Produção de procedimentos pelo SAMU 192 no Brasil: performance, benchmarking e desafios / Implementation of procedures by the Mobile Emergency Care Service (SAMU 192) in Brazil: performance, benchmarking, and challenges

Resumo O objetivo deste artigo é descrever e analisar a produção de procedimentos realizados pelas centrais de regulação e recursos móveis do SAMU 192 entre 2015 e 2019, segundo frequência, indicadores de base populacional e produtividade diária, estabelecendo um indicador de performance. Estudo censitário, observacional e descritivo, realizado com dados de produção, extraídos do Sistema de Informações Ambulatoriais, complementados com dados do Instituto Brasileiro de Geografia e Estatística e do Ministério da Saúde. Os 116,8 milhões de procedimentos analisados decorrem de 28,5% de aumento no período enquanto a população coberta e os recursos móveis cresceram 9,7% e 14,4% respectivamente. Cada mil habitantes cobertos geraram 109,8 chamadas, resultando em 24,0 envios de recursos móveis anuais. Diariamente, unidades de suporte básico realizaram 3,3 atendimentos e 0,5 transporte, enquanto o suporte avançado realizou 2,7 atendimentos e 0,9 transporte. A produção de procedimentos excedeu o crescimento de população coberta, com variações entre estados, alta produção em áreas populosas, forte presença do suporte básico e elevação dos transportes, todavia a produtividade nacional mostrou-se inferior a internacional.

Abstract The scope of this article is to describe and analyze the production of approved procedures carried out by regulation centers and mobile resources of SAMU 192 between 2015 and 2019, according to frequency, population-based indicators, and daily productivity, to establish a performance indicator. It consisted of an observational and descriptive census study, with production data drawn from the Outpatient Information System, and population data from the Brazilian Institute of Geography and Statistics and information from the Ministry of Health. The 116.8 million procedures analyzed resulted from a 28.5% increase in the period, while the population covered and mobile resources grew by 9.7% and 14.4%, respectively. Every 1,000 inhabitants covered generated 109.8 calls, resulting in 24.0 mobile resource dispatches per year. Basic support units performed 3.3 consultations, and 0.5 transfers daily, while advanced support performed 2.7 consultations and 0.9 transfers. The production of procedures exceeded the increase in the population covered, with variations between states, high incidence in populated areas, a strong presence of basic support and an increase in transfers, although national productivity was seen to be lower than international productivity.

Safety culture among operating room healthcare workers: still a long way to go. An analytical cross-sectional study from Turkey

Introduction: safety culture attitudes of health workers are still not at the desired level. Although the creation of patient safety culture is important for all health care environments, it is more vital for critical units. Objective: to determine the patient safety culture levels of those working in the operating room environment and compare them with the 2008 results of the same hospitals. Materials and Methods: an analytical cross-sectional study was conducted in 2017-2018. The Turkish version of the Hospital Survey on Patient Safety Culture was administered to nurses, anesthesia technicians, assistant physicians, and specialist physicians working in the Operating Rooms (n=258) of two university hospitals in Konya, a large city in Anatolian region of Turkey. Results: average percent positive response to the 42 items was low (41%, n=258). While there was no change in one dimension of the questionnaire compared to 2008; there was a positive change in 8 dimensions and a negative change in 3 dimensions. All 12 dimensions were lower than the Agency for Healthcare Research and Quality score. Discussion: Despite many studies, policy developments and interventions on patient safety, the improvement of a patient safety culture is very slowly in Turkey as in other countries. Conclusion: non-reporting of errors and a punitive approach in case of errors are still considered the most important problems.

Introducción: las actitudes del personal de salud frente a la cultura de la seguridad siguen sin alcanzar su nivel deseado. Aunque la creación de una cultura de seguridad del paciente es importante en todos los entornos de cuidado, es vital en las unidades de cuidado crítico. Objetivo: determinar los niveles de cultura de seguridad del paciente de quienes trabajan en quirófanos y compararlos con los 2008 resultados de los mismos hospitales. Materiales y métodos: se realizó un estudio transversal analítico entre 2017 y 2018. La versión en turco de la Encuesta Hospitalaria sobre Cultura de Seguridad del Paciente se administró a profesionales de enfermería, anestesistas, médicos auxiliares y médicos especialistas que trabajaban en los quirófanos (n=258) de dos hospitales universitarios de Konya, una ciudad de la región de Anatolia en Turquía. Resultados: El porcentaje medio de respuestas positivas a los 42 ítems fue bajo (41%, n=258). Si bien no hubo cambios en una dimensión del cuestionario en comparación con los 2008 resultados, hubo un cambio positivo en 8 dimensiones y un cambio negativo en 3 dimensiones. Las 12 dimensiones presentaron una puntuación inferior a la de la Agencia para la Investigación y la Calidad del Cuidado de la Salud. Discusión: A pesar de los numerosos estudios, desarrollos en política e intervenciones en materia de seguridad del paciente, la mejora de la cultura de seguridad del paciente es muy lenta en Turquía, al igual que en otros países. Conclusión: No notificar errores y un enfoque punitivo en caso de error siguen considerándose los problemas más importantes.

Introdução: as atitudes de cultura de segurança dos profissionais de saúde ainda não estão no nível desejado. Embora a criação da cultura de segurança do paciente seja importante para todos os ambientes de assistência médica, ela é mais vital para as unidades críticas. Objetivo: determinar os níveis de cultura de segurança do paciente daqueles que trabalham no ambiente da sala de cirurgia e compará-los com os resultados de 2008 dos mesmos hospitais. Materiais e Métodos: um estudo analítico de corte transversal foi realizado em 2017-2018. A versão turca da Pesquisa Hospitalar sobre Cultura de Segurança do Paciente foi aplicada a enfermeiros, técnicos de anestesia, médicos assistentes e médicos especialistas que trabalham nas salas de cirurgia (n=258) de dois hospitais universitários em Konya, uma grande cidade na região da Anatólia, Turquia. Resultados: a porcentagem média de respostas positivas aos 42 itens foi baixa (41%, n=258). Embora não tenha havido alteração em uma dimensão do questionário em comparação com 2008, houve uma alteração positiva em 8 dimensões e uma alteração negativa em 3 dimensões. Todas as 12 dimensões foram inferiores à pontuação da Agency for Healthcare Research and Quality. Discussão: Apesar de muitos estudos, desenvolvimentos de políticas e intervenções sobre a segurança do paciente, o aprimoramento de uma cultura de segurança do paciente é muito lento na Turquia, assim como em outros países. Conclusão: a não notificação de erros e uma abordagem punitiva em caso de erros ainda são considerados os problemas mais importantes.

Benchmarking of apps for mobile devices targeted at children's health / Benchmarking de aplicaciones para dispositivos móviles dirigidas a la salud infantil / Benchmarking de aplicações para dispositivos móveis direcionados à saúde da criança

ABSTRACT Objective: to identify which of the apps available for children include information on monitoring growth and development, in a way similar to the Brazilian Children's Handbook. Method: this is an exploratory research study to survey apps designed to monitor children's growth and development. The "Benchmarking" technique was used to assist in the process. The search for apps was carried out in January 2023 in the Google Play and App Store stores. The data were tabulated in Microsoft Excel. After classifying the variables, absolute and relative frequencies were calculated. Results: a total of 624 apps were identified. Of these, 491 were found in Google Play and 133 in the App Store. After analyzing the app descriptions and excluding duplicates, 48 software options were selected for the final sample. 41% (19) of the apps are in Portuguese, 36% (17) of those selected intend to record children's development, and only 2% (1) store children's growth, development and vaccination data. Conclusion: the absence of an app similar to Children's Handbook for monitoring and recording children's health within the Unified Health System scope was evidenced.

RESUMEN Objetivo: identificar cuáles de las aplicaciones disponibles para el público infantil incluyen información sobre el control del crecimiento, en forma análoga a la Libreta de Salud Infantil brasileña. Método: investigación exploratoria para sondear aplicaciones destinadas a controlar el crecimiento y desarrollo infantil. Para facilitar el proceso se utilizó la técnica de Benchmarking. Se buscaron aplicaciones en las tiendas Google Play y App Store, en enero de 2023. Los datos se tabularon en Microsoft Excel. Luego de clasificar las variables se calcularon frecuencias absolutas y relativas. Resultados: se identificaron 624 aplicaciones. De ellas, se encontraron 491 en Google Play y 133 en App Store. Después de analizar la descripción de cada aplicación y de excluir duplicados se seleccionaron 48 opciones de software para la muestra final. El 41% (19) de las aplicaciones estaba en portugués, el 36% (17) de las seleccionadas están destinadas a registrar el desarrollo infantil, y solamente el 2% (1) almacena datos de crecimiento, desarrollo y vacunación infantil. Conclusión: se hizo evidente que no existe ninguna aplicación similar a la Libreta de Salud Infantil para controlar y registrar la salud en este grupo etario para el ámbito del Sistema Único de Salud.

RESUMO Objetivo: Identificar quais dos aplicativos disponíveis para o público infantil contemplam informações sobre o acompanhamento do crescimento e desenvolvimento, análogos à Caderneta da Criança brasileira. Método: Trata-se de uma pesquisa exploratória de levantamento de aplicativos destinados ao acompanhamento do crescimento e desenvolvimento infantil. Para auxiliar no processo, foi utilizada a técnica de benchmarking. A busca pelos aplicativos foi realizada nas lojas de aplicativos Google Play e App Store, em janeiro de 2023. Os dados foram tabulados no Microsoft Excel. Após a classificação de variável, calculou-se a frequência absoluta e relativa. Resultados: Foram identificados 624 aplicativos. Desses, 491 foram encontrados no Google play e 133 no App Store. Após análise da descrição da aplicação e exclusão de duplicatas, foram selecionados 48 softwares para a amostra final. 41% (19) dos aplicativos apresentam-se na língua portuguesa, 36% (17) dos selecionados propõem-se a registrar o desenvolvimento da criança, e apenas 2% (1) faz o armazenamento do crescimento, desenvolvimento e vacinação infantil. Conclusão: Evidenciou-se a ausência de um aplicativo análogo à Caderneta da Criança para o acompanhamento e registro da saúde infantil para o âmbito do Sistema Único de Saúde.

Countermeasures for the construction of occupational health information standard system / 中华劳动卫生职业病杂志

As an important part of health information standard system, occupational health information standard system is the foundation and guarantee of promoting the construction of occupational health information. This article is based on the literature research about current situation of domestic and foreign health information standards and occupational health information standard system, thus take "the National Health Information Standardization System" and "the National Public Health Information Construction Standards and Norms" into account, focus on the requirements of occupational health information construction and related work. Thus, put forward suggestions on the construction of occupational health information standard system, to accelerate the occupational health information construction, data collection, transmission and application.

Influence of sports elective courses on college students' physical health / Influência dos cursos eletivos esportivos sobre a saúde física dos estudantes universitários / Influencia de las asignaturas deportivas optativas en la salud física de los estudiantes universitarios

ABSTRACT Introduction The college sports environment is characterized by breadth, diversity, and personality. This is an important period to develop students' physical ability and improve their personality. Objective Compare the effects of different exercise methods on students' health status. Methods 2991 college students participated in different sports activities. These sports were conducted based on the selection course (PE), all during one semester. The students' physical health status was observed through experiments performed before and after the intervention. Results Activities such as basketball and soccer showed high effectiveness in improving students' vital capacity index, volleyball expressively improved students' performance in the long jump, tennis and table tennis were effective in improving students' strength and adherence index, being lower in other indices. Martial arts also stood out in improving the students' vital capacity index. Conclusion Improving physical health should be an overall process of students' fitness development, and universities should actively encourage college students to participate in long-term sports to improve their health. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução O ambiente do esporte universitário é caracterizado pela abrangência, diversidade e personalidade. Este é um período importante para desenvolver a capacidade física dos estudantes e melhorar a sua personalidade. Objetivo Comparar os efeitos de diferentes métodos de exercício sobre o estado de saúde dos estudantes. Métodos 2991 estudantes universitários participaram de diferentes atividades esportivas. Estes esportes foram conduzidos com base no curso de seleção (PE), todos durante um semestre. O estado de saúde física dos estudantes foi observado através de experimentos executados previa e posteriormente à intervenção. Resultados Atividades como basquetebol e futebol demonstraram alta efetividade para melhorar o índice de capacidade vital dos estudantes, voleibol melhorou expressivamente o desempenho dos alunos no salto em distância, o tênis e o tênis de mesa foram efetivos para aprimorar o índice de força e de adesão dos alunos, sendo inferior noutros índices. Também as artes marciais se destacaram ao melhorar o índice de capacidade vital dos alunos. Conclusão O aprimoramento da saúde física deve ser um processo global de desenvolvimento da aptidão física dos estudantes e as universidades devem encorajar ativamente os estudantes universitários a participar de esportes de longo prazo para melhorar sua saúde. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción El entorno del deporte universitario se caracteriza por su alcance, diversidad y personalidad. Es un periodo importante para desarrollar la capacidad física de los alumnos y mejorar su personalidad. Objetivo Comparar los efectos de diferentes métodos de ejercicio sobre el estado de salud de los estudiantes. Métodos 2991 estudiantes universitarios participaron en diferentes actividades deportivas. Estos deportes se llevaron a cabo basándose en el curso de selección (PE), todo ello durante un semestre. El estado de salud física de los alumnos se observó mediante experimentos realizados antes y después de la intervención. Resultados Actividades como el baloncesto y el fútbol mostraron una alta eficacia para mejorar el índice de capacidad vital de los alumnos, el voleibol mejoró expresivamente el rendimiento de los alumnos en salto de longitud, el tenis y el tenis de mesa fueron eficaces para mejorar el índice de fuerza y adherencia de los alumnos, siendo inferiores en otros índices. También las artes marciales se destacaron en la mejora del índice de capacidad vital de los alumnos. Conclusión La mejora de la salud física debería ser un proceso global del desarrollo de la forma física de los estudiantes y las universidades deberían animar activamente a los universitarios a participar en deportes de larga duración para mejorar su salud. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Educação Física no 1º Ciclo do Ensino Básico (1º CEB), Provas de Aferição e Pais: perceções globais / Physical Education in the elementary school, assessment tests and parentes: global perceptions / Las pruebas de evaluación en Educación Física en educación primaria: la opinión de los padres y tutores

As Provas de Aferição em Educação Física (PAEF) integram um processo de avaliação externa dos alunos e do currículo da Educação Física (EF) na escola do 1º Ciclo do Ensino Básico (1º CEB) em Portugal. Assim, a opinião dos pais e encarregados de educação (PEE) sobre as PAEF pode ser um fator relevante. Analisaram-se as perceções globais de 127 PEE dos alunos do 2º ano de escolaridade, recolhidas através de um questionário, com os dados tratados através de análise de conteúdo (categorias emergentes) e estatística. Os resultados evidenciaram que os PEE têm uma dispersão de perceções sobre as PAEF, que vão desde uma posição contrária e negativa até à sua apreciação positiva e fundamentada. Identificam também que estas podem ter um impacte futuro expressivo, monitorização da aprendizagem, do currículo e papel de avaliação formativa. Há necessidade de ampliar o conhecimento sobre a natureza e objetivos das PAEF e sua influência na valorização da área de EF na escola do 1º CEB.

The Assessment Tests in Physical Education (ATPE) are part of an external assessment process of students and the Physical Education (PE) curriculum in the Elementary School (ES) in Portugal. Thus, the opinion of parents and guardians (PG) about the ATPE can be a relevant factor. The global perceptions of 127 PEE of 2nd year students were analyzed, collected through a questionnaire, with the data processed through content analysis (emerging categories) and statistics. The results showed that the PG have a dispersion of perceptions about the ATPE, ranging from a contrary and negative position to a positive and reasoned assessment. They also identify that these can have a significant future impact, monitoring learning, the curriculum and the role of formative assessment. There is a need to expand knowledge about the nature and objectives of ATPE and its influence on valuing the PE area in the ES

Las Pruebas de Evaluación en Educación Física (PAEF) forman parte de un proceso de evaluación externa de los alumnos y del currículo de Educación Física (EF) en Escuela Primária en Portugal. Así, la opinión de los padres y tutores (PT) sobre el PAEF puede ser un factor relevante. Se analizaron las percepciones globales de 127 PT de alumnos de 2º año, recogidas a través de un cuestionario, siendo los datos procesados mediante análisis de contenido (categorías emergentes) y estadística. Los resultados mostraron que los PT tienen una dispersión de percepciones sobre el PAEF, que van desde una posición contraria y negativa hasta una valoración positiva y razonada. También identifican que estos pueden tener un impacto futuro significativo, monitoreando el aprendizaje, el currículo y el rol de la evaluación formativa. Existe la necesidad de ampliar el conocimiento sobre la naturaleza y objetivos del PAEF y su influencia en la valorización del área de EF en la Escuela Primária.

Fatores determinantes para a excelência no vôlei de praia: o caso de uma dupla de elite / Determining factors for excellence in beach volleyball: the case of an elite pai / Factores determinantes de laexcelenciaenel voleibol de playa: el caso de una pareja de élite

O objetivo deste estudo foi conhecer os fatores determinantes na aquisição, desenvolvimento e manutenção da excelência no Vôlei de Praia (VP) a partir da percepção de uma dupla de atletas de elite e seu técnico. Trata-se de um estudo de caso com abordagem qualitativa dos resultados que se utilizou da entrevista e análise documental para recolha dos dados. Sobre os fatores determinantes da excelência no VP destacaram-se nos fatores primários, o aspecto psicológico, verificado nos elementos disciplina, força de vontade, motivação e foco, seguido pelo tempo de parceria e da preparação física iniciada (prática deliberada). Enquanto nos fatores secundários, o apoio, técnico, infraestrutura, qualidade de material esportivo e financeiro. Conclui-se que a junção dos fatores primários e secundários descritos acima foi essencial para aquisição, desenvolvimento emanutenção da excelência no VP.

The objective of this study was to know the determining factors in the acquisition, development and maintenance of excellence in Beach Volleyball (VP) from the perception of a pair of elite athletes and theircoach. This is a case study with a qualitative approach to the results that used the interview and document analysis for data collection. Regarding the determining factors of excellence in the VP, the psychological aspect stood out in the primary factors,verified in the elements discipline, willpower, motivation and focus, followed by the partnership time and the physical preparation started (deliberate practice). While in secondary factors, support, technical, infrastructure, quality of sports and financial equipment. It is concluded that the combination of the primary and secondary factors described above was essential for the acquisition, development and maintenance of excellence in PV.

El propósito de este estudio fue conocer los factores determinantes en la adquisición, desarrollo y mantenimiento de la excelencia en el Voleibol de Playa (VP) a partir de la percepción de una pareja de deportistas de élite y su entrenador. Este es un estudio de caso con enfoque cualitativo de los resultados que utilizó la entrevista y el análisis de documentos para la recolección de datos. En cuanto a los determinantes de la excelencia en la PV, el aspecto psicológico se destacó en los factores primarios, verificado en los elementos disciplina, fuerza de voluntad, motivación y enfoque, seguido del tiempo de compañerismo y la preparación física iniciada (práctica deliberada). Mientras que en factores secundarios, soporte, técnico, infraestructura, calidad del equipamiento deportivo y financiero. Se concluye que la combinación de los factores primarios y secundarios descritos anteriormente fue fundamental para la adquisición, desarrollo y mantenimiento de la excelencia en el VP.

Semi-automated data collection from electronic health records in a stroke unit in Brazil / Coleta de dados semiautomáticos de registros eletrônicos de saúde na unidade de acidente vascular cerebral no Brasil

ABSTRACT Background: There is a high demand for stroke patient data in the public health systems of middle and low-income countries. Objective: To develop a stroke databank for integrating clinical or functional data and benchmarks from stroke patients. Methods: This was an observational, cross-sectional, prospective study. A tool was developed to collect all clinical data during hospitalizations due to stroke, using an electronic editor of structured forms that was integrated with electronic medical records. Validation of fields in the electronic editor was programmed using a structured query language (SQL). To store the results from SQL, a virtual table was created and programmed to update daily. To develop an interface between the data and user, the Embarcadero Delphi software and the DevExpress component were used to generate the information displayed on the screen. The data were extracted from the fields of the form and also from cross-referencing of other information from the computerized system, including patients who were admitted to the stroke unit. Results: The database was created and integrated with the hospital electronic system, thus allowing daily data collection. Quality indicators (benchmarks) were created in the database for the system to track and perform decision-making in conjunction with healthcare service managers, which resulted in improved processes and patient care after a stroke. An intelligent portal was created, in which the information referring to the patients was accessible. Conclusions: Based on semi-automated data collection, it was possible to create a dynamic and optimized Brazilian stroke databank.

RESUMO Antecedentes: Há alta demanda de dados de pacientes com acidente vascular cerebral (AVC) nos sistemas de saúde de países de baixa e média renda. Objetivo: Desenvolver um banco de dados de AVC para integrar dados clínicos ou funcionais e indicadores de qualidade de pacientes com AVC. Métodos: Estudo observacional, transversal e prospectivo. Foi desenvolvida uma ferramenta para coletar dados clínicos durante as internações por AVC por meio de um editor eletrônico de formulários estruturados integrado ao prontuário eletrônico. A validação dos campos no editor eletrônico foi programada em linguagem de consulta estruturada (SQL). Para armazenar os resultados da SQL, uma tabela virtual foi criada e programada para atualização diária. Para desenvolver interface entre os dados e o usuário, foram utilizados o software Embarcadero Delphi e o componente DevExpress para gerar informações apresentadas na tela. Os dados foram extraídos dos campos do formulário e também do cruzamento de outras informações do sistema informatizado, incluindo pacientes internados na unidade de AVC. Resultados: O banco de dados foi criado e integrado ao sistema eletrônico do hospital, permitindo coleta diária de dados. Indicadores de qualidade foram criados no banco de dados para que o sistema acompanhasse e realizasse a tomada de decisão com os gestores dos serviços de saúde, resultando em melhoria no processo e no atendimento ao paciente após AVC. Foi criado um portal inteligente, no qual eram registradas as informações referentes aos pacientes. Conclusões: Com a coleta de dados semiautomática, foi possível criar um banco de dados de AVC dinâmico e otimizado em unidade de AVC no Brasil.

The standardized diagnosis and treatment of rheumatoid arthritis / 中华内科杂志

Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovial inflammation of the joints with high risk of disability. In recent years, remarkable progress has been made towards the diagnosis and treatment of RA, and the international RA guidelines have been also kept updated. Nevertheless, there are many challenges in China, especially inadequate number of rheumatologists and insufficient experience in the diagnosis and treatment of RA. Therefore, Chinese Rheumatology Association drafted the standardized diagnosis and treatment of RA based on the available evidence, so as to improve the management of RA patients in China.

Effects of standardized treatment combined with medical nutrition intervention on blood glucose level, body mass management and glucose metabolism at 3 months after delivery in patients with gestational diabetes mellitus / 中国基层医药

Objective:To investigate the effects of standardized treatment combined with medical nutrition intervention on blood glucose level, body mass management and glucose metabolism at 3 months postpartum in patients with gestational diabetes mellitus (GDM).Methods:A total of 114 patients with GDM who received treatment in Shunyi District Hospital of Beijing from June 2017 to October 2019 were included in this study. They were randomly divided into observation group ( n = 57) and control group ( n = 57). The control group was treated with standardized therapy, and the observation group was treated with standardized therapy combined with medical nutrition intervention. Blood glucose level, body mass management, glucose metabolism outcomes at 3 months postpartum, pregnancy outcome, and neonatal outcome were compared between the two groups. Results:After treatment, hemoglobin A1c (HbA1c), fasting blood glucose, 2-hour plasma glucose (2hPG) after breakfast, and 2hPG after dinner in the observation group were (5.20 ± 0.34)%, (4.69 ± 0.31) mmol/L, (7.32 ± 2.13) mmol/L, and (7.54 ± 2.36) mmol/L, respectively, which were significantly lower than those in the control group [(6.38 ± 0.42)%, (6.34 ± 0.45) mmol/L, (9.01 ± 2.27) mmol/L, (9.35 ± 2.47) mmol/L, t = 16.48, 22.79, 4.09, 4.00, all P < 0.001]. The increases in body mass and body mass index during pregnancy in the observation groups were (12.19 ± 2.35) kg and (4.52 ± 1.13) kg/m 2, respectively, which were significantly lower than those in the control group [(16.21 ± 2.64) kg, (6.11 ± 1.25) kg/m 2, t = 8.58, 7.12, both P < 0.001]. The abnormal rate of glucose metabolism at 3 months postpartum in the observation group was significantly lower than that in the control group [5.3% (3/57) vs. 8.8% (5/57), χ2 = 0.53, P = 0.462]. The incidences of premature rupture of membranes, polyhydramnios, and cesarean section in the observation group were 5.3% (3/57), 14.0% (8/57) and 15.8% (9/57), which were significantly lower than those in the control group [22.8% (13/57), 35.1% (20/57), 40.4% (23/57), χ2 = 7.27, 6.81, 8.51, all P < 0.05]. There were no significant differences in the incidences of pregnancy-induced hypertension and postpartum hemorrhage between the two groups (both P > 0.05). The incidences of premature births, macrosomia, respiratory distress, neonatal hypoglycemia and hyperbilirubinemia in the observation groups were 5.3% (3/57), 3.5% (2/57), 7.0% (4/57), 3.5% (2/57), 5.3% (3/57), respectively, which were significantly lower than those in the control group [22.8% (13/57), 17.5% (10/57), 21.1% (12/57), 15.8% (9/57), 19.3% (11/57), χ2 = 7.27, 5.96, 5.60, 4.93, 5.21, all P < 0.05). Conclusion:Standardized treatment combined with medical nutrition intervention can effectively reduce blood glucose level in patients with GMD, control body mass, and improve glucose metabolism at 3 months after delivery.

Standardized manipulations for pediatric Tuina in medical institutions / 国际中医中药杂志

The standardization of pediatric Tuina is beneficial to pediatric Tuina practitioners in a norm practices. The paper collects the content from teaching textbooks, TCM ancient books and database literature, and tries to develop the technical specifications of pediatric Tuina by four rounds Delphi surveys and expert consensus. This specification covers the manipulation of pediatric Tuina, the position of acupoints, the effects of acupoints and the diagnosis and treatment of pediatric Tuina, including indications, contraindications, cautious use, operation steps and methods.

Núcleo Interno de Regulação hospitalar: repercussões da implantação nos indicadores dos serviços de saúde / Internal Regulation Center in hospitals: Repercussions of its implementation on the health services' indicators / Centro Interno de Regulación hospitalaria: repercusiones de la implantación en los indicadores de los servicios de salud

Resumo Objetivo Avaliar os indicadores hospitalares e suas repercussões, antes e após a implantação do Núcleo Interno de Regulação, no número de internações mensais em hospital universitário público. Método Pesquisa avaliativa, do tipo Estudo de Caso desenvolvida em hospital universitário público. Foram mensurados 28 indicadores relacionados à estrutura, produção, produtividade e qualidade, que integram o referencial de Benchmarking interno. Os dados foram analisados por estatística descritiva e regressão múltipla para identificar os fatores independentes e associados ao número de internações mensais com intervalos de confiança de 95%. Resultados A implantação do Núcleo aumentou significativamente (p<0,001) o número de altas, o fator de utilização e índice de renovação dos leitos, internação de urgência, porcentagem de ocupação dos leitos, procedimentos cirúrgicos realizados e média de paciente-dia (p=0,027). Houve redução (p<0,001) no número de atendimentos no pronto socorro médico, obstétrico e ortopédico, nas taxas de infecção hospitalar e de mortalidade infantil, bem como na diminuição média de permanência de 0,81/dia, aproximadamente um dia a menos de internação por paciente, ou um ganho de 40 leitos disponíveis ao mês. Conclusão Embora o número de leitos disponíveis tenha sido menor no período pós-implantação, o intervalo de substituição de leitos reduziu, representando o aumento de mais 40 leitos ao mês devido à diminuição do tempo de permanência dos pacientes na instituição.

Abstract Objective To evaluate the hospital indicators and their repercussions on the number of monthly admissions to a public university hospital, before and after implementing the Internal Regulation Center. Method An evaluative research study, of the Case Study type, developed in a public university hospital. A total of 28 indicators related to structure, production, productivity and quality were measured, which are part of internal Benchmarking. The data were analyzed by means of descriptive statistics and multiple regression to identify the independent factors and those associated with the number of monthly hospitalizations with 95% confidence intervals. Results Implementation of the Center significantly increased (p<0.001) the number of discharges, the bed utilization factor and the bed renewal rate, emergency hospitalization, bed occupancy percentage, surgical procedures performed and the patient-day mean value (p=0.027). There was a reduction (p<0.001) in the number of visits to the medical, obstetric and orthopedic emergency room, in the rates of in-hospital infection and infant mortality, as well as a mean reduction of 0.81/day, approximately one day less of hospitalization per patient, or a gain of 40 available beds per month. Conclusion Although the number of available beds was lower in the post-implementation period, the bed replacement interval was reduced, representing an increase of 40 more beds per month due to the reduction in the patients' length of stay in the institution.

Resumen Objetivo Evaluar los indicadores hospitalarios y sus repercusiones, antes y después de la implantación del Centro Interno de Regulación, sobre el número de internaciones mensuales en un hospital universitario público. Método Investigación evaluativa, del tipo Estudio de Caso, desarrollada en un hospital universitario público. Se midieron 28 indicadores relacionados con la estructura, producción, productividad y calidad, que forman parte del Benchmarking interno. Los datos fueron analizados por estadística descriptiva y regresión múltiple para identificar factores independientes y asociados con el número de hospitalizaciones mensuales con un intervalo de confianza del 95%. Resultados La implantación del Centro incrementó significativamente (p<0,001) el número de altas, el factor de utilización y tasa de renovación de camas, la hospitalización de urgencia, el porcentaje de ocupación de camas, los procedimientos quirúrgicos realizados y el promedio de pacientes/día (p =0,027). Se registró una reducción (p<0,001) en el número de las consultas de emergencias médicas, obstétricas y ortopédicas, en las tasas de infección hospitalaria y mortalidad infantil, además de una disminución promedio de la estancia del 0,81/día, aproximadamente un día menos de hospitalización por paciente, o 40 camas disponibles más mes. Conclusión Aunque el número de camas disponibles fue menor en el período posterior a la implantación, el intervalo de sustitución de camas se redujo, lo que representó un aumento de 40 camas más por mes debido a la disminución de la estancia de los pacientes en la institución.

Demostración de la aplicación del Modelo global de referencia para las tasas de cesárea (C-Model) y la Clasificación de Robson en la estimación y la caracterización del exceso de cesáreas institucionales / Demonstration of the application of the global cesarean section rate model (C-Model) and the Robson Classification to estimate and characterize excess numbers of institutional c-sections

RESUMEN Objetivo: Hacer un ejercicio académico, con datos locales reales, sobre la aplicación del C-Model v1.0 en cuanto a la manera como se obtiene y utiliza la información para generar el modelo, su aplicación a fin de identificar el posible exceso de cesáreas en una institución y, si se identifica, cómo se aplica la distribución de los partos según los grupos de la Clasificación de Robson para explicar ese exceso. Metodología: A partir de las bases de datos reales de cinco instituciones hospitalarias de Colombia, seleccionadas a conveniencia para lograr el cumplimiento de los objetivos, se estimó la razón estandarizada y la diferencia absoluta entre la proporción observada y la probabilidad esperada de cesárea según el C-Model v1.0 en cada institución. Con base en los supuestos que subyacen a la distribución de los grupos según la Clasificación de Robson, se proponen explicaciones a los excesos y a las diferencias entre las instituciones. Resultados: La razón estandarizada de cesárea aplicando el C-Model identificó excesos del procedimiento diferentes en presencia de proporciones institucionales similares de cesárea. Se encontró variabilidad importante en la proporción de cesárea dentro de grupos de mujeres con características clínicas y obstétricas similares que podría ser la explicación para los excesos detectados. Conclusión: El C-Model permite estimar proporciones de cesárea esperadas según las condiciones específicas de las mujeres atendidas en cada institución; su distribución de acuerdo con la Clasificación de Robson permite explorar el origen y las particularidades de dichas diferencias.

ABSTRACT Objective: To carry out an academic exercise based on real local data regarding the application of the C-Model v1.0 to determine how data are gathered and used to generate the model, how the model is applied in order to identify potential excess numbers of cesarean sections in an institution, and when identified, how the model is applied to distribute deliveries according to the Robson Classification system and explain excess numbers. Methodology: The standardized ratio and absolute difference between the observed proportion and the expected probability of c-sections according to the C-Model v1.0 were estimated for each institution using real databases of five hospitals in Colombia. Convenience selection was used to meet the objectives. Based on the assumptions underpinning group distributions according to the Robson classification, proposed explanations for excess numbers and differences among institutions are presented. Results: Applying the C-Model, the c-section standardized ratio identified different excess numbers of the procedure in the presence of similar institutional c-section proportions. Important variability was found in the proportion of c-sections among women with similar clinical and obstetric characteristics, which might explain the excess numbers identified. Conclusion: The C-Model allows to estimate expected c-section proportions according to the specific characteristics of the women seen at each institution; their distribution according to the Robson Classification is a way to explore the origin and particulars of those differences.

Gestión por procesos y la referenciación competitiva para la mejora de la calidad de la atención / Process Management and Benchmarking for Improving Quality of Care

Introducción: La calidad es un elemento estratégico que incide en la transformación y mejora de los sistemas sanitarios. Dado su carácter continuo es necesario visualizar y asumir enfoques efectivos para su mejora, como son la gestión por procesos y la referenciación competitiva. Objetivo: Identificar las tendencias de aplicación de la gestión por procesos y la referenciación competitiva en la mejora de la calidad de la atención. Métodos: Metarevisión de artículos de segunda generación del conocimiento, de los años 2014-2020. Se utilizaron las palabras clave "gestión por procesos", "referenciación competitiva", "benchmarking", "benchmarking AND gestión por procesos" y "referenciación competitiva AND gestión por procesos". Los criterios de inclusión para la selección de los artículos fueron: artículos originales publicados a textos completos en inglés, portugués y español, disponible en sitios especializados en áreas de gerencia, revistas electrónicas administración y gestión sanitaria y revistas científicas de calidad en salud. Conclusiones: La revisión realizada mostró escasa literatura que integre la gestión por procesos y la referenciación competitiva para la mejora de la calidad, sin embargo, se identificaron ejemplos de su aplicación de forma independiente. La aplicación de estas tecnologías por los profesionales de enfermería evidenció algunas reservas de mejora que permiten futuras aplicaciones en diversas áreas de práctica de estos profesionales(AU)

Introduction: Quality is a strategic element with an incidence in the transformation and improvement of health systems. Given its continuous nature, it is necessary to visualize and assume effective approaches for its improvement, such as process management and benchmarking. Objective: Identify the application trends of process management and benchmarking in improving quality of care. Methods: Metareview of articles from the second generation of knowledge and published from 2014 to 2020. The following keywords were used: gestión de procesos [process management], referenciación competitiva [benchmarking], benchmarking, benchmarking AND gestión de procesos [benchmarking and process management] and referenciación competitiva AND gestión de procesos [benchmarking AND process management]. The following inclusion criteria were considered for the selection of the articles: original articles published in full texts in English, Portuguese and Spanish; as well as available on sites specialized in management areas, electronic journals on health administration and management, and journals on health quality. Conclusions: The review carried out showed little literature integrating process management and benchmarking for quality improvement; however, examples of their application were identified independently. The application of these technologies by nursing professionals showed some involvement for improvement that allow future applications in several areas of performance by these professionals(AU)

Evaluación de bienestar animal en fincas bovinas lecheras basadas en pastoreo en la Sabana de Bogotá, Colombia / Animal welfare assessment on pasture-based dairy farms in Savanna of Bogota, Colombia

RESUMEN Objetivos. Determinar un puntaje de bienestar animal (PBA) a nivel de hato para ganaderías lecheras utilizando un protocolo que involucrara variables basadas en los animales y en manejo/recursos, e identificar las variables que más contribuyen a la varianza del PBA. Materiales y métodos. Veinticinco fincas lecheras basadas en pastoreo (Sabana de Bogotá - trópico alto colombiano) fueron visitadas dos veces. Durante cada visita, 15 variables basadas en el animal y 13 basadas en manejo/ recursos fueron evaluadas. Para cada variable se estableció un punto de corte negativo a nivel de hato para determinar el cumplimiento. En función del cumplimiento, se determinó un PBA (de 0 a 100) y las fincas se clasificaron como 'excelente', 'buena', 'aceptable' o 'no-aceptable'. Se usó una regresión lineal para evaluar la asociación entre variables a nivel de hato con PBA. Resultados. La mediana de PBA fue de 82 (mín = 67; máx = 97). Dos fincas fueron clasificadas como "excelentes" (PBA=94.5), 20 como "buenas" (PBA = 82.5) y 3 como "aceptables" (PBA = 68). Entre todas las variables, el incumplimiento con respecto a mastitis subclínica, calificación de suciedad (patas y ubre), heridas en la línea ventral, recuentos de mosca Haematobia ¡rritans y condición/limpieza del área de espera pre-ordeño se asociaron significativamente con 5.6; 3.6; 6.7; 5.1; 6.5 y 6.1 puntos de reducción en el PBA, respectivamente (R2 = 0.84). Conclusiones. El nivel de bienestar encontrado fue bueno y alentador. No obstante, se identificaron seis variables que contribuyeron a un resultado desfavorable. Las estrategias de mejora podrían centrarse en estas variables para alcanzar un buen nivel de bienestar.

ABSTRACT Objectives. The aim of this study was to determine an overall on-farm animal welfare score (WS) for dairy farms using a protocol involving animal- and management/resource-based variables; and to identify the variables that contributed the most to the variance for the WS. Materials and methods. Twenty-five pasture-based dairy farms in Savanna of Bogota - Colombian high tropic, were visited twice. During each visit, a total of 15 animal- and 13 management/resource-based variables were evaluated. For each variable, a herd-level negative cut-off point was established to determine compliance. Based on compliance, a WS was determined (from 0 to 100) and farms were classified as 'excellent', 'enhanced', 'acceptable', or 'non-acceptable'. A linear regression model was used to evaluate the association between variables at the herd-level with the WS. Results. Overall, median WS was 82 (min=67; max=97). Two farms were classified as 'excellent' (WS=94.5), 20 as 'enhanced' (WS=82.5), and 3 as 'acceptable' (WS=68). Among all variables, the noncompliance regarding subclinical mastitis, hind-legs and udder dirtiness score, ventral line wounds, Haematobia ¡rritans fly counts, and condition/cleanliness of pre-milking holding area was significantly associated with a 5.6, 3.6, 6.7, 5.1, 6.5, and 6.1 points reduction in the WS, respectively (R2 = 0.84). Conclusions. Welfare level found across farms was good and encouraging. Nonetheless, six variables were identified as the main contributors to an unfavorable result. Strategies for improvement could focus on these variables to be able to reach a welfare level of 'excellence'.

Benchmarking de indicadores de qualidade e dimensionamento de pessoal de enfermagem entre unidades hospitalares / Benchmarking de indicadores de calidad y dimensionamiento del personal de enfermería entre unidades hospitalarias / Benchmarking of quality indicators and dimensioning of nursing staff among hospital units

Objetivo realizar benchmarking interno de indicadores de qualidade e do dimensionamento de pessoal de enfermagem entre unidades de internação hospitalar. Método estudo transversal. Foram levantados/avaliados nove indicadores de qualidade por sítios de observação nas unidades de internação em clínica médica (n=450) e cirúrgica (n=274) de hospital público do Centro-Oeste, Brasil, além da aplicação de Sistema de Classificação de Pacientes, para o dimensionamento de pessoal. Empregou-se análise estatística descritiva (no dimensionamento) e inferencial (para os indicadores). Resultados houve diferença significativa (p-valor<0,0001) na conformidade da identificação do leito (melhor na unidade cirúrgica) e de acessos venosos (melhor na internação clínica). A classificação da qualidade foi equânime. A clínica médica apresentou déficit de enfermeiros (-11). Conclusão a qualidade assistencial - mediada à métrica dos indicadores - foi equânime entre os setores de internação e o dimensionamento de pessoal foi discrepante, em virtude do evidente déficit de enfermeiros, dada à maior complexidade assistencial na clínica médica.

Objetivo realizar un benchmarking interno de los indicadores de calidad y dimensionamiento del personal de enfermería entre las unidades de hospitalización. Método estudio transversal. Nueve indicadores de calidad fueron recogidos/evaluados por los sitios de observación en las unidades médicas (n-450) y quirúrgicas (n-274) de un hospital público en el Medio Oeste, Brasil, además de la aplicación de un Sistema de Clasificación de Pacientes para el dimensionamiento del personal. Se utilizaron análisis estadísticos descriptivos (en dimensionamiento) e inferenciales (para indicadores). Resultados hubo una diferencia significativa (valor p<0.0001) en el cumplimiento de la identificación de la cama (mejor en la unidad quirúrgica) y el acceso venoso (mejor en hospitalización clínica). La clasificación de calidad fue equitativa. La clínica médica presentaba un déficit de enfermeras (-11). Conclusión la calidad de la atención - mediada a las métricas de los indicadores - era equitativa entre los sectores de hospitalización y el dimensionamiento del personal era discreto, debido al evidente déficit de enfermeras, dada la mayor complejidad de la atención en la clínica médica.

Objective to perform internal benchmarking of quality indicators and the dimensioning of nursing staff between hospitalization units. Method cross-sectional study. Nine quality indicators were collected/evaluated by observation sites in the medical (n=450) and surgical (n=274) hospital units of a public hospital in the Midwest, Brazil, in addition to the application of a Patient Classification System for the dimensioning of personnel. Descriptive statistical analysis (in sizing) and inferential (for indicators) were used. Results there was a significant difference (p-value<0.0001) in the compliance of bed identification (better in the surgical unit) and venous access (better in clinical hospitalization). The quality classification was equitable. The medical clinic presented a deficit of nurses (-11). Conclusion the quality of care - mediated to the metrics of the indicators - was equitable between the hospitalization sectors and the personnel dimensioning was discrepant, due to the evident deficit of nurses, given the greater complexity of care in the medical clinic.

Strategies and Challenges for the Circular Economy: a Case Study in Portugal and a Panorama for Brazil

Abstract: This article is about a case study based on the participation and contact with dynamized activities through action plans for the circular economy in Europe, specifically in Portugal. It aims to identify the main in-progress actions and the challenges for the diffusion of the circular economy in the Portuguese nation and draw a panorama for Brazil, transiting through different data sources, economic sectors and stakeholders. Through data triangulation, the investigative plan contemplated participatory observations in workshops, interviews with experts, documental analyses and means of communication. After going through data cross checking for validation, the content was aggregated to a strategic analysis matrix. As a result, it was possible to identify the strengths, weaknesses, opportunities and challenges associated with the growth of the circular economy in Portugal, as well as to indicate directions and possibilities in the Brazilian context. It is possible to realize, for both countries, the importance of the international benchmarking for the recognition and promotion of circular economy actions, besides the necessity to revise laws aligned with the internal e external market rules, by increasing the offer of circular products and services.

Proposal for detection of 2019-nCoV nucleic acid in clinical laboratories / 中华检验医学杂志

In December, the outbreak of a novel coronavirus (2019-nCoV) in Wuhan, China, has attracted extensive global attention. On January 20, 2020,the Chinese health authorities upgraded the coronavirus to a Class B infectious disease in the Law of the People's Republic of China on the Prevention and Treatment of Infectious Diseases, and considered it as Class A infectious diseases in disease control and prevention. On January 22, 2020, the 2019-nCoV nucleic acid detection test was listed as the diagnostic criteria in the "guidelines for diagnosis and treatment of pneumonia due to 2019-nCoV (Trial Version 2)" . Therefore, standardizing the operation process of the 2019-nCoV nucleic acid detection in clinical laboratories has become a top priority. It is of paramount importance to establish standard protocols for detection of the 2019-nCoV nucleic acids in clinical laboratories to improve the reliability of the results and ensure the biosafety of laboratory personnel.

Capturing the trends in hospital standardized mortality ratios for pneumonia: a retrospective observational study in Japan (2010 to 2018)

BACKGROUND@#Pneumonia has a high human toll and a substantial economic burden in developed countries like Japan, where the crude mortality rate was 77.7 per 100,000 people in 2017. As this trend is going to continue with increasing number of the elderly multi-morbid population in Japan; monitoring performance over time is a social need to alleviate the disease burden. The study objective was to determine the characteristics of hospital standardized mortality ratios (HSMRs) for pneumonia in Japan from 2010 to 2018 to describe this trend.@*METHODS@#Data of the DPC (Diagnostic Procedures Combination) database were used, which is an administrative claims and discharge summary database for acute care in-patients in Japan. HSMRs were calculated using the actual and expected numbers of in-hospital deaths, the latter of which was calculated using logistic regression model, with a number of explanatory variables, e.g., age, sex, urgency of admission, mode of transportation, patient volume per month in each hospital, A-DROP score, and Charlson comorbidity index (CCI). We constructed two HSMR models: a single-year model, which included hospitals with > 10 in-patients per month and, a 9-year model, which included those hospitals with complete 9-year data. Predictive accuracy of the logistic models was assessed using c-index (area under receiver operating curve).@*RESULTS@#Total 230,372 patients were included for the analysis over the 9-year study period. Calculated HSMRs showed wide variation among hospitals. The proportion of hospitals with HSMR less than 100 increased from 36.4% in 2010 to 60.6% in 2018. Both models showed good predictive ability with a c-statistic of 0.762 for the 9-year model, and no less than 0.717 for the single-year model.@*CONCLUSION@#This study denoted that HSMRs of pneumonia can be calculated using DPC data in Japan and revealed significant variations among hospitals with comparable case-mixes. Therefore, HSMR can be used as yet another measure to help improve quality of care over time if other indicators are examined in parallel and to get a clear picture of where hospitals excel and lack.

Specifications for diagnosis and treatment of non-neonatal tetanus / 中华创伤杂志

Tetanus consists of neonatal tetanus and non-neonatal tetanus. Non-neonatal tetanus remains a serious public health problem, although neonatal tetanus has been eliminated in China since 2012. Non-neonatal tetanus is a potential fatal disease. In the absence of medical intervention, the mortality rate of severe cases is almost 100%. Even with vigorous treatment, the mortality rate remains 30%-50% globally. These specifications aim to regulate non-neonatal tetanus diagnosis and treatment in China, in order to improve medical quality and safety. These specifications introduce the etiology, epidemiology, pathogenesis, clinical manifestations and laboratory tests, diagnosis, differential diagnosis, grading and treatment of non-neonatal tetanus.