Remote Training of Neurointerventions by Audiovisual Streaming : Experiences from the European ESMINT-EYMINT E-Fellowship Program.

BACKGROUND: Remote access of trainees to training centers via video streaming (tele-observership, e­fellowship) emerges as an alternative to acquire knowledge in endovascular interventions. Situational awareness is a summary term that is also used in surgical procedures for perceiving and understanding the situation and projecting what will happen next. A high situational awareness would serve as prerequisite for meaningful learning success during tele-observerships. We hypothesized that live perception of the angiographical procedures using streaming technology is feasible and sufficient to gain useful situational awareness of the procedure. METHODS: During a European tele-observership organized by the European Society of Minimally Invasive Neurological Therapy (ESMINT) and its trainee association (EYMINT), a total of six neurointerventional fellows in five countries observed live cases performed by experienced neurointerventionalists (mentors) in six different high-volume neurovascular centers across Europe equipped with live-streaming technology (Tegus Medical, Hamburg, Germany). Cases were prospectively evaluated during a 12-month period, followed by a final questionnaire after completion of the course. RESULTS: A total of 102/161 (63%) cases with a 1:1 allocation of fellow and mentor were evaluated during a 12-month period. Most frequent conditions were ischemic stroke (27.5%), followed by embolization of unruptured aneurysms (25.5%) and arteriovenous malformations (AVMs) (15.7%). A high level of situational awareness was reported by fellows in 75.5% of all cases. After finishing the program, the general improvement of neurointerventional knowledge was evaluated to be extensive (1/6 fellows), substantial (3/6), and moderate (2/6). The specific fields of improvement were procedural knowledge (6/6 fellows), technical knowledge (3/6) and complication management (2/6). CONCLUSION: Online streaming technology facilitates location-independent training of complex neurointerventional procedures through high levels of situational awareness and can therefore supplement live hands-on-training. In addition, it leads to a training effect for fellows with a perceived improvement of their neurointerventional knowledge.

Neuroimaging assessment in Down syndrome: a pictorial review.

Down syndrome (DS), or trisomy 21, is the leading genetic cause of intellectual incapacity worldwide, with a reported incidence of about 1 in 1,000 to 1 in 1,100 live births. Besides the several commonly known physical features characteristic of this syndrome present at birth, DS may additionally affect every organ system. In addition, despite the large number of published papers concerning this syndrome, there is scarce literature focusing specifically in the typical neuroimaging features associated with this condition. The aim of this paper is to review and systematize the distinctive characteristics and abnormalities of the central nervous system, head and neck, and spine present in DS patients that should actively be searched for and evaluated by radiologists and/or neuroradiologists.

Comparison of different histological indexes in the assessment of UC activity and their accuracy regarding endoscopic outcomes and faecal calprotectin levels.

OBJECTIVE: Histological remission is being increasingly acknowledged as a therapeutic endpoint in patients with UC. The work hereafter described aimed to evaluate the concordance between three histological classification systems-Geboes Score (GS), Nancy Index (NI) and RobartsHistopathologyIndex (RHI), as well as to evaluate their association with the endoscopic outcomes and the faecal calprotectin (FC) levels. DESIGN: Biopsy samples from 377 patients with UC were blindly evaluated using GS, NI and RHI. The results were compared with the patients' Mayo Endoscopic Score and FC levels. RESULT: GS, NI and RHI have a good concordance concerning the distinction between patients in histological remission or activity. RHI was particularly close to NI, with 100% of all patients classified as being in remission with NI being identified as such with RHI and 100% of all patients classified as having activity with RHI being identified as such with NI. These scores could also predict the Mayo Endoscopic Score and the FC levels, with their sensitivity and specificity levels depending on the chosen cut-offs. Moreover, higher FC levels were statistically associated with the presence of neutrophils in the epithelium, as well as with ulceration or erosion of the intestinal mucosa. CONCLUSIONS: GS, NI and RHI histopathological scoring systems are comparable in what concerns patients' stratification into histological remission/activity. Additionally, FC levels are increased when neutrophils are present in the epithelium and the intestinal mucosa has erosions or ulcers. The presence of neutrophils in the epithelium is, indeed, the main marker of histological activity.

[Development of the short version of the informal caregiver burden assessment questionnaire]. / Desenvolvimento de uma versão reduzida do Questionário De Avaliação Da Sobrecarga do Cuidador Informal.

OBJETIVE: to create a reduced version of the QASCI, which is structurally equivalent to the long one and meets the criteria of reliability and validity. METHOD: Through secondary data from previous studies, the participants were divided into two samples, one for the development of reduced version and the second for study of the factorial validity. Participants responded to QASCI, the SF 36, the ADHS and demographic questions. RESULTS: A reduced version of 14 items showed adequate psychometric properties of validity and internal consistency, adapted to a heptadimensional structure that assesses positive and negative aspects of care. CONCLUSION: Confirmatory factor analysis revealed a good fit with the advocated theoretical model.

Development of the short version of the informal caregiver burden assessment questionnaire / Desarrollo De Una Versión Reducida Del Cuestionario De Evaluación De La Sobrecarga Del Cuidador Informal / Desenvolvimento de uma versão reduzida do Questionário de Avaliação da Sobrecarga do Cuidador Informal

OBJETIVE to create a reduced version of the QASCI, which is structurally equivalent to the long one and meets the criteria of reliability and validity. METHOD Through secondary data from previous studies, the participants were divided into two samples, one for the development of reduced version and the second for study of the factorial validity. Participants responded to QASCI, the SF 36, the ADHS and demographic questions. RESULTS A reduced version of 14 items showed adequate psychometric properties of validity and internal consistency, adapted to a heptadimensional structure that assesses positive and negative aspects of care. CONCLUSION Confirmatory factor analysis revealed a good fit with the advocated theoretical model. .

OBJETIVO Crear una versión reducida del Cuestionario de Evaluación de la Sobrecarga del Cuidador Informal (CESCI) que sea estructuralmente equivalente y que reúna criterios de fidelidad y validez. MÉTODO Mediante datos secundarios a estudios anteriores se constituyeron dos muestras, la primera para el desarrollo de la versión reducida y la segunda para estudiar la validez factorial. Los participantes respondieron al CESCI, el SF 36, la HAD y a preguntas sociodemográficas. RESULTADOS La versión reducida de 14 ítems demostró adecuadas propiedades psicométricas de validez y consistencia interna adaptadas a una estructura heptadimensional que evalúa los aspectos negativos y positivos del cuidar. CONCLUSIÓN El análisis factorial confirmatorio reveló un buen ajuste al modelo teórico preconizado. .

OBJETIVO Criar uma versão reduzida do Questionário de Avaliação da Sobrecarga do Cuidador Informal (QASCI), que seja estruturalmente equivalente e que reúna critérios de fidelidade e validade. MÉTODO Através de dados secundários a estudos anteriores constituíram-se duas amostras, uma para o desenvolvimento da versão reduzida e a segunda para estudar a validade fatorial. Os participantes responderam ao QASCI, ao SF 36, à EADH e a perguntas sociodemográficas. RESULTADOS A versão reduzida de 14 itens mostrou adequadas propriedades psicométricas de validade e consistência interna adaptada a uma estrutura heptadimensional que avalia aspetos negativos e positivos do cuidar. CONCLUSÃO A análise fatorial confirmatória revelou um bom ajustamento ao modelo teórico preconizado. .

Crisis intervention related to the use of psychoactive substances in recreational settings--evaluating the Kosmicare Project at Boom Festival.

Kosmicare project implements crisis intervention in situations related to the use of psychoactive substances at Boom Festival (Portugal). We present evaluation research that aims to contribute to the transformation of the project into an evidence-based intervention model. It relies on harm reduction and risk minimization principles, crisis intervention models, and Grof's psychedelic psychotherapy approach for crisis intervention in situations related to unsupervised use of psychedelics. Intervention was expected to produce knowledge about the relation between substance use and mental health impact in reducing potential risk related to the use of psychoactive substances and mental illness, as well as an impact upon target population's views of themselves, their relationship to substance use, and to life events in general. Research includes data on process and outcome indicators through a mixed methods approach, collected next to a sample of n=176 participants. Sample size varied considerably, however, among different research measures. 52% of Kosmicare visitors reported LSD use. Over 40% also presented multiple drug use. Pre-post mental state evaluation showed statistically significant difference (p<.05) confirming crisis resolution. Crisis episodes that presented no resolution were more often related with mental health outburst episodes, with psychoactive substance use or not. Visitors showed high satisfaction with intervention (n=58) and according to follow-up (n=18) this perception was stable over time. Crisis intervention was experienced as very significant. We discuss limitations and implications of evaluating natural setting based interventions, and the relation between psychoactive substance use and psychopathology. Other data on visitor's profile and vulnerability to crisis showed inconclusive.

De José Sarney a Fernando Henrique Cardoso: relação Executivo-legislativo e política de saúde no Brasil / Jose Sarney the Fernando Enrique Cardoso: Executive-legislative relation and politics of health in Brazil

Este artigo tem como foco a dinâmica da relação entre os Poderes Executivo e Legislativo federais no processo decisório da política de saúde durante um período que se inicia com a posse de José Sarney na Presidência da República (1985) e vai até o término do primeiro mandato do presidente Fernando Henrique Cardoso (1998). Procura-se problematizar a tese da primazia do Executivo Federal no processo legislativo em detrimento da autonomia e da iniciativa do Congresso Nacional. Inicialmente, analisam-se a participação e o peso relativo do Executivo e do Legislativo federais na conformação da agenda decisória da política pública de saúde no Brasil. Em seguida, enfatiza-se o tema dos recursos políticos de que dispuseram os dois Poderes durante os processos de negociação e voltados para a aprovação da legislação na área da saúde no Congresso Nacional.