices that can be used for point-of-care monitoring purposes. To the best of the authors' knowledge, no other published study has reviewed these topics. Therefore, this analysis and its results will fill this research gap.

Triage Strategies for COVID-19 Cases: A Scope Review.

In the midst of the pandemic caused by the new coronavirus (SARS-CoV-2), researchers and governmental and non-governmental institutions are mobilizing to implement strategies to face cases of COVID-19. Aim: This study aimed to map the triage strategies for cases of COVID-19, with the purpose of identifying sources in the literature that make it possible to explore the understanding of the strategies in different contexts. A scope review was conducted with searches in the CINAHL Database, PubMed, LILACS and hand-search, considering studies carried out with users of health services and documents published by governmental and non-governmental institutions, between the years 2019 and 2020, resulting in 40 articles for full reading. To explore the key concept, thematic analysis was carried out at two levels: (1) triage strategies, (2) forms and experiences of triage. Five triage strategies were mapped: health services triage; digital triage by remote use of technologies; community triage; home visit triage and airport and port triage. The forms and experiences of mapped triages involved risk classification, diagnosis and definition of conducts or combined. The use of strategies with remote technological resources stands out, as well as the adaptation of existing scales with simple algorithms as a tendency.

Organ-on-a-Chip Platforms for Drug Screening and Delivery in Tumor Cells: A Systematic Review.

The development of cancer models that rectify the simplicity of monolayer or static cell cultures physiologic microenvironment and, at the same time, replicate the human system more accurately than animal models has been a challenge in biomedical research. Organ-on-a-chip (OoC) devices are a solution that has been explored over the last decade. The combination of microfluidics and cell culture allows the design of a dynamic microenvironment suitable for the evaluation of treatments' efficacy and effects, closer to the response observed in patients. This systematic review sums the studies from the last decade, where OoC with cancer cell cultures were used for drug screening assays. The studies were selected from three databases and analyzed following the research guidelines for systematic reviews proposed by PRISMA. In the selected studies, several types of cancer cells were evaluated, and the majority of treatments tested were standard chemotherapeutic drugs. Some studies reported higher drug resistance of the cultures on the OoC devices than on 2D cultures, which indicates the better resemblance to in vivo conditions of the former. Several studies also included the replication of the microvasculature or the combination of different cell cultures. The presence of vasculature can influence positively or negatively the drug efficacy since it contributes to a greater diffusion of the drug and also oxygen and nutrients. Co-cultures with liver cells contributed to the evaluation of the systemic toxicity of some drugs metabolites. Nevertheless, few studies used patient cells for the drug screening assays.

[Application of conceptual mapping in the regulation of access to public health services in the Federal District, Brazil]. / Aplicação do mapeamento conceitual na regulação do acesso aos serviços públicos de saúde, Distrito Federal, Brasil.

Health regulation in the pursuit of equity is the goal of management and requires evaluation methods that improve work processes. The scope of this article is to analyze the application of conceptual mapping in the regulation of access to public health services. It is an exploratory and descriptive study, using a mixed approach, carried out at the Health Regulatory Complex of the Federal District. The data were collected between August and October 2019 and analyzed with the assistance of IRaMuTeQ and Concept Systems® software. There is a convergence of the 25 statements generated by the 71 participants, grouped into 4 clusters, on regulation towards the principle of equity. The healthcare priority level was presented as the focus of regulation and management, the driving force behind the integration of processes. Conceptual mapping is a tool that can support regulation planning and evaluation, as it makes it possible to identify priority points to be worked on by management in improving the regulatory processes identified in this study. These include the training of professionals, the transparency of information and the level of priority healthcare, for effective, equitable, rational and timely access for users of the health system.

A regulação em saúde na busca da equidade subsidia a gestão e necessita de métodos avaliativos que incrementem os processos de trabalho. O objetivo deste artigo é analisar a aplicação do mapeamento conceitual na regulação do acesso aos serviços públicos de saúde. Estudo exploratório e descritivo, sob abordagem mista, realizado no Complexo Regulador em Saúde do Distrito Federal. Os dados foram coletados entre agosto e outubro de 2019 e analisados com o auxílio dos softwares IRaMuTeQ e Concept Systems®. Há uma convergência de 25 declarações geradas pelos 71 participantes, agrupadas em 04 Clusters sobre a regulação rumo ao princípio da equidade. O nível de prioridade assistencial apresentou-se como o foco da regulação e a gestão, a força motriz para a integração dos processos. O mapeamento conceitual é uma ferramenta que pode apoiar o planejamento e avaliação da regulação, pois possibilita identificar pontos prioritários a serem trabalhados pela gestão na melhoria dos processos regulatórios evidenciados neste estudo como a capacitação dos profissionais, a transparência da informação e o nível de prioridade assistencial para um acesso efetivo, equânime, racional e oportuno aos usuários do sistema de saúde.

Establishment of Colorectal Cancer Organoids in Microfluidic-Based System.

Colorectal cancer is the second leading cause of cancer death worldwide. Significant advances in the molecular mechanisms underlying colorectal cancer have been made; however, the clinical approval of new drugs faces many challenges. Drug discovery is a lengthy process causing a rapid increase in global health care costs. Patient-derived tumour organoids are considered preclinical models with the potential for preclinical drug screening, prediction of patient outcomes, and guiding optimized therapy strategies at an individual level. Combining microfluidic technology with 3D tumour organoid models to recapitulate tumour organization and in vivo functions led to the development of an appropriate preclinical tumour model, organoid-on-a-chip, paving the way for personalized cancer medicine. Herein, a low-cost microfluidic device suitable for culturing and expanding organoids, OrganoidChip, was developed. Patient-derived colorectal cancer organoids were cultured within OrganoidChip, and their viability and proliferative activity increased significantly. No significant differences were verified in the organoids' response to 5-fluorouracil (5-FU) treatment on-chip and on-plate. However, the culture within the OrganoidChip led to a significant increase in colorectal cancer organoid-forming efficiency and overall size compared with conventional culture on a 24-well plate. Interestingly, early-stage and late-stage organoids were predominantly observed on-plate and within the OrganoidChip, respectively. The OrganoidChip thus has the potential to generate in vivo-like organotypic structures for disease modelling and drug screening applications.

Manual and Automatic Image Analysis Segmentation Methods for Blood Flow Studies in Microchannels.

In blood flow studies, image analysis plays an extremely important role to examine raw data obtained by high-speed video microscopy systems. This work shows different ways to process the images which contain various blood phenomena happening in microfluidic devices and in microcirculation. For this purpose, the current methods used for tracking red blood cells (RBCs) flowing through a glass capillary and techniques to measure the cell-free layer thickness in different kinds of microchannels will be presented. Most of the past blood flow experimental data have been collected and analyzed by means of manual methods, that can be extremely reliable, but they are highly time-consuming, user-intensive, repetitive, and the results can be subjective to user-induced errors. For this reason, it is crucial to develop image analysis methods able to obtain the data automatically. Concerning automatic image analysis methods for individual RBCs tracking and to measure the well known microfluidic phenomena cell-free layer, two developed methods are presented and discussed in order to demonstrate their feasibility to obtain accurate data acquisition in such studies. Additionally, a comparison analysis between manual and automatic methods was performed.

Interprofessional simulation effects for healthcare students: A systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review of studies describing the effects of interprofessional education (IPE) on collaborative competence using simulated-based training of undergraduate healthcare students. DESIGN: A systematic review and meta-analysis based on PRISMA guidelines. DATA SOURCES: PubMed and Cumulative Index to Nursing and Allied Health Literature databases were searched to identify articles in all languages published up to 2018. The systematic review protocol was registered at PROSPERO under number 133330. REVIEW METHODS: In total, 419 articles were identified. The following articles were excluded: non-English articles, articles for which the full text was not available, articles that did not employ a validated tool, articles that did not use quasi-experimental methods and that did not assess healthcare student populations. Eleven studies were included, and 6 were submitted to meta-analysis using forest plots through RevMan 5.3. RESULTS: Interprofessional simulation analysis yielded results regarding participants, protocols, scenarios, validated tools, collaborative competencies and primary outcomes. The meta-analysis was organized based on assessment tool, and summary value, confidence interval, and Z test results for the random-effects model are presented. CONCLUSION: Quantitative analysis reveals a positive impact and the effectiveness of interprofessional simulation. However, more research should be conducted utilizing clinical trials with distinguished analyses for each collaborative competency factor to assess long-term effects on the outcome.

Visualization and Measurements of Blood Cells Flowing in Microfluidic Systems and Blood Rheology: A Personalized Medicine Perspective.

Hemorheological alterations in the majority of metabolic diseases are always connected with blood rheology disturbances, such as the increase of blood and plasma viscosity, cell aggregation enhancement, and reduction of the red blood cells (RBCs) deformability. Thus, the visualizations and measurements of blood cells deformability flowing in microfluidic devices (point-of-care devices) can provide vital information to diagnose early symptoms of blood diseases and consequently to be used as a fast clinical tool for early detection of biomarkers. For instance, RBCs rigidity has been correlated with myocardial infarction, diabetes mellitus, hypertension, among other blood diseases. In order to better understand the blood cells behavior in microfluidic devices, rheological properties analysis is gaining interest by the biomedical committee, since it is strongly dependent on the interactions and mechanical cells proprieties. In addition, the development of blood analogue fluids capable of reproducing the rheological properties of blood and mimic the RBCs behavior at in vitro conditions is crucial for the design, performance and optimization of the microfluidic devices frequently used for personalized medicine. By combining the unique features of the hemorheology and microfluidic technology for single-cell analysis, valuable advances in personalized medicine for new treatments and diagnosis approach can be achieved.