Finding social need-les in a haystack: ascertaining social needs of Medicare patients recorded in the notes of care managers.

BACKGROUND: Unmet social needs may impair health and access to health care, and intervening on these holds particular promise in high-risk patient populations, such as those with multiple chronic conditions. Our objective was to identify social needs in a patient population at significant risk-Medicare enrollees with multiple chronic illnesses enrolled in care management services-and measure their prevalence prior to any systematic screening. METHODS: We partnered with Renova Health, an independent Medicare Chronic Care Management (CCM) provider with patients in 10 states during our study period (January 2017 through August 2020). Our data included over 3,000 Medicare CCM patients, representing nearly 20,000 encounters. We used a dictionary-based natural language processing approach to ascertain the prevalence of six domains of barriers to care (food insecurity, housing instability, utility hardship) and unmet social needs (health care affordability, need for supportive services, transportation) in notes taken during telephonic Medicare CCM patient encounters. RESULTS: Barriers to care, specifically need for supportive services (2.4%) and health care affordability (0.8%), were the most prevalent domains identified. Transportation as a barrier to care came up relatively less frequently in CCM encounters (0.1%). Unmet social needs were identified at a comparatively lower rate, with potential housing instability (0.3%) flagged most followed by potential utility hardship (0.2%) and food insecurity (0.1%). CONCLUSIONS: There is substantial untapped opportunity to systematically screen for social determinants of health and unmet social needs in care management.

From Product to Patient-Transfusion and Patient Blood Management.

This Viewpoint discusses how patient blood management can help curb the demand for blood products and reduce harm by determining who would most benefit from a blood transfusion.

Integrated Telehealth Infrastructure for Ambulatory Stroke Pathway Tyrol.

BACKGROUND: The Integrated Treatment Pathway Stroke Tyrol was introduced for the care of people after an acute stroke event and includes four phases: acute prehospital care, inpatient treatment, inpatient rehabilitation and ambulatory, outpatient rehabilitation. For the 4th phase, the ambulatory rehabilitation of patients after discharge, the ICT platform "StrokeNet Tyrol" was established. METHODS: Requirements and processes along the pathway and between the interdisciplinary team were taken into account for implementation based on a modular software architecture. Flexible rights and role concept was developed to support efficient collaboration of the heterogenic professions. RESULTS: The routine usage of 342 users with 8 different roles, 2,219 registered patient cases within the last 4 years and first results of the integrated benchmarking solution give a positive impression regarding feasibility and effectiveness. CONCLUSION: To this point, a comprehensive infrastructure for the Ambulatory Tyrolean Stroke Pathway has been established. Results from outcome analyses and comparative studies could help to further improve usability and to expand the area of application for other indications.

Implementation Science Perspectives on Implementing Telemedicine Interventions for Hypertension or Diabetes Management: Scoping Review.

BACKGROUND: Hypertension and diabetes are becoming increasingly prevalent worldwide. Telemedicine is an accessible and cost-effective means of supporting hypertension and diabetes management, especially as the COVID-19 pandemic has accelerated the adoption of technological solutions for care. However, to date, no review has examined the contextual factors that influence the implementation of telemedicine interventions for hypertension or diabetes worldwide. OBJECTIVE: We adopted a comprehensive implementation research perspective to synthesize the barriers to and facilitators of implementing telemedicine interventions for the management of hypertension, diabetes, or both. METHODS: We performed a scoping review involving searches in Ovid MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and Google Scholar to identify studies published in English from 2017 to 2022 describing barriers and facilitators related to the implementation of telemedicine interventions for hypertension and diabetes management. The coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research. RESULTS: Of the 17,687 records identified, 35 (0.2%) studies were included in our scoping review. We found that facilitators of and barriers to implementation were dispersed across the constructs of the Consolidated Framework for Implementation Research. Barriers related to cost, patient needs and resources (eg, lack of consideration of language needs, culture, and rural residency), and personal attributes of patients (eg, demographics and priorities) were the most common. Facilitators related to the design and packaging of the intervention (eg, user-friendliness), patient needs and resources (eg, personalized information that leveraged existing strengths), implementation climate (eg, intervention embedded into existing infrastructure), knowledge of and beliefs about the intervention (eg, convenience of telemedicine), and other personal attributes (eg, technical literacy) were the most common. CONCLUSIONS: Our findings suggest that the successful implementation of telemedicine interventions for hypertension and diabetes requires comprehensive efforts at the planning, execution, engagement, and reflection and evaluation stages of intervention implementation to address challenges at the individual, interpersonal, organizational, and environmental levels.

Dispositivos cardíacos implantables y uso de resonancia magnética / Cardiac implantable devices and use of magnetic resonance / Dispositivos cardíacos implantáveis e utilização da ressonância magnética

El uso de la resonancia magnética (RM) en las distintas áreas de la medicina se ha expandido de manera significativa y de forma diaria se solicitan numerosos estudios. El hecho de que los resonadores pueden interaccionar con algunos objetos ha llevado a que históricamente se les niegue la realización de este estudio a pacientes portadores de dispositivos cardíacos porque se entiende que existen contraindicaciones absolutas. El avance de la tecnología de los dispositivos y la creciente evidencia publicada han cambiado este concepto. Nos proponemos revisar los mecanismos por los cuales un dispositivo implantable puede interactuar con el resonador y las implicancias clínicas que esto podría tener si las hubiera. La mayoría de los pacientes portadores de dispositivos cardíacos de estimulación podrán realizarse una RM, pero para que este procedimiento sea seguro es importante conocer las características y el tipo específico de dispositivo implantado. Proponemos finalmente puntos clave y algoritmos para tener en cuenta para el manejo adecuado de estos pacientes.

The use of magnetic resonance imaging (MRI) in different areas of medicine has expanded significantly and numerous procedures are indicated daily. The fact that resonators could interact with some objects has historically led to patients with cardiac devices being denied an MRI on the understanding that they suppose an absolute contraindication. Advances in device technology and the increasing evidence have changed this concept. We intend to review the mechanisms by which an implantable device could interact with the resonator and the clinical implications that this could have if any. Most patients will be able to undergo these studies, but to determine the safety of performing an MRI it is important to know the characteristics and specific type of implanted device. Finally, we provide key points and algorithms to take into account for these patients.

O uso da ressonância magnética em diferentes áreas da medicina tem se expandido significativamente e inúmeros exames são indicados diariamente. A possibilidade de que os ressonadores interajam com alguns objetos historicamente levou os pacientes com dispositivos cardíacos a terem a ressonância magnética negada por entender que existem contraindicações absolutas. Os avanços na tecnologia de dispositivos e o aumento das evidências publicadas mudaram esse conceito. Pretendemos revisar os mecanismos pelos quais um dispositivo implantável pode interagir com o ressonador e as implicações clínicas que isso pode ter, se houver. A grande maioria dos pacientes poderá se submeter a esses estudos, mas para determinar a segurança de realizar uma ressonância magnética é importante conhecer as características e o tipo específico de dispositivo implantado. Por fim, propomos pontos e algoritmos para a gestão dos pacientes.

Manejo del paciente anticoagulado en una cirugía dental / Management of the anticoagulated patient in dental surgery / Gerenciamento do paciente anticoagulado em cirurgia odontológica

Introducción: una adecuada hemostasia es crucial para el éxito del tratamiento odontológico invasivo, ya que los problemas de sangrado pueden dar lugar a complicaciones asociadas a una importante morbimortalidad. El tratamiento odontológico de pacientes que tienden a un mayor riesgo de sangrado debido al uso de fármacos anticoagulantes plantea un desafío en la práctica diaria de los profesionales de la odontología. El conocimiento adecuado de los mecanismos subyacentes a la hemostasia y el manejo optimizado de estos pacientes son, por lo tanto, cuestiones muy importantes. Se realiza un estudio de los fármacos anticoagulantes actualmente disponibles en el mercado, evaluando los riesgos y beneficios de suspender dicho fármaco previo a un tratamiento odontológico invasivo. Además, se hace una revisión de los protocolos de manejo actuales que se utilizan en estos pacientes. Material y métodos: se realizó una búsqueda bibliográfica en las bases de datos Epistemonikos y Medline/PubMed; en el portal Timbó y en la biblioteca virtual Scielo. Abarcando todos los estudios publicados en los últimos 15 años en inglés y español. Se encontraron 30 artículos, se seleccionaron 15 en primera instancia para finalizar con 11 artículos. En dicha selección el filtro fue que los demás artículos se referían a otros anticoagulantes que no eran parte de este trabajo. Resultados: se han desarrollado múltiples protocolos de manejo, aunque en todos los casos se requiere una historia clínica completa, junto con pruebas hemostáticas complementarias para minimizar los riesgos derivados del tratamiento odontológico. Discusión: muchos autores consideran que la medicación de los pacientes indicada para el tratamiento de una enfermedad de base no debe ser alterada o suspendida a menos que así lo indique el médico prescriptor. Se ha demostrado que las medidas hemostáticas locales son suficientes para controlar los posibles problemas de sangrado derivados del tratamiento dental.

Introduction: Adequate hemostasis is crucial for the success of invasive dental treatment, since bleeding problems can lead to complications associated with significant morbidity and mortality. The dental treatment of patients who are prone to an increased risk of bleeding due to the use of anticoagulant drugs poses a challenge in the daily practice of dental professionals. Adequate knowledge of the mechanisms underlying hemostasis and optimized management of these patients are therefore very important issues. A review is made of the anticoagulant drugs currently available on the market, evaluating the risks and benefits of suspending such a drug prior to invasive dental treatment. In addition, a review is made of the current management protocols used in these patients. Material and methods: A bibliographic search was carried out in the Epistemonikos and Medline/PubMed databases; in the Timbo portal and in the Scielo virtual library. All the studies published in the last 15 years in English and Spanish were included. Thirty articles were found, 15 were selected in the first instance to end up with 11 articles. In this selection, the filter was that the other articles referred to other anticoagulants that were not part of this work. Results: multiple management protocols have been developed, although in all cases a complete clinical history is required, together with complementary hemostatic tests to minimize the risks derived from dental treatment. Discussion: many authors consider that the patient's medication indicated for the treatment of an underlying disease should not be altered or suspended unless so indicated by the prescribing physician. It has been shown that local hemostatic measures are sufficient to control possible bleeding problems derived from dental treatment.

Introdução: A hemostasia adequada é crucial para o sucesso do tratamento dentário invasivo, pois problemas de sangramento podem levar a complicações associadas a uma morbidade e mortalidade significativas. O tratamento odontológico de pacientes que são propensos a um risco maior de sangramento devido ao uso de drogas anticoagulantes representa um desafio na prática diária dos profissionais da odontologia. O conhecimento adequado dos mecanismos subjacentes à hemostasia e o gerenciamento otimizado desses pacientes são, portanto, questões muito importantes. É realizada uma revisão dos anticoagulantes atualmente disponíveis no mercado, avaliando os riscos e benefícios de descontinuar tal medicamento antes do tratamento dentário invasivo. Além disso, é feita uma revisão dos protocolos de gerenciamento atuais usados nesses pacientes. Material e métodos: Foi realizada uma pesquisa bibliográfica nas bases de dados Epistemonikos e Medline/PubMed; no portal Timbo e na biblioteca virtual Scielo. Todos os estudos publicados nos últimos 15 anos, em inglês e espanhol, foram incluídos. Trinta artigos foram encontrados, 15 foram selecionados em primeira instância para acabar com 11 artigos. Nesta seleção, o filtro foi que os outros artigos se referiam a outros anticoagulantes que não faziam parte deste trabalho. Resultados: foram desenvolvidos múltiplos protocolos de gerenciamento, embora em todos os casos seja necessário um histórico clínico completo, juntamente com testes hemostáticos complementares para minimizar os riscos derivados do tratamento odontológico. Discussão: muitos autores consideram que a medicação os pacientes indicada para o tratamento de uma doença subjacente não deve ser alterada ou descontinuada, a menos que o médico que a prescreve dê instruções nesse sentido. Medidas hemostáticas locais demonstraram ser suficientes para controlar potenciais problemas de sangramento resultantes do tratamento odontológico.

Implementation of a patient blood management program based on a low-income country-adapted clinical decision support system

ABSTRACT Introduction: Patient blood management (PBM) programs are associated with better patient outcomes, a reduced number of transfusions and cost-savings The Clinical Decision Support (CDS) systems are valuable tools in this process, but their availability is limited in developing countries This study assesses the feasibility and effectiveness of an adapted CDS system for low-income countries. Methods: This was a prospective study of the PBM program implementation, in a 200-bed tertiary hospital, between February 2019 and May 2020. Outcome measures were red blood cell (RBC), fresh frozen plasma (FFP) and platelet unit transfusions, the transfusion of a single unit of red blood cells and an RBC adequacy index (RAI). Results: Comparing the post-PBM program era with the pre-PBM system era, there was a decrease in red blood cell transfusions (p = 0.05), with an increase in single unit red blood cell transfusions (p = 0.005) and RAI (p < 0.001). Conclusions: The PBM programs, including electronic transfusion guidelines with pre-transfusion medical auditing, was associated with improved transfusion practices and reduced product acquisition-related costs.

Clinical management of COVID-19: living guideline - 15 September 2022

The WHO COVID-19 Clinical management: living guidance contains the Organization's most up-to-date recommendations for the clinical management of people with COVID-19. Providing guidance that is comprehensive and holistic for the optimal care of COVID-19 patients throughout their entire illness is important. The latest version of this living guideline is available in pdf format (via the 'Download' button) and via an online platform, and is updated regularly as new evidence emerges. No further updates to the previous existing recommendations were made in this latest version. This updated (fifth) version contains 16 new recommendations for the rehabilitation of adults with post COVID-19 condition (see Chapter 24), which includes: strong recommendation that exertional desaturation and cardiac impairment following COVID-19 should be ruled out and managed before consideration of physical exercise training

Recommendations for the diagnosis and management of Fabry disease in pediatric patients: a document from the Rare Diseases Committee of the Brazilian Society of Nephrology (Comdora-SBN) / Recomendações para o diagnóstico e manejo de pacientes pediátricos com doença de Fabry: documento do comitê de doenças raras da Sociedade Brasileira de Nefrologia (Comdora-SBN)

Fabry disease (FD) is a genetic disease, with X-chromosome linked inheritance, due to variants in the GLA gene that encodes the α-galactosidase A (α-GAL) enzyme. The purpose of the present study was to create a consensus aiming to standardize the recommendations regarding the renal involvement of FD with guidelines on the diagnosis, screening, and treatment of pediatric patients. This consensus is an initiative of the Rare Diseases Committee (Comdora) of the Brazilian Society of Nephrology (SBN). Randomized controlled clinical studies and studies with real-life data added to the authors' experience were considered for this review. The result of this consensus was to help manage patient and physician expectations regarding treatment outcomes. Thus, this consensus document recommends the investigation of the pediatric family members of an index case, as well as cases with suggestive clinical signs. From the diagnosis, assess all possible FD impairments and grade through scales. From an extensive review of the literature including pediatric protocols and particularly evaluating pediatric cases from general studies, it can be concluded that the benefits of early treatment are great, especially in terms of neuropathic pain and renal impairment parameters and outweigh the possible adverse effects that were mainly manifested by infusion reactions.

A doença de Fabry (DF) é uma doença genética, com herança ligada ao cromossomo X, devido a variantes no gene GLA que codifica a enzima α-galactosidase A (α-GAL). O propósito do presente estudo foi criar um consenso objetivando padronizar as recomendações em relação ao acometimento renal da DF com orientações sobre o diagnóstico, rastreamento, e tratamento de pacientes pediátricos. Esse consenso é uma iniciativa do Comitê de Doenças Raras (Comdora) da Sociedade Brasileira de Nefrologia (SBN). Foram considerados para esta revisão estudos clínicos controlados randomizados e estudos com dados de vida real somados à experiência dos autores. O resultado desse consenso foi auxiliar no gerenciamento das expectativas de pacientes e médicos quanto aos resultados do tratamento. Assim, este documento de consenso recomenda a investigação dos familiares pediátricos de um caso índice, assim como de casos com clínica sugestiva. A partir do diagnóstico, avaliar todos os possíveis acometimentos da DF e graduar através de escalas. A partir de uma revisão extensa da literatura incluindo protocolos pediátricos e avaliando particularmente os casos pediátricos de estudos gerais, pode-se concluir que os benefícios do tratamento precoce são grandes, principalmente quanto aos parâmetros de dor neuropática e do acometimento renal, e suplantam os possíveis adversos que foram sobretudo manifestados por reações infusionais.

Modelo ontológico para sistematização da assistência de enfermagem na perspectiva da teoria da complexidade / Ontological model for the systematization of nursing care from the perspective of complexity theory

Resumo: Introdução: A Sistematização da Assistência de Enfermagem corresponde à organização do trabalho quanto ao método, pessoal e instrumentos, vislumbrando operacionalizar o processo de enfermagem. Porém, há limitação da compreensão semântica do seu significado, conhecimento, operacionalização dos seus componentes e da contribuição para prática profissional e Ciência da Enfermagem. Objetivo: analisar, sob a ótica da Teoria da Complexidade, a construção de um modelo ontológico sobre Sistematização da Assistência de Enfermagem como tecnologia de apoio à organização da prática profissional do enfermeiro. Método: estudo qualitativo e exploratório, em três etapas. Primeiramente, construiu-se um mapa conceitual baseado nas sete etapas apresentadas por Cañas, Novak, Reiska (2015), almejando identificar conceitos, estrutura, processos e operação da Sistematização da Assistência de Enfermagem, à luz da Teoria da Complexidade. Organizou-se e representou-se o conhecimento com apoio do software CMap Tools. A segunda etapa compôs-se de entrevistas semiestruturadas, entre maio e dezembro de 2020, com 17 enfermeiros, dos quais nove eram do Grupo de Trabalho da Sistematização da Prática de Enfermagem da Comissão Mista da Associação Brasileira de Enfermagem e Conselho Regional de Enfermagem-PR e oito da Comissão Permanente de Sistematização da Prática de Enfermagem, nomeada pela Associação Brasileira de Enfermagem. Empregou-se a Análise de Conteúdo Temática, apoiada no software MAXQDA. Na terceira etapa, modelou-se a representação de uma ontologia sobre a Sistematização da Assistência de Enfermagem, baseada no guia interativo Ontology Development 101 apoiada pelo software Protégé (versão 5.5.0), a partir do mapa conceitual e das entrevistas. Resultados: identificou-se inconsistência semântica e de correlações, retratando a complexidade dos componentes da Sistematização da Assistência de Enfermagem, com fragmentos mecanicistas. No mapa conceitual, elaboraram-se três camadas conceituais. Organizaram-se os conceitos de acordo com a proposta conceitual da Sistematização da Assistência de Enfermagem prevista em sua principal legislação e posteriormente foram ampliados. Desta análise, procedeu-se ao agrupamento por temáticas: Sistematização da Assistência de Enfermagem; Ações de Enfermagem; Ações da Gestão do Cuidado; Ações de Gestão do Serviço de Enfermagem; Ações para Aplicação dos Cuidados; Ações para Aplicação no Serviço de Enfermagem; Fundamentos; Competências; Instrumentos; Normativas e Pessoal. Das entrevistas, emergiram 863 unidades de registro e seis categorias: Significado de Sistematização da Assistência de Enfermagem, com três subcategorias primárias; Construção Histórica do Conceito de Sistematização da Assistência de Enfermagem, com quatro subcategorias primárias; Ensino e Aprendizagem; Pesquisa da Enfermagem; Implicações Prática e Concretização da Sistematização da Assistência de Enfermagem. Identificaram-se 156 conceitos relevantes para modelagem da ontologia, utilizando-se da "metodologia 101", objetivando representar o conhecimento do domínio Sistematização da Assistência de Enfermagem. Considerações finais: a ontologia sobre Sistematização da Assistência de Enfermagem ancorada na Teoria da Complexidade permitiu um novo olhar sobre os fenômenos, os quais devem ser desenvolvidos, revistos e ressignificados. Acredita-se que esta ontologia facilite a representação formal do conhecimento sobre Sistematização da Assistência de Enfermagem, afirmando-a enquanto área de conhecimento representativo, fortalecendo sua identidade, significado unívoco, organização, compartilhamento de saberes e de informação. Ademais, pode favorecer difusão de vocabulário comum, contribuindo com a prática profissional de enfermeiros.

Abstract: Introduction: the Systematization of Nursing Care is the work organization according to the method, personnel and instruments, which glimpses to operationalize the nursing process. However, there is a limitation in the semantic understanding of its meaning, knowledge, and operationalization of its components and the contribution to the practice and science of nursing. Objective: to analyze, from the perspective of Complexity Theory, the process of building an ontological model on Systematization of Nursing Care as a technology to support the organization of professional nursing practice. Method: qualitative and exploratory study, in three stages. Firstly, a conceptual map was built based on the seven stages presented by Cañas, Novak, Reiska (2015), aiming to identify concepts, structure, processes and operation of the Systematization of Nursing Care, in light of the complexity, anchored in the related literature. Knowledge was organized and represented with the support of CMap Tools software. The second stage consisted of semi-structured interviews, between May and December 2020, done with 17 professionals, of whom nine from the Working Group on the Systematization of Nursing Practice of the Mixed Commission of the Brazilian Nursing Association and Regional Nursing Council-PR and eight from the Permanent Commission for the Systematization of Nursing Practice, appointed by the Association. Thematic Content Analysis was used, supported by the MAXQDA software. In the third stage, the representation of ontology on the Systematization of Nursing Care was modeled, based on the interactive guide Ontology Development 101 supported by the software Protégé (version 5.5.0), from the conceptual map and the interviews. Results: semantic inconsistency and correlations were identified, portraying the complexity of the components of the Systematization of Nursing Care, with mechanistic fragments. In the conceptual map, three conceptual layers were elaborated. The concepts were organized according to the conceptual proposal of the Systematization of Nursing Care provided for in its main legislation and were later expanded. From this analysis, we proceeded to group by themes: Systematization of Nursing Care; Nursing Actions; Management Care Actions; Nursing Service Management Actions, Care Management Actions; Nursing Service Management Actions; Actions for Application of Care, and Actions for Application in the Nursing Service; Fundamentals, Competencies; Instruments; Regulations and Personnel. From the interviews, 863 record units and six categories emerged: Meaning of Systematization of Nursing Care, with three primary subcategories; Historical Construction of the Concept of Systematization of Nursing Care, with four primary subcategories; Teaching and Learning; Nursing Research; Practical Implications and Implementation of the Systematization of Nursing Care. 156 relevant concepts for ontology modeling were identified using the "101 methodology", aiming to represent the knowledge of the Systematization of Nursing Care domain. Final considerations: the ontology on Systematization of Nursing Care anchored in Complexity Theory allowed a new look at the phenomena, which must be developed, reviewed and re-signified. It is believed that this ontology facilitates the formal representation of knowledge about Systematization of Nursing Care, affirming it as a representative area of knowledge, strengthening its identity, univocal meaning, organization, sharing of knowledge and information. Furthermore, it can favor the diffusion of common vocabulary, contributing to the professional practice of nurses.

Resumen: Introducción: la sistematización de la asistencia de Enfermeríaes la organización del trabajo en cuanto a método, personal e instrumentos, con el objetivo de operacionalizar el proceso de enfermería. Sin embargo, existe una limitación en la comprensión semántica de su significado, conocimiento, operacionalización de sus componentes y el aporte a la práctica y ciencia de enfermería. Objetivo: analizar, en la perspectiva de la Teoría de la Complejidad, el proceso de construcción de un modelo ontológico sobre la sistematización de la asistencia de Enfermería como tecnología de apoyo a la organización de la práctica profesional de enfermería. Método: estudio cualitativo y exploratorio, en tres etapas. En primer lugar, se construyó un mapa conceptual a partir de las siete etapas proclamadas presentadas por Cañas, Novak, Reiska (2015), con el objetivo de identificar conceptos, estructura, procesos y funcionamiento de la sistematización de la asistencia de Enfermería, a la luz de la complejidad, anclada en la literatura relacionada. El conocimiento fue organizado y representado con el apoyo del software CMap Tools. La segunda etapa consistió en entrevistas semiestructuradas, entre mayo y diciembre de 2020, con 17 profesionales, de los cuales nueve del Grupo de Trabajo sobre Sistematización de la Práctica de Enfermería de la Comisión Mixta de la Asociación Brasileña de Enfermería y Consejo Regional de Enfermería-PR y ocho del Comisión Permanente para la Sistematización de la Práctica de Enfermería, designada por el Colegio. Se utilizó el Análisis de Contenido Temático, apoyado en el software MAXQDA. En la tercera etapa, se modeló la representación de una ontología sobre la sistematización de la asistencia de Enfermería, a partir de la guía interactiva Ontology Development 101 con el apoyo del software Protégé (versión 5.5.0), del mapa conceptual y de las entrevistas. Resultados: fueron identificadas inconsistencias semánticas y correlaciones, retratando la complejidad de los componentes de lasistematización de la asistencia de Enfermería, con fragmentos mecanicistas. En el mapa conceptual se elaboraron tres capas conceptuales. Los conceptos fueron organizados de acuerdo con la propuesta conceptual de la sistematización de la asistencia de Enfermeríaprevista en su legislación principal y posteriormente fueron ampliados. A partir de ese análisis, se procedió a agrupar por temas: Sistematización de la Asistencia de Enfermería; Acciones de Enfermería; Acciones de Gestión del Cuidado; Acciones de Gestión del Servicio de Enfermería; Acciones de Gestión del Cuidado; Acciones de Gestión del Servicio de Enfermería; Acciones de Aplicación de Cuidados; Acciones de Aplicación en el Servicio de Enfermería; Fundamentos; Competencias; Instrumentos; Reglamentos y Personal. De las entrevistas surgieron 863 unidades de registro y seis categorías: Significado de sistematización de la asistencia de Enfermería, con tres subcategorías primarias; Construcción Histórica del Concepto de Sistematización de la Atención de Enfermería, con cuatro subcategorías primarias; Enseñanza y Aprendizaje; Investigación en Enfermería; Implicaciones Prácticas e Implementación de la sistematización de la asistencia de Enfermería. Fueron identificados 156 conceptos relevantes para el modelado ontológico utilizando la "metodología 101", con el objetivo de representar el conocimiento del dominio sistematización de la asistencia de Enfermería. Consideraciones finales: la ontología sobre sistematización de la asistencia de Enfermería anclado en la Teoría de la Complejidad permitió una nueva mirada sobre los fenómenos, que deben ser desarrollados, revisados y redefinidos. Se cree que esta ontología facilita la representación formal del conocimiento sobre sistematización de la asistencia de Enfermería, afirmándola como área representativa del saber, fortaleciendo su identidad, sentido unívoco, organización, intercambio de saberes e informaciones. Además, puede favorecer la difusión del vocabulario común, contribuyendo a la práctica profesional de los enfermeros.

The digital transformation of hepatology: The patient is logged in.

The rise in innovative digital health technologies has led a paradigm shift in health care toward personalized, patient-centric medicine that is reaching beyond traditional brick-and-mortar facilities into patients' homes and everyday lives. Digital solutions can monitor and detect early changes in physiological data, predict disease progression and health-related outcomes based on individual risk factors, and manage disease intervention with a range of accessible telemedicine and mobile health options. In this review, we discuss the unique transformation underway in the care of patients with liver disease, specifically examining the digital transformation of diagnostics, prediction and clinical decision-making, and management. Additionally, we discuss the general considerations needed to confirm validity and oversight of new technologies, usability and acceptability of digital solutions, and equity and inclusivity of vulnerable populations.

Medications and dosages used in medical assistance in dying: a cross-sectional study.

BACKGROUND: There is little evidence describing the technical aspects of medical assistance in dying (MAiD) in Canada, such as medications, dosages and complications. Our objective was to describe clinical practice in providing MAiD in Ontario and Vancouver, Canada, and explore relations between medications used, time until death and complications. METHODS: We conducted a retrospective cohort study of a sample of adult (age ≥ 18 yr) patients who received MAiD in Ontario between 2016 and 2018, and patients who received MAiD in 1 of 3 Canadian academic hospitals (in Hamilton and Ottawa, Ontario, and Vancouver, British Colombia) between 2019 and 2020. We used de-identified data for 2016-2018 from the Office of the Chief Coroner for Ontario MAiD Database and chart review data for 2019-2020 from the 3 centres. We used multivariable parametric survival analysis to identify relations between medications, dosages and time from procedure start until death. RESULTS: The sample included 3557 patients (1786 men [50.2%] and 1770 women [49.8%] with a mean age of 74 [standard deviation 13] yr). The majority of patients (2519 [70.8%]) had a diagnosis of cancer. The medications most often used were propofol (3504 cases [98.5%]), midazolam (3251 [91.4%]) and rocuronium (3228 [90.8%]). The median time from the first injection until death was 9 (interquartile range 6) minutes. Standard-dose lidocaine (40-60 mg) and high-dose propofol (> 1000 mg) were associated with prolonged time until death (prolonged by a median of 1 min and 3 min, respectively). Complications occurred in 41 cases (1.2%), mostly related to venous access or need for administration of a second medication. INTERPRETATION: In a large sample of patients who died with medical assistance, certain medications were associated with small differences in time from injection to death, and complications were rare. More research is needed to identify the medication protocols that predict outcomes consistent with patient and family expectations for a medically assisted death.

Melhores práticas no cuidado durante a doação de plaquetas por aférese: protocolo de revisão de escopo / Best care practices during apheresis platelet donation: a scoping review protocol / Mejores prácticas de atención durante la donación de plaquetas por aféresis: un protocolo de scoping review

OBJETIVO: mapear, na literatura científica, as melhores práticas na gestão do cuidado, durante o processo de doação de plaquetas por aférese. MÉTODO: esta revisão de escopo seguirá a metodologia proposta pelo Joanna Briggs, sendo norteada pela questão de pesquisa: Quais as melhores práticas na gestão do cuidado durante o processo de doação de plaquetas por aférese? Serão considerados artigos originais, independente do desenho do estudo; em português, inglês, francês e espanhol; entre os anos 2017 e 2021; que forneçam texto completo. Como critérios de exclusão: estudos relacionados à terapêutica de aférese plaquetária ou pesquisas que envolvam animais. Após seleção dos descritores, será realizada busca prévia nas bases MEDLINE, via PubMed, e CINAHL. Os dados selecionados para revisão serão exibidos no fluxograma PRISMA para revisões de escopo.

OBJECTIVE: to map, in the scientific literature, the best care practices during platelet donation by apheresis. METHOD: this scoping review will follow the Joanna Briggs Institute's framework, guided by the research question: What are the best care practices during platelet donation by apheresis? Original articles will be considered, regardless of the study design, in Portuguese, English, French, and Spanish, published from 2017 to 2021, with full text available. As exclusion criteria: studies related to platelet apheresis therapy or animal research. After selecting the descriptors, a previous search will be conducted in MEDLINE via PubMed and CINAHL. Studies selected for review will be displayed in the PRISMA flowchart for scoping reviews.