A comprehensive analysis of patients with cerebral arteriovenous malformation with headache: assessment of risk factors and treatment effectiveness.

BACKGROUND: Due to the high mortality and disability rate of intracranial hemorrhage, headache is not the main focus of research on cerebral arteriovenous malformation (AVM), so research on headaches in AVM is still scarce, and the clinical understanding is shallow. This study aims to delineate the risk factors associated with headaches in AVM and to compare the effectiveness of various intervention treatments versus conservative treatment in alleviating headache symptoms. METHODS: This study conducted a retrospective analysis of AVMs who were treated in our institution from August 2011 to December 2021. Multivariable logistic regression analysis was employed to assess the risk factors for headaches in AVMs with unruptured, non-epileptic. Additionally, the effectiveness of different intervention treatments compared to conservative management in alleviating headaches was evaluated through propensity score matching (PSM). RESULTS: A total of 946 patients were included in the analysis of risk factors for headaches. Multivariate logistic regression analysis identified that female (OR 1.532, 95% CI 1.173-2.001, p = 0.002), supply artery dilatation (OR 1.423, 95% CI 1.082-1.872, p = 0.012), and occipital lobe (OR 1.785, 95% CI 1.307-2.439, p < 0.001) as independent risk factors for the occurrence of headaches. There were 443 AVMs with headache symptoms. After propensity score matching, the microsurgery group (OR 7.27, 95% CI 2.82-18.7 p < 0.001), stereotactic radiosurgery group(OR 9.46, 95% CI 2.26-39.6, p = 0.002), and multimodality treatment group (OR 8.34 95% CI 2.87-24.3, p < 0.001) demonstrate significant headache relief compared to the conservative group. However, there was no significant difference between the embolization group (OR 2.24 95% CI 0.88-5.69, p = 0.091) and the conservative group. CONCLUSIONS: This study identified potential risk factors for headaches in AVMs and found that microsurgery, stereotactic radiosurgery, and multimodal therapy had significant benefits in headache relief compared to conservative treatment. These findings provide important guidance for clinicians when developing treatment options that can help improve overall treatment outcomes and quality of life for patients.

Improved Short-Term Prognosis of Pediatric Partial-Thickness Burns: Emergency Conservative Debridement Under Topical Anesthesia.

OBJECTIVES: Early wound management for pediatric patients with partial-thickness burns in the emergency department remains debatable. This study aims to evaluate the value of emergency conservative debridement under topical anesthesia in improving short-term prognosis of pediatric partial-thickness burns. METHODS: This retrospective cohort study enrolled children with partial-thickness thermal burns presenting to the emergency department within 6 hours postburn. All the enrolled patients were divided into 2 groups: the debridement group and the dressing group. The associations between emergency conservative debridement and time to reepithelialization was analyzed by using Kaplan-Meier curves with log rank test and multivariate Cox regression analysis. Moreover, the associations between emergency conservative debridement and in-hospital cost and length of stay were also evaluated. RESULTS: All baseline characteristics between groups were comparable (all P > 0.05). Emergency conservative debridement under topical anesthesia significantly decreased the median value of time to reepithelialization (13 vs 14 days, P = 0.02). Cox regression analysis showed that emergency conservative debridement significantly improved wound reepithelialization after adjusting for burn size (odds ratio, 4.07; 95% confidence interval, 1.64-10.11; P < 0.01). The mean length of stay of patients receiving conservative wound debridement was lower than that of patients in the wound dressing group (14.3 ± 7.3 vs 18.8 ± 10.4 days, P < 0.01), but not in terms of mean in-hospital cost per 1% total body surface area (2.8 ± 1.9 vs 3.0 ± 2.1 × 103 RMB per 1% total body surface area, P = 0.58). CONCLUSIONS: Emergency conservative debridement of pediatric partial-thickness burns under topical anesthesia significantly improves the wound healing outcomes without increasing health care burden.

Effectiveness of conservative management versus laparoscopic cholecystectomy in the prevention of recurrent symptoms and complications in adults with uncomplicated symptomatic gallstone disease (C-GALL trial): pragmatic, multicentre randomised controlled trial.

OBJECTIVE: To assess the clinical and cost effectiveness of conservative management compared with laparoscopic cholecystectomy for the prevention of symptoms and complications in adults with uncomplicated symptomatic gallstone disease. DESIGN: Parallel group, pragmatic randomised, superiority trial. SETTING: 20 secondary care centres in the UK. PARTICIPANTS: 434 adults (>18 years) with uncomplicated symptomatic gallstone disease referred to secondary care, assessed for eligibility between August 2016 and November 2019, and randomly assigned (1:1) to receive conservative management or laparoscopic cholecystectomy. INTERVENTIONS: Conservative management or surgical removal of the gallbladder. MAIN OUTCOME MEASURES: The primary patient outcome was quality of life, measured by area under the curve, over 18 months using the short form 36 (SF-36) bodily pain domain, with higher scores (range 0-100) indicating better quality of life. Other outcomes included costs to the NHS, quality adjusted life years (QALYs), and incremental cost effectiveness ratio. RESULTS: Of 2667 patients assessed for eligibility, 434 were randomised: 217 to the conservative management group and 217 to the laparoscopic cholecystectomy group. By 18 months, 54 (25%) participants in the conservative management arm and 146 (67%) in the cholecystectomy arm had received surgery. The mean SF-36 norm based bodily pain score was 49.4 (standard deviation 11.7) in the conservative management arm and 50.4 (11.6) in the cholecystectomy arm. The SF-36 bodily pain area under the curve up to 18 months did not differ (mean difference 0.0, 95% confidence interval -1.7 to 1.7; P=1.00). Conservative management was less costly (mean difference -£1033, (-$1334; -€1205), 95% credible interval -£1413 to -£632) and QALYs did not differ (mean difference -0.019, 95% credible interval -0.06 to 0.02). CONCLUSIONS: In the short term (≤18 months), laparoscopic surgery is no more effective than conservative management for adults with uncomplicated symptomatic gallstone disease, and as such conservative management should be considered as an alternative to surgery. From an NHS perspective, conservative management may be cost effective for uncomplicated symptomatic gallstone disease. As costs, complications, and benefits will continue to be incurred in both groups beyond 18 months, future research should focus on longer term follow-up to establish effectiveness and lifetime cost effectiveness and to identify the cohort of patients who should be routinely offered surgery. TRIAL REGISTRATION: ISRCTN registry ISRCTN55215960.

Successful conservative management of a large 12-week-old cervical ectopic pregnancy in a nulliparous woman: a case report.

Cervical ectopic pregnancy (CEP) accounts for less than 0.1% of all ectopic pregnancies. CEP is associated with high morbidity and mortality potential due to the associated life-threatening hemorrhage. When it is large, detected late, and occurs in a nulliparous woman, management is more challenging as it requires the need to preserve the uterus. We present a case of a 33-year-old nulliparous woman with a large live cervical ectopic pregnancy at 12 weeks + 1 day gestation and a very high serum ß-HCG of 126,750 Miu/ml. She was successfully managed with suction curettage and cervical encerclage tamponade in order to preserve the uterus. The treatment was associated with significant hemorrhage and a prolonged period of follow-up. In low-resource settings, uterine-conserving management of CEP can be challenging, and curettage with cervical encerclage tamponade can be a cost-effective treatment modality even though it is associated with significant haemorrhage and prolonged treatment period.

Atraumatic Sternoclavicular Joint Instability: Prevalence, Etiology, and Management.

Sternoclavicular joint instability is a rare complaint in the orthopedic clinic, but patients can experience chronic pain and functional impacts. Causes of instability may be posttraumatic, infectious, autoimmune, degenerative, or secondary to generalized laxity. Conservative treatment is the initial approach to management and involves activity modification, physical therapy, oral nonsteroidal anti-inflammatory drugs, and corticosteroid injections. Surgery is indicated when conservative treatment does not manage symptoms. Figure-of-eight reconstruction techniques provide greatest biomechanical strength but are associated with risk of neurovascular injury. Other reconstruction methods have been shown to mitigate these risks with favorable short-term outcomes.

Health care delivery system contributions to management of newly diagnosed prostate cancer.

BACKGROUND: Despite clinical guidelines advocating for use of conservative management in specific clinical scenarios for men with prostate cancer, there continues to be tremendous variation in its uptake. This variation may be amplified among men with competing health risks, for whom treatment decisions are not straightforward. The degree to which characteristics of the health care delivery system explain this variation remains unclear. METHODS: Using national Medicare data, men with newly diagnosed prostate cancer between 2014 and 2019 were identified. Hierarchical logistic regression models were used to assess the association between use of treatment and health care delivery system determinants operating at the practice level, which included measures of financial incentives (i.e., radiation vault ownership), practice organization (i.e., single specialty vs. multispecialty groups), and the health care market (i.e., competition). Variance was partitioned to estimate the relative influence of patient and practice characteristics on the variation in use of treatment within strata of noncancer mortality risk groups. RESULTS: Among 62,507 men with newly diagnosed prostate cancer, the largest variation in the use of treatment between practices was observed for men with high and very high-risk of noncancer mortality (range of practice-level rates of treatment for high: 57%-71% and very high: 41%-61%). Addition of health care delivery system determinants measured at the practice level explained 13% and 15% of the variation in use of treatment among men with low and intermediate risk of noncancer mortality in 10 years, respectively. Conversely, these characteristics explained a larger share of the variation in use of treatment among men with high and very high-risk of noncancer mortality (26% and 40%, respectively). CONCLUSIONS: Variation among urology practices in use of treatment was highest for men with high and very high-risk noncancer mortality. Practice characteristics explained a large share of this variation.

Incidence and characteristics of ovarian cancer following endometrial cancer in the emerging era of conservative management of endometrial cancer-Implications for counseling-A SEER analysis.

OBJECTIVE: To assess the ovarian cancer (OC) risk following endometrial cancer (EC) in patients who underwent ovarian preservation as part of the EC staging. STUDY DESIGN: With permission of the Surveillance, Epidemiology and End Results (SEER) program of the United States National Cancer Institute, clinicopathological information of women diagnosed with EC and following OC were analyzed. Incidence of OC and survival according to the surgical approach were studied. Primary analysis was conducted in women up to and including the age of 49 years. RESULTS: A total of 116 patients up to the age of 49 years were diagnosed with EC and following OC. In this group of patients, no differences in incidence (IRR 0.9, CI 0.56-1.49, p = 0.66) or survival rates (p = 0.71) were found comparing ovarian preservation and bilateral salpingo-oophorectomy (BSO) performance. In an overall analysis of women diagnosed with EC and following OC at any age, incidence of OC did not differ between groups (IRR 1.07, CI 0.83-1.39, p = 0.59) yet when including patients older than 49 years old survival rates were shorter in ovarian preservation patients compared to patients with BSO performed as part of their EC treatment. CONCLUSION: Ovarian preservation in EC patients under the age of 49 years may be considered safe, with no impact on OC incidence or survival, benefiting longer natural hormonal status.

Current treatments for endometriosis in South Korea: an analysis of nationwide data from 2010 to 2019.

While a wide range of treatments, including medical therapies and surgery, are used to manage endometriosis, the characteristics and treatment status of patients who received these treatments have not been investigated in Korea. This study analyzed the Korean Health Insurance Review & Assessment Service-National Patient Sample (HIRA-NPS) data from 2010 to 2019 with 7530 patients diagnosed with endometriosis. Annual trends in the types of visit and surgery, medication prescriptions and associated costs were investigated. The analysis showed that surgery slightly decreased among the types of utilized healthcare services (2010: 16.3, 2019: 12.7), dienogest prescription rapidly increased due to national health insurance coverage from 2013 (2013: 12.1, 2019: 36.0), and the use of gonadotrophin-releasing hormone analogues decreased (2010: 33.6, 2019: 16.4). There was no significant change in total and outpatient costs per person over time. Regarding endometriosis treatment, conservative treatment mainly based on prescribed medications has been gradually replacing surgery. Particularly, the listing of dienogest for national health insurance coverage might have affected the trend. However, there were no significant changes in terms of total and medication costs per person.

Fertility and prognosis assessment between bleomycin/etoposide/cisplatin and paclitaxel/carboplatin chemotherapy regimens in the conservative treatment of malignant ovarian germ cell tumors: a multicenter and retrospective study.

OBJECTIVE: To evaluate the impact of bleomycin/etoposide/cisplatin (BEP) and paclitaxel/carboplatin (PC) chemotherapy regimens on the fertility and prognostic outcomes in malignant ovarian germ cell tumor (MOGCT) patients who underwent fertility-sparing surgery (FSS). METHODS: A propensity score matching algorithm was performed between the BEP and PC groups. The χ² test and the Kaplan-Meier method were used to compare the fertility outcome, disease-free survival (DFS) and overall survival (OS). The Cox proportional hazards regression analysis was used to identify risk factor of DFS. RESULTS: We included 213 patients, 185 (86.9%) underwent BEP chemotherapy, and 28 (13.1%) underwent PC chemotherapy. The median age was 22 years (range, 8-44 years), and the median follow-up period was 63 months (range, 2-191 months). Fifty-one (29.3%) patients had a pregnancy plan, and 35 (85.4%) delivered successfully. In the before and after propensity score matching cohorts, there were no significant differences in spontaneous abortion, selective termination of pregnancy, during-pregnancy status, and live birth between the BEP and PC groups (p>0.05). Fourteen (6.6%) patients experienced recurrence, including 11 (5.9%) in the BEP group and 3 (10.7%) in the PC group. Four (1.9%) patients in the BEP group died. Kaplan-Meier analysis revealed no significant differences in DFS (p=0.328) and OS (p=0.446) between the BEP and PC groups, and the same survival results were observed in the after matching cohort. CONCLUSION: The PC regimen is as safe as the BEP regimen for MOGCT patients with fertility preservation treatment, and no differences were observed in fertility and clinical prognosis.

Cost-effectiveness analysis of intradiscal condoliase injection vs. surgical or conservative treatment for lumbar disc herniation.

AIMS: This study aimed to analyze the cost-effectiveness of intradiscal condoliase injection compared to surgical or conservative treatment for patients with lumbar disc herniation (LDH) who are refractory to conservative treatment. METHODS: We performed the following cost-effectiveness analyses: (I) condoliase followed by open surgery (for non-responders to condoliase) vs. open surgery from the beginning, (II) condoliase followed by endoscopic surgery (for non-responders to condoliase) vs. endoscopic surgery from the beginning, and (III) condoliase + conservative treatment vs. conservative treatment. In the first two comparisons with surgical treatments, we assumed that utilities were equal in both groups and estimated the tangible (treatment, adverse events, postoperative follow-up) and intangible (mental and physical burden, and productivity loss) costs based on the existing literature, the medical expense scoring table, and online questionnaire. In the last comparison without surgical treatment, we estimated the incremental cost-effectiveness. RESULTS: The average cost per patient of condoliase followed by open surgery (for non-responders to condoliase) was 701,643 yen, with a reduction of 663,369 in comparison to that of open surgery from the beginning (1,365,012 yen). The average cost per patient of condoliase followed by endoscopic surgery (for non-responders to condoliase) was 643,909 yen, with a reduction of 514,909 in comparison to that of endoscopic surgery from the beginning (1,158,817 yen). ICER was 1.58 million yen/QALY (ΔQALY = 0.119, 95% confidence interval: 0.059-0.180; Δcost = 188,809 yen at 2 years post-treatment). CONCLUSIONS: Condoliase as a first line treatment option ahead of surgical treatment for LDH is superior, from a cost perspective, to surgical treatment from the beginning. Condoliase is also a cost-effective alternative to non-surgery conservative treatment.

Cost-effectiveness of cholecystectomy compared to conservative management in people presenting with uncomplicated symptomatic gallstones or cholecystitis in India.

OBJECTIVES: Gallstone diseases impose a significant economic burden on the health care system; thus, determining cost-effective management for gallstones is essential. We aim to estimate the cost-effectiveness of cholecystectomy compared with conservative management in individuals with uncomplicated symptomatic gallstones or cholecystitis in India. METHODS: A decision-analytic Markov model was used to compare the costs and QALY of early laparoscopic cholecystectomy (ELC), delayed laparoscopic cholecystectomy (DLC), and conservative management (CM) in patients with symptomatic uncomplicated gallstone/cholecystitis from an Indian health system perspective. Incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analyses were performed to test parameter uncertainties. RESULTS: ELC and DLC, compared to CM, incurred an incremental cost of -₹10,948 ($146) and ₹1,054 ($14) for the 0.032 QALYs gained. The ICER was -₹3,42,758 ($4577) for ELC vs. CM, and ₹33,183 ($443) for DLC vs. CM, suggesting ELC and DLC are cost-effective. ELC saved ₹12,001 ($160) for 0.0002 QALYs gained compared to DLC, resulting in an ICER of -₹6,43,89,441 ($8,59,733). The results were robust to changes in the input parameters in sensitivity analyses. CONCLUSION: ELC is dominant compared to both DLC and CM, and DLC is more cost-effective than CM. Thus, ELC may be preferable to other gallstone disease managements.

Endovascular aneurysm repair offers a survival advantage and is cost-effective compared with conservative management in patients physiologically unfit for open repair.

OBJECTIVE: The endovascular aneurysm repair-2 (EVAR-2) trial suggested that EVAR in patients unfit for open surgical repair (OSR) failed to provide a significant overall survival advantage compared with conservative management. The aim is to compare survival and cost-effectiveness in patients with poor cardiopulmonary exercise test (CPET) metrics who underwent EVAR or were managed conservatively. METHODS: A prospective database of all CPETs (1435 patients) performed to assess preoperative fitness for abdominal aortic aneurysm repair was maintained. A total of 350 patients deemed unfit for OSR underwent EVAR or were managed conservatively. A 1:1 propensity-matched analysis incorporating age, gender, anaerobic threshold, and aneurysm size was used to compare survival. Cost-effectiveness analysis was based on the economic model for the National Institute for Health and Care Excellence clinical guideline on abdominal aortic aneurysm treatment. RESULTS: Propensity matching produced 122 pairs of patients in the EVAR and conservative management groups. The median overall survival for the EVAR group was significantly longer than that for the conservative management group (84 vs 30 months, P < .001). One-, three-, and five-year mortality in the EVAR group was 7%, 40%, and 68%, respectively, compared with 25%, 68%, and 82% in the conservative management group, all P < .001. The increment cost-effectiveness ratio for EVAR was £8023 (US$11,644) per quality-adjusted life year gained compared with £430,602 (US$624,967) in the National Institute for Health and Care Excellence guideline, which is based on EVAR-2 results. CONCLUSIONS: EVAR offers a survival advantage and is cost-effective in selected patients deemed unfit for OSR based on CPET compared with conservative management.

Tonsillectomy compared with conservative management in patients over 16 years with recurrent sore throat: the NATTINA RCT and economic evaluation.

Background: The place of tonsillectomy in the management of sore throat in adults remains uncertain. Objectives: To establish the clinical effectiveness and cost-effectiveness of tonsillectomy, compared with conservative management, for tonsillitis in adults, and to evaluate the impact of alternative sore throat patient pathways. Design: This was a multicentre, randomised controlled trial comparing tonsillectomy with conservative management. The trial included a qualitative process evaluation and an economic evaluation. Setting: The study took place at 27 NHS secondary care hospitals in Great Britain. Participants: A total of 453 eligible participants with recurrent sore throats were recruited to the main trial. Interventions: Patients were randomised on a 1 : 1 basis between tonsil dissection and conservative management (i.e. deferred surgery) using a variable block-stratified design, stratified by (1) centre and (2) severity. Main outcome measures: The primary outcome measure was the total number of sore throat days over 24 months following randomisation. The secondary outcome measures were the number of sore throat episodes and five characteristics from Sore Throat Alert Return, describing severity of the sore throat, use of medications, time away from usual activities and the Short Form questionnaire-12 items. Additional secondary outcomes were the Tonsil Outcome Inventory-14 total and subscales and Short Form questionnaire-12 items 6 monthly. Evaluation of the impact of alternative sore throat patient pathways by observation and statistical modelling of outcomes against baseline severity, as assessed by Tonsil Outcome Inventory-14 score at recruitment. The incremental cost per sore throat day avoided, the incremental cost per quality-adjusted life-year gained based on responses to the Short Form questionnaire-12 items and the incremental net benefit based on costs and responses to a contingent valuation exercise. A qualitative process evaluation examined acceptability of trial processes and ramdomised arms. Results: There was a median of 27 (interquartile range 12-52) sore throats over the 24-month follow-up. A smaller number of sore throats was reported in the tonsillectomy arm [median 23 (interquartile range 11-46)] than in the conservative management arm [median 30 (interquartile range 14-65)]. On an intention-to-treat basis, there were fewer sore throats in the tonsillectomy arm (incident rate ratio 0.53, 95% confidence interval 0.43 to 0.65). Sensitivity analyses confirmed this, as did the secondary outcomes. There were 52 episodes of post-operative haemorrhage reported in 231 participants undergoing tonsillectomy (22.5%). There were 47 re-admissions following tonsillectomy (20.3%), 35 relating to haemorrhage. On average, tonsillectomy was more costly and more effective in terms of both sore throat days avoided and quality-adjusted life-years gained. Tonsillectomy had a 100% probability of being considered cost-effective if the threshold for an additional quality-adjusted life year was £20,000. Tonsillectomy had a 69% probability of having a higher net benefit than conservative management. Trial processes were deemed to be acceptable. Patients who received surgery were unanimous in reporting to be happy to have received it. Limitations: The decliners who provided data tended to have higher Tonsillectomy Outcome Inventory-14 scores than those willing to be randomised implying that patients with a higher burden of tonsillitis symptoms may have declined entry into the trial. Conclusions: The tonsillectomy arm had fewer sore throat days over 24 months than the conservative management arm, and had a high probability of being considered cost-effective over the ranges considered. Further work should focus on when tonsillectomy should be offered. National Trial of Tonsillectomy IN Adults has assessed the effectiveness of tonsillectomy when offered for the current UK threshold of disease burden. Further research is required to define the minimum disease burden at which tonsillectomy becomes clinically effective and cost-effective. Trial registration: This trial is registered as ISRCTN55284102. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/146/06) and is published in full in Health Technology Assessment; Vol. 27, No. 31. See the NIHR Funding and Awards website for further award information.

Tonsillectomy is an operation to take out the pair of tonsil glands at the back of the throat. It is an option for adults who suffer from repeated, severe sore throats. Adults who have a tonsillectomy say that they get fewer sore throats afterwards, but it is not clear whether or not they would have got better over time without the operation. There is pressure on doctors to limit the number of tonsillectomies carried out. At the same time, emergency hospital admissions for adults with severe throat infections have been increasing. NAtional Trial of Tonsillectomy IN Adults aimed to find out whether tonsillectomy is an effective and worthwhile treatment for repeated severe sore throats or whether patients would be better off treated without an operation. A total of 453 patients from 27 hospitals in Great Britain took part in the study. Patients were assigned at random to receive either tonsillectomy or conservative management (treatment as needed from their general practitioner). We measured how many sore throats patients had in the next 2 years by sending them text messages every week. We asked about the impact of their sore throats on their quality of life and time off work, and looked at the costs of treatment. We also interviewed 47 patients, general practitioners and hospital staff about their experiences of tonsillectomy and NAtional Trial of Tonsillectomy IN Adults. The typical patient in the tonsillectomy arm had 23 days of sore throat compared with 30 days of sore throat in the conservative management arm. Tonsillectomy resulted in higher quality of life. We looked to see whether or not it was only those with the most severe sore throats who benefited from tonsillectomy, but we found that patients with more or less severe sore throats at the start all did better with tonsillectomy. Patients who had a tonsillectomy were happy to have undertaken this. Our findings suggest a clear benefit of tonsillectomy using modest additional NHS resources for adults with repeated severe sore throats.

Sistema de avaliação de práticas psicológicas Aluízio Lopes de Brito (SAPP) sobre políticas de cuidado / Aluízio Lopes de Brito psychological practices assessment system (SAPP) on care policies / Sistema de evaluación de prácticas psicológicas Aluízio Lopes de Brito (SAPP) sobre políticas de cuidado

O objetivo do presente manuscrito é caracterizar e descrever os fluxos do Sistema de Avaliação de Práticas Psicológicas Aluízio Lopes de Brito (SAPP), dispositivo instituído no âmbito do Sistema Conselhos de Psicologia e regulamentado pelo Conselho Federal de Psicologia através da Resolução CFP nº 15, de 18 de agosto de 2023. O SAPP surge da necessidade premente de orientação e qualificação profissionais frente às práticas emergentes que produzem o saber/ fazer da psicologia. Nesse sentido, trata-se de processo que busca orientar, qualificar e fazer conhecer práticas que sejam compatíveis ou não com o exercício profissional em psicologia. Com o trabalho realizado no SAPP serão produzidos pareceres que contribuirão minimamente para o conhecimento das fronteiras que delimitam os campos da psicologia e, por excelência, conheceremos melhor nossas próprias formas de atuação. Através da consideração do trinômio teoria-prática-ética, o CFP espera com o SAPP abrir diálogos com grupos, práticas e saberes fronteiriços e constantemente relegados pela psicologia hegemônica. Para tanto, parte do pressuposto de que os saberes e fazeres destas populações podem refinar as teorias psicológicas e fazer a psicologia avançar como ciência e profissão.(AU)

This manuscript aims to characterize and describe the flows of the Aluízio Lopes de Brito Psychological Practices Assessment System (SAPP), an instrument established within the framework of the Psychology Council System and regulated by the Federal Council of Psychology (CFP) with Resolution CFP No. 15, of August 18, 2023. The SAPP arises from the pressing need for professional guidance and qualification in the face of emerging practices that shape the knowledge/practice of psychology. In this sense, it is a process that seeks to guide, qualify, and make known practices that are compatible or not with the professional practice of psychology. The work carried out in the SAPP will produce opinions that will contribute minimally to the understanding of the boundaries that delimit the fields of psychology and, by excellence, we will better understand our own modes of operation. Considering the trinity of theory-practice-ethics, the CFP hopes with the SAPP to open dialogues with groups, practices, and knowledge that are in the borders and are constantly relegated by hegemonic psychology. To this end, it assumes that the knowledge and practices of these populations can refine psychological theories and advance psychology as a science and profession.(AU)

El objetivo de este manuscrito es caracterizar y describir los flujos del Sistema de Evaluación de Prácticas Psicológicas Aluízio Lopes de Brito (SAPP), un dispositivo establecido en el marco del Sistema de Consejos de Psicología y regulado por el Consejo Federal de Psicología a través de la Resolución CFP n.º 15, con fecha del 18 de agosto de 2023. El SAPP surge de la necesidad apremiante de orientación y calificación profesional frente a las prácticas emergentes que configuran el conocimiento y las habilidades de la psicología. En este sentido, es un proceso que busca orientar, calificar y dar a conocer prácticas que sean compatibles o no con el ejercicio profesional de la psicología. El trabajo realizado en el SAPP generará opiniones que contribuirán mínimamente a la comprensión de los límites que delimitan los campos de la psicología y, por excelencia, comprender mejor nuestras propias formas de actuación. A través de la consideración de la tríada teoría-práctica-ética, el CFP espera que con el SAPP puede llevar a cabo el diálogo con grupos, prácticas y conocimientos fronterizos y constantemente pasados por alto por la psicología hegemónica. Con este fin, se asume que los conocimientos y prácticas de estas poblaciones pueden refinar las teorías psicológicas y hacer avanzar la psicología como ciencia y profesión.(AU)

Resolução de conflitos familiares por adolescentes e defesa do domínio pessoal / Adolescents' family conflict resolution and defense of personal domain / Resolución de conflictos familiares por adolescentes y defensa del dominio personal

Compreender as estratégias de resolução de conflitos utilizadas por adolescentes na relação com seus pais é fundamental para entender como ocorre seu desenvolvimento saudável. Este artigo investigou a resolução de conflitos de adolescentes em situações de confronto entre o seu domínio pessoal e o controle parental. 36 adolescentes com idades entre 15 e 17 anos, divididos igualmente conforme o sexo, responderam a uma entrevista semiestruturada, que continha quatro situações de conflito hipotéticas. Os dados foram submetidos à análise de conteúdo semântica e a testes não paramétricos. Os resultados foram categorizados em sete estratégias: Assunção de culpa, Submissão, Mentira, Hostilidade, Diálogo/Explicação, Negociação e Outra. A forma predominante de resolução utilizada foi o Diálogo/Explicação, considerada como uma forma recorrente de defender o domínio pessoal. Foram encontradas diferenças em relação ao sexo dos participantes e à situação hipotética. Por fim, os resultados são discutidos em termos de grau de autonomia e tipo de defesa do domínio pessoal.(AU)

Understanding the conflict resolution strategies used by adolescents in their relationship with their parents is fundamental to understanding how their healthy development occurs. This article investigated the resolution of conflicts by adolescents in confrontation situations between their personal domain and parental control. A total of 36 adolescents, aged 15 to 17 years, divided equally according to sex, answered a semi-structured interview that contained four hypothetical conflict situations. Data were subjected to semantic content analysis and non-parametric tests. The results were categorized into seven strategies: Assumption of Guilt, Submission, Lie, Hostility, Dialogue/Explanation, Negotiation, and Other. The predominant form of resolution used was Dialogue/Explanation, considered a recurrent form of defense of the personal domain. Differences were found depending on the participants' gender and the hypothetical situation. Finally, the results are discussed regarding the degree of autonomy and type of defense of the personal domain.(AU)

Enterarse de las estrategias de resolución de conflictos que los adolescentes utilizan en la relación con sus padres es fundamental para comprender cómo ocurre el desarrollo saludable de los adolescentes. A partir de una entrevista semiestructurada, presentamos cuatro situaciones hipotéticas de conflicto que fueron analizadas y respondidas por 36 adolescentes de entre 15 y 17 años, divididos según el género. Los datos se sometieron a un análisis de contenido semántico y a pruebas no paramétricas. Los resultados se categorizaron en siete estrategias de resolución de conflictos: Asunción de culpa, Sumisión, Mentira, Hostilidad, Diálogo/Explicación, Negociación y Otros. La forma de resolución más utilizada fue Diálogo/Explicación, y esta categoría fue una forma de defensa del dominio personal. Asimismo, se encontraron diferencias en función del género de los participantes y conforme la situación hipotética. Los resultados se discuten en términos de grado de autonomía y tipo de defensa del dominio personal.(AU)

Assessment of Patients' Quality of Life during Conservative Treatment after Distal Radius Fracture.

Introduction: This study aimed to assess patients' quality of life after distal radius fracture treatment (at least six months, but no more than ten years, after the treatment) based on the analysis of objective and subjective parameters and the influence of the fractured side on the final results. Materials and Methods: The study sample consisted of 30 women who claimed to be right-handed, divided depending on the side of the fracture (left vs. right limb). Patients were evaluated with a goniometer for active wrist movement, pronation, and supination in the elbow joint. Furthermore, the global grip strength of the upper limb was assessed using a dynamometer (Biometrics Ltd.) device, after which patients were asked to complete a wrist evaluation questionnaire (PRWE) and the Polish version of the SF-36 questionnaire assessing the quality of life. Results: There were statistically significant differences in the active movement of the wrist of the injured limb compared to the non-injured limb. In addition, inferior results were reported for injury of the right limb to those of the left. Conclusions: Injury of the right limb as opposed to injury of the left limb can have a negative impact on the assessment of quality of life in patients with right-limb dominance.

[Direct medical cost of late rehabilitation in workers with conservatively managed proximal humerus fracture]. / Costo médico directo de la rehabilitación tardía en trabajadores con fractura proximal de húmero de manejo conservador.

INTRODUCTION: Eighty percent of the Proximal humerus fractures are not displaced or minimally displaced and stable. The international treatment recommendation is conservative. Immobilization of the limb carries risk of stiffness, pain and decreased function. Currently being used rehabilitation programs with early mobilization of the injured shoulder within the first week post-fracture, with evidence of early functional and labor recovery and with no risk for displacement of fragments. However, in our country, these patients start rehabilitation late, which leads to a delay in the recovery of functionality and delay in returning to work, translating into increased costs. At the moment there is no national benchmark for the cost of this late-onset rehabilitation. MATERIAL AND METHODS: From a non-probabilistic sample for convenience, were analyzed records of 52 patients, treated in the period from January to December 2019. Inclusion criteria were workers diagnosed with a proximal humeral fracture, conservative management; exclusion criteria were peripheral nerve injury, aggregate fracture or surgically treated. RESULTS: The mean direct medical cost was $19,090.69 Mexican pesos, directly proportional to the days of stay in the unit and disability. CONCLUSION: Late rehabilitation leads to more days of disability than recommended by the based guidelinesin the workload, therefore, higher cost.

INTRODUCCIÓN: Ochenta por ciento de las fracturas de húmero proximal son no desplazadas o mínimamente desplazadas y estables. La recomendación internacional de tratamiento es de uno conservador. La inmovilización de la extremidad conlleva riesgo de rigidez, dolor y disminución de función. Actualmente se están empleando programas de rehabilitación con movilización precoz del hombro lesionado dentro de la primera semana postfractura, con evidencia de recuperación funcional y laboral precoces y con ausencia de riesgo para desplazamiento de fragmentos. Sin embargo, en nuestro país, estos pacientes inician la rehabilitación de forma tardía, lo que conlleva un retardo en la recuperación de funcionalidad y retardo en reincorporación laboral, traduciendo incremento en costos. Al momento no existe un referente nacional del costo que implica esta rehabilitación de inicio tardío. MATERIAL Y MÉTODOS: De una muestra no probabilística por conveniencia, se analizaron expedientes de 52 pacientes, atendidos en el período de Enero a Diciembre de 2019. Los criterios de inclusión fueron trabajadores con diagnóstico de fractura de húmero proximal, manejo conservador; criterios de exclusión fueron lesión de nervio periférico, fractura agregada o postoperados. RESULTADOS: La media del costo médico directo fue $19,090.69 pesos mexicanos, con relación directamente proporcional a los días de estancia en la unidad y de incapacidad. CONCLUSIÓN: La rehabilitación tardía conlleva más días de incapacidad que las recomendadas por las guías con base en la carga de trabajo, por ende, mayor costo.

Eficacia y seguridad de la colocación de un sling masculino ajustable, en comparación con la colocación de un sling masculino fijo en pacientes con incontinencia urinaria de esfuerzo de intensidad leve a moderada post prostatectomía que han fallado al tratamiento conservador / Efficacy and safety of the placement of an adjustable male sling, compared with the placement of a fixed male sling in patients with post-prostatectomy mild to moderate stress urinary incontinence who have failed conservative treatment

ANTECEDENTES: En el marco de la metodología ad hoc para evaluar solicitudes de tecnologías sanitarias (ETS), aprobada mediante Resolución de Instituto de Evaluación de Tecnologías en Salud e Investigación N° 111-IETSI-ESSALUD-2021, se ha elaborado el presente dictamen, el cual expone la evaluación de la eficacia y seguridad de la colocación de un sling masculino (SM) transobturatriz ajustable con puerto de implantación subcutánea, en comparación con la colocación de un SM fijo, en pacientes varones con incontinencia urinaria (IU) de esfuerzo de intensidad leve a moderada, post prostatectomía y que han fallado al tratamiento conservador (ejercicios del piso pélvico). Mediante la Carta N° 056-DU-GQ-HNERM-GRPRESSALUD-2020, los médicos especialistas del servicio de urología general del Hospital Nacional Edgardo Rebagliati Martins (HNERM), a través de la gerencia de la Red Prestacional Rebagliati, solicitan al Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) la evaluación de la tecnología "Sistema Ajustable Transobturatriz masculino" para evaluar su posible inclusión al listado de material médico disponible en EsSalud para su utilización en el tratamiento de la incontinencia urinaria masculina por esfuerzo. ASPECTOS GENERALES: La IU es una complicación conocida del tratamiento de la próstata que impacta de manera negativa la calidad de vida (Miller et al., 2005). Esta condición predomina después de una prostatectomía radical (PR) debido a cáncer de próstata; pero también puede aparecer después de procedimientos por otras enfermedades prostáticas benignas. La IU después de un tratamiento prostático o IU post prostatectomía (IUPP), se debe principalmente a una función inadecuada del esfínter uretral. Esta deficiencia del esfínter se debe al efecto directo de la cirugía, con el daño al esfínter estriado externo durante la ligadura del complejo venoso dorsal, el daño al musculo liso de la uretra causado por las suturas de anastomosis, y/o denervación debido a la disección de la uretra y próstata. METODOLOGÍA: Se realizó una búsqueda sistemática de información con el objetivo de identificar la mejor evidencia disponible a la fecha sobre la eficacia y seguridad del sling masculino transobturatriz ajustable con puerto de implantación subcutánea. Se realizó una búsqueda bibliográfica avanzada en las bases de datos de PubMed, Cochrane Library y LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud). La búsqueda sistemática fue suplementada con una búsqueda manual en la lista de referencias bibliográficas de los estudios incluidos en la ETS. Además, se realizó una búsqueda de literatura gris en el motor de búsqueda Google, a fin de poder identificar otras publicaciones de relevancia que pudiesen haber sido omitidas por la estrategia de búsqueda o que no hayan sido publicadas en las bases de datos consideradas. Asimismo, se realizó una búsqueda dentro de las páginas web pertenecientes a grupos que realizan ETS y GPC, incluyendo, el National Institute for Health and Care Excellence (NICE), la Canadian Agency for Drugs and Technologies in Health (CADTH), la Haute Autorité de Santé (HAS), el Institut für Qualitát und Wirtschaftlichkeit im Gesundheitswesen (IQWiG), además de la Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA). Por último, se realizó una búsqueda de estudios clínicos en ejecución o aún no terminados en: ClinicalTrials.gov. RESULTADOS: No se identificaron estudios aleatorizados ni estudios observacionales con grupos de control para responder a la pregunta de interés. Para sintetizar mejor la evidencia y evaluar los aspectos de seguridad, se incluyeron un total de seis series de casos con al menos 50 participantes en cada estudio. Tres correspondieron al uso de sling masculino transobturatriz fijo (SMTF) y tres al ajustable. Además, inicialmente se incluyeron dos GPC del manejo de la incontinencia urinaria en el hombre. Sin embargo, durante la elaboración del presente dictamen, se publicó una versión actualizada (al 2022) de una de ellas, optando por su inclusión en el documento. CONCLUSIÓN: Por lo expuesto, el Instituto de Evaluación de Tecnologías en Salud e Investigación aprueba el uso del sling masculino transobturatriz fijo en el tratamiento de la incontinencia urinaria de esfuerzo post prostatectomía de intensidad leve a moderada.

Level of knowledge on conservative management of adolescent idiopathic scoliosis among undergraduate students in healthcare: A scoping review.

BACKGROUND: Adolescent Idiopathic Scoliosis (AIS) is a three-dimensional deformity of the spine associated with pain and aesthetic changes. Various health care professionals may be led to evaluate and/or manage adolescents presenting AIS. There is no compiling of the studies evaluating the level of knowledge on AIS conservative management among undergraduate students in healthcare. OBJECTIVE: To identify and map the current studies evaluating the level of knowledge of health profession students on AIS conservative management. DESIGN: Scoping review. METHODS: The search strategy was conducted in Scopus database. Three concepts were included: "Adolescent idiopathic scoliosis", "Knowledge" and "Undergraduate students studying in a healthcare field". Studies identification included (1) duplicates removing, (2) title and abstract screening, and (3) full-text screening. The quality of the included studies was assessed. Studies' characteristics were extracted, and results were summarized. RESULTS: Searches yielded the identification of 245 citations. After duplicates removal and abstract screening, three full-text articles were identified. Following full-text review, two full-text articles were finally included. Both studies evaluated students in physiotherapy, but using distinct questionnaires. Both studies reported an unsatisfactory level of knowledge. CONCLUSION: Knowledge of future health professionals about the conservative management of AIS has been barely evaluated. Therefore, no conclusion can be drawn regarding the level of knowledge of undergraduate health professions' students on AIS conservative management. The development a standardized questionnaire to adequately assess this knowledge across institutions and professions is required.

Assessment of the masseter stiffness in patients during conservative therapy for masticatory muscle disorders with shear wave elastography.

BACKGROUND: The complex structure of the stomatognathic system plays a vital role in chewing, digestion, speaking, breathing, facial expression and swallowing. Its complexity is the primary reason for creating multidisciplinary teams to manage temporomandibular disorders (TMD). We aimed to assess the masseter stiffness in patients undergoing conservative therapy for masticatory muscle disorders and evaluate the efficacy of manual therapy and stabilization occlusal splint in the treatment of masticatory muscle disorders. METHODS: This uncontrolled prospective cohort study included 35 patients with masticatory muscle disorders. The study lasted for eight weeks. The patients were treated with manual therapy and stabilization occlusal splint and evaluated using shear wave elastography of the masseter muscles and patient-reported outcome measures (PROMs) to assess pain, anxiety, quality of sleep, satisfaction with life and perceived stress. RESULTS: After the treatment, the stiffness of both masseter muscles decreased significantly (by 4.21 kPa). The patients reported a significant reduction in pain. At baseline, the median scores ranged from 5 to 8; after treatment, they ranged from 0 to 1 (p < 0.0001). The patients also reported significant improvement in terms of all patient-reported outcome measures. The reduction in stiffness corresponded to the improvement in pain and PROMs, as shown by correlations which were insignificant for all measures. CONCLUSIONS: Conservative therapy of masticatory muscle disorders involving manual therapy and stabilization occlusal splint is effective. It reduces the masseter stiffness as objectively shown in shear wave elastography and improves subjective PROMs scores, including numerical pain assessment and selected questionnaires. Shear wave elastography has the potential for broad application in clinical practice to monitor masticatory muscle disorders treatment effects due to its objectivity and non-invasive character. Further research is recommended on larger patient populations and longer follow-up. TRIAL REGISTRATION: The study was registered at clinicaltrials.gov ( NCT03844854 ). First posted date: 19/02/2019.