3D-Printed Implant Sliding Guide: A New Dental Implant Surgical Guide.

PURPOSE: To compare the linear and angular deviations of sites prepared for implants with the proposed 3D-printed sliding guide vs a 3D-printed conventional sleeveless static guide. MATERIALS AND METHODS: This study consisted of two groups: a control group of 14 3D-printed conventional sleeveless static guides, and a test group of 37 3D-printed sliding guides. The guides were designed to drill 37 implant sites in each group. Linear and angular deviations were determined after scanning the drilled casts. Linear deviations were measured at the coronal and apical aspects of the drilled implant sites at 5-, 10-, 15-, and 20-mm distances. RESULTS: There were no significant differences between the control and study groups regarding the coronal and 5-mm apical linear deviations. The angular and 10-, 15-, and 20-mm linear deviations of the 3D-printed sliding guide were significantly smaller than the control group. CONCLUSIONS: The proposed 3D-printed sliding guide could reduce the angular deviation of drilled implant sites from the planned positions, which is reflected in reducing the linear apical deviation of prepared implant sites longer than 5 mm.

Fuzzy-Set Qualitative Comparative Analysis (fsQCA) in Organizational Psychology: Theoretical Overview, Research Guidelines, and A Step-By-Step Tutorial Using R Software

Fuzzy set qualitative comparative analysis (fsQCA) is a method for assessing the effects of configurations of variables leading to an outcome. The recent growth of interest in this technique in organizational psychology is proving this method to be an important tool for addressing new and decisive research hypotheses. However, the effectiveness of fsQCA is dictated not only by its general principles, but also by how well these are understood and applied in the research community. Consequently, a guide that covers the fundamental ideas and tenets of the approach is required to aid the research community in its comprehension and practical application. The current study seeks to offer an understanding of FsQCA by providing: (a) A complete description of the method highlighting some of the most important theoretical-methodological aspects; (b) a perspective on the most used guidelines and recommendations, and (c) step-by-step instructions on how to carry out FsQCA in R using the QCA package. Data from 120 employees and supervisors derived from a company based in central Italy were used o best to illustrate how to carry out fsQCA. Codes for conducting the analyses from the QCA package for R accompany the tutorial and can be adapted to a new dataset. (AU)

La experimentación en la formación de especialistas en Bioquímica Clínica / Experimentation in the training of specialists in Clinical Biochemistry

Fundamento: la bioquímica es una ciencia experimental, por lo que la Bioquímica Clínica es muy apropiada para la creación de habilidades de trabajo experimental, en la carrera de Medicina. Objetivo: diseñar actividades prácticas para el módulo Proteínas, a fin de contribuir a la adquisición de las habilidades experimentales en la formación de los especialistas desde la Bioquímica Clínica. Métodos: se realizó una investigación cualitativa transversal observacional en la Facultad de Medicina, durante el año 2019. Los métodos teóricos utilizados fueron el analítico-sintético y el inductivo-deductivo; y empírico: el análisis documental; además, los métodos de diseño inverso para la planificación de las actividades prácticas, y el de aprendizaje por indagación en el desarrollo de los seminarios y de las actividades prácticas. Resultados: se diseñaron las actividades, teniendo en cuenta las unidades didácticas, habilidades experimentales a crear y las actividades prácticas de laboratorio. Se brindaron tareas específicas para desarrollar el pensamiento crítico, la resolución de problemas y la evaluación de situaciones complejas. Para su correcta aplicación se elaboraron guías y se orientó la bibliografía, lo cual facilitó el trabajo independiente. Conclusiones: las actividades prácticas diseñadas para el módulo Proteínas contribuyeron a que los residentes de Bioquímica Clínica adquirieran las habilidades del trabajo experimental, imprescindible para alcanzar la competencia profesional en la docencia, la investigación y la asistencia médica.

Background: biochemistry is an experimental science, so Clinical Biochemistry is very appropriate for the creation of experimental work skills in the Medicine career. Objective: design practical activities for the Proteins module, in order to contribute to the acquisition of experimental skills in the training of specialists from Clinical Biochemistry. Methods: a qualitative cross-sectional observational research was carried out at the Faculty of Medicine during 2019. The theoretical methods used were analytical-synthetic and inductive-deductive; and empirical ones: documentary analysis; In addition, reverse design methods for planning practical activities, and inquiry learning in the development of seminars and practical activities. Results: the activities were designed, taking into account the teaching units, experimental skills to be created and the practical laboratory activities. Specific tasks were provided to develop critical thinking, problem solving, and evaluating complex situations. For its correct application, guides were prepared and the bibliography was oriented, which facilitated independent work. Conclusions: the practical activities designed for the Proteins module contributed to the Clinical Biochemistry residents acquiring the skills of experimental work, essential to achieve professional competence in teaching, research and medical care.

Análisis de la organización docente universitaria de la Anatomía Patológica en España / Analysis of the university teaching organization of Pathological Anatomy in Spain

Introducción: Describir y analizar la situación actual de la docencia de la Anatomía Patológica (AP) y sus características en el grado de las facultades públicas de medicina en España. Métodos: Análisis descriptivo de las guías docentes de los estudios de grado de estudio de 32 facultades públicas de medicina españolas, identificando en la asignatura de AP número de créditos, horas de docencia teórico-práctica, elementos docentes, rotación por servicios hospitalarios y profesorado. Resultados: En las 32 facultades de medicina analizadas, 31 (96,7%) presentan en sus planes de estudio al menos una asignatura de AP. De una facultad no se pudieron obtener datos. Un 67% de las asignaturas ofertadas implican actividad práctica por servicios de AP. La asignatura de AP se cursa con mayor frecuencia en el tercer curso, y la mediana de créditos del European Credit Transfer System (ECTS) es seis. Un 49,5% de las asignaturas implica contenidos relacionados con la autopsia clínica. Un 12,5% de las asignaturas tienen contenidos bien teóricos o prácticas sobre patología digital o telepatología. Respecto al profesorado, 112 docentes son personal funcionario (catedrático o profesor titular de universidad, de los cuales, 91 son vinculados –92,9%), 244 son personal no funcionario, donde el 76,2% tiene la figura docente de profesor asociado. Conclusiones: La ensẽnanza de Anatomía Patológica está ampliamente distribuida, la rotaciónpor los servicios sanitarios de AP es escasa y la figura docente más frecuente es la de profesorasociado.(AU)

Introduction: To describe and analyze the current situation of Pathology teaching and its characteristics in the degree of Medicine in public medical schools in Spain. Methods: Descriptive analysis of the teaching guides of the undergraduate studies of 32 Spanish public medical schools, identifying the number of credits, hours of theoretical practical teaching, teaching elements, rotation through hospital services and teachers in the subject of Pathology. Results: In the 32 medical schools analyzed, 31 (96.7%) present in their study plans at least 1 AP subject. Data could not be obtained from one faculty. 67% of the subjects offered imply rotation by AP services. The most frequent year for AP teaching is the third one, and the median number of ECTS credits is 6. 49.5% of the subjects involve contents related to the clinical autopsy. 12.5% of the subjects have either theoretical or practical content on digital Pathology or telepathology. Regarding the teaching staff, 112 people are civil servants (University Professor or Professor, of which 91 are linked -92,9%), 244 people are non-civil servants, where 76.2% have the teaching figure of Associate Professor. Conclusions: The teaching of Pathology is widely distributed, the rotation of Pathology health services is scarce and the most frequent teaching figure is that of an Associate Professor.(AU)

Epidemiology, the cherry on the cake.

PURPOSE: In guideline development the evidence is more and more coming exclusively from randomized-controlled trials (RCTs), while all other evidential levels are too easily brushed aside. This adopted creed is based on the radical ideas of Archibald Cochrane. Randomize until it hurts-which should presumably be read as a stimulus to perform better research-was the initial suggestion of Cochrane. METHODS: This commentary is based on quotes from Cochrane's original work. RESULTS: Cochrane's statements were figured out in a long-gone era in which medical and social inequality prevailed. Adhering to the orthodoxy nowadays hurts both clinicians and patients. I doubt that this was ever Cochrane's intention. CONCLUSION: In my opinion, the most important part of guideline development should be making inferences of the total medical content (all available evidence including expert opinion); a process that can only be done by subject experts. Methodological assessment, which is undoubtedly the most essential point in the planning of future studies, should come only second place in guideline development and should be used for grading of the evidential level, not for the decision to reject studies completely. Otherwise, far too much relevant evidence is ignored.

Multidisciplinary practice guidelines for the diagnosis, genetic counseling and treatment of pheochromocytomas and paragangliomas

'Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors that arise from chromaffin cells of the adrenal medulla and the sympathetic/parasympathetic neural ganglia, respectively. The heterogeneity in its etiology makes PPGL diagnosis and treatment very complex. The aim of this article was to provide practical clinical guidelines for the diagnosis and treatment of PPGLs from a multidisciplinary perspective, with the involvement of the Spanish Societies of Endocrinology and Nutrition (SEEN), Medical Oncology (SEOM), Medical Radiology (SERAM), Nuclear Medicine and Molecular Imaging (SEMNIM), Otorhinolaryngology (SEORL), Pathology (SEAP), Radiation Oncology (SEOR), Surgery (AEC) and the Spanish National Cancer Research Center (CNIO). We will review the following topics: epidemiology; anatomy, pathology and molecular pathways; clinical presentation; hereditary predisposition syndromes and genetic counseling and testing; diagnostic procedures, including biochemical testing and imaging studies; treatment including catecholamine blockade, surgery, radiotherapy and radiometabolic therapy, systemic therapy, local ablative therapy and supportive care. Finally, we will provide follow-up recommendations (AU)

Construção do guia de plantas medicinais de Florianópolis, SC, Brasil / Production of the guide to medicinal plants in Florianópolis, Santa Catarina, Brazil / Construcción de la guía de plantas medicinales de Florianópolis, Estado de Santa Catarina, Brasil

Há escassez relativa de experiências com plantas medicinais e de orientações para confecção de materiais didáticos sobre elas na Atenção Primária à Saúde (APS). Uma equipe interinstitucional (Universidade Federal de Santa Catarina e Secretaria Municipal de Saúde de Florianópolis) produziu um guia de plantas medicinais em Florianópolis, SC. O objetivo deste trabalho é apresentar essa experiência e o guia, que é voltado para profissionais da APS e que valorizou saberes científicos, populares e profissionais, evitando uma abordagem colonizadora do tema. Após alguns tópicos introdutórios, o guia apresenta 38 plantas medicinais comumente usadas em Florianópolis (nomes científicos e populares; partes usadas; fotos; características botânicas; uso popular; informações científicas; uso clínico; modo de usar; reações adversas e contraindicações; plantas na gestação; toxicidade; glossário; e referências). Espera-se contribuir para a construção de outros guias adaptados aos contextos locais e para a valorização do uso de plantas medicinais na APS. (AU)

Experiences with medicinal plants and guidance for producing educational resources about these plants for use in primary health care (PHC) are relatively scarce. A team from the Santa Catarina Federal University and Florianópolis City Council Department of Health produced the "Guide to Medicinal Plants in Florianópolis". This article presents this experience and the guide, which is aimed at PHC professionals and values scientific, traditional and professional knowledge, avoiding a colonizing approach to the topic. After presenting some introductory topics, the guide describes 38 medicinal plants commonly used in Florianópolis (scientific and common names, parts used, photo, botanical characteristics, common uses, scientific information, clinical use, adverse reactions and contraindications, plants during pregnancy, toxicity, glossary and references). It is hoped this guide will contribute to the production of other guides adapted to local contexts and recognition of the value of medicinal plants in PHC. (AU)

Hay una escasez relativa de experiencias con plantas medicinales y de orientaciones para la confección de materiales didácticos sobre ellas en la atención primaria de la salud (APS). Un equipo interinstitucional (Universidad Federal de Santa Catarina y Secretaría Municipal de Salud de Florianópolis) produjo una guía de plantas medicinales en Florianópolis, estado de Santa Catarina. El objetivo de este trabajo es presentar esa experiencia y la guía, dirigida a los profesionales de la APS y que valorizó saberes científicos populares y profesionales, evitando un abordaje colonizador del tema. Después de algunos tópicos de introducción, la guía presenta 38 plantas medicinales comúnmente utilizadas en Florianópolis (nombres científicos y populares, partes usadas, foto, características botánicas, uso popular, informaciones científicas, uso clínico, modo de usar, reacciones adversas y contraindicaciones, plantas en la gestación, toxicidad, glosario y referencias). Se espera contribuir para la construcción de otras guías adaptadas a los contextos locales y para la valorización del uso de plantas medicinales en la APS. (AU)

La guía de estudio, un recurso didáctico en la enseñanza médica de la asignatura enfermedades infecciosas / The study guide, a didactic resource in the medical education of the subject infectious diseases

El objetivo de la enseñanza de Enfermedades Infecciosas en el Ciclo Clínico de la Carrera de Medicina de la Facultad de Medicina de la UBA es desarrollar los contenidos de la asignatura que le permitan al alumno adquirir las competencias, habilidades y destrezas necesarias para el ejercicio de la Atención Primaria de la Salud. Las guías didácticas constituyen un recurso del proceso de enseñanza y aprendizaje que tienen el propósito de orientar metodológicamente al estudiante en su actividad independiente, al mismo tiempo que sirven de apoyo a la dinámica del proceso docente y orientan la actividad del alumno en su aprendizaje. Es el documento que orienta el estudio, acercando a los procesos cognitivos del alumno el material didáctico, con el fin de que pueda trabajarlos. Una guía de estudios en la signatura Enfermedades Infecciosas es una herramienta colaborativa en el cumplimiento de las metas propuestas.

The primary function of the teaching of Infectious Diseases in the Clinical Cycle of the Medical Career of the UBA School of Medicine is to develop the contents of the subject that allow the student to acquire the necessary skills, abilities and skills for the exercise of Primary Health Care. The didactic guides are a resource of the teaching-learning process that have the purpose of methodologically guiding the student in their independent activity, at the same time that they support the dynamics of the teaching process and guide the student's activity in their learning. It is the document which guides the study, bringing the teaching material closer to the cognitive processes of the student, so that he can work on them. A study guide in the Infectious Diseases subject is a collaborative tool in fulfilling the proposed goals.

General Surgery Resident Use of Electronic Resources: 15 Minutes a Day.

BACKGROUND: General surgery resident performance on the American Board of Surgery In-Service Training Exam (ABSITE) has been used to predict American Board of Surgery (ABS) passage rates, selection for remediation programs, and ranking of fellowship applicants. We sought to identify electronic resource study habits of general surgery residents associated with successful test scores. STUDY DESIGN: A single-institution, retrospective review of general surgery resident use of 2 electronic study resources, Surgical Council on Resident Education (SCORE) and TrueLearn (TL), were evaluated for the 7 months before the 2019 ABSITE. Metrics included TL question performance, SCORE use, and a survey about other reading sources. These metrics were evaluated in 3 ABSITE percentile groupings: ≥80th, 31st to 79th, and ≤30th. RESULTS: The ≥80th and 31st to 79th percentile groups scored higher on TL questions, at 69% and 67.7%, respectively, compared with 61.4% for the ≤30th percentile group (p < 0.03). The ≥80th percentile group spent on average 14.6 minutes/day on SCORE compared with 5.0 minutes/day and 4.7 minutes/day for the 31st to 79th and ≤30th percentile groups, respectively (p < 0.04). The ≥80th percentile group spent 34.8 minutes/session (77 sessions) compared with 19.2 minutes/session (49 sessions) and 20.7 minutes/session (43 sessions) in the 31st to 79th and ≤30th percentile groups, respectively (p = 0.009). CONCLUSIONS: Our nomogram incorporates time spent accessing an electronic content-based resource, SCORE, and performance on an electronic question-based resource as a novel method to provide individualized feedback and predict future ABSITE performance.

SVI Self-Study Guide: A Study Tool for Independent Preparation for the AAMC Standardized Video Interview.

Introduction: Since 2017, students applying to emergency medicine residencies must take the AAMC Standardized Video Interview (SVI) to assess their knowledge of professional behaviors and interpersonal and communication skills. Due to the SVI's novelty, there are not many study tools available to prepare for it, outside of the resources provided by the AAMC. Methods: The SVI Self-Study Guide is a PowerPoint document that learners can use to prepare for the SVI independently. It is intended for fourth-year medical students who are applying to emergency medicine residencies and therefore planning to take the SVI. The guide was distributed via email and assessed with a pre- and postquiz measuring subjective feelings of preparedness as well as testing knowledge of professionalism and interpersonal and communication skills. Results: Eleven students were invited to use the SVI Self-Study Guide, of whom 10 and eight took the pre- and postquiz, respectively. There was a statistically significant increase in learners' self-rated feelings of preparedness to take the SVI (p < .05). Although there was no significant change in the average score on four knowledge-based questions (p = .29), the average score increased from 72.50% to 93.25%. Discussion: Overall, there was a higher improvement in feelings of preparedness to take the SVI than in performance on knowledge-based questions. This suggests that learners benefited the most from practicing using the SVI testing format. The SVI Self-Study Guide can be distributed via email to supplement existing resources in preparing for the SVI.

Quality of methods and reporting in association studies of chronic periodontitis and IL1A -889 and IL1B +3953/4 SNPs: A systematic review.

OBJECTIVE: The aim of this systematic review was to evaluate the quality of reporting and methodology in genetic association studies between IL1A -889 and IL1B +3954 polymorphisms and chronic periodontitis. BACKGROUND: Evidence provided by periodontal research on genetic risk factors is of uttermost importance in clinical practice as a possible diagnostic and prognostic tool for periodontitis. Inadequate reporting of results as well as high risk of bias due to methodological inconsistency hampers the integration of evidence in terms of clinical applicability. METHODS: This review includes case-control studies in humans published between 1997 and July 2017. Searching was conducted through MEDLINE, EMBASE, and search handing. Specific scoring systems have been developed to evaluate the quality of methods and reporting. Each article was scored according to its adequacy, and then, the total number and the percentage of items positively qualified for both methods and reporting were calculated. The quality of methods in studies scoring 0-6, 7-12, and 13-16 was, respectively, considered poor, moderate, and good. For reporting, scores of 0-9, 10-18, and 19-26 were deemed of poor, moderate, and good quality, respectively. Pearson's correlation coefficient was calculated to explore the correlation between the year of publication and the quality in terms of methods and reporting. RESULTS: From the 531 screened studies, 52 met the inclusion criteria and were thus included in the study. The quality of methods and reporting of published genetic association papers on IL1 and chronic periodontitis is moderate. On a scale from 0 to 16, the mean score for methods of the reviewed studies was 8.19 ± 1.93. The items more frequently considered inadequate concerned the handling of confounders in statistical analysis, especially oral hygiene habits, socioeconomic status, subgingival colonization of specific periodontal pathogens, and stress. A significant positive correlation was found between the year of publication and the quality scores in terms of method (r = 0.401, P = 0.003). In terms of reporting, the mean score was 14.83 ± 3.04 on a scale from 0 to 26 and it was considered overall moderate. No statistically significant correlation was found between the year of publication and the quality of reporting (P = 0.266). CONCLUSIONS: The association between IL1A -889 and IL1B +3954 polymorphisms and chronic periodontitis is questionable due to methodological inconsistency. Evidence arising from meta-analysis is unreliable due to high risk of bias and moderate quality in terms of reporting.

Experiencias de capacitación a manipuladores de alimentos desde la promoción de salud / Experiences of the food handlers´ training from the health promotion

RESUMEN Introducción: las personas que manipulan alimentos son responsables de la elaboración inocua de los mismos, son claves para desarrollar y fomentar una cultura alimentaria saludable. Objetivo: describir el desarrollo del curso "El manipulador de alimentos y la promoción de Salud" impartido por la Escuela Nacional de Salud Pública, durante el curso 2015-2016. Materiales y métodos: se realizó un estudio descriptivo, de corte transversal.El universo lo constituyó 97 cursistas. Resultados: las principales necesidades de aprendizaje fueron: normas jurídicas cubanas para la manipulación de alimentos inocuos, (97=100 %); buenas prácticas de manufactura en la limpieza y desinfección en establecimientos de alimentos, (96=93,12%); conocimiento de enfermedades trasmitidas por los alimentos, (89= 86,33 %); la necesidad de poseer conocimientos relacionados con los alimentos saludables y factores que influyen en su calidad, (60=58,20 %). Las principales expectativas declaradas al inicio del curso fueron cumplidas en un 100 %. El 91,75 % de los cursistas expresaron sentirse muy satisfechos. Conclusiones: el curso impartido desde la perspectiva de la promoción de la salud, posibilitó que los manipuladores de alimentos se empoderen de los conocimientos necesarios para contribuir a garantizar la inocuidad de los alimentos, en sus comunidades y escenarios laborales y así lograr una alimentación saludable y de calidad... (AU)

ABSTRACT Introduction: people handling food are responsible for their innocuous elaboration and are very important for developing and fomenting a healthy food culture. Objective: to describe the conduction of the training "The Food Handler and Health Promotion", taught at the National School of Public Health, during the school year 2015-2016. Materials and methods: a cross-sectional, descriptive study was carried out. The universe was formed by 97 trainees. Results: the main learning necessities were: Cuban juridical norms for handling innocuous food (97=100 %); good manufacturing practices in food establishments cleaning and disinfestation (96=93.12%); knowledge on food-transmitted diseases (89= 86.33 %); necessity of having knowledge related to healthy food and factors influencing on their quality (60=58.20 %). The main expectations declared at the beginning of the training were 100 % fulfilled. 91.70 % of the trainees said they were satisfied. Conclusions: the training from the point of view of health promotion provided the food handlers the necessary knowledge for them to contribute to warrant the food innocuousness in their communities and working places, achieving that way a healthy, qualitative feeding... (AU)

Experiencias de capacitación a manipuladores de alimentos desde la promoción de salud / Experiences of the food handlers´ training from the health promotion

Introducción: las personas que manipulan alimentos son responsables de la elaboración inocua de los mismos, son claves para desarrollar y fomentar una cultura alimentaria saludable. Objetivo: describir el desarrollo del curso “El manipulador de alimentos y la promoción de Salud” impartido por la Escuela Nacional de Salud Pública, durante el curso 20152016. Materiales y métodos: se realizó un estudio descriptivo, de corte transversal. El universo lo constituyó 97 cursistas. Resultados: las principales necesidades de aprendizaje fueron: normas jurídicas cubanas para la manipulación de alimentos inocuos, (97=100 %); buenas prácticas de manufactura en la limpieza y desinfección en establecimientos de alimentos, (96=93,12%); conocimiento de enfermedades trasmitidas por los alimentos, (89= 86,33 %); la necesidad de poseer conocimientos relacionados con los alimentos saludables y factores que influyen en su calidad, (60=58,20 %). Las principales expectativas declaradas al inicio del curso fueron cumplidas en un 100 %. El 91,75 % de los cursistas expresaron sentirse muy satisfechos. Conclusiones: el curso impartido desde la perspectiva de la promoción de la salud, posibilitó que los manipuladores de alimentos se empoderen de los conocimientos necesarios para contribuir a garantizar la inocuidad de los alimentos, en sus comunidades y escenarios laborales y así lograr una alimentación saludable y de calidad (AU).

Introduction: people handling food are responsible for their innocuous elaboration and are very important for developing and fomenting a healthy food culture. Objective: to describe the conduction of the training “The Food Handler and Health Promotion”, taught at the National School of Public Health, during the school year 2015-2016. Materials and methods: a cross-sectional, descriptive study was carried out. The universe was formed by 97 trainees. Results: the main learning necessities were: Cuban juridical norms for handling innocuous food (97=100 %); good manufacturing practices in food establishments cleaning and disinfestation (96=93.12%); knowledge on food-transmitted diseases (89= 86.33 %); necessity of having knowledge related to healthy food and factors influencing on their quality (60=58.20 %). The main expectations declared at the beginning of the training were 100 % fulfilled. 91.70 % of the trainees said they were satisfied. Conclusions: the training from the point of view of health promotion provided the food handlers the necessary knowledge for them to contribute to warrant the food innocuousness in their communities and working places, achieving that way a healthy, qualitative feeding (AU).

Methods for time-varying exposure related problems in pharmacoepidemiology: An overview.

PURPOSE: Lack of control for time-varying exposures can lead to substantial bias in estimates of treatment effects. The aim of this study is to provide an overview and guidance on some of the available methodologies used to address problems related to time-varying exposure and confounding in pharmacoepidemiology and other observational studies. The methods are explored from a conceptual rather than an analytical perspective. METHODS: The methods described in this study have been identified exploring the literature concerning to the time-varying exposure concept and basing the search on four fundamental pharmacoepidemiological problems, construction of treatment episodes, time-varying confounders, cumulative exposure and latency, and treatment switching. RESULTS: A correct treatment episodes construction is fundamental to avoid bias in treatment effect estimates. Several methods exist to address time-varying covariates, but the complexity of the most advanced approaches-eg, marginal structural models or structural nested failure time models-and the lack of user-friendly statistical packages have prevented broader adoption of these methods. Consequently, simpler methods are most commonly used, including, for example, methods without any adjustment strategy and models with time-varying covariates. The magnitude of exposure needs to be considered and properly modelled. CONCLUSIONS: Further research on the application and implementation of the most complex methods is needed. Because different methods can lead to substantial differences in the treatment effect estimates, the application of several methods and comparison of the results is recommended. Treatment episodes estimation and exposure quantification are key parts in the estimation of treatment effects or associations of interest.

Effect of flowable composites on the clinical performance of non-carious cervical lesions: A systematic review and meta-analysis.

OBJECTIVES: To answer the following PICO question (participant, intervention, comparator and outcome): Does flowable resin composite restorations compared with regular resin composites improve the marginal adaptation, marginal discoloration and retention rates of restorations placed in non-carious cervical lesions [NCCLs] of adults?, through a systematic review and meta-analysis. SOURCE: MEDLINE, Scopus, Web of Science, LILACS, BBO, Cochrane Library and SIGLE were searched without restrictions, as well as the abstracts of the IADR, clinical trials registries, dissertations and theses in May 2016 (updated in April 2017). STUDY SELECTION: We included randomized clinical trials (RCTs) that answered the PICO question. RCTs were excluded if cavities other than NCCLs were treated; indirect restorations; polyacid-based resins instead of composite resins were employed, restorations in primary teeth and restorations were placed in carious cervical lesions. The risk of bias tool of the Cochrane Collaboration was applied in the eligible studies and the GRADE tool was used to assess the quality of the evidence. DATA: After duplicates removal, 5137 articles were identified. After abstract and title screening, 8 studies remained. Six were at "unclear" risk of bias. The study follow-ups ranged from 1 to 3 years. No significant difference was observed between groups for loss of retention and marginal discoloration in all follow-ups. Better marginal adaptation was observed for restorations performed with flowable composites. At 1-year (risk ratio=0.27 [0.10 to 0.70]) and 3-year (risk ratio=0.34 [0.17 to 0.71]) follow-ups, flowable composites showed a risk 73% and 66% lower than regular composites for lack of adaptation, respectively. The evidence was graded as moderate quality for loss or retention at 3 years due to risk of bias and low and very low for all other outcomes due to risk of bias, imprecision and inconsistency. CONCLUSIONS: We have moderate confidence that the resin composite viscosity does not influence the retention rates at 3 years. Similar marginal discoloration and better marginal adaptation was observed for flowable composites but the quality of evidence is doubtful. (PROSPERO CRD42015019560).

Guia para o processo de ajuda interpessoal de enfermagem ao familiar do paciente crítico / Guía para el proceso de ayuda interpersonal de enfermería al familiar del paciente crítico / Guide for interpersonal process of help in nursing to relatives of the critical patient

RESUMO Fundamentando-se no referencial de Viktor Frankl, propõe-se um guia sobre o processo de ajuda interpessoal entre a enfermeira e o familiar do paciente em estado crítico. Trata-se de uma estratégia sustentada em uma perspectiva humanista, existencial e personalista para despertar, no profissional enfermeiro, sua atuação ética, consciente e responsável pelo cuidado. O tema surgiu da tríade trágica: sofrimento, culpa e morte, vivenciada pelo familiar do paciente em estado crítico hospitalizado em uma Unidade de Terapia Intensiva (UTI), de um hospital geral e privado da cidade de Salvador, Brasil. Considerando-se que do trágico emerge o otimismo e este possibilita a resiliência para direcionar o cuidado do enfermeiro até o familiar do paciente em estado crítico, a proposta do guia possui quatro etapas: diagnóstico triádico, planejamento de ajuda, aplicação das estratégias de ajuda e avaliação do processo de ajuda. Com esta ferramenta, espera-se apoiar a transformação da tríade trágica, ou seja, transformar o sofrimento em atitude, a culpa em reflexões para a mudança e a possibilidade de morte, em ações responsáveis.

ABSTRACT Based on Viktor Frankl's logotherapy, a guide on the process of interpersonal help between the nurse and the relatives of the critically-ill patient is proposed. This is a strategy based on a humanist, existential and person-alistic perspective, to awake, in the professional nurse, their ethical, conscious and responsible action towards caring. The theme arose from Frankl's tragic triad: suffering, guilt and death, experienced by the relative of the critically-ill patient treated in an Intensive Care Unit (ICU), of a general and private hospital in the city of Salvador, Brazil. Considering the fact that from tragic events optimism emerges and it generates resilience to direct the care of the nurse towards the relatives of the patient in critical condition, the proposed guide has four stages: triadic diagnosis, aid planning, application of the aid strategies and evaluation of the aid process. With this tool it is expected to support the transformation of the tragic triad, that is, to transform suffering into attitude, guilt into reflections for change, and the possibility of death into responsible actions.

RESUMEN Fundamentada en el referencial de Víctor Frankl se propone una guía sobre el proceso de ayuda interpersonal de enfermería hacia el familiar del paciente crítico. Se trata de una estratégia sustentada en una perspectiva humanista, existencial y personalista para despertar, en el profesional de enfermería, su actuar ético, consciente y responsable por el cuidado. El tema surge de la tríada trágica -sufrimiento, culpa y muerte- vivenciada por el familiar del paciente crítico hospitalizado en una Unidad de Cuidados Intensivos (UCI), de un hospital general y privado de la ciudad de Salvador, Brasil. Considerando que de lo trágico emerge el optimismo que hace posible la resiliencia para iluminar el cuidado de enfermería hacia el familiar del paciente crítico, la guía propuesta posee 4 etapas: diagnóstico triádico, planificación de ayuda, aplicación de estrategias de ayuda y evaluación del proceso de ayuda. Con esta herramienta se espera apoyar la transformación de la tríada trágica, es decir, el sufrimiento en actitud, la culpa en reflexiones para el cambio y la posibilidad de muerte en acciones responsables.

The Evolution of Recommended Naloxone Dosing for Opioid Overdose by Medical Specialty.

INTRODUCTION: Opioid abuse and opioid overdose deaths have increased significantly over the past decade. Naloxone is a potentially life-saving medication that can reverse opioid-induced respiratory depression, though precipitated opioid withdrawal can pose acute risks to the patient and medical personnel. The optimal naloxone dose is unclear and few studies address this question. METHODS: A convenience sample of commonly available references were queried for the recommended IV naloxone dose. When dosing recommendations were different for opioid-tolerant patients these were also recorded. RESULTS: Twenty-five references were located. 48% recommended a starting dose ≤ 0.05 mg while 36% recommend a dose ten-fold higher. More than half of medical toxicology and general medical sources recommended a low-dose strategy with a starting dose lower than 0.05 mg IV. CONCLUSION: There are variations in the recommended doses for naloxone with ranges spanning an order of magnitude. Further exploration is needed to determine the dose that balances reversal of respiratory depression with mitigation of withdrawal.