Consultoria colaborativa em educação física: planejamento e implementação de programa para estudante com deficiência física / Consultoría colaborativa en educación física: planificación e implementación de un programa para estudiantes con discapacidad física / Collaborative consulting in physical education: program planning and implementation for students with physical disabilities

Resumo O objetivo do estudo foi planejar, aplicar e avaliar um programa de consultoria colaborativa como modelo de suporte à inclusão de estudante com deficiência física no contexto da Educação Física escolar. Foi realizada uma pesquisa de campo de abordagem colaborativa, como estratégia recorreu-se ao estudo de caso. Participou desse estudo um professor de Educação Física de uma escola pública do interior do estado de São Paulo, que ministrava aulas para estudantes com deficiência física. O programa foi desenvolvido em quatro etapas: 1) Aproximação e estabelecimento de vínculos; 2) Identificação do problema e Planejamento do plano de ação; 3) Implementação e 4) Avaliação do programa. Os resultados indicaram que a prestação do serviço de consultoria colaborativa se mostrou uma estratégia de apoio viável no contexto das aulas de Educação Física, sendo capaz de fornecer ao professor do ensino regular mais segurança para lidar com os desafios da inclusão escolar.(AU)

Resumen El objetivo del estudio fue planificar, aplicar y evaluar un programa de consultoría colaborativa como modelo para apoyar la inclusión de estudiantes con discapacidad física en el contexto de la Educación Física en la escuela. Se realizó una investigación de campo con enfoque colaborativo, como estrategia se recurrió al estudio de caso. En este estudio participó un profesor de Educación Física de una escuela pública del interior del estado de São Paulo, quien impartió clases para estudiantes con discapacidad física. El programa se desarrolló en cuatro etapas: 1) Aproximación y establecimiento de vínculos; 2) Identificación de problemas y planificación del plan de acción; 3) Implementación y 4) Evaluación del Programa. Los resultados indicaron que la prestación del servicio de consultoría colaborativa resultó ser una estrategia de apoyo viable en el contexto de las clases de Educación Física, pudiendo brindar más seguridad al docente de educación regular para enfrentar los desafíos de la inclusión escolar. (AU)

Abstract The aim of the study was to plan, apply and evaluate a collaborative consulting program as a model to support the inclusion of students with physical disabilities in the context of Physical Education. A field research with a collaborative approach was conducted, as a strategy we resorted to the case study. Participated in this study a Physical Education teacher from a public school in the interior of the state of São Paulo, who taught classes for students with physical disabilities. The program was developed in four stages: 1) Approximation and establishment of bonds; 2) Problem identification and action plan planning; 3) Implementation and 4) Program Evaluation. The results indicated that the provision of collaborative consulting service provided to be a viable support strategy in the context of Physical Education classes, being able to provide the regular education teacher with more security to deal with the challenges of school inclusion. (AU)

Indução da lactação em mulheres nuligestas: relato de experiência / Inducción de la lactancia en mujeres nuligestas: informe de experiencia / Lactation induction in women who never got pregnant: experience report

Resumo Objetivo relatar a experiência de indução da lactação em nuligestas realizada por enfermeira consultora em aleitamento. Método relato de experiência. O processo de indução láctea foi realizado com três mulheres por motivo de gestação em útero de substituição e relacionamento homoafetivo. Resultados todas perceberam o aumento de tamanho e a sensibilidade nas mamas, bem como apresentaram secreção láctea. No entanto, a continuidade da amamentação foi diferenciada entre elas. A primeira não recebeu apoio de profissionais de saúde no contexto de pós-parto hospitalar, nem em casa, e não deu continuidade à amamentação. A segunda recebeu apoio da equipe do hospital e da parceira, amamentando por três meses. A terceira, com o apoio da parceira, amamentou por dois meses, mas interrompeu por sentir-se inibida por familiares. Conclusão e implicações para a prática a técnica de indução é capaz de desencadear a produção láctea. Já o processo de amamentação só se estabeleceu mediante a associação com a rede de apoio, o acolhimento, o incentivo da equipe de saúde e o olhar integral à mulher e sua família. Dessa forma, o cuidado de Enfermagem na indução láctea não deve focar apenas no manejo da indução, mas transcender o aspecto técnico, o que se mostra como fundamental para a proteção, o estabelecimento e a continuidade da amamentação.

Resumen Objetivo reportar la experiencia de inducir la lactancia en nuligestas realizada por una consultora de enfermería en lactancia materna. Método relato de experiencia. El proceso de inducción de la leche se realizó con tres mujeres por embarazo en útero de reemplazo y relación homoafectiva. Resultados todas notaron el aumento de tamaño y la sensibilidad en las mamas, además de presentar secreción de leche. Sin embargo, la continuidad de la lactancia materna se diferencia entre ellos. La primera no recibió apoyo de los profesionales de la salud en el contexto posparto hospitalario, ni en el domicilio, y no continuó con la lactancia. La segunda recibió apoyo del personal del hospital y su pareja, amamantando durante tres meses. La tercera, con el apoyo de su pareja, amamantó durante dos meses, pero la interrumpió porque se sentía inhibida por familiares. Conclusión e implicaciones para la práctica la técnica de inducción es capaz de desencadenar la producción de leche. El proceso de lactancia materna, en cambio, solo se estableció a través de la asociación con la red de apoyo, la acogida, el estímulo del equipo de salud y la mirada integral a la mujer y su familia. Así, el cuidado de Enfermería en la inducción de la leche no debe enfocarse solo en el manejo de la inducción, sino trascender el aspecto técnico, que se muestra fundamental para la protección, el establecimiento y la continuidad de la lactancia materna.

Abstract Objective to report the experience of lactation induction in women who never got pregnant by a lactation consultant nurse. Method experience report. The process of lactation induction was performed with three women due to surrogate pregnancy and homosexual relationships. Results all noticed an increase in the size and sensitivity of the breasts, as well as milk secretion. However, the continuity of breastfeeding was different between them. The first did not receive support from health professionals in the postpartum hospital setting, nor at home, and did not continue breastfeeding. The second received support from the hospital staff and her partner, breastfeeding for three months. The third, with the support of her partner, breastfed for two months, but stopped because she felt inhibited by family members. Conclusion and implications for practice the induction technique is capable of triggering milk production. However, the breastfeeding process was only established through the association with the support network, the reception, the encouragement of the health team, and the comprehensive view of the woman and her family. Thus, nursing care in lactation induction should not focus only on the management of induction, but transcend the technical aspect, which is essential for the protection, establishment, and continuity of breastfeeding.

Profil épidémiologique des patients consultants et des cas positifs Covid-19 de l'unité de triage EHU Oran (mars 2020 - août 2020) / Epidemiological profile of consulting patients and Covid-19 positive cases in the triage unit - EHU Oran (March 2020 - August 2020)

Introduction. En décembre 2019, la population de Wuhan, une grande ville chinoise de 11 millions d'habitants, est atteinte par une pneumonie virale extrêmement contagieuse due au coronavirus SARSCoV-2. En Algérie, le premier cas a été identifié le 25 février 2020, un plan de riposte national élaboré par le ministère de la santé a été mis en place pour affronter l'épidémie. Dès le début de la pandémie, l'établissement hospitalier et universitaire d'Oran (EHUO), centre de soins de première ligne, d'une capacité 780 lits desservant environ 2 millions d'habitants s'est complètement réorganisé, en aménageant principalement des circuits pour le tri des patients « suspects Covid 19 ¼. L'objectif de notre travail consiste à décrire le profil épidémiologique des patients consultants et des cas incidents Covid-19 au niveau de l'unité de triage EHUO depuis le début de l'épidémie au 07 Aout 2020. Méthodes. Les données sont collectées à partir des enquêtes épidémiologiques auprès des patients consultant au niveau de l'unité de triage Covid-19 de l'EHUO. Résultats. À la date du 7 aout 2020, un total de 7110 cas suspects de Covid-19 ont été enregistrés. Du total des cas suspects, 3036 (42,7 %) étaient positifs par RT-PCR. Il s'agissait de 1421 de sexe masculin (46,8 %) et de 1615 de sexe féminin (53,2 %), soit une sex-ratio de 0,88. La répartition globale des cas Covid19 par tranches d'âge était la suivante : 21,9 % des patients avaient un âge entre 30 et 39 ans, 17,3 % entre 40 et 49 ans. Le tableau clinique était dominé par la toux (26,5%), suivi de céphalées (19 %), de fièvre (16,2 %) et d'anosmie (15,9 %). 234 patients (7,7 %) avaient une SpO2 < 95 %. Conclusion. L'épidémiologie de l'infection Covid 19 reste encore peu connue à l'heure actuelle dans notre wilaya. Un dépistage de masse permettrait d'avoir une vision plus claire sur le nombre réel de patients atteints. La Covid 19 est une infection avec un large panel de symptômes autres que respiratoires, souvent non spécifiques, faisant d'elle une pathologie difficile à diagnostiquer cliniquement, d'où la nécessité de la confirmation biologique (PCR).

Consultoría integral en salud sexual y reproductiva: Guía operativa para equipos de salud: Marzo 2021 / Comprehensive consulting in sexual and reproductive health: Operational guide for health teams: March 2021

Guía basada en el trabajo de la becaria María Pía Elissetche, que fue dirigido por la Lic. Graciela Giorgetti. El trabajo de campo de la beca "Consejerías integrales en salud sexual y salud reproductiva: articulación e integración intersectorial para garantizar derechos" fue realizado durante 2019-2020 en los centros de salud del primer nivel de CABA y tuvo como finalidad conocer la articulación intersectorial entre Salud y Educación con foco en las consejerías integrales en salud sexual y reproductiva en escuelas medias. Este documento está dirigido a los/as profesionales de los equipos de salud que trabajan en el primer nivel de atención de la Ciudad de Buenos Aires y propone el fortalecimiento y la creación de consejerías integrales en salud sexual y reproductiva en las escuelas medias, como un modo de ampliar la promoción y prevención en salud sexual integral y de fomentar la autonomía en la toma de decisiones de los/as adolescentes. (AU)

Breastfeeding in the first six months of life for babies seen by Lactation Consulting / Amamentação nos seis primeiros meses de vida de bebês atendidos por Consultoria em Lactação / Lactancia materna en los primeros seis meses de vida de los bebés atendidos por Consultoría de Lactancia

Objective: to identify breastfeeding patterns, survival of exclusive breastfeeding and factors associated with its interruption, in the first six months of life of babies seen by Lactation Consulting. Method: a prospective cohort, with 231 mother-babies in a Baby-Friendly Hospital. An initial questionnaire was applied after 24 hours of birth, after consulting, as well as a follow-up questionnaire, applied by telephone at 15, 30, 60, 120 and 180 days, with sociodemographic and obstetric variables, maternal habits, father's schooling, birth data and baby feeding. Survival Analysis was carried out. Results: at 180 days of age, exclusive breastfeeding was 12.7% and the probability was 19.6% in the analysis of the survival curve. The factors associated with its interruption were smoking during pregnancy (HR 1.66; CI 1.05 - 2.61), age ≥ 35 years old (HR 1.73; CI 1.03 - 2.90), difficulty in breastfeeding after hospital discharge (HR 2.09; CI 1.29 - 3.41), search for professional assistance (HR 2.45; CI 1.69 - 3.54) and use of a pacifier (HR 1.76; IC 1.21 - 2.58). Conclusion: lactation consultancy contributed to the improvement of the exclusive breastfeeding rates, although there are opportunities for advances.

Objetivo: identificar padrões de amamentação, sobrevida do aleitamento materno exclusivo e fatores associados à sua interrupção, nos seis primeiros meses de vida de bebês atendidos por Consultoria em Lactação. Método: coorte prospectiva, com 231 mãe-bebê em Hospital Amigo da Criança. Utilizou-se questionário inicial aplicado após 24 horas do nascimento, depois da consultoria, e de seguimento, aplicado por telefone aos 15, 30, 60, 120 e 180 dias, com variáveis sociodemográficas, obstétricas, hábitos maternos, escolaridade paterna, dados do nascimento e alimentação do bebê. Procedeu-se à Análise de Sobrevivência. Resultados: aos 180 dias de vida, o aleitamento materno exclusivo foi 12,7% e probabilidade de 19,6% na análise da curva de sobrevivência. Os fatores associados à sua interrupção foram tabagismo na gestação (HR 1,66; IC 1,05 - 2,61), idade ≥ 35 anos (HR 1,73; IC 1,03 - 2,90), dificuldade na amamentação pós-alta hospitalar (HR 2,09; IC 1,29 - 3,41), busca por auxílio profissional (HR 2,45; IC 1,69 - 3,54) e uso de chupeta (HR 1,76; IC 1,21 - 2,58). Conclusão: a consultoria em lactação contribuiu para melhoria das taxas de aleitamento materno exclusivo, embora existam oportunidades de avanços.

Objetivo: identificar patrones de lactancia materna, supervivencia de la lactancia materna exclusiva y factores asociados a su interrupción, en los primeros seis meses de vida de los bebés atendidos por Consultoría de Lactancia. Método: cohorte prospectiva, con 231 madres-bebés en el Hospital Amigo del Niño. Se aplicó un cuestionario inicial a las 24 horas del nacimiento, previa consultoría, y de seguimiento, aplicado por teléfono a los 15, 30, 60, 120 y 180 días, con variables sociodemográficas, obstétricas, hábitos maternos, educación del padre, datos de nacimiento y alimentación del bebé. Se llevó a cabo un Análisis de Supervivencia. Resultados: a los 180 días de vida, la lactancia materna exclusiva fue del 12,7% y la probabilidad del 19,6% en el análisis de la curva de supervivencia. Los factores asociados a su interrupción fueron el tabaquismo en la gestación (HR 1,66; IC 1,05 - 2,61), edad ≥ 35 años (HR 1,73; IC 1,03 - 2,90), dificultad para amamantar después del alta hospitalaria (HR 2,09; IC 1,29 - 3,41), búsqueda de asistencia profesional (HR 2,45; IC 1,69 - 3,54) y uso de chupete (HR 1,76; IC 1, 21-2,58). Conclusión: la consultoría en lactancia contribuyó a la mejora de las tasas de lactancia materna exclusiva, aunque existen oportunidades de avances.

Diseño y validación de un Protocolo de Atención Psicológica para la ideación suicida / Design and validation of a psychological attention protocol for suicidal ideation

Resumen La cifra de personas que presentan o han presentado alguna conducta suicida ha aumentado significativamente en Colombia desde el año 2014 al 2019, convirtiendo la conducta suicida en una problemática de salud pública; sin embargo, es un concepto amplio, que abarca diferentes tipos de conductas, por esto es necesario establecer un protocolo de atención para estandarizar las acciones del terapeuta o personas que se desempeñan en los servicios prestadores de salud. El presente artículo tiene como objetivo describir cómo se realizó el diseño y la validación de un protocolo de atención psicológica para atención en ideación suicida de los consultantes que asisten a un centro de atención psicológica de una institución universitaria de la ciudad de Bogotá. Se realizó un estudio cuantitativo, de tipo instrumental, el cual implicó: a) el diseño de la ruta de atención, situaciones que activan el protocolo y el módulo de atención en crisis; b) la participación de 10 jueces expertos con el fin de realizar la validación por contenido de todos los componentes del protocolo de atención psicológica. Los resultados arrojaron que el diseño es pertinente, suficiente y relevante para la problemática que se buscó abordar.

Abstract Currently, the number of people who present or have presented some suicidal behavior has increased significantly in Colombia from 2014 to 2019, making suicidal behavior a public health problem. However, it is abroad concept that covers different types of behavior, so it is necessary to establish a protocol of care to standardize the actions of the therapist and/or people who work in health care services. The present article aims to describe how a psychological care protocol was designed and validated for the care of suicidal ideation of consultants who attend a psychological care center at a university institution in the city of Bogotá. A quantitative, instrumental study was carried out, which involved: a) designing the care route, situations that activate the protocol and the crisis care module; b) the participation of 10 expert judges to carry out the validation of the content of all the components of the psychological care protocol. The results showed that the design of the care protocol is pertinent, sufficient, and relevant to the problem to be addressed.

Reflexiones de un neurocirujano militar de la segunda mitad del siglo XX / Reflections of a military neurosurgeon from the second half of the 20th century

Experiencias y reflexiones del Dr. José Hernán Salas Rubio, presentadas en forma de conferencia, en el Congreso Internacional Neuro-Cuba 2017. Es profesor titular y consultante, uno de los más prominentes neurocirujanos cubanos. Ha trabajado como neurocirujano desde 1962 y contribuido a la formación de jóvenes neurocirujanos. Ha publicado cinco libros y más de cincuenta artículos científicos(AU)

Experiences and reflections of Dr. José Hernán Salas Rubio, presented as a lecture, at the Neuro-Cuba International Congress 2017. He is a full professor and consultant, one of the most prominent Cuban neurosurgeons. He has worked as a neurosurgeon since 1962 and contributed to the training of young neurosurgeons. He has published five books and more than fifty scientific articles(AU)

Consultoria em amamentação durante a pandemia COVID-19: relato de experiência / Asesoría en lactancia materna durante la pandemia de COVID-19: informe de experiencia / Breastfeeding consultancy during the COVID-19 pandemic: experience report

Objetivo: relatar a experiência de consultoras em amamentação no atendimento às lactantes durante a pandemia de COVID-19. Método: relato de experiência de atendimentos de consultoria em amamentação, nas modalidades online e presencial, na cidade de Fortaleza-CE, Brasil, entre março e abril de 2020. Resultados: diante de sentimentos de medo e ansiedade das lactantes, as consultoras prestaram apoio por meio de aconselhamento, bem como orientações com equipe multiprofissional. Todas as lactantes estavam amamentando e realizando distanciamento social e cuidados de higiene pessoal, sendo reforçado pelas consultoras a importância do acesso às fontes confiáveis de informação. Quanto aos problemas mamários, foram realizadas intervenções preventivas e curativas. Percebeu-se a satisfação das lactantes pelo serviço. Conclusão e implicações para a prática: a consultoria em amamentação constitui-se como um dispositivo agregador na saúde das mulheres que favorece tanto a promoção do aleitamento materno quanto a saúde mental durante a pandemia de Covid-19. Este relato traz direcionamentos para uma prática holística, com vistas à melhoria da qualidade do cuidado prestado, levando-se em consideração os atuais desafios da promoção da saúde diante da pandemia e pode fomentar novas estratégias exitosas

Objective: to report the experience of breastfeeding consultants in caring for breastfeeding women during the Covid-19 pandemic. Method: an experience report of breastfeeding consultancy services, online and face-to-face modalities, in the city of Fortaleza­CE, between March and April 2020. Results: given the mothers' feelings of fear and anxiety, the consultants provided support through counseling, as well as guidance with a multidisciplinary team. All the women were breastfeeding and performing social distancing and personal hygiene care actions, the importance of access to reliable information sources being reinforced by the consultants. As for breast problems, preventive and curative interventions were carried out. The mothers' satisfaction with the consultant service was noticed. Conclusion and implications for practice: breastfeeding consultancy is an aggregating device in women's health that favors both the promotion of breastfeeding and mental health during the Covid-19 pandemic. This report provides directions for a holistic practice, to improve the provided care quality, considering the current challenges of health promotion given the pandemic, and can foster new successful strategies

Objetivo: relatar la experiencia de consultores de lactancia materna en el cuidado de mujeres en periodo de lactancia durante la pandemia de Covid-19. Método: informe de experiencia de los servicios de consultoría en lactancia materna en modalidades en línea y cara a cara, en la ciudad de Fortaleza-CE, entre marzo y abril de 2020. Resultados: ante los sentimientos de miedo y ansiedad de las mujeres lactantes, los consultores proporcionaron apoyo a través de asesoramiento, así como orientación con un equipo multidisciplinario. Todas las mujeres amamantaban y practicaban el distanciamiento social y cuidados de higiene personal, siendo que los consultores reforzaron la importancia del acceso a fuentes confiables de información. En cuanto a los problemas mamarios, se realizaron intervenciones preventivas y curativas. Se notó la satisfacción de las madres lactantes por el servicio. Conclusión e implicaciones para la práctica: la consultoría sobre lactancia materna es un dispositivo agregado en la salud de la mujer que favorece tanto la promoción de la lactancia materna como la salud mental frente a la pandemia de Covid-19. Este estudio proporciona instrucciones para una práctica holística, con miras a mejorar la calidad de la atención brindada, teniendo en cuenta los desafíos actuales de la promoción de la salud frente a la pandemia y puede fomentar nuevas estrategias exitosas

Application and evaluation of mobile nutrition management service for breast cancer patients / 한국영양학회지

PURPOSE: This study evaluated the effects of nutrition management application in a mobile device on obesity management of patients with breast cancer.METHODS: Fifty subjects, who were breast cancer survivors, aged 30 years and older, participated in an obesity management program for four weeks. They were divided randomly into two groups: a control group (n = 25) and a treatment group (n = 25). The treatment group was provided an application for nutrition management and diet consultant, while the control group maintained their ordinary life without any nutrition management.RESULTS: The weight of the treatment group decreased by 0.8 kg, but the change was not significant. In contrast, the waist-hip ratio of the treatment group decreased significantly from 0.75 to 0.71 (p = 0.012). The Nutrition Quotients of the treatment group increased significantly from 61.3 to 69.6 points (p < 0.001), whereas that of the control group decreased significantly from 61.5 to 59.0 (p = 0.002).CONCLUSION: This mobile nutrition management application for breast cancer patients is effective in managing obesity and dietary habits. These results can be used as basic information to prepare an obesity management program for breast cancer patients.

Consultoria e ligação em saúde mental na perspectiva da equipe da Estratégia de Saúde da Família / Mental health consultation-liaison from the perspective of the primary health care team / Consultoría y conexión en salud mental en la perspectiva de la estrategia de salud de la familia

OBJETIVO: analisar as atividades de consultoria e ligação, realizadas pelos profissionais especializados em Saúde Mental, na perspectiva dos profissionais da ESF. MÉTODO: estudo exploratório, realizado em cinco núcleos de Saúde da Família, em um município do interior paulista, em 2010. Os dados foram obtidos por meio de entrevistas, os quais foram submetidos à Análise de Conteúdo. RESULTADOS: as atividades de consultoria e ligação mostraram-se como um espaço de aprendizado mútuo entre especialistas de Psiquiatria e Saúde Mental e equipes da ESF. CONCLUSÃO: recomenda-se a ampliação do número de atividades que articulem as ações de saúde mental com a ESF, como a consultoria e ligação, a fim favorecer a sensibilidade das equipes para as demandas de saúde mental na ESF e consolidação da integralidade do cuidado.

OBJECTIVE: analyze the consulting and liaison activities carried out by professionals specialized in mental health from the perspective of the PHC. METHOD: an exploratory study, realized in five Family Health centers, in a municipality in the countryside of São Paulo, in 2010. Data were collected through interviews, which were submitted to content analysis. RESULTS: as consultation-liaison activities were shown as a space for mutual learning between specialists in psychiatry and mental health and PHC teams. CONCLUSION: it is recommended to increase the number of activities that articulate mental health actions with PHC, such as consultation and liaison, in order to favor the sensitivity of the teams to the demands of mental health in the PHC and consolidation of the integral care.

OBJETIVO: analisar como actividades de consultoría y ligação realizadas pelis profissionais tourism em saúde mental na perspective dos profissionais da ESF. MÉTODO: estudo exploratorio, realizado en cinco núcleos de Salud de la familia, en el municipio de interior paulista, en 2010. Os dados foram obtidos por meio de entrevistas, os quais foram submetidos à análise de conteúdo. RESULTADOS: como atividades de consultoría y ligação mostraram-se como um espaço de aprendised mútuo entre especialistas de psiquiatria e saúde mental e equipes del ESF. CONCLUSIÓN: recomendar una ampliación del número de actividades que articulan como funciones de salud mental con un ESF, como una consultoría y ligazón, un enfoque para sensibilizar a los equipos para las demandas de salud mental en ESF y consolidación de la integridad del cuidado.

Clinical Practice Guideline for Cardiac Rehabilitation in Korea Online only

OBJECTIVE: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and three additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and two general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, three rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. PRINCIPAL CONCLUSIONS: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

The Volume of Subscapularis Muscle Remains Unaffected by Supraspinatus Tendon Tears: Three-dimensionally Reconstructed Magnetic Resonance Imaging Analysis

BACKGROUND: This study aimed to compare the subscapularis muscle volume between the intact groups (group I) and supraspinatus tendon tear groups (group T) based on the sex and three different age groups. METHODS: Subjects with a group I and subjects with group T without any other lesions were retrospectively evaluated from among patients who received a magnetic resonance imaging (MRI) scan between January 2011 and December 2013. The MRI scans were studied by a consultant radiologist. The subscapularis muscle volume was compared according to the age and sex; the age groups were categorized as patients in their 40s, 50s, and 60s. The volume of subscapularis muscle was measured by three-dimensional reconstructed images acquired through the axial section of 1.5T MRI. RESULTS: No statistically significant differences were observed between subscapularis muscle volume of the group I and group T, except for male patients in their 50s (group I: 100,650 mm3 vs. group T: 106,488 mm3) and 60s (group I: 76,347 mm3 vs. group T: 99,549 mm3) (p<0.05). Males had a larger mean volume of subscapularis muscle than females, and the subscapularis muscle volume decreased in a linear manner with increasing age. CONCLUSIONS: Decrease in subscapularis muscle volume was observed with increasing age, and the impact of supraspinatus tear on subscapularis muscle volume is age and sex dependent.

Implementation of Korean Clinical Imaging Guidelines: A Mobile App-Based Decision Support System

OBJECTIVE: The aims of this study were to develop a mobile app-based clinical decision support system (CDSS) for implementation of Korean clinical imaging guidelines (K-CIGs) and to assess future developments therein. MATERIALS AND METHODS: K-CIGs were implemented in the form of a web-based application (http://cdss.or.kr/). The app containing K-CIGs consists of 53 information databases, including 10 medical subspecialties and 119 guidelines, developed by the Korean Society of Radiology (KSR) between 2015 and 2017. An email survey consisting of 18 questions on the implementation of K-CIGs and the mobile app-based CDSS was distributed to 43 members of the guideline working group (expert members of the KSR and Korean Academy of Oral and Maxillofacial Radiology) and 23 members of the consultant group (clinical experts belonging to related medical societies) to gauge opinion on the future developmental direction of K-CIGs. RESULTS: The web-based mobile app can be downloaded from the Google Play Store. Detailed information on the grade of recommendation, evidence level, and radiation dose for each imaging modality in the K-CIGs can be accessed via the home page and side menus. In total, 32 of the 66 experts contacted completed the survey (response rate, 45%). Twenty-four of the 32 respondents were from the working group and eight were from the consulting group. Most (93.8%) of the respondents agreed on the need for ongoing development and implementation of K-CIGs. CONCLUSION: This study describes the mobile app-based CDSS designed for implementation of K-CIGs in Korea. The results will allow physicians to have easy access to the K-CIGs and encourage appropriate use of imaging modalities.

Follow-up of Metal-on-Metal Hip Replacements at a Large District Hospital and the Implementation of Medicines and Healthcare Products Regulatory Agency Guidelines: A Review of 297 Patients

BACKGROUND: Medicines and Healthcare products Regulatory Agency (MHRA) guidance for patients with metal-on-metal (MoM) hip replacements was provided in 2012 and updated in 2017 to assist in the early detection of soft-tissue reactions due to metal wear debris. A large number of MoM hip replacements were undertaken at our hospital trust. A program of recall for all patients with MoM hip replacements was undertaken and MHRA guidelines were implemented. In this study, we aimed to investigate the effectiveness of the revised MHRA guidelines in the detection of early adverse reactions to metal debris and to re-evaluate the indications for metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) and revision surgery. METHODS: Identification and recall of all patients with MoM hip replacements from 2001 were conducted by using theatre logs, patient records, clinical coding information, and consultant logbooks. Two senior arthroplasty consultants reviewed X-rays and patient records. Postal questionnaires were forwarded to patients, together with requests for general practitioners to complete cobalt and chromium blood tests. The two consultant-led review of MOM replacements was undertaken with further radiological investigations (X-rays, MARS-MRI) performed according to the 2017 guidance with support of consultant radiologists. RESULTS: Of 674 identified patients, 297 were available for review: 26 patients did not have MoM implants, 36 were untraceable, 59 refused follow-up, 87 moved out of area, 147 had died, and 22 already had revision. Of 297 patients, 126 were women and 171 were men; age range was 39 to 95 years (mean age, 69 years); 126 had resurfacing and 171 had MoM replacements. Twenty-six patients had elevated metal ions. Thirty-three patients underwent MARS-MRI: MARS-MRI results were positive in 17 and negative in 16. Of 17 patients with positive MARS-MRI, 10 patients were asymptomatic and seven were waiting revision. CONCLUSIONS: Positive MARS-MRI can often occur in the absence of elevated metal ion levels; elevated blood metal ion levels do not mean MARS-MRI will be positive. All patients with MoM replacements were at risk. It is imperative to assess patients regularly for symptoms that may raise clinical suspicion and maintain a low threshold to performing MARS-MRI.

Clinical Practice Guideline for Cardiac Rehabilitation in Korea: Recommendations for Cardiac Rehabilitation and Secondary Prevention after Acute Coronary Syndrome

Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.