Demandas clínicas e intervenções de enfermagem em consultas gerontológicas: Revisão integrativa / Demandas Clínicas e intervenciones de Enfermería en consultas gerontológicas: Una revisión integrativa / Clinical demands and nursing interventions in gerontological consultations: An integrative review

Resumen Introdução: A criação de guias que unificam as demandas clínicas prevalentes em consultas de enfermagem gerontológica e, das suas respectivas intervenções, se faz presente, devido a heterogeneidade das patologias emergentes no processo de envelhecimento, que irão precisar de cuidados. Objetivo: Identificar as demandas clínicas em consultas de enfermagem gerontológica e, as intervenções implementadas pelos(as) enfermeiros(as). Método: Revisão integrativa de pesquisas originais, publicadas entre 2018 e 2022, em inglês, espanhol e português, disponíveis nas bases de dados Scopus, MEDLINE/PubMed, BIREME/LILACS/BDENF/IBECS/BVS, SciELO e Google Scholar, pelos descritores DeCS/MESH: "Idoso"; "Enfermagem no Consultório"; "Enfermagem Geriátrica" e "Geriatria". O Rating System for the Hierarchy of Evidence for Intervention foi usado para determinar o nível de evidência da amostra final. Foram excluídos editoriais, estudos de revisão e artigos duplicados. A análise dos dados se deu pela leitura analítica e interpretativa, guiadas por um checklist. Resultados: Oito artigos foram selecionados e trouxeram demandas clínica tais como: o déficit no autocuidado para banho; autonegligência; fadiga; risco de integridade da pele prejudicada; desesperança; tristeza e depressão. As intervenções se relacionaram ao incentivo ao autocuidado; otimização dos medicamentos; estímulo a atividade física; cuidados com a pele; aconselhamento; musicoterapia e reabilitação psicossocial. Conclusão: Demandas clínicas atendidas nas consultas de enfermagem gerontológica possuem grande variação, com prevalência no domínio atividade/repouso, tais como intervenções voltadas para o tratamento e prevenção de doenças e ações visando a promoção da saúde, tendo o domínio comportamental mais expressivo.

Resumen Introducción: La creación de guías que unifiquen las demandas clínicas prevalentes en las consultas de enfermería gerontológica y sus respectivas intervenciones es necesaria, debido a la heterogeneidad de patologías emergentes en el proceso de envejecimiento que requerirán cuidados. Objetivo: Identificar las demandas clínicas en las consultas de enfermería gerontológica y las intervenciones implementadas por el personal de enfermería. Método: Revisión integrativa de investigaciones originales, publicadas entre 2018 y 2022, en inglés, español y portugués, en las bases de datos Scopus, MEDLINE/PubMed, BIREME/LILACS/BDENF/IBECS/BVS, SciELO y Google Scholar. Se utilizaron los descriptores DeCS/MESH: "Idoso"; "Enfermagem no Consultório"; "Enfermagem Geriátrica" e "Geriatria". Para determinar el nivel de evidencia de la muestra final, se usó el Rating System for the Hierarchy of Evidence for Intervention. Además, se excluyeron los editoriales, los estudios de revisión y los artículos duplicados. Los datos se analizaron mediante lectura analítica e interpretativa, guiada por una lista de verificación. Resultados: Se seleccionaron ocho artículos que aportaron demandas clínicas como déficit en el autocuidado para el baño, autodescuido, fatiga, riesgo integridad de la piel perjudicada; desesperanza, tristeza y depresión. Las intervenciones estaban orientadas al fomento del autocuidado, la optimización de la medicación, el fomento de la actividad física, el cuidado de la piel, el asesoramiento, la musicoterapia y la rehabilitación psicosocial. Conclusión: Las demandas clínicas atendidas en las consultas de enfermería gerontológica son muy variadas, con predominio en el dominio actividad/reposo, como intervenciones dirigidas al tratamiento y prevención de enfermedades y acciones dirigidas a la promoción de la salud, siendo más expresivo el dominio conductual.

Abstract Introduction: The creation of guidelines that unify the prevalent clinical demands from gerontological nursing consultations and their corresponding interventions are necessary due to the heterogeneity of emerging pathologies in the aging process that will require nursing care. Objective: To identify clinical demands in gerontological nursing consultations and the interventions implemented by nurses. Method: An integrative review of original research published from 2018 and 2022, in English, Spanish, and Portuguese, in Scopus, MEDLINE/PubMed, BIREME/lilacs/BDENF/IBECS/VHL, SciELO, and Google Scholar databases, using the DeCS/MESH descriptors: "Elderly", "Nursing in the Office", "Geriatric Nursing", and "Geriatrics". The Rating System for the Hierarchy of Evidence for Intervention was used to determine the level of evidence of the final sample. Editorials, review studies, and duplicate articles were excluded. The data were analyzed by analytical and interpretative reading, guided by a checklist. Results: Eight articles were selected that showed clinical demands such as deficits in self-care for bathing, self-negligence, fatigue, risk of damaged skin integrity, hopelessness, sadness, and depression. Interventions were related to encouraging self-care, medication optimization, encouragement of exercise, skin care, counseling, music therapy, and psychosocial rehabilitation. Conclusion: There are many different clinical demands in gerontological nursing consultations, especially associated with the domain of activity/rest. These include interventions to treat and prevent diseases, and actions aimed at health promotion, in most cases associated with the behavioral domain.

Factors associated with neurofeedback and mindfulness-based combination therapy for patients with substance use disorder: A multicenter study

Background and objectives Substance use disorder (SUD) has become a major concern in public health globally, and there is an urgent need to develop an integrated psychosocial intervention. The aims of the current study are to test the efficacy of the integrated treatment with neurofeedback and mindfulness-based therapy for SUD and identify the predictors of the efficacy. Methods This study included 110 participants with SUD into the analysis. Outcome of measures includes demographic characteristics, severity of dependence, quality of life, symptoms of depression, and anxiety. Independent t test is used to estimate the change of scores at baseline and three months follow-up. Generalized estimating equations are applied to analyze the effect of predictors on the scores of dependence severity over time by controlling for the effects of demographic characteristics. Results A total of 22 (20 %) participants were comorbid with major mental disorder (MMD). The decrement of the severity in dependence, anxiety, and depression after treatment are identified. Improved scores of qualities of life in generic, psychological, social, and environmental domains are also noticed. After controlling for the effects of demographic characteristics, the predictors of poorer outcome are comorbid with MMD, lower quality of life, and higher level of depression and anxiety. Conclusion The present study implicates the efficacy of integrated therapy. Early identification of predictors is beneficial for healthcare workers to improve the treatment efficacy. (AU)

La teoría de las transiciones como paradigma de apoyo al automanejo en personas con condiciones crónicas / Transitions theory as a paradigm for supporting self-management in people with chronic conditions / A teoria das transições como paradigma para apoiar a autogestão em pessoas com condições crónicas

Resumen Introducción: La experiencia de vivir con una enfermedad crónica no es una tarea sencilla, se requiere de herramientas que permitan aumentar el grado de conciencia para enfrentar las necesidades y superar desafíos sobre el estado de salud y enfermedad. En los últimos años, se ha instaurado el apoyo al automanejo, con la finalidad de potenciar las habilidades en personas con este tipo de afecciones. Resulta trascendental considerar como desde enfermería se puede contribuir al logro de aquello. El objetivo del presente ensayo es reflexionar acerca de la teoría de las transiciones de Meléis como paradigma de apoyo al automanejo en personas con condiciones crónicas. Desarrollo: La teoría de las transiciones de Meléis establece que las personas están en constante cambio, tal como ocurre en el proceso de transición de salud-enfermedad. Recibir el diagnóstico de una enfermedad crónica, conlleva una serie de procesos complejos para la persona, debido a la multiplicidad de variables que ello implica. La teoría de Meléis entrega lineamientos para orientar a la persona profesional de enfermería sobre elementos claves e interrelacionados, como la concepción previa de la naturaleza de la transición y sus condiciones, lo que servirá para la planificación de modalidades de intervención congruentes con las experiencias de la persona y su evaluación en el transcurso del proceso de salud y enfermedad. Conclusión: El paradigma ofrecido por Meléis puede ser considerado un enfoque clave para emprender el proceso de cuidado de enfermería tendiente a apoyar a las personas con enfermedad crónica en el logro del automanejo.

Abstract Introduction: The experience of living with a chronic disease is not a simple task, since it requires tools that allow increasing the degree of awareness to face the needs and overcome challenges about the state of health and disease. In recent years, support for self-management has been established, with the aim of enhancing the skills of people with this type of condition. It is important to consider how the nursing discipline can contribute to achieve this. The aim of this paper is to reflect on Meléis' theory of transitions as a paradigm to support self-management in people with chronic conditions. Development: Meléis' theory of transitions establishes that people are in constant change, as occurs in the health-illness transition process. Receiving the diagnosis of a chronic disease involves a series of complex processes for the person, due to the multiplicity of variables involved. Meléis' theory provides guidelines to orient the nursing professional on key and interrelated elements, such as the previous conception of the nature of the transition and its conditions, which will serve for the planning of intervention modalities congruent with the person's experiences and their evaluation in the course of the health and disease process. Conclusion: The paradigm offered by Meléis can be considered a key approach to undertake the nursing care process aimed at supporting people with chronic illness in achieving self-management.

Resumo Introdução: A experiênca de viver com uma doença crônica não é uma tarefa simple, pois requer ferramentas que permitam aumentar o nível de consciência para enfrentar as necessidades e superar desafios relativos ao estado de saúde e doença. Nos últimos anos, foi estabelecido o apoio à autogestão, com o objetivo de melhorar as habilidades das pessoas com este tipo de condições. É transcendental considerar como a disciplina de Enfermagem pode contribuir para isso. O objetivo deste ensaio é refletir sobre a teoria das transições de Meleis como paradigma de apoio à autogestão em pessoas com condições crônicas. Desenvolvimento: A teoria das transições de Meléis estabelece que as pessoas estão em constante mudança, como acontece no processo de transição saúde-doença. Receber o diagnóstico de uma doença crónica implica uma série de processos complexos para a pessoa, devido à multiplicidade de variáveis envolvidas. A teoria de Meléis fornece directrizes para orientar o profissional de enfermagem sobre elementos-chave e inter-relacionados, como a conceção prévia da natureza da transição e das suas condições, que servirão para o planeamento de modalidades de intervenção congruentes com as experiências da pessoa e a sua avaliação no decurso do processo saúde-doença. Conclusão: O paradigma oferecido por Meleis pode ser considerado uma abordagem chave para empreender o processo de cuidado de enfermagem que visa apoiar as pessoas com doenças crônicas no alcance do autogerenciamento.

Estudo busca novos tratamentos para a esquistossomose

Um estudo liderado pelo Instituto Oswaldo Cruz (IOC/Fiocruz) em parceria com instituições britânicas abre portas para o desenvolvimento de novos tratamentos para a esquistossomose.

Infografía diálogos de saberes

Los diálogos de saberes, también llamados diálogos interculturales, son procesos de comunicación e intercambio entre personas, grupos o comunidades que provienen de diferentes orígenes o culturas. En el caso del sector de la salud, los intercambios se realizan entre determinados grupos o personas y personal de salud capacitado. Su objetivo es, entre otros, mejorar el acceso a los servicios de salud y construir una salud intercultural, con énfasis en la resolución de problemas previamente planteados y sus causas, la comprensión mutua y la creación de vínculos sólidos. Esta infografía destaca los aspectos principales de los Diálogos de saberes

¿Cómo mejoramos la participación comunitaria en salud? Análisis de las acciones propuestas tras la aplicación de una herramienta de evaluación / How to improve community engagement in health: Analysis of proposed actions following the implementation of a community engagement assessment tool

Objetivo Analizar las líneas de acción propuestas por los proyectos de promoción de la salud participantes en el proyecto de investigación EvaluAGPS, y su relación con las puntuaciones obtenidas con EvalGuía, una herramienta para evaluar la participación comunitaria basada en la evidencia. Diseño Estudio multicéntrico cuali-cuantitativo. Emplazamiento Proyectos de atención primaria o de red intersectorial de atención primaria y municipalidades de 5 comunidades autónomas en España. Participantes Personas que trabajan en 10 proyectos de promoción de la salud, seleccionados con muestreo intencional según criterios de inclusión (proyectos con un mínimo de participación comunitaria centrados en la salud comunitaria). Método Se recogieron los datos mediante cuestionarios (herramienta EvalGuía) y talleres participativos. Los datos cuantitativos se analizaron con estadística descriptiva, los datos cualitativos se analizaron utilizando el análisis de matriz. Resultados Tras pasar la herramienta EvalGuía, las puntuaciones más bajas estaban en la evaluación de resultados, conocimiento de leyes relacionadas con participación comunitaria, diversidad en el grupo motor, medidas de conciliación, recursos financieros y devolución de resultados. Las líneas de acción planteadas eran heterogéneas y no siempre coinciden con las priorizadas. Las líneas priorizadas giraban en torno a la organización del proyecto y a la comunicación. Conclusiones La herramienta EvalGuía puede ser útil para diseñar planes de acción en proyectos de promoción de la salud. La implementación de medidas en 12 meses para aumentar la diversidad del grupo motor, incorporar medidas de conciliación o mejorar la evaluación es difícil. Se requiere más tiempo para implementar este tipo de medidas. (AU)

Objective To analyse the lines of action identified in the health promotion projects participating in the EvaluA GPS research, and their relationship with the scores assigned in EvalGuia, a tool for evaluating evidence-based community participation. Design Qualitative-quantitative multicentre study. Setting Primary care or intersectoral network of primary care and municipalities in five autonomous communities in Spain. Participants Participants of 10 health promotion projects, selected with convenience sampling, following inclusion criteria (projects with a minimum of community engagement and centred on community health). Method Data were collected through questionnaires (EvalGuía tool) and participatory workshops. Quantitative data were analysed with descriptive statistics, qualitative data were analysed using matrix analysis. Results After implementing the EvalGuide tool, the lowest scores were assigned in outcome evaluation, knowledge of policies related to community participation, diversity in the core working group, inclusivity policies, financial resources and diffusion of results. The lines of action proposed were heterogeneous and did not always match with those prioritised as lower score. The prioritised lines revolved around project organisation and communication. Conclusions The EvalGuide tool can be helpful to design action plans in Health Promotion projects. The implementation of measures in 12 months to increase the diversity of the core working group, to incorporate work–life balance measures or to improve evaluation is difficult. More time is needed to implement such measures. (AU)

Accelerating implementation of adolescent digital health prevention programs: analysis of insights from Australian stakeholders.

Background: Chronic disease risk factors are increasing amongst adolescents, globally. Digital health prevention programs, which provide education and information to reduce chronic disease risk factors need to be equitable and accessible for all. For their success, multiple highly engaged stakeholders should be involved in development and implementation. This study aimed to evaluate stakeholders' support for, and perspectives on potential public health impact of digital health prevention programs for adolescents and potential pathways for future implementation. Methods: Qualitative semi-structured online interviews with stakeholders. Stakeholder mapping identified key individuals, groups and organizations across Australia that may influence the implementation of digital health prevention programs for adolescents. Recorded and transcribed interviews were analyzed within the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework, using deductive content analysis. Findings: Nineteen interviews were conducted in 2023 with stakeholders from government, health, non-government organizations, youth services, education, community settings and others. Four overarching themes were identified: (i) existing digital health initiatives are not fit for purpose; (ii) the co-creation of digital health prevention programs is critical for successful implementation; (iii) digital health prevention programs must address equity and the unique challenges raised by technology and; (iv) system level factors must be addressed. Interpretation: Stakeholders broadly supported digital health prevention programs, yet raised unique insights to ensure that future programs create public health impact by improving chronic disease risk factors among adolescents. These insights can be applied in future development of digital health prevention programs for adolescents to strengthen widespread implementation.

Comparison of medical image interpretation time between conventional and automated methods of breast ultrasound.

Objective: To compare the medical image interpretation's time between the conventional and automated methods of breast ultrasound in patients with breast lesions. Secondarily, to evaluate the agreement between the two methods and interobservers. Methods: This is a cross-sectional study with prospective data collection. The agreement's degrees were established in relation to the breast lesions's ultrasound descriptors. To determine the accuracy of each method, a biopsy of suspicious lesions was performed, considering the histopathological result as the diagnostic gold standard. Results: We evaluated 27 women. Conventional ultrasound used an average medical time of 10.77 minutes (± 2.55) greater than the average of 7.38 minutes (± 2.06) for automated ultrasound (p<0.001). The degrees of agreement between the methods ranged from 0.75 to 0.95 for researcher 1 and from 0.71 to 0.98 for researcher 2. Among the researchers, the degrees of agreement were between 0.63 and 1 for automated ultrasound and between 0.68 and 1 for conventional ultrasound. The area of the ROC curve for the conventional method was 0.67 (p=0.003) for researcher 1 and 0.72 (p<0.001) for researcher 2. The area of the ROC curve for the automated method was 0. 69 (p=0.001) for researcher 1 and 0.78 (p<0.001) for researcher 2. Conclusion: We observed less time devoted by the physician to automated ultrasound compared to conventional ultrasound, maintaining accuracy. There was substantial or strong to perfect interobserver agreement and substantial or strong to almost perfect agreement between the methods.

Timing of semen cryopreservation: before or after processing?

Objective: Seminal cryopreservation causes significant damage to the sperm; therefore, different methods of cryopreservation have been studied. The aim of the study was to compare the effects of density gradient processing and washing/centrifugation with seminal plasma removal for cryopreservation in semen parameters. Methods: Seminal samples of 26 normozoospermic patients were divided into 3 parts: with seminal plasma; after washing/centrifugation; and after selection through density gradient. The samples were cryopreserved for at least two weeks. Motility, sperm count, morphology and viability were evaluated before cryopreservation and after thawing. Results: Density gradient processing selected motile and viable sperm with normal morphology in fresh samples (p<0.05). Cryopreservation negatively affected all sperm parameters regardless of the processing performed, and even if the sperm recovery was lower in the density gradient after the thawing, progressive motility, total motility, viability and morphology remained higher (p<0.05). Conclusion: Cryopreservation significantly compromises sperm parameters (motility, morphology, viability). In normozoospermic patients, the density gradients select better quality spermatozoa compared to other processing methods; this benefit was kept after thawing.

Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital.

Objective: To show the experience of a Latin American public hospital, with SNM in the management of either OAB, NOUR or FI, reporting feasibility, short to medium-term success rates, and complications. Methods: A retrospective cohort was conducted using data collected prospectively from patients with urogynecological conditions and referred from colorectal surgery and urology services between 2015 and 2022. Results: Advanced or basic trial phases were performed on 35 patients, 33 (94%) of which were successful and opted to move on Implantable Pulse Generator (GG) implantation. The average follow-up time after definitive implantation was 82 months (SD 59). Of the 33 patients undergoing, 27 (81%)reported an improvement of 50% or more in their symptoms at last follow-up. Moreover, 30 patients (90%) with a definitive implant reported subjective improvement, with an average PGI-I "much better" and 9 of them reporting to be "excellent" on PGI-I. Conclusion: SNM is a feasible and effective treatment for pelvic floor dysfunction. Its implementation requires highly trained groups and innovative leadership. At a nation-wide level, greater diffusion of this therapy among professionals is needed to achieve timely referral of patients who require it.

Outcomes of urethral meatal preservation ventral urethroplasty for female urethral stricture: a series of cases.

Objective: To present a series of cases with our initial experience and short-term outcomes of a modified vaginal mucosal flap urethroplasty. Methods: Patients diagnosed with urethral stricture and operated by the same operative technique between January 2012 and January 2018 were followed for at least 6 months. Uroflowmetry and clinical outcomes were evaluated. Results: Nineteen patients were included with an average age of 56.4 years, mean preoperative Qmax of 5.3 ml/s, and PVR of 101.4 mL. After 6 months of the procedure, the mean Qmax improved to 14.7 mL/s (p<0.05), PVR decreased to 47.3 mL (p<0.05), and 84.2% of all patients reported improvement in clinical self-reported symptoms. There was an improvement in symptoms such as voiding effort in 84.2% of patients, weak stream (89.5%), and recurrent urinary tract infection (85.7%). The success rate (absence of symptoms and normal Qmax with no significant PVR) of the procedure was 84.2%. Conclusion: The described technique was considered effective for the treatment of female urethra stricture, with a high clinical success rate and an objective improvement of Qmax and decrease in PVR after 6 months of the procedure.

Outcomes after elevation of serratus anterior fascia flap versus serratus muscle flap in direct-to-implant breast reconstruction following mastectomy: a prospective study.

Objective: The purpose of this study was to compare postoperative pain between SF flap and serratus anterior muscle (SM) in direct-to-implant breast reconstruction. Methods: This is a prospective cohort study that included 53 women diagnosed with breast cancer who underwent mastectomy and one-stage implant-based breast reconstruction from January 2020 to March 2021. Twenty-nine patients (54.7%) had SF elevation, and 24 patients (45.3%) underwent SM elevation. We evaluated patient-reported early postoperative pain on the first day after surgery. Also, it was reported that all surgical complications in the first month and patient reported outcomes (PROs) were measured with the BRECON 23 questionnaire. Results: The serratus fascia group used implants with larger volumes, 407.6 ± 98.9 cc (p < 0.01). There was no significant difference between the fascial and muscular groups regarding the postoperative pain score reported by the patients (2 versus 3; p = 0.30). Also, there was no difference between the groups regarding early surgical complications and PROs after breast reconstruction. Conclusion: The use of SF seems to cause less morbidity, which makes the technique an alternative to be considered in breast reconstruction. Although there was no statistical difference in postoperative pain scores between the fascia and serratus muscle groups.

Application and Prospects of Artificial Intelligence Technology in Early Screening of Chronic Obstructive Pulmonary Disease at Primary Healthcare Institutions in China.

Chronic Obstructive Pulmonary Disease (COPD), as one of the major global health threat diseases, particularly in China, presents a high prevalence and mortality rate. Early diagnosis is crucial for controlling disease progression and improving patient prognosis. However, due to the lack of significant early symptoms, the awareness and diagnosis rates of COPD remain low. Against this background, primary healthcare institutions play a key role in identifying high-risk groups and early diagnosis. With the development of Artificial Intelligence (AI) technology, its potential in enhancing the efficiency and accuracy of COPD screening is evident. This paper discusses the characteristics of high-risk groups for COPD, current screening methods, and the application of AI technology in various aspects of screening. It also highlights challenges in AI application, such as data privacy, algorithm accuracy, and interpretability. Suggestions for improvement, such as enhancing AI technology dissemination, improving data quality, promoting interdisciplinary cooperation, and strengthening policy and financial support, aim to further enhance the effectiveness and prospects of AI technology in COPD screening at primary healthcare institutions in China.

Causal Associations of DNA Methylation and Cardiovascular Disease: A Two-Sample Mendelian Randomization Study.

Background: There is growing evidence that concentrations of DNA methylation are associated with cardiovascular disease; however, it is unclear whether this association reflects a causal relationship. Methods: We utilized a two-sample Mendelian randomization (MR) approach to investigate whether DNA methylation can affect the risk of developing cardiovascular disease in human life. We primarily performed the inverse variance weighted (IVW) method to analyze the causal effect of DNA methylation on multiple cardiovascular diseases. Additionally, to ensure the robustness of our findings, we conducted several sensitivity analyses using alternative methodologies. These analysis methods included maximum likelihood, MR-Egger regression, weighted median method, and weighted model methods. Results: Inverse variance weighted estimates suggested that an SD increase in DNA methylation Hannum age acceleration exposure increased the risk of cardiac arrhythmias (OR = 1.03, 95% CI 1.00-1.05, p = 0.0290) and atrial fibrillation (OR = 1.03, 95% CI 1.00-1.05, p = 0.0022). We also found that an SD increase in DNA methylation PhenoAge acceleration exposure increased the risk of heart failure (OR = 1.01, 95% CI 1.00-1.03, p = 0.0362). Exposure to DNA methylation-estimated granulocyte proportions was found to increase the risk of hypertension (OR = 1.00, 95% CI 1.00-1.0001, p = 0.0291). Exposure to DNA methylation-estimated plasminogen activator inhibitor-1 levels was found to increase the risk of heart failure (OR = 1.00, 95% CI 1.00-1.00, p = 0.0215). Conclusion: This study reveals a causal relationship between DNA methylation and CVD. Exposed to high levels of DNA methylation Hannum age acceleration inhabitants with an increased risk of cardiac arrhythmias and atrial fibrillation. DNA methylation PhenoAge acceleration levels exposure levels were positively associated with the increased risk of developing heart failure. This has important implications for the prevention of cardiovascular diseases.

The Echocardiographic Diagnosis of Rheumatic Heart Disease: A Review of the Performance of the World Heart Federation Criteria 2012-2023.

Background: The World Heart Federation (WHF) published the first evidence-based guidelines on the echocardiographic diagnosis of rheumatic heart disease (RHD) in 2012. These guidelines have since been applied internationally in research and clinical practice. Substantial research has assessed the utility of the 2012 WHF criteria, including its applicability in low-resource settings. This article summarises the evidence regarding the performance of the guidelines. Methods: A scoping review assessing the performance of the guidelines was performed. Cochrane, Embase, Medline, PubMed Lilacs, Sielo, and Portal BVS databases were searched for studies on the performance of the guidelines between January 2012-March 2023, and 4047 manuscripts met the search criteria, of which 34 were included. This included papers assessing the specificity, inter-rater reliability, application using hand-carried ultrasound, and modification of the criteria for simplicity. The review followed the PRISMA Extension for Scoping Reviews guideline. Results: The WHF 2012 criteria were 100% specific for definite RHD when applied in low-prevalence populations. The criteria demonstrated substantial and moderate inter-rater reliability for detecting definite and borderline RHD, respectively. The inter-rater reliability for morphological features was lower than for valvular regurgitation. When applied to hand-carried ultrasound performed by an expert, modified versions of the criteria demonstrated a sensitivity and specificity range of 79-90% and 87-93% respectively for detecting any RHD, performing best for definite RHD. The sensitivity and the specificity were reduced when performed in task-sharing but remains moderately accurate. Conclusion: The WHF 2012 criteria provide clear guidance for the echocardiographic diagnosis of RHD that is reproducible and applicable to a range of echocardiographic technology. Furthermore, the criteria are highly specific and particularly accurate for detecting definite RHD. There are limitations in applying all aspects of the criteria in specific settings, including task-sharing. This summary of evidence can inform the updated version of the WHF guidelines to ensure improved applicability in all RHD endemic regions.