Hilab System Device in an Oncological Hospital: A New Clinical Approach for Point of Care CBC Test, Supported by the Internet of Things and Machine Learning.

The complete blood count (CBC) is a highly requested test that is generally restricted to centralized laboratories, which are limited by high cost, being maintenance-demanding, and requiring costly equipment. The Hilab System (HS) is a small, handheld hematological platform that uses microscopy and chromatography techniques, combined with machine learning (ML) and artificial intelligence (AI), to perform a CBC test. This platform uses ML and AI techniques to add higher accuracy and reliability to the results besides allowing for faster reporting. For clinical and flagging capability evaluation of the handheld device, the study analyzed 550 blood samples of patients from a reference institution for oncological diseases. The clinical analysis encompassed the data comparison between the Hilab System and a conventional hematological analyzer (Sysmex XE-2100) for all CBC analytes. The flagging capability study compared the microscopic findings from the Hilab System and the standard blood smear evaluation method. The study also assessed the sample collection source (venous or capillary) influences. The Pearson correlation, Student t-test, Bland-Altman, and Passing-Bablok plot of analytes were calculated and are shown. Data from both methodologies were similar (p > 0.05; r ≥ 0.9 for most parameters) for all CBC analytes and flagging parameters. Venous and capillary samples did not differ statistically (p > 0.05). The study indicates that the Hilab System provides humanized blood collection associated with fast and accurate data, essential features for patient wellbeing and quick physician decision making.

Hilab system, a new point-of-care hematology analyzer supported by the Internet of Things and Artificial Intelligence.

The complete blood count (CBC) is one of the most requested tests by physicians. CBC tests, most realized in conventional hematological analyzers, are restricted to centralized laboratories due to frequent maintenance, large devices, and expensive costs required. On the other hand, most handheld CBC devices commercially available show high prices and are not liable to calibration or control procedures, which results in poor quality compared to standard hematology instruments. The Hilab system is a small-handed hematological platform that uses microscopy and chromatography techniques for blood cells and hematimetric parameters analysis through artificial intelligence, machine learning, and deep learning techniques. For clinical evaluation of the handheld CBC device, 450 blood samples were analyzed. The samples encompassed normal (82%) and pathological conditions (18%), such as thalassemias (2.2%), anemias (6.6%), and infections (9.2%). For all analytes, accuracy, precision, method comparison, and flagging capabilities of the Hilab System, were compared with the Sysmex XE-2100 (Sysmex, Japan) results. The sample source (venous and capillary) influences were also evaluated. Pearson correlation, Student t test, bias, and the Bland-Altman plot of each blood count analyte were calculated and shown. The significance level was set at p ≤ 0.05. For clinical evaluation, Hilab System and the Sysmex XE-2100 showed a strong correlation (r ≥ 0.9) for most evaluated parameters. In the precision study, analytes showed CV inside the limits established according to European Federation of Clinical Chemistry and Laboratory Medicine guidelines. The flagging capabilities of the Hilab system, compared to the manual microscopy technique, presented high sensibility, specificity, and accuracy. Venous and capillary samples (p > 0.05) do not differ statistically. Considering the need for point-of-care CBCs, the study indicated that the Hilab system provides fast, accurate, low cost, and robust analysis for reliable clinical use.

Atendimento em dupla como modalidade de intervenção interdisciplinar na clínica com crianças pequenas / Dual care as a modality of interdisciplinary intervention in the clinic with young children / Atención en doble como modalidad de intervención interdisciplinaria en la clínica con niños pequeños

Introdução: Uma abordagem terapêutica na clínica com crianças pequenas, no âmbito da atuação interdisciplinar, permite pensar a intervenção de forma integral, assumindo uma intervenção centrada na família. Objetivo: Este estudo tem como objetivo discutir os benefícios e cuidados que os terapeutas precisam ter para a realização de atendimentos conjuntos, bem como manejar a participação dos pais em sessão. Método: Estudo de caso composto por duas meninas com idade de 3 anos e 6 meses e 4 anos e 9 meses atendidas por duplas de terapeutas em uma clínica escola. Realizada análise de cunho qualitativo por meio de observação em prontuário, relato de campo da experiência clínica, discussões após atendimento, supervisões e orientações. Resultados: Em ambos os casos apresentados, foi possível observar evoluções positivas, nos pacientes e na relação familiar, bem como identificar as cenas presentes durante o atendimento conjunto, que se apresentou como modalidade eficiente de intervenção a tempo. Conclusão: O atendimento conjunto mostrou-se efetivo, sendo um método facilitador na clínica, principalmente quando considerada a dupla criança-familiar, desde que haja uma boa sintonia entre ambos os terapeutas.

Introduction: A therapeutic approach, with an interdisciplinary approach, allows us to think about the intervention in an integral way, assumed in the intervention centered in the family. Objective: This study aims to discuss the benefits and care that therapists need to have to perform joint care, and how to handle parents' presence in session. Method: Case study composed of two girls aged 3 years and 6 months and 4 years and 9 months attended by doubles of therapists in a school clinic. Qualitative analysis was carried out by means of observation in medical records, field reports of clinical experience, discussions after care, supervisions and guidelines. Results: In both cases, it was possible to observe positive evolutions in patients and in the family relationship, as well as to identify the scenes present during the joint care, which presented as an efficient modality of intervention in time. Further studies on the subject are still needed as a way of continuing to test its efficiency. Conclusion: Joint care proved to be effective, being a facilitator method in the clinic, especially when considering the baby-parent pair, provided there is harmony between the therapists and evaluate when it is possible or not the parents' presence in the session.

Introduction:Une approche thérapeutique, avec une approche interdisciplinaire, nous permet de penser l'intervention de manière intégrale, assumée dans l'intervention centrée dans la famille. Objetivo: Este estudio tiene como objetivo discutir los beneficios y cuidados que los terapeutas necesitan tener para la realización de atendimientos conjuntos,y cómo manejar la presencia de los padres in sesión. Método: Estudio de caso compuesto por dos niñas con edad 3 años y 6 meses y 4 años y 9 meses atendidas por dobles de terapeutas en una clínica escolar. Se realizó un análisis de cuño cualitativo por medio de observación en prontuario, relato de campo de la experiencia clínica, discusiones tras atención, supervisión y orientaciones. Resultados: En ambos casos presentados, fue posible observar evoluciones positivas, en los pacientes y en la relación familiar, así como identificar las escenas presentes durante la atención conjunta, que se presentó como modalidad eficiente de intervención a tiempo. Aún se necesitan más estudios sobre el tema, como forma de continuar probando su eficiencia. Conclusión: La atención conjunta se mostró efectiva, siendo un método facilitador en la clínica principalmente cuando se considera la doble bebé-familiar, desde que haya sintonía entre los terapeutas y evaluar cuando es posible o no la presencia de los padres en la sesión.

A revelação de puérperas na assistência pré-natal em estratégias de saúde da família / Revelation of puerperal females in pre-natal assistance in family health strategies

O objetivo deste estudo foi averiguar junto às puérperas da maternidade de um Hospital Universitário referência em alto risco de um município do Rio Grande do Sul, suas percepções sobre a qualidade da assistência pré-natal oferecida em Estratégias de Saúde da Família (ESF). Pesquisa de abordagem qualitativa, descritiva, utilizado um questionário semiestruturado com 16 puérperas. Para o tratamento dos dados foi utilizada a análise de conteúdo de Minayo. Emergiu por meio da análise das falas das puérperas quatro categorias. Os resultados inerentes às análises, evidenciou-se que existem diferentes olhares na assistência pré-natal e são necessárias ações conjuntas em saúde pública que favoreçam a assistência de qualidade. Considerase imprescindível que haja ações profissionais acolhedoras, redes de serviços com comunicação efetiva entre os profissionais envolvidos na atenção à saúde pública e mudança na cultura da sociedade com relação ao modelo biomédico centralizado.

Current analysis studies the perception of puerperal females on the quality of pre-natal assistance by the Family Health Strategies (FHS) in a University Hospital, reference for high-risk pregnancy, in a municipality in the state of Rio Grande do Sul, Brazil. Qualitative and descriptive research comprised a half-structured questionnaire with 16 puerperal women. Minayo´s content analysis was employed for the treatment of data. Four categories emerged after analyzing the women´s discourse. Results showed several points of view in pre-natal assistance and several activities in public health should be employed that would favor assistance with quality. It is highly important that welcoming professional activities should be endeavored, coupled to effective communication between professionals involved in public health care and changes in society´s culture with regard to the centralized biomedical model.

Operationalizing and Examining Family Planning Vigilance in Adult Women With Type 1 Diabetes.

OBJECTIVE: Because unplanned pregnancies could cause maternal-fetal complications for women with diabetes, family planning vigilance (FPV) is imperative. The aims of this article are to operationalize and describe FPV and examine the associations among FPV behaviors and diabetes self-care management (DSM) and health outcomes of women with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: Retrospective data were used from a follow-up study of adult women with T1D who participated as adolescents in a preconception counseling (PC) intervention trial and matched comparison women with T1D who did not receive the adolescent PC intervention. Participants completed online questionnaires regarding family planning behaviors, DSM, and clinical and reproductive health outcomes. RESULTS: Participants (N = 102) were, on average, 23.7 years old (range 18-38) and 98.0% were white, 82.2% had some college, 25.8% were married, and 11.8% had biological children. Of those sexually active (n = 80, 78.4%), 50% were contraceptive vigilant and 11% were FPV (i.e., being contraceptive vigilant, receiving PC, and initiating discussions with health care professionals). Among FPV behaviors, only receiving PC and initiating discussion with health care professionals were correlated (r = 0.29, P = 0.010). Compared with nonvigilant women, contraceptive vigilant and FPV women used more effective contraceptive methods (P = 0.025) and experienced less diabetic ketoacidosis (P = 0.040) and hospitalizations (P = 0.064), whereas FPV women were aware of PC (P = 0.046) and younger when they received PC (P < 0.001). FPV components were associated with DSM and health outcomes (P < 0.05). CONCLUSIONS: Women with diabetes should be FPV, but few were. FPV women were more likely to have PC earlier and better health outcomes, supporting early PC intervention.

Mother-daughter dyadic approach for starting preconception counseling at puberty in girls with diabetes.

BACKGROUND: Preconception counseling (PC) significantly and inexpensively reduces risks of reproductive-health complications for women with diabetes. Our validated technology-based preconception counseling intervention, READY-Girls, is tailored for female teens with type 1 (T1D) and type 2 (T2D) diabetes and targets decision-making regarding effective family planning and seeking PC. Our teen-focused research was instrumental in changing the American Diabetes Association's Practice Recommendations to specify that preconception counseling should "Start at puberty…". This directive requires support from well-informed mothers of teens. Our goal is to provide both teen girls and their mothers with preconception counseling knowledge, and provide mothers with sex-communication training. Evaluation should focus on mother-daughter dyads. PURPOSE: This feasibility study explored mother's and daughter's awareness and knowledge of diabetes and pregnancy, and preconception counseling; and compared mother-daughter responses using dyadic analyses. METHODS: A mixed-method design was conducted with 10 mothers of daughters with T1D. Mothers were given READY-Girls intervention and completed knowledge and support questionnaires. Their responses were compared to those of their daughter's who were participating in a large randomized, control intervention trial with READY-Girls. RESULTS: The major theme from one-on-one interviews was, "I know nothing about diabetes/pregnancy risks and PC". Mother's and daughter's perceptions of having limited knowledge were confirmed by low knowledge scores. Mothers perceived giving higher levels of support compared to their daughter's perceptions of receiving support. CONCLUSION: Mothers can play a vital role in initiating discussions regarding reproductive-health with their daughters and reinforcing preconception counseling. Mother-daughter team approach for starting preconception counseling at puberty in girls with diabetes is feasible. Mother-daughter dyadic analyses can be important to explore possible mediating and moderating roles of mother-daughter communication and support about reproductive health on the relationship between READY-Girls intervention and sustainable outcomes.

Long-term effects of the booster-enhanced READY-Girls preconception counseling program on intentions and behaviors for family planning in teens with diabetes.

OBJECTIVE: To examine 12-month effects of a booster-enhanced preconception counseling (PC) program (READY-Girls) on family planning for teen girls with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS: Participants 13-19 years of age (n = 109) were randomized to a standard care control group (CG) or intervention group (IG) that received PC over three consecutive clinic visits. Prepost data were collected at baseline, 3- and 6-month booster sessions, and a 12-month follow-up visit. RESULTS: Mean age was 15.8 years; 9 (8%) subjects had type 2 diabetes; and 18 (17%) subjects were African American. At baseline, 20% (n = 22 of 109) had been sexually active, and of these, 50% (n = 11) had at least one episode of unprotected sex. Over time, IG participants retained greater PC knowledge (F[6, 541] = 4.05, P = 0.0005) and stronger intentions regarding PC (significant group-by-time effects) especially after boosters. IG participants had greater intentions to discuss PC (F[6, 82.4] = 2.56, P = 0.0254) and BC (F[6, 534] = 3.40, P = 0.0027) with health care providers (HCPs) and seek PC when planning a pregnancy (F[6, 534] = 2.58, P = 0.0180). Although not significant, IG participants, compared with CG, showed a consistent trend toward lower rates of overall sexual activity over time: less sexual debut (35 vs. 41%) and higher rates of abstinence (44 vs. 32%). No pregnancies were reported in either group throughout the study. CONCLUSIONS: READY-Girls appeared to have long-term sustaining effects on PC knowledge, beliefs, and intentions to initiate discussion with HCPs that could improve reproductive health behaviors and outcomes. Strong boosters and providing PC at each clinic visit could play important roles in sustaining long-term effects.

Critérios adotados para a escolha da escova dental: estudo com consumidores de Florianópolis, Santa Catarina (Brasil) / Criteria adopted for the toothbrush choice: a study among consumers in Florianópolis, Santa Catarina (Brazil)

Introdução e objetivo: Buscou-se conhecer os critérios adotadospor sujeitos adultos para a aquisição da escova dental e identificar ainfluência do cirurgião-dentista nessa escolha. Material e métodos:Trata-se de um estudo descritivo, transversal, feito por intermédio dolevantamento de dados primários. A população-alvo foi formada porconsumidores de um supermercado da região central de Florianópolis(SC, Brasil). Para o cálculo da amostra considerou-se uma população infinita e erro de 5%. A seleção dos sujeitos aconteceu de modoacidental. O critério de inclusão foi idade igual ou superior a 18 anos.Foi aplicado um questionário, estruturado em duas partes, comquestões fechadas e abertas. A análise estatística descritiva ocorreupor meio da distribuição de frequência relativa. Resultados: Ao todoparticiparam da pesquisa 409 sujeitos (54,65% homens) com idadede 19 a 72 anos, e a maioria era da faixa etária de 41 a 51 anos. Pelomenos uma vez ao ano 41,1% realizam consulta odontológica e 52%afirmaram trocar sua escova a cada três ou quatro meses, em funçãodo desgaste das cerdas. Um baixo percentual (25,6% homens, 25,5%mulheres) recebeu orientação do cirurgião-dentista sobre a escovadental. O critério mais adotado para a aquisição da escova é o preço(43,6%), e a participação do dentista foi citada por 10,5%, a qual foimais evidenciada por sujeitos de classe socioeconômica mais elevada.Conclusão: Para o grupo pesquisado, o critério mais adotado paraaquisição de escovas dentais é o preço, e a influência do cirurgiãodentistanesse procedimento é reduzida.

Introduction and objective: To identify the criteria adopted by adultconsumers when buying a toothbrush and to determine whetherdentists influence on this choice. Material and methods: It was atransversal descriptive study through primary data collection. Thetarget population consisted of consumers in a supermarket in thedowntown of Florianópolis (SC, Brazil). An infinite population and anerror of 5% were considered to the sample calculation. The selectionof people was random. The inclusion criterion was being above 18years old. A questionnaire structured in two parts with closed andopen questions was applied. Data was submitted to statistical analysisthrough distribution of relative frequency. Results: Altogether, 409people (54.65% male) participated in the survey, aged from 19 to 72years, and the majority (28%) aged between 41 and 51 years. 41.1% visitthe dentist at least once a year, and 52% change their toothbrushes everythree months due to the wear of the bristles. A low percentage of people(25.6% male and 25.5% female) received orientation of the dentist onthe toothbrush. The most adopted criterion for the acquisition of thetoothbrush was the price (43.6%), and the participation of the dentistwas cited by 10.5%, being more common for people of the highersocioeconomic class. Conclusion: For this group, price is the mostadopted criterion for the acquisition of toothbrushes, and the influenceof the dentist on this procedure is reduced.

A self-instructional program for diabetes educators on preconception counseling for women with diabetes.

PURPOSE: The purpose of this study was to develop, implement, and evaluate the effectiveness of a self-instructional preconception counseling (PC) training program for Certified Diabetes Educators (CDEs) to enhance PC knowledge and self-efficacy. METHODS: A 1-group, pre-post test study was conducted with 31 CDEs from a large medical center in western Pennsylvania. The self-instructional program included selected readings, such as the American Diabetes Association's position statement on PC of women with diabetes and an interactive CD-ROM, "Reproductive-Health Awareness for Teenage Women With Diabetes" ("READY-Girls"). Paper-and-pencil knowledge and self-efficacy questionnaires regarding PC and pregnancies of women with diabetes were completed by the CDEs before and immediately following the self-instructional program. Upon completion, participants received 5.0 Continuing Nursing Education contact hours (CNEs) from the State Nurses Association. RESULTS: Prior to receiving the program, all of the participants indicated they would benefit from further training on PC. Pretest knowledge scores averaged in the 70th percentile; following the program, the participants significantly increased (P < .01) PC knowledge and self-efficacy in providing PC to women with diabetes, including adolescents. CONCLUSIONS: Although CDEs knew relevant information, they lacked some specific knowledge about PC, and they lacked confidence in their knowledge and in their ability to counsel patients. Diabetes educators can benefit from an education program to provide PC to their female patients, including adolescents. Computer or Web-based accessibility could make this a low-cost and easily disseminated program.

In vivo comparison of two 5-HT1A receptors agonists alnespirone (S-20499) and buspirone on locus coeruleus neuronal activity.

The aim of the present study was to compare, in chloral-hydrate anaesthetized rats, the alpha(2)-adrenergic properties of the selective 5-HT(1A) receptor agonist, alnespirone (S-20499), with those of buspirone, a 5-HT(1A) receptor agonist exhibiting potent alpha(2)-adrenoceptor antagonist properties via its principal metabolite, 1-(2-pyrimidinyl)-piperazine. Both locus coeruleus spontaneous firing activity and noradrenaline release in the medial prefrontal cortex were potently inhibited by the alpha(2)-adrenoceptor agonist clonidine, at a dose of 40 microg/kg (i.p.). Such an inhibition was neither prevented nor reversed by alnespirone (10 mg/kg, i.p.), while buspirone, at the same dose, potently antagonized the locus coeruleus inhibitory effects of clonidine. These data demonstrate that, in contrast with some aryl-piperazine compounds (such as buspirone), alnespirone, either on its own or via a possible metabolite such as buspirone, is devoid in vivo of significant alpha(2)-adrenoceptor antagonist properties.