Propiedades psicométricas de la Escala de Bienestar Psicológico de Ryff en Argentina

Objetivo: probar la versión adaptada al español de la Escala de Bienestar Psicológico de Ryff en población argentina y analizar su consistencia interna y evidencias de validez basadas en la estructura interna y en la relación con otras variables. Método: se trabajó con dos grupos de participantes: uno de 3228 adultos argentinos (población general), con edades comprendidas entre los 20-83 años (M= 42.21; DE= 13.17). 81.9 % de género femenino. El otro grupo, de 153 estudiantes universitarios, edades entre 18-57 años (M= 26.71; DE =7.53), 85 % de género femenino. Resultados: A través de un análisis factorial confirmatorio pudo observarse un buen ajuste del modelo de Ryff, con cargas factoriales apropiadas. La confiabilidad se analizó mediante fiabilidad compuesta. Los resultados indicaron una buena confiabilidad para todas las dimensiones. Se analizaron las correlaciones con variables teóricamente relacionadas: ansiedad, depresión y personalidad. Se observaron correlaciones estadísticamente significativas en las variables bajo análisis, en el sentido esperado. Conclusión: esta versión del instrumento mostró un ajuste muy bueno, buena confiabilidad y asociaciones descriptas previamente de las dimensiones con variables de ansiedad, depresión y personalidad. Se considera que esta versión es adecuada para ser utilizada en población argentina como herramienta para el estudio del bienestar psicológico desde el enfoque eudaimónico, tanto en el ámbito de la investigación como la clínica.

Objetivo: Testar a versão adaptada ao espanhol da Escala De Bem-Estar Psicológico de Ryff em uma população argentina e analisar sua consistência interna e evidências de validade com base na estrutura interna e na relação com outras variáveis. Método: Foram estudados dois grupos de participantes: um de 3228 adultos argentinos (população geral) com idades entre 20 e 83 anos (M = 42,21; DP = 13,17), 81,9 % do gênero feminino; e outro grupo, de 153 estudantes universitários, com idades entre 18 e 57 anos (M = 26,71; DP = 7,53), 85 % do gênero feminino. Resultados: Por meio de uma análise fatorial confirmatória, pode-se observar um bom ajuste ao modelo de Ryff, com cargas fatoriais apropriadas. A confiabilidade foi avaliada por meio da confiabilidade composta. Os resultados indicaram uma boa confiabilidade para todas as dimensões. Foram analisadas correlações com variáveis teoricamente relacionadas, incluindo ansiedade, depressão e personalidade. Foram observadas correlações estatisticamente significativas nas variáveis analisadas, na direção esperada. Conclusão: Esta versão do instrumento demonstrou um ajuste muito bom, boa confiabilidade e associações previamente descritas das dimensões com variáveis de ansiedade, depressão e personalidade. Esta versão é considerada adequada para uso na população argentina como ferramenta para o estudo do bem-estar psicológico a partir de uma perspectiva eudemônica, tanto em pesquisas quanto em contextos clínicos.

Aim: To test the Spanish-adapted version of Ryff's Psychological Well-Being Scale in Argentine population and analyze its internal consistency, validity evidence based on internal structure, and its relationship with other variables. Method: Two groups of participants were studied: one consisting of 3228 Argentine adults (general population) aged 20-83 years (M = 42.21; SD = 13.17), 81.9 % female, and another group of 153 university students aged 18-57 years (M = 26.71; SD = 7.53), 85 % female. Results: A confirmatory factor analysis revealed a good fit for Ryff's model, with appropriate factor loadings. Reliability was assessed using composite reliability, with results indicating good reliability across all dimensions. Correlations were analyzed with theoretically related variables, including anxiety, depression, and personality, revealing statistically significant correlations in the expected direction. Conclusion: This version of the instrument demonstrated a very good fit, good reliability, and previously described associations of the dimensions with variables such as anxiety, depression, and personality. This version is considered suitable for use in the Argentine population as a tool for studying psychological well-being from a eudaimonic perspective, both in research and clinical settings.

Evidence-based practice in respiratory healthcare professionals in Latin America: a survey of the Latin American Thoracic Association (ALAT).

Background: Evidence-based practice (EBP) is a systematic approach to professional practice using the best available evidence to make informed clinical decisions in healthcare. It is necessary to measure and identify strengths and opportunities for improvement. Objective: To assess the knowledge and application of EBP in respiratory health professionals in Latin America. Methods: A cross-sectional study was conducted. The questionnaire was distributed online to health professionals in Latin American countries. Demographic data, professional characteristics, EBP training, and questionnaire responses were collected. Descriptive and inferential statistical analyses were performed. Results: A total of 448 respiratory health professionals participated in the study. Responses were obtained from 17 countries where the majority were female, with an average age of 42. Participants included physicians, physiotherapists, nurses, respiratory therapists, speech therapists, and occupational therapists. Overall scores indicated moderate to high levels of EBP knowledge and application. However, variations were observed in different dimensions. Factors such as EBP training, reading scientific articles, and professional characteristics were associated with higher scores. Barriers to implementing EBP were identified mostly related to institutional support. Conclusions: This study provides information on the knowledge and implementation of EBP in respiratory health professionals in Latin America. Although the overall levels of knowledge and application of EBP were moderate to high, there are options for improvement, especially in addressing barriers to implementation.

Introducción: La práctica basada en evidencia (PBE) es un enfoque sistemático para la práctica profesional que utiliza la mejor evidencia para tomar decisiones informadas. Es necesario identificar fortalezas y oportunidades de mejora. Objetivo: Evaluar el conocimiento y la aplicación de la EBP en profesionales de la salud respiratoria en Latinoamérica. Métodos: Se desarrolló un estudio transversal. El cuestionario se distribuyó en línea a profesionales de la salud en países latinoamericanos. Se recopilaron datos demográficos, características profesionales, capacitación en EBP y respuestas al cuestionario. Se realizaron análisis estadísticos descriptivos e inferenciales. Resultados: Un total de 448 profesionales de la salud respiratoria participaron en el estudio. Se obtuvieron respuestas de 17 países donde la mayoría eran mujeres, con una edad promedio de 42 años. Los participantes incluyeron médicos, fisioterapeutas, enfermeras, terapeutas respiratorios, fonoaudiólogos y terapeutas ocupacionales. Las puntuaciones generales indicaron niveles moderados a altos de conocimiento y aplicación de la EBP. Sin embargo, se observaron variaciones en diferentes dimensiones. Factores como la capacitación en EBP, la lectura de artículos científicos y las características profesionales se asociaron con puntuaciones más altas. Se identificaron barreras para implementar la EBP, principalmente relacionadas con el apoyo institucional. Conclusiones: Este estudio proporciona información sobre el conocimiento y la implementación de la EBP en profesionales de la salud respiratoria en América Latina. Aunque los niveles generales de conocimiento y aplicación de la EBP fueron moderados a altos, existen opciones de mejora, especialmente en abordar las barreras.

Medical Ozone as a Therapeutic Option in Musculoskeletal Pain Control: A Critical Review of Clinical Trials Considering Safety and Quality Indicators for Procedures and Devices.

Background: Drug therapies have been widely applied for pain management, however, there are important side effects such as those related to corticosteroids and opioids. Recent studies demonstrated promising results using medical ozone as a safe, effective, and low-cost intervention for pain control. Objective: to review and critically analyze clinical studies that used ozone therapy for musculoskeletal pain. Methods: a literature search of various databases was performed to identify relevant studies. From a total of 249 records, 27 studies were included. Quality indicators, human and device factors that strongly influence the generation of evidence were considered, such as study design and device safety. We also mitigated biases, considering the safety and efficacy of the intervention itself. Results: Regarding safety, 77 (8%) of studies reported no adverse effects; concerning efficacy outcomes, medical ozone shows to be an effective intervention on musculoskeletal pain control. Important information about used devices were missing. Conclusions: medical ozone shows to be safe and effective; qualification of health professionals as well as the device safety are mandatory. However, there is a lack of requirements to identify the best therapeutic scheme; further longer, clinical and rigorous trials are needed.

V Brazilian Consensus on Rhinitis - 2024.

Since we published the "IV Brazilian Consensus on Rhinitis", in2017, several advances have been achieved and have enabled a further understanding of the different aspects of "Rhinitis". This new guideline, developed jointly by ASBAI, SBP and SBORL, represents a relevant milestone in the updated and integrated management of the different forms of the disease, and it aims to unify evidence-based approaches to improve the diagnosis and treatment of this common and often underestimated condition. The document covers a wide range of topics, including clear definitions of the different phenotypes and endotypes of rhinitis, risk factors, updated diagnostic criteria, and recommended methods for clinical and laboratory investigation. We stress the importance of detailed clinical history and objective assessment, as well as tools for control and assessing severity tools an accurate diagnostic approach to the disease. Regarding treatment, it emphasizes the treatment customization, considering the severity of symptoms, the presence of comorbidities and the impact on the patient's quality of life. We discuss different drug treatment, in addition to non-pharmacological measures, such as environmental control and specific immunotherapy; and the possible role of immunobiological agents. Furthermore, the consensus addresses issues related to patient education, prevention and management of special situations, such as rhinitis in children, in pregnant women and in the elderly. In short, the "V Brazilian Consensus on Rhinitis" represents a comprehensive and updated guide for healthcare professionals involved in the diagnosis and management of rhinitis, aiming to improve patients' quality of life through an integrated and evidence-based approach.

Modified Fresno test to assess Physical therapists' use of evidence-based practice: measurement properties of the Brazilian-Portuguese short version: Modified Fresno test Brazilian-Portuguese short version.

BACKGROUND: The modified Fresno test is a questionnaire developed to evaluate Evidence-Based Practice among physical therapists. A previous study has indicated that a shorter version with 9 items would be more appropriate for Brazilian physical therapists. OBJECTIVES: To test the measurement properties of the modified Fresno test - Brazilian-Portuguese short version. METHODS: To analyze the reliability of the modified Fresno test - Brazilian-Portuguese short version by two raters (intra and inter-rater) in a sample of 133 physical therapists. The intraclass correlation coefficient (ICC2,1) and standard error of measurement (SEM) was used to assess the test-retest reliability. Internal consistency was tested using the Cronbach's alpha coefficient. An expert committee analyzed content validity using the content validity index (CVI). Confirmatory factor analysis (CFA) using the principal components method was used to assess construct validity. Responsiveness was estimated using effect size, and ceiling and floor effects were also investigated. RESULTS: Inter-rater and intra-rater reliability were, respectively: ICC= 0.93 (95 % CI 0.91, 0.95); rater 1 - ICC= 0.95 (95 % CI 0.94, 0.97); rater 2 - ICC= 0.98 (95 % CI 0.98, 0.99). The agreement was very good (values ≤ 5 %). Internal consistency was good for most instrument items (≥ 0.80). The CVI showed agreement among the expert committee members (0.96). The Cronbach's alpha coefficients calculated for the corrected item total showed values greater than 0.40. In the CFA, the "model 2" showed acceptable indices (≥ 0.90). Responsiveness was classified as very small. No ceiling and floor effects. CONCLUSION: The Fresno Modified Test - Brazilian-Portuguese short version has good to excellent reliability. CFA showed that the fit indices were adequate to be used in the population of interest.

Mapping Systematic Reviews on the Management of Dental Caries in Primary Teeth: A Meta-Research.

BACKGROUND: Systematic reviews (SRs) represent the most robust source of evidence for informing decision-making. While there are rigorous protocols for properly conducting SRs, sometimes the methodological biases in the primary studies are accounted for in the conclusions of the SRs. OBJECTIVE: This study aimed to map the evidence regarding the management of caries lesions in primary teeth. METHODS: Two reviewers conducted a systematic search up to March 2024 in electronic data-bases. Any SR concerning the management of caries lesions in primary teeth was considered eli-gible. RESULTS: About 162 SRs were included. Among these, 80 focused on restorative treatments, 64 on endodontic treatments, and 18 on non-invasive treatments. Only 42.6% presented a study registra-tion protocol. The majority (67.9%) performed a meta-analysis, while a minority exclusively car-ried out qualitative data analysis. Despite 92.6% of the SRs evaluating the methodological quality or risk of bias of the primary studies using some tool, only 24% assessed the certainty of evidence using the GRADE approach, resulting in classifications ranging from very low to moderate. CONCLUSION: There is a limited adherence to study registration protocols, indicating a need for improvements in this practice. Additionally, among the few SRs that used the GRADE approach, the majority demonstrated levels of very low to moderate certainty.

[Evidence for Health Promotion in Brazil: report on a rapid response serviceEvidencia para la promoción de la salud en Brasil: informe sobre un servicio de respuesta rápida]. / Evidências para a Promoção da Saúde no Brasil: relato de um serviço de resposta rápida.

Objective: Present the experience of a rapid response service to support decision-making in health systems. Methodology: Description of the processes and results of a service that produces rapid reviews and evidence maps to support decision-making under the National Health Promotion Policy, as well as the authors' perception of the work process. Results: The rapid response service started in 2020. By December 2023, 54 rapid reviews and five evidence maps had been produced, covering nine health promotion topics. These products were developed in 14 stages by a team made up of a coordinator, supervisors, proofreaders, and a librarian. The development of rapid responses involved a knowledge translation process, with continuous interactions between the requesting teams and production teams. Establishing effective communication was a critical factor in delivering products on time and in line with the needs of decision-makers and their supporters. Conclusion: Rapid response services can help improve the use of evidence for decision-making in health policies and health systems.

Objetivo: Presentación de la experiencia de un servicio de respuesta rápida para brindar apoyo a la toma de decisiones en materia de salud. Método: Se describen los procesos y resultados de un servicio de elaboración de revisiones rápidas y mapas de evidencia para brindar apoyo a la toma de decisiones en el marco de la Política Nacional de Promoción de la Salud, así como la percepción de los autores sobre el proceso de trabajo. Resultados: El servicio de respuesta rápida se inició en el 2020. Hasta diciembre del 2023, se habían elaborado 54 revisiones rápidas y cinco mapas de evidencia, que abarcaban nueve temas de promoción de la salud. Estos productos fueron elaborados en 14 etapas por un equipo formado por un coordinador, varios supervisores y revisores y un bibliotecario. La elaboración de respuestas rápidas fue un proceso de traducción del conocimiento e implicó una interacción continua entre los equipos solicitantes y el equipo de elaboración. El establecimiento de una comunicación eficaz fue un factor decisivo para entregar los productos a tiempo y en consonancia con las necesidades de los responsables de la toma de decisiones y su personal de apoyo. Conclusión: Los servicios de respuesta rápida pueden ayudar a mejorar el uso de evidencia en la toma de decisiones relacionadas con las políticas y los sistemas de salud.

Meta-Research in Geriatric Surgery: Improving the Quality of Surgical Evidence for Older Persons in a Multidimensional-Scale Research Field.

The world is facing a significant demographic transition, with a substantial increase in the proportion of older persons, as well as long-lived persons (especially nonagenarians and centenarians). One of the popular beliefs is that old age is synonymous with disease and disability. However, the successful aging hypothesis suggests that those older persons with advanced chronological age who maintain their functional capacity derive from it a delay in biological aging, enhancing the quality of organic aging and regulation. Therefore, regardless of chronological age, even in cases of extreme longevity, those older adults with a successful aging phenotype and favorable functional capacity would be expected to have satisfactory post-surgical recovery with a low risk of morbidity and mortality. Currently, there is a significant gap between the availability of high-certainty surgical evidence that allows for evidence-based interventions applicable to the long-lived population-taking into account the actual conditioning factors of the health phenotype in older persons-and, above all, predictors of satisfactory post-surgical evolution. The application of meta-research to geriatric surgery emerges as a fundamental tool to address this knowledge gap and reveals opportunities and limitations that need to be resolved in the near future to establish evidence-based surgical care for older persons. The aim of this manuscript was to present a real and globally relevant scenario related to surgical care, addressing the longevity, the availability, and the quality of surgical evidence applicable to this population, and also to present variables to consider in analysis and future perspectives in research and meta-research in geriatric surgery.

Is Artificial Intelligence (AI) currently able to provide evidence-based scientific responses on methods that can improve the outcomes of embryo transfers? No.

OBJECTIVE: The rapid development of Artificial Intelligence (AI) has raised questions about its potential uses in different sectors of everyday life. Specifically in medicine, the question arose whether chatbots could be used as tools for clinical decision-making or patients' and physicians' education. To answer this question in the context of fertility, we conducted a test to determine whether current AI platforms can provide evidence-based responses regarding methods that can improve the outcomes of embryo transfers. METHODS: We asked nine popular chatbots to write a 300-word scientific essay, outlining scientific methods that improve embryo transfer outcomes. We then gathered the responses and extracted the methods suggested by each chatbot. RESULTS: Out of a total of 43 recommendations, which could be grouped into 19 similar categories, only 3/19 (15.8%) were evidence-based practices, those being "ultrasound-guided embryo transfer" in 7/9 (77.8%) chatbots, "single embryo transfer" in 4/9 (44.4%) and "use of a soft catheter" in 2/9 (22.2%), whereas some controversial responses like "preimplantation genetic testing" appeared frequently (6/9 chatbots; 66.7%), along with other debatable recommendations like "endometrial receptivity assay", "assisted hatching" and "time-lapse incubator". CONCLUSIONS: Our results suggest that AI is not yet in a position to give evidence-based recommendations in the field of fertility, particularly concerning embryo transfer, since the vast majority of responses consisted of scientifically unsupported recommendations. As such, both patients and physicians should be wary of guiding care based on chatbot recommendations in infertility. Chatbot results might improve with time especially if trained from validated medical databases; however, this will have to be scientifically checked.

High-frequency chest wall oscillation devices: An umbrella review and bibliometric analysis.

INTRODUCTION: High-frequency chest wall oscillation (HFCWO) devices are used to improve airway clearance in various respiratory conditions. This study comprehensively assesses the evidence on efficacy and safety and identifies trends in scientific publications and patents across geographic regions. METHODS: This study utilized an integrated approach, combining bibliographic and bibliometric research with artificial intelligence (AI) tools. Four databases - PubMed, Europe Pubmed Central, Cochrane Database of Systematic Reviews, and CINAHL - were searched for systematic reviews on the effectiveness of treatment options for HFCWO. The AMSTAR-2 tool was used to evaluate the risk of bias in systematic reviews. Bibliographic research synthesized the evidence following PRISMA and Cochrane guidelines. The Dimensions platform was used for bibliometric analysis to provide insights into the global landscape. AI tools with prompt engineering tools Chain-of-Thoughts (CoT) and Tree of Thoughts (ToT) were used to enhance data extraction capabilities. RESULTS: The umbrella review identified 12 systematic reviews supporting the effectiveness of HFCWO in improving pulmonary function parameters, sputum characteristics, dyspnea, health scores, and quality of life in conditions including cystic fibrosis, bronchiectasis, chronic obstructive pulmonary disease (COPD), or neuromuscular diseases, with varying evidence of certainty. Eight of the twelve reviews had a moderate to high AMSTAR-2 confidence level, while several studies lacked sufficient descriptions of methods, treatment regimens, outcome measures, and adverse effects. Despite the absence of adverse events, the overall evidence quality between studies is evaluated as low to very low. Bibliometric analysis found a significant increase in global interest over the past two decades, with 230 research publications, 137 patents, and 56 clinical trials. CONCLUSIONS: The study highlights the potential of HFCWO devices in respiratory care but demands more robust evidence. The increasing interest in airway clearance devices highlights the necessity for HFCWO mechanism and safety research, underlining its therapeutic relevance in respiratory medicine. The interdisciplinary integration of AI tools and prompt engineering contributes to a nuanced understanding of the available evidence.

Supporting evidence-based judicial decisions on health care in Brazil: an experience report / Apoio técnico-científico à tomada de decisão judicial em saúde no Brasil: um relato de experiência / Apoyo técnico-científico a la toma de decisiones judiciales en salud en Brasil: un relato de experiencia

Objective: The main objective of this study is to report on the implementation and results of the "Supporting Health-Related Judicial Decisions in Brazil" project conducted at the Health Technology Assessment Center, Hospital Sírio-Libanês through the "Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde", in Brazil. Methods: This study is an experience report of a project conducted at the Health Technology Assessment Center, Hospital Sírio-Libanês. Results: The activities of the project occurred in 2023 and included two online training courses on primary studies and systematic reviews, 11 one-day workshops with technical-scientific content for members of the Technical Support Centers for the Judiciary (NATJus), 40 online technical-scientific consultations for magistrates on a digital platform, 11 technical-scientific reports addressing the most legally claimed technologies in Brazil; two methodological tools, a national forum (hybrid event), 10 chat-based mentorships for NATJus members; and the maintenance of an open-access blog, by publishing news on relevant topics on law and health. Discussion and conclusion: This project has contributed to the improvement of the judicial decision-making process by providing a range of activities aimed at aiding the prioritization of health technologies that are clearly effective and safe over those that are ineffective, harmful, or have uncertain effects.

Objetivo: O objetivo principal deste estudo é relatar a implementação e os resultados do projeto "Apoio técnico-científico à tomada de decisão judicial em Saúde no Brasil" realizado no Hospital Sírio-Libanês por meio do "Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde". Métodos: Este estudo é um relato de experiência de um projeto realizado no Núcleo de Avaliação de Tecnologias em Saúde do Hospital Sírio-Libanês. Resultados: As atividades do projeto ocorreram em 2023 e incluíram dois cursos de formação online sobre estudos primários e revisões sistemáticas, 11 oficinas de um dia com conteúdo técnico-científico para membros dos Núcleos de Apoio Técnico ao Judiciário (NATJus), 40 consultas on-line técnico-científicas para magistrados em plataforma digital, 11 relatórios técnico-científicos abordando as tecnologias mais reivindicadas judicialmente no Brasil; duas ferramentas metodológicas, um fórum nacional (evento híbrido), 10 mentorias via chat para membros do NATJus; e a manutenção de um blog de acesso aberto, com publicação de notícias sobre temas relevantes de direito e saúde. Discussão e conclusão: Este projeto contribuiu para a melhoria do processo de tomada de decisão judicial, fornecendo uma série de atividades destinadas a ajudar na priorização de tecnologias de saúde que sejam claramente eficazes e seguras em detrimento daquelas que são ineficazes, prejudiciais ou têm efeitos incertos.

Objetivo: El objetivo principal de este estudio es informar sobre la implementación y los resultados del proyecto "Apoyo a las Decisiones Judiciales Relacionadas con la Salud en Brasil" realizado en el Centro de Tecnología en Salud del Hospital Sírio-Libanês a través del "Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde", en Brasil. Métodos: Este estudio es un informe de experiencia de un proyecto realizado en el Centro de Tecnología en Salud del Hospital Sírio-Libanês. Resultados: Las actividades del proyecto ocurrieron en 2023 e incluyeron dos cursos de capacitación en línea sobre estudios primarios y revisiones sistemáticas, 11 talleres de un día de contenido técnico-científico para miembros de los Centros de Apoyo Técnico al Poder Judicial (NATJus), 40 consultas técnico-científicas en línea para magistrados en plataforma digital, 11 informes técnico-científicos que abordan las tecnologías más reclamadas legalmente en Brasil; dos herramientas metodológicas, un foro nacional (evento híbrido), 10 mentorías basadas en chat para miembros de NATJus; y el mantenimiento de un blog de acceso abierto, mediante la publicación de noticias sobre temas relevantes en derecho y salud. Discusión y conclusión: Este proyecto ha contribuido a mejorar el proceso de toma de decisiones judiciales proporcionando actividades para priorizar las tecnologías sanitarias claramente eficaces y seguras frente a aquellas que son ineficaces, nocivas o de efectos inciertos.

What do Brazilian paediatric dentists know about bruxism in children? Cross-sectional study.

PURPOSE: Little is known about the knowledge of paediatric dentists on bruxism in children. The aim of this cross-sectional study was to assess the knowledge of paediatric dentists on the concept, associated factors of bruxism and management of sleep bruxism (SB) in children'. METHODS: An electronic questionnaire was sent to paediatric dentists in the state of Goiás, Brazil. Information was collected on (1) characteristics of the participants; (2) the concept of bruxism; (3) diagnosis; (4) associated factors; (5) strategies for the management of SB; and (6) updated knowledge on bruxism in children. The data were analysed descriptively. RESULTS: Fifty-seven paediatric dentists participated (10.7% of the total number of professionals). A high level of agreement was found with statements on the concepts of SB (94.7%) and awake bruxism (96.5%). The main strategy for the diagnosis was the combination of a parental report and a clinical examination (79.0%). Most participants indicated that bruxism is associated with anxiety/stress (96.5%), screen use (93%), airway obstruction (91.2%), and sleep apnoea (91.2%). In suspected cases of bruxism, the dentists would send the child for assessment by other health care providers (87.7%). The management options frequently indicated were the use of an occlusal splint, aromatherapy, and homeopathy. More than 70% of them considered themselves to be updated on the issue and sought information through scientific articles and discussions with colleagues. CONCLUSION: Paediatric dentists have knowledge on the concept of bruxism and associated factors. However, further information is needed on the management of this condition in children.

Characterization of an At-Risk Population for Nonalcoholic Fatty Liver Disease (NAFLD) in a Primary Care Setting Along the U.S.-Mexico Border.

INTRODUCTION: This study aimed to determine the burden of suspected nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) in a predominantly Hispanic patient population and explore the utility of the American Gastroenterological Association's NAFLD Clinical Care Pathway (CCP). METHODOLOGY: Electronic medical records (n = 223) were used to divide patients into risk groups based on the amount of metabolic risk factors they presented, diabetic status, or if they presented other liver diseases. Fribosis-4 (FIB-4) scores were used to determine the risk for advanced fibrosis. RESULTS: Most patients (83.8%) were considered at risk for NAFLD based on CCP criteria, and about a third of patients (33.2%) were found to be at indeterminate (n = 60; 26.9%) or high risk (n = 14; 6.3%) for advanced fibrosis. Most indeterminate-risk patients (78.3%) were not referred for liver imaging. DISCUSSION: This study demonstrates the potential of the CCP as a corrective tool that could help to better identify and screen patients at risk for NAFLD.

Research evidence communication for policy-makers: a rapid scoping review on frameworks, guidance and tools, and barriers and facilitators.

BACKGROUND: Communication is a multifaceted process, ranging from linear, one-way approaches, such as transmitting a simple message, to continuous exchanges and feedback loops among stakeholders. In particular the COVID-19 pandemic underscored the critical need for timely, effective and credible evidence communication to increase awareness, levels of trust, and evidence uptake in policy and practice. However, whether to improve policy responses in crises or address more commonplace societal challenges, comprehensive guidance on evidence communication to decision-makers in health policies and systems remains limited. Our objective was to identify and systematize the global evidence on frameworks, guidance and tools supporting effective communication of research evidence to facilitate knowledge translation and evidence-informed policy-making processes, while also addressing barriers and facilitators. METHODS: We conducted a rapid scoping review following the Joanna Briggs Manual. Literature searches were performed across eight indexed databases and two sources of grey literature, without language or time restrictions. The methodological quality of included studies was assessed, and a narrative-interpretative synthesis was applied to present the findings. RESULTS: We identified 16 documents presenting either complete frameworks or framework components, including guidance and tools, aimed at supporting evidence communication for policy development. These frameworks outlined strategies, theoretical models, barriers and facilitators, as well as insights into policy-makers' perspectives, communication needs, and preferences. Three primary evidence communication strategies, comprising eleven sub-strategies, emerged: "Health information packaging", "Targeting and tailoring messages to the audience", and "Combined communication strategies". Based on the documented barriers and facilitators at micro, meso and macro levels, critical factors for successful communication of evidence to policy-makers were identified. CONCLUSIONS: Effective communication is indispensable for facilitating knowledge translation and evidence-informed policy-making. Nonetheless gaps persist in frameworks designed to enhance research communication to policy-makers, particularly regarding the effectiveness of multiple communication strategies. To advance in this field, the development of comprehensive frameworks incorporating implementation strategies is warranted. Additionally, barriers and facilitators to implementing effective communication must be recognized and addressed taking diverse contexts into consideration. Registration https://zenodo.org/record/5578550.

Models and frameworks for assessing the implementation of clinical practice guidelines: a systematic review.

BACKGROUND: The implementation of clinical practice guidelines (CPGs) is a cyclical process in which the evaluation stage can facilitate continuous improvement. Implementation science has utilized theoretical approaches, such as models and frameworks, to understand and address this process. This article aims to provide a comprehensive overview of the models and frameworks used to assess the implementation of CPGs. METHODS: A systematic review was conducted following the Cochrane methodology, with adaptations to the "selection process" due to the unique nature of this review. The findings were reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Electronic databases were searched from their inception until May 15, 2023. A predetermined strategy and manual searches were conducted to identify relevant documents from health institutions worldwide. Eligible studies presented models and frameworks for assessing the implementation of CPGs. Information on the characteristics of the documents, the context in which the models were used (specific objectives, level of use, type of health service, target group), and the characteristics of each model or framework (name, domain evaluated, and model limitations) were extracted. The domains of the models were analyzed according to the key constructs: strategies, context, outcomes, fidelity, adaptation, sustainability, process, and intervention. A subgroup analysis was performed grouping models and frameworks according to their levels of use (clinical, organizational, and policy) and type of health service (community, ambulatorial, hospital, institutional). The JBI's critical appraisal tools were utilized by two independent researchers to assess the trustworthiness, relevance, and results of the included studies. RESULTS: Database searches yielded 14,395 studies, of which 80 full texts were reviewed. Eight studies were included in the data analysis and four methodological guidelines were additionally included from the manual search. The risk of bias in the studies was considered non-critical for the results of this systematic review. A total of ten models/frameworks for assessing the implementation of CPGs were found. The level of use was mainly policy, the most common type of health service was institutional, and the major target group was professionals directly involved in clinical practice. The evaluated domains differed between the models and there were also differences in their conceptualization. All the models addressed the domain "Context", especially at the micro level (8/12), followed by the multilevel (7/12). The domains "Outcome" (9/12), "Intervention" (8/12), "Strategies" (7/12), and "Process" (5/12) were frequently addressed, while "Sustainability" was found only in one study, and "Fidelity/Adaptation" was not observed. CONCLUSIONS: The use of models and frameworks for assessing the implementation of CPGs is still incipient. This systematic review may help stakeholders choose or adapt the most appropriate model or framework to assess CPGs implementation based on their specific health context. TRIAL REGISTRATION: PROSPERO (International Prospective Register of Systematic Reviews) registration number: CRD42022335884. Registered on June 7, 2022.

Development of Automated Triggers in Ambulatory Settings in Brazil: Protocol for a Machine Learning-Based Design Thinking Study.

BACKGROUND: The use of technologies has had a significant impact on patient safety and the quality of care and has increased globally. In the literature, it has been reported that people die annually due to adverse events (AEs), and various methods exist for investigating and measuring AEs. However, some methods have a limited scope, data extraction, and the need for data standardization. In Brazil, there are few studies on the application of trigger tools, and this study is the first to create automated triggers in ambulatory care. OBJECTIVE: This study aims to develop a machine learning (ML)-based automated trigger for outpatient health care settings in Brazil. METHODS: A mixed methods research will be conducted within a design thinking framework and the principles will be applied in creating the automated triggers, following the stages of (1) empathize and define the problem, involving observations and inquiries to comprehend both the user and the challenge at hand; (2) ideation, where various solutions to the problem are generated; (3) prototyping, involving the construction of a minimal representation of the best solutions; (4) testing, where user feedback is obtained to refine the solution; and (5) implementation, where the refined solution is tested, changes are assessed, and scaling is considered. Furthermore, ML methods will be adopted to develop automated triggers, tailored to the local context in collaboration with an expert in the field. RESULTS: This protocol describes a research study in its preliminary stages, prior to any data gathering and analysis. The study was approved by the members of the organizations within the institution in January 2024 and by the ethics board of the University of São Paulo and the institution where the study will take place. in May 2024. As of June 2024, stage 1 commenced with data gathering for qualitative research. A separate paper focused on explaining the method of ML will be considered after the outcomes of stages 1 and 2 in this study. CONCLUSIONS: After the development of automated triggers in the outpatient setting, it will be possible to prevent and identify potential risks of AEs more promptly, providing valuable information. This technological innovation not only promotes advances in clinical practice but also contributes to the dissemination of techniques and knowledge related to patient safety. Additionally, health care professionals can adopt evidence-based preventive measures, reducing costs associated with AEs and hospital readmissions, enhancing productivity in outpatient care, and contributing to the safety, quality, and effectiveness of care provided. Additionally, in the future, if the outcome is successful, there is the potential to apply it in all units, as planned by the institutional organization. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55466.

Domains and Methods of Medical Device Technology Evaluation: A Systematic Review.

Objectives: Identify, through a systematic review, the main domains and methods to support health technology assessment of Medical Devices (MD) from the perspective of technological incorporation into healthcare systems. Methods: Performed structured searches in MEDLINE, Embase, BVS, Cochrane Library, and Web of Science for full studies published between 2017 and May 2023. Selection, extraction, and quality assessment were performed by two blinded reviewers, and discrepancies were resolved by a third reviewer. Results: A total of 5,790 studies were retrieved, of which 41 were included. We grouped the identified criteria into eight domains for the evaluations. Conclusion: Overall, studies discuss the need to establish specific methods for conducting HTA in MD. Due to the wide diversity of MD types, a single methodological guideline may not encompass all the specificities and intrinsic characteristics of the plurality of MD. Studies suggest using clustering criteria through technological characterization as a strategy to make the process as standardized as possible.

Closing the gap: prognostic and predictive biomarker validation for personalized care in a Latin American hormone-dependent breast cancer cohort.

BACKGROUND: Several guidelines recommend the use of different classifiers to determine the risk of recurrence (ROR) and treatment decisions in patients with HR+HER2- breast cancer. However, data are still lacking for their usefulness in Latin American (LA) patients. Our aim was to evaluate the comparative prognostic and predictive performance of different ROR classifiers in a real-world LA cohort. METHODS: The Molecular Profile of Breast Cancer Study (MPBCS) is an LA case-cohort study with 5-year follow-up. Stages I and II, clinically node-negative HR+HER2- patients (n = 340) who received adjuvant hormone therapy and/or chemotherapy, were analyzed. Time-dependent receiver-operator characteristic-area under the curve, univariate and multivariate Cox proportional hazards regression (CPHR) models were used to compare the prognostic performance of several risk biomarkers. Multivariate CPHR with interaction models tested the predictive ability of selected risk classifiers. RESULTS: Within this cohort, transcriptomic-based classifiers such as the recurrence score (RS), EndoPredict (EP risk and EPClin), and PAM50-risk of recurrence scores (ROR-S and ROR-PC) presented better prognostic performances for node-negative patients (univariate C-index 0.61-0.68, adjusted C-index 0.77-0.80, adjusted hazard ratios [HR] between high and low risk: 4.06-9.97) than the traditional classifiers Ki67 and Nottingham Prognostic Index (univariate C-index 0.53-0.59, adjusted C-index 0.72-0.75, and adjusted HR 1.85-2.54). RS (and to some extent, EndoPredict) also showed predictive capacity for chemotherapy benefit in node-negative patients (interaction P = .0200 and .0510, respectively). CONCLUSION: In summary, we could prove the clinical validity of most transcriptomic-based risk classifiers and their superiority over clinical and immunohistochemical-based methods in the heterogenous, real-world node-negative HR+HER2- MPBCS cohort.

Health care transition models in spina bifida care: evidence-based lessons in support of neurosurgical practice.

OBJECTIVE: The purpose of this study was to conduct a literature review on transition programs from pediatric to adult care and the role of neurosurgery as individuals with spina bifida (SB) transition, and to provide a framework for neurosurgical providers to assist in the transition to adult-centered care. METHODS: A comprehensive literature review was conducted according to the PRISMA statement, with a search in Medline and Embase to identify US clinical programs reporting on their experiences establishing a transition program for adolescents and young adults with SB. Data were collected for authors, year, transition clinic location, model of care for transition clinic, ages served, and specialty clinical team. RESULTS: The literature search yielded 698 articles, 5 of which met the inclusion criteria. These 5 studies included 4 transition programs for which models of care and approach to transition, clinical services involved, establishment of goals, and age of initiation and transition were identified. All programs described setting transition goals, ranging from community services, to self-management, to health care navigation, to patient-driven goals, with 1 program reporting a quality-of-life measurement component to their model. CONCLUSIONS: Robust SB transition programs can be established by applying the expanded chronic care model, reviewing lessons learned by other programs, advocating at the institutional level, and seeking support via professional organizations. While the comprehensive role of neurosurgical providers in these programs is still being defined, a shared vision of enhancing the health and quality of life for individuals with SB and their families is needed by all subspecialists involved.