RESUMO
Infections caused by mycobacteria, including Mycobacterium tuberculosis complex (MTBC) and non-tuberculous mycobacteria (NTM), are a major public health issue worldwide. An accurate diagnosis of mycobacterial species is a challenge for surveillance and treatment, particularly in high-burden settings usually associated with low- and middle-income countries. In this study, we analyzed the clinical performance of two commercial PCR kits designed for the identification and differentiation of MTBC and NTM, available in a high-burden setting such as Ecuador. A total of 109 mycobacteria isolates were included in the study, 59 of which were previously characterized as M. tuberculosis and the other 59 as NTM. Both kits displayed great clinical performance for the identification of M. tuberculosis, with 100% sensitivity. On the other hand, for NTM, one of the kits displayed a good clinical performance with a sensitivity of 94.9% (CI 95%: 89-100%), while the second kit had a reduced sensitivity of 77.1% (CI 95%: 65-89%). In conclusion, one of the kits is a fast and reliable tool for the identification and discrimination of MTBC and NTM from clinical isolates.
Assuntos
Mycobacterium tuberculosis , Tuberculose , Humanos , Mycobacterium tuberculosis/genética , Micobactérias não Tuberculosas/genética , Saúde Pública , Tuberculose/diagnóstico , Reação em Cadeia da PolimeraseRESUMO
OBJECTIVES: Answer the PICO question: Do class I and II posterior restorations in permanent teeth placed with high-viscosity glass-ionomer cement (HV-GIC) fail more than composite resin (CR) restorations? DATA: The study was registered in the PROSPERO database (CRD42020138290). Randomized and controlled clinical trials, comparing the performance of HV-GIC and CR in load bearing cavities of posterior permanent teeth were included. Cochrane risk of bias tool and GRADE were used to assess the quality and certainty of the evidence. Meta-analyses were performed for clinical outcomes on USPHS and FDI criteria for 12-, 24- and 36-months follow-ups. SOURCES: PubMed, Scopus and Web of Science were last searched on April 2, 2022, without language or date restrictions. Reference lists of primary studies and their related article link in PubMed were manually searched. STUDY SELECTION: Ten studies were included, while data from 8 were used for the meta-analyses. A total of 849 HV-GIC and 800 CR restorations were followed. The primary outcome was the fracture/retention of the restoration, with a comparable performance for both materials on all follow-ups. The 36 months follow-up for class I restorations (longest) showed risk difference of -0,00 (95%CI -0,03 to 0,03; p = 0,98) and no heterogeneity (p = 0,98, I2=0%). The certainty of the evidence is moderate, as all included studies were at an uncertain risk of bias. CONCLUSIONS: HV-GIC and CR presented comparable clinical performance in posterior permanent teeth up to 36 months. HV-GIV wear in class I restorations followed by 24 months was the only poorer result compared to CR. CLINICAL SIGNIFICANCE: Conservative load bearing cavities in permanent posterior teeth can be restored with HV-GIC with comparable clinical performance to CR expected at least up to 3 years. HV-GIC is a valuable direct restorative option for posterior teeth in high caries risk patients, in which CR is frequently associated with failure.
Assuntos
Cárie Dentária , Cimentos de Ionômeros de Vidro , Humanos , Cimentos de Ionômeros de Vidro/uso terapêutico , Resinas Compostas/uso terapêutico , Viscosidade , Restauração Dentária Permanente , Dentição Permanente , Cárie Dentária/tratamento farmacológicoRESUMO
During the second year of the COVID-19 pandemic, the use of Rapid Diagnosis Antigen Tests (RDAgTs) for SARS-CoV-2 detection has substantially increased as some of the brands available in the market were certified for clinical use by international regulatory agencies. RDAgTs are a fast and cheap tool for SARS-CoV-2 surveillance with great potential to improve testing capacities in middle- and low-income countries compared to the gold standard RT-qPCR. However, as the clinical performance of RDAgTs has been shown to vary greatly between the commercial brands available, evaluation studies are necessary. Moreover, the available evaluation has been done in high-income countries while SARS-CoV-2 transmission is also actively happening in developing countries, many of which are located in tropical latitudes where cross-reactivity with other infectious agents is highly prevalent, which could compromise RDAgT specificity. Moreover, unreported mutations and/or new SARS-CoV-2 variants may compromise RDAgT sensitivity as genomic surveillance is limited in these settings. Here we describe a multicenter and manufacturer-independent evaluation of the clinical performance and analytical sensitivity of three different RDAgTs brands available in South America from three companies, Rapigen (South Korea), SD-Biosensor (South Korea), and Certest (Spain), compared to the gold standard RT-qPCR. A total number of 1,646 nasopharyngeal swabs from community-dwelling individuals were included in the study, and 379 of them were SARS-CoV-2 positive by RT-qPCR. The overall sensitivity for each RDAgT was 79% (IC95%: 72 - 86.2), 64.2% (IC95%: 56.7 - 71.6), and 45.8% (IC95%: 35.8 - 55.8) for SD-Biosensor, Certest, and Rapigen, respectively. The overall specificity for each RDAgT was 100%, 97.7% (IC95%: 96.8 - 98.6), and 100% for SD-Biosensor, Certest, and Rapigen, respectively. However, the limit of detection (LoD) to achieve a sensitivity over 90% was substantially lower for Certest RDAgT (102 copies/uL) compared to SD-Biosensor (103 copies/uL) or Rapigen (106 copies/uL) RDAgTs, considering that the gold standard RT-qPCR method used in this study has a high sensitivity of 97.7% and low LoD of 5 copies/uL. Additionally, the Certest RDAgT also showed an improved sensitivity up to 79.7% (IC95%: 70.2 - 89.2) for symptomatic individuals. Finally, the slight reduction in specificity for Certest RDAgTs was only associated with one of the laboratories performing this study, pointing out the need for locally assessed evaluation for RDAgTs like this one carried out in Ecuador. In conclusion, two of the three the RDAgTs tested in this study are a fast, cheap, and point of care tool for SARS-CoV-2 surveillance and reliable enough to detect SARS-CoV-2 infectious individuals.
Assuntos
COVID-19 , SARS-CoV-2 , COVID-19/diagnóstico , Humanos , Vida Independente , Pandemias , SARS-CoV-2/genética , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: A systematic review was performed to analyze the clinical performance of class I and II restorations in posterior teeth placed with the incremental or the bulk-filling techniques. The primary outcome was retention/fracture rate, and the secondary outcomes evaluated were anatomical form, surface texture, color match, marginal adaption, marginal discoloration, caries, and postoperative sensitivity. METHODS: Electronic and manual searches were performed for randomized clinical trials comparing the clinical performance of composite resin restorations in posterior teeth placed with the incremental or the bulk-filling techniques. The Cochrane Collaboration risk of bias tool was used to assess the quality of the studies and the GRADE tool was used to access the quality of the evidence. RESULTS: Fourteen studies were included in this systematic review and most of them had unclear risk of bias. The risk difference (RD) for retention/fracture was 0.00 (95%CI = - 0.01, 0.01; p = 0.86) for 1-1.5 years of follow-up; 0.00 (95%CI = - 0.02, 0.02; p = 0.88) for 2-3 years of follow-up; 0.05 (95%CI = - 0.08, 0.18; p = 0.46) for 5 or more years of follow-up. The RD for postoperative sensitivity was 0.04 (95%CI = - 0.02, 0.10; p = 0.18) for up to 30 days; 0.00 (95%CI = - 0.01, 0.02; p = 0.63) for 1-1.5 years of follow-up; and 0.00 (95%CI = - 0.01, 0.02; p = 0.71) for 2-3 years of follow-up. For the other secondary outcomes, no significant differences were observed (p > 0.05) between the restorative techniques. The certainty of evidence was graded as moderate. CONCLUSIONS: The clinical performance of class I and II restorations in posterior teeth is similar when placed with the incremental and bulk-filling techniques. CLINICAL RELEVANCE: Based on the results of this study, posterior restorations placed with bulk-filling technique present satisfactory clinical performance, which is similar to direct restorations placed with the conventional incremental technique, considering various follow-up periods evaluated. TRIAL REGISTRATION: CRD42018108450.
Assuntos
Resinas Compostas , Cárie Dentária , Resinas Compostas/uso terapêutico , Cárie Dentária/tratamento farmacológico , Adaptação Marginal Dentária , Restauração Dentária Permanente/métodos , HumanosRESUMO
OBJECTIVE: To compare the expulsion and continuation rates of the levonorgestrel (LNG) 52 mg intrauterine system (IUS) in a cohort of nulligravid and parous users. METHODS: We conducted a retrospective cohort study that included 996 participants in whom we placed an LNG-IUS, and the participants were monitored for up to 5 years after device placement. We identify 498 nulligravid participants in the medical record database between 2012 and 2020. Each nulligravida was paired with a parous users who had an LNG-IUS inserted on the same day, just before or after the nulligravida. The Kaplan-Meier method and the log-rank test were used to compare the survival curves of the two groups. RESULTS: By the fifth year of use, the expulsion rates were 7.6/100 and 8.2/100 women-years (W-Ys) and the continuation rates were 641/100 W-Ys and 65.4/100 W-Ys without difference among nulligravid and parous users, respectively (P = 0.782 and P = 0.564, respectively). We observed 29 and 31 expulsions among nulligravid and parous users, respectively. CONCLUSION: Nulligravid and parous participants who used the 52 mg LNG-IUS showed similar expulsion and continuation rates during five years of use.
Assuntos
Anticoncepcionais Femininos , Dispositivos Intrauterinos Medicados , Estudos de Coortes , Feminino , Humanos , Levanogestrel , Estudos RetrospectivosRESUMO
OBJECTIVE: We evaluated clinical performance when the TCu380A intrauterine device (IUD) and the levonorgestrel (LNG) 52-mg intrauterine system (IUS) were inserted by different categories of healthcare professionals. METHODS: A retrospective study was conducted at the University of Campinas, Brazil. The medical records were reviewed of all women in whom an IUD was inserted between January 1980 and December 2018, with data for at least 1 year, and for whom information on the healthcare provider who inserted the device was available. RESULTS: Overall, 19 132 (76.9%) IUD and 5733 (23.1%) LNG-IUS insertions were included, with residents/interns performing 13 853 (55.8%), nurses 7024 (28.2%), and physicians 3988 (16.0%). Removals for pregnancy and infection were significantly higher when physicians inserted the device, while removals for bleeding/pain and other medical reasons were more common when nurses performed the insertion. Expulsion and removals for personal reasons were similar for all three categories. CONCLUSION: Clinical outcomes were similar regardless of whether trained nurses, residents/interns, or physicians inserted the device, and were irrespective of users' age and parity. These results could stimulate other healthcare services, particularly in regions where there is a shortage of physicians, to invest in training nurses to perform insertions of IUDs.
Assuntos
Pessoal de Saúde/estatística & dados numéricos , Dispositivos Intrauterinos de Cobre/estatística & dados numéricos , Dispositivos Intrauterinos Medicados/estatística & dados numéricos , Levanogestrel/administração & dosagem , Adolescente , Adulto , Brasil , Criança , Anticoncepcionais Femininos/administração & dosagem , Atenção à Saúde , Feminino , Hemorragia/epidemiologia , Humanos , Gravidez , Estudos Retrospectivos , Adulto JovemRESUMO
Objective: To evaluate fracture resistance and survival rate of IPS Empress CAD versus Polished Celtra Duo ceramic laminate veneers. Material and Methods:Thirty-six ceramic laminate veneers were fabricated for maxillary anterior teeth. The patients were divided into two groups according to the material Group 1(control group) fabricated from IPS Empress CAD laminate veneers and group 2 (intervention group) fabricated from Polished Celtra Duo laminate veneers. Standardized the same preparation with butt joint design and chamfer finish line located supra gingival were performed for all the teeth. The fabrication of the veneers was performed using Cad\Cam (Ceramill motion) machine, with software (Exocad). The veneers surfaces were treated and silanated according to the manufacture instruction of each ceramic and enamel surfaces were etched where total etch adhesive protocol was obeyed using BISCO. Follow up sessions were done every two months up to one year for each patient using dental probe and operator vision to evaluate the fracture, survival rate, marginal adaptation, sensitivity and caries. according to USPHS criteria (United States Public Health Service). This was performed by an experienced, blinded investigator. Results: Fracture resistance, marginal adaptation, retention, caries and sensitivity were evaluated according to the criteria of USPHS and we found there is no significant difference as both groups scaled zero score. Conclusion: Both IPS Empress Cad and Polished Celtra Duo laminate veneers revealed successful clinical performance in terms of fracture resistance, marginal adaptation, retention, and sensitivity after one year follow up period (AU)
Objetivo: Avaliar a resistência à fratura e a taxa de sobrevivência de laminados de cerâmica IPS Empress CAD versus Celtra Duo polidos. Material e Métodos: Trinta e seis facetas cerâmicas laminadas foram confeccionadas para dentes anteriores superiores. Os pacientes foram divididos em dois grupos de acordo com o material Grupo 1 (grupo controle) confeccionado com laminados IPS Empress CAD e grupo 2 (grupo intervenção) confeccionado com laminados Celtra Duo polidos. A mesma forma de preparo e acabamento de chanfro localizado supra-gengival padronizados foram realizados para todos os dentes. A confecção das facetas foi realizada em máquina Cad \ Cam (Ceramill motion), com software (Exocad). As superfícies laminadas foram tratadas e silanizadas de acordo com as instruções do fabricante de cada cerâmica e as superfícies de esmalte foram condicionadas seguindo o protocolo adesivo de condicionamento ácido total com BISCO. Sessões de acompanhamento foram realizadas a cada dois meses durante um ano para cada paciente usando sonda exploradora e visão do operador para avaliar a fratura, taxa de sobrevivência, adaptação marginal, sensibilidade e cárie; de acordo com os critérios USPHS (Serviço de Saúde Pública dos Estados Unidos). Isso foi realizado por um investigador experiente e cego. Resultados: a resistência à fratura, adaptação marginal, retenção, cárie e sensibilidade foram avaliadas de acordo com os critérios da USPHS e não encontramos diferença significativa, pois ambos os grupos escalonaram pontuação zero. Conclusão: As facetas laminadas IPS Empress Cad e Celtra Duo polido revelaram desempenho clínico bem-sucedido em termos de resistência à fratura, adaptação marginal, retenção e sensibilidade após um período de acompanhamento de um ano. (AU)
Assuntos
Humanos , Adaptação Marginal Dentária , Cárie Dentária , Facetas Dentárias , Sensibilidade da Dentina , Resistência à FlexãoRESUMO
BACKGROUND: Little is known about adherence to American Heart Association/American Stroke Association (AHA/ASA) stroke performance measures in developing countries like Peru. AIMS: We assessed adherence and determined factors associated with adherence to the AHA/ASA stroke performance measures at a reference center for neurological diseases in Lima, Peru. METHODS: We conducted a retrospective chart review of 150 stroke patients admitted to the Neurological Institute of Neurological Science from 2014 to 2016 to ascertain adherence to 15 different AHA/ASA stroke performance measures. Adherence was measured as a simple proportion, with both single and composite measures. Associations were analyzed with nonparametric statistics and multivariate logistic regression. RESULTS: Mean adherence to AHA/ASA stroke performance measures was 47%. We observed a statistically significant relationship between adherence to ischemic stroke performance measures and being married (OR = 3.78, 95% CI: 1.05-13.55), as well as an inverse relationship with an onset of symptoms of greater than 4.5 h prior to arrival at the hospital compared to those with ≤ 4.5 h (OR = 0.14, 95% CI: 0.02-0.97). Compared to patients with a lower National Institutes of Health Stroke Scale (NIHSS) score (<13), those with a score of ≥13 were less likely to have good adherence (OR = 0.11, 95% CI: 0.04-0.31). CONCLUSIONS: The mean composite measure of adherence to internationally recognized standards of stroke management in our Peruvian institution was below the level needed for an achievement award by AHA/ASA. An intervention targeted toward stroke prevention and training could lead to improved outcomes of stroke patients in Peru.
Assuntos
American Heart Association , Isquemia Encefálica/terapia , Países em Desenvolvimento , Fidelidade a Diretrizes/normas , Neurologistas/normas , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Isquemia Encefálica/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Indicadores de Qualidade em Assistência à Saúde/normas , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Resultado do Tratamento , Estados Unidos , Adulto JovemRESUMO
PURPOSE: Most studies assessing the value of the university admissions test (UAT) to predict academic performance at the end of a medical course were carried out on lecture-based medical courses. However, the association between performance in the UAT with academic achievement at the end of medical course in a problem-based learning (PBL) medical hybrid curriculum remains controversial. The aim of this study was to correlate marks in the UAT with those obtained in the Organized Structured Clinical Examination (OSCE), in the progress testing (PT), and in the final marks of the clerkship (FMC). METHODS: We used data from 48 medical students. A single and a multiple dependency studies were performed to assess bivariate and multiple correlation between the UAT or the essay scores (dependent variables) and the OSCE, PT, and FMC (independent variables). Pearson test, multiple linear regression, and ANOVA tests were used and a p-value < 0.05 was considered significant. RESULTS: In the bivariate analysis, only the UAT and FMC marks were correlated (r=0.34; p=0.02). However, the multiple dependency study showed a moderate correlation among UAT, OSCE, PT, and FMC marks (r=0.46; p=0.01). No correlation was found between the essay scores and PT, FMC, and OSCE scores. CONCLUSION: Our study shows that UAT marks, but not essay scores, can predict academic achievement, particularly in terms of clinical competence (FMC) at the end of a medical course in a PBL hybrid curriculum.
RESUMO
BACKGROUND: There is little information of intensive care unit (ICU) performance when it's relocated to a totally new and equipped area. OBJECTIVE: To analyze the clinical performance and use of resources of a new respiratory-ICU (nRICU) in a large third-level care hospital. METHOD: Cross-sectional, comparative study using prospective data of patients admitted from July 17, 2017 to July 17, 2018. The Rapoport adjusted method was used to obtain the standardized clinical performance index (SCPI) and the standardized resource use index (SRUI). RESULTS: Out of 354 patients, those who were readmissions or remained hospitalized and those whose treatment was withheld or withdrawn where excluded from the analysis. In 301 patients, the observed survival at hospital discharge was 63% while the expected survival was 67.7%. Values of SCPI and SRUI were -1.03 and 0.05 respectively, placing results in coordinates within two standard deviations when plotted in the Rapoport chart. There was a statistically significant difference in survival when comparing the study period with outcomes obtained in the RICU before its relocation (63% vs. 55%, p = 0.01). CONCLUSIONS: In its 1st year of operation, the nRICU had better clinical performance compared to the former RICU, with no change in the use of resources.
ANTECEDENTES: Existe poca información acerca del desempeño de una unidad de cuidados intensivos (UCI) cuando es reubicada en un área totalmente nueva y equipada. OBJETIVO: Analizar el rendimiento clínico y el uso de recursos de la nueva UCI respiratoria (UCIR) de un hospital grande de tercer nivel. MÉTODO: Estudio transversal, comparativo, con datos prospectivos de pacientes ingresados del 17 de julio de 2017 al 17 de julio de 2018. Se usa el método ajustado de Rapoport para obtener el índice de rendimiento clínico estandarizado (IRCE) y el índice de uso de recursos estandarizado (IRURE). RESULTADOS: De 354 pacientes fueron excluidos los reingresos, los pacientes aún hospitalizados y aquellos a quienes se limitó o retiró el tratamiento. En 301 pacientes la sobrevida hospitalaria fue del 63%, mientras que la sobrevida esperada fue del 67.7%. El IRCE fue −1.03 y el IRURE fue 0.05, situando el resultado en coordenadas dentro de dos desviaciones estándar en el gráfico de Rapoport. Hubo una diferencia estadísticamente significativa en la sobrevida comparando el periodo de estudio con resultados de la UCIR obtenidos antes de su reubicación (63 vs. 55%, p = 0.01). CONCLUSIONES: En su primer año de funcionamiento, la nueva UCIR tuvo mejor rendimiento clínico que la antigua, sin modificación en el uso de recursos.
Assuntos
Arquitetura Hospitalar , Unidades de Terapia Intensiva/organização & administração , Adulto , Idoso , Cuidados Críticos/organização & administração , Estudos Transversais , Grupos Diagnósticos Relacionados , Equipamentos e Provisões Hospitalares/estatística & dados numéricos , Feminino , Recursos em Saúde/estatística & dados numéricos , Arquitetura Hospitalar/estatística & dados numéricos , Hospitais Gerais/organização & administração , Hospitais Gerais/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , México , Pessoa de Meia-Idade , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento , Desempenho Profissional , Adulto JovemRESUMO
Objective: to evaluate the clinical performance of the dual shade layering and polychromatic resin composite layering techniques using a randomized controlled trail. Material and Methods: 42 participants (84 restorations) of class IV or class III through and through within a pair of anterior contra-lateral teeth were randomly allocated into two groups according to technique of composite restoration placement: control "polychromatic layering" and intervention "dual-shade layering". Follow-up was done at 1 month (baseline) and 1 year. Restorations were evaluated using Visual Analog Scale (VAS), restoration color shade match using Vita Easyshade V ®, and blinded assessor using FDI criteria for assessment of dental restorations measuring (aesthetic properties). Chi-square test was used to compare between restorations of both techniques. Results: There was no statistically significant difference between restorations of both techniques for patient satisfaction outcome, restorations color match outcome, and for all tested FDI outcomes except surface luster with 100% success. Conclusion: Bothdual-shade layering and polychromatic natural layering techniques, exhibited acceptable clinical and esthetic performance (AU)
Objetivo: Avaliar o comportamento de desgaste do esmalte humano e lascamento de zircônia de cobrimento e monolítica para restaurações posteriores de cobertura total. Material e métodos: Trinta e quatro restaurações de zircônia de cobertura total (dezessete em cada grupo) foram fabricadas. Os pacientes foram divididos em dois grupos de acordo com o tipo de zircônia utilizada; grupo 1 (grupo comparador) coroas com zircônia de cobrimento e grupo 2 (grupo de intervenção) coroas únicas de zircônia monolítica. Todas as coroas foram fabricadas e polidas em laboratório. Para medidas de desgaste de dentes opostos, foi utilizado um perfilômetro 3D sem contato, onde réplicas de resina epóxi foram construídas para o arco oposto imediatamente após a cimentação das coroas, três, seis e doze meses. O lascamento da restauração foi medido usando critérios modificados dos Serviços de Saúde Pública dos Estados Unidos (USPHS). Resultados: Todas as restaurações foram relatadas como alfa sem lascamento. Não houve diferença estatisticamente significativa entre (Grupo 1) e (Grupo 2) para o teste de desgaste. Conclusão: As restaurações monolíticas e de cobrimento revelaram propriedades mecânicas satisfatórias sem lascamento após um ano de uso clínico. O desgaste do esmalte oposto foi clinicamente aceitável para ambos os materiais (AU)
Assuntos
Humanos , Cerâmica , Desgaste de Restauração Dentária , Desgaste dos DentesRESUMO
OBJECTIVES: Recent studies have identified large and systematic deficits in clinical care in low-income countries that are likely to limit health gains. This has focused attention on effectiveness of pre-service education. One approach to assessing this is observation of clinical performance among recent graduates providing care. However, no studies have assessed performance in a standard manner across countries. We analysed clinical performance among recently graduated providers in nine low- or middle-income countries. METHODS: Service Provision Assessments from Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda were used. We constructed a Good Medical Practice Index that assesses completion of essential clinical actions using direct observations of care (range 0-1), calculated index scores by country and clinical cadre, and assessed the role of facility and clinical characteristics using regression analysis. RESULTS: Our sample consisted of 2223 clinicians with at least one observation of care. The Good Medical Practice score for the sample was 0.50 (SD = 0.20). Nurses and midwives had the highest score at 0.57 (SD = 0.20), followed by associate clinicians at 0.43 (SD = 0.18), and physicians at 0.42 (SD = 0.16). The average national performance varied from 0.63 (SD = 0.18) in Uganda to 0.39 (SD = 0.17) in Nepal, persisting after adjustment for facility and clinician characteristics. CONCLUSIONS: These results show substantial gaps in clinical performance among recently graduated clinicians, raising concerns about models of clinical education. Competency-based education should be considered to improve quality of care in LMICs. Observations of care offer important insight into the quality of clinical education.
OBJECTIFS: Des études récentes ont identifié des déficits importants et systématiques dans les soins cliniques dans les pays à faible revenu, susceptibles de limiter les progrès en matière de santé. Cela a attiré l'attention sur l'efficacité de la formation initiale. Une des approches permettant cette évaluation a été l'observation de la performance clinique des diplômés récents dispensant des soins. Cependant, aucune étude n'a évalué la performance de manière standard dans tous les pays. Nous avons analysé les performances cliniques de prestataires récemment diplômés dans neuf pays à revenu faible ou intermédiaire. MÉTHODES: Des évaluations de la fourniture de services en Haïti, au Kenya, au Malawi, en Namibie, au Népal, au Rwanda, au Sénégal, en Tanzanie et en Ouganda ont été utilisées. Nous avons construit un indice de bonne pratique médicale qui évalue l'achèvement des actions cliniques essentielles à l'aide d'observations directes des soins (plage de 0 à 1), calculé les scores d'index par pays et par cadre clinique, et évalué le rôle de l'établissement et des caractéristiques cliniques à l'aide d'une analyse de régression. RÉSULTATS: Notre échantillon était constitué de 2.223 cliniciens avec au moins une observation des soins. Le score de bonne pratique médicale pour l'échantillon était de 0,50 (écart-type = 0,20). Les infirmières et les sages-femmes avaient le score le plus élevé de 0,57 (écart-type = 0,20), suivies des cliniciens associés avec 0,43 (écart-type = 0,18) et des médecins avec 0,42 (écart-type = 0,16). La performance moyenne nationale variait de 0,63 (écart-type = 0,18) en Ouganda à 0,39 (écart-type = 0,17) au Népal, persistant après ajustement en fonction des caractéristiques de l'établissement et du clinicien. CONCLUSIONS: Ces résultats montrent des écarts substantiels dans les performances cliniques des cliniciens récemment diplômés, ce qui soulève des inquiétudes concernant les modèles de formation clinique. Une éducation axée sur les compétences devrait être envisagée pour améliorer la qualité des soins dans les PRFM. Les observations des soins offrent des informations importantes sur la qualité de la formation clinique.
Assuntos
Competência Clínica/normas , Atenção à Saúde/normas , Países em Desenvolvimento , Educação Médica , Enfermeiras e Enfermeiros/normas , Médicos/normas , Qualidade da Assistência à Saúde , Adulto , África , Criança , Pré-Escolar , Feminino , Haiti , Pesquisas sobre Atenção à Saúde , Humanos , Renda , Lactente , Recém-Nascido , Masculino , Serviços de Saúde Materno-Infantil/normas , Tocologia/normas , Nepal , GravidezRESUMO
PURPOSE: To analyze the clinical success of direct light-activated composite resin restorations in posterior teeth. The quality of the margins and occlusal surfaces were evaluated, as well as their survival, according to their extensions and locations. The clinical performance of posterior composite resin restorations with different compositions were compared. All restorations were performed by the first author in his private practice, in a 5- to 20-year period. MATERIALS AND METHODS: Several types of composite resins, provided by different manufacturers, were placed in posterior teeth, after isolation with rubber dams. To be included in the study, the restorations had to have been in function for at least 5 years and had to have been placed between October 1993 and October 2008 by the first author. The established failure criteria were: tooth and/or restoration fracture, secondary caries, endodontic treatment, or tooth loss. Included patients must have been treated in the first author's office for at least 7 years and still in the practice through 2013; all patients had complete dental arches. Patients with removable dental prostheses or disabilities, who had moved, or who had died were excluded. Of 210 patients who fulfilled the inclusion criteria, 138 randomly selected subjects were clinically examined between November 2013 and April 2014. Of these 138 patients, 61 had received 105 direct-light-activated composite resin restorations in posterior teeth, which met the inclusion criteria. Twenty-nine patients (47.5%) underwent annual maintenance therapy. The patient-based data collected from clinical exams and personal records were recorded on a specially designed form. Age, gender, period of clinical attendance, tooth preparation, location, size, quality and longevity of the restorations, restorative materials, adhesive systems, parafunctional habits, secondary caries, and maintenance therapy were the variables evaluated. Authors were blinded to the clinical assessments. Cohen's Kappa coefficient of the quality analysis of the margins and occlusal surfaces of the restorations ranged from 0.78 to 1. Data processing was performed using Epidat software, v3.1, developed by the Consellería de Sanidade de la Xunta de Galicia with the support of PAHO-WHO and SPSS software v13.0. If the number of complete values was too small, a Kaplan-Meier curve could not be used. Therefore the Fisher's exact test, Chi-square test, Kruskal-Wallis test, and Mann-Whitney non-parametric test were indicated to analyze significant differences. RESULTS: At the time of the examinations, 103 (98%) restorations were in function, and 98 (95.1%) were rated as clinically successful. Two restorations failed (2%). The observed mean survival time of restorations that remained functional was 11 years and 7 months. CONCLUSIONS: In the present report, direct light-activated composite resin restorations in posterior teeth showed a high clinical success rate and long-term mean survival time. These composite resins might be considered the material of choice to restore medium, extended, and in some clinical situations, large preparations in posterior teeth.
Assuntos
Resinas Compostas/química , Resinas Compostas/efeitos da radiação , Falha de Restauração Dentária , Restauração Dentária Permanente , Resinas Acrílicas , Adulto , Idoso , Idoso de 80 Anos ou mais , Resinas Compostas/uso terapêutico , Cárie Dentária/terapia , Preparo da Cavidade Dentária , Adaptação Marginal Dentária , Materiais Dentários , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Dente Molar , Poliuretanos , Cimentos de Resina , Estudos RetrospectivosRESUMO
OBJECTIVE: To assess the contraceptive performance of the 52-mg 20 µg/day levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena; Bayer Oy, Turku, Finland) among women who maintain the same device without changes after 60 months. STUDY DESIGN: This is a chart review study in which we assessed the charts of 766 women who continue the same LNG-IUS for contraception beyond 60 months. The women were evaluated at the Family Planning clinic, University of Campinas Medical School, Campinas, SP, Brazil, from November 1990 to March 2011. We obtained sociodemographic data, duration of use, continuation and discontinuation rates and reasons, bleeding pattern at the recorded last visit. The statistical analysis was performed using Kaplan-Meier analysis. RESULTS: A total of 776 charts were identified of women who used the LNG-IUS beyond 60 months. The mean age (±S.E.M.) at LNG-IUS placement was 32.0±0.2 years (ranged 15 to 44 years; median was 32 years). The distribution of number of pregnancies was 0-1 (45%); 2-4 (54.1%) and≥5 (0.9%). The median length of the LNG-IUS' use was 73 months after placement (ranged 61-184 months). Zero pregnancies were reported and the main reasons for discontinuation were expiration of approved effective lifespan, menopause and planning pregnancy. The cumulative women-years (W-Y) of exposure were 967 and 1403 up to seven and 15 years, respectively. The main bleeding pattern reported by the women was amenorrhea. CONCLUSIONS: The 52-mg 20 µg/day LNG-IUD (Mirena) showed continue contraceptive efficacy beyond 5 years of use with no pregnancies detected over 967 and 1403 W-Y up to seven and 15 years after placement. IMPLICATIONS STATEMENT: The 52-mg 20 µg/day LNG-IUD presented a very high contraceptive efficacy beyond the first 5 years of lifetime labeled. Increasing data support that efficacy beyond 5 years of use, and new data suggested efficacy as long as 15 years. Healthcare professionals, policy makers and stakeholders could take advantage of the present information to decide to maintain the same device at least up to seven years. Furthermore, amenorrhea could be a good indicator of contraceptive effect.
Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais Femininos/administração & dosagem , Dispositivos Intrauterinos Medicados/estatística & dados numéricos , Levanogestrel/administração & dosagem , Resultado da Gravidez/epidemiologia , Adolescente , Brasil/epidemiologia , Esquema de Medicação , Feminino , Humanos , Estimativa de Kaplan-Meier , Gravidez , Estudos Retrospectivos , Fatores de Tempo , Suspensão de Tratamento/estatística & dados numéricos , Adulto JovemRESUMO
Introducción: el proceso de formación de habilidades profesionales de intervención clínica relacionadas con los modos de actuación profesional en los estudiantes de tercer año de la carrera de Estomatología, en la Universidad de Ciencias Médicas de Pinar del Río se ha caracterizado por su falta de sistematicidad, al no garantizar la relación entre los objetivos y propósitos del año con los problemas a enfrentar, limitando su contribución al modo de actuación del Estomatólogo General Básico. Objetivo: definir, a partir de la aplicación de un grupo de fundamentos pedagógicos y didácticos basados en reconocidas teorías, el sistema de habilidades profesionales de intervención clínica en función de los modos de actuación de este profesional. Métodos: se aplicaron métodos de investigación teóricos y empíricos, donde destaca el dialéctico que guía el proceso de perfeccionamiento de la formación del estudiante de Estomatología, a partir de las demandas que impone el sistema nacional de salud en Cuba, garantizando la relación básica entre habilidad-objetivo de salida del año y modo de actuación del profesional. Resultados: se obtuvo el sistema de habilidades profesionales de intervención clínica a partir del objetivo integrador del año, compuesto por 165 habilidades en cinco grupos: de intervención comunitaria, de intervención clínica, diagnósticas-comunicativas, docente-investigativas y administrativas. Conclusiones: el enfoque sistémico del proceso de formación de habilidades de intervención clínica en el tercer año de la carrera de Estomatología se sustenta en la correlación de sus componentes tomando como eje articulador el objetivo de salida, para la habilidad rectora en aras de alcanzar el tributo al modo de actuación que caracteriza el año(AU)
Introduction: The process of building professional skills in clinical intervention associated with the performance ways of third-year students of the Dental Surgery major at Pinar del Rio University of Medical Sciences has not been systematic, since it does not guarantee the relation between the objectives and purposes of the year with the problems to be faced, limiting their contribution to the performance ways of the basic comprehensive doctor in dental surgery. Objective: To define, from the application of a group of pedagogical and didactic foundations based on recognized theories, the system of professional skills in clinical intervention in view of the professional's performance ways. Methods: Theoretical and empirical research methods were applied, highlighting the dialectic approach that guides the process of perfecting the student's training in dentistry, based on the demands imposed by the national health system in Cuba, guaranteeing the basic relationship between skill-objective of year outcome and the professional's performance ways. Results: We obtained the system of professional skills in clinical intervention from the integrating objective of the year, consisting of 165 skills in five groups: community intervention, clinical intervention, diagnostic-communicative, teaching-research and administrative. Conclusions: The systemic approach to the process of training skills in clinical intervention in the third year of the Dental Surgery major is based on the correlation of its components, taking the outcome objective as an articulating axis, for the guiding ability to achieve the tribute to the performance ways characterizing this year(AU)
Assuntos
Competência Clínica , Educação em Odontologia/métodos , Estudantes de Odontologia , CubaRESUMO
OBJECTIVES: Zirconia-based prostheses are commonly used for aesthetic crown and fixed restorations, although follow-up data are limited, especially for implant-supported crowns. The aim of this study was to evaluate the threeyear clinical results of the installation of 463 zirconia core crowns by a general dental private practice. METHODS: This study followed 142 patients (69 men and 73 women; aged 28-82 years) who had received 248 single crowns (202 tooth-supported, 36 implant-supported) and 225 multiple units of up to six elements (81 toothsupported, 144 implant-supported). Clinical events, including fracture and loss of retention, secondary caries, and marginal integrity, were recorded. The overall failure rate was computed for the fractured and lost prostheses. Aesthetic, functional, and biological properties were rated, and patient satisfaction was investigated. RESULTS: During the three-year follow-up period, four patients were lost from the study (18 crowns, 4 percent of the total crowns). Three of the zirconia prostheses suffered fractures in more than three units (11 crowns; one- vs. three-year follow-up, p,0.05, Wilcoxon signed-rank test), and the cumulative prosthesis survival rate was 98.2 percent. Twelve units lost retention and were re-cemented, and no secondary caries of the abutment teeth were reported. The aesthetic, functional, and biological properties were generally well-rated, and there were no differences between tooth- and implant-supported crowns. The lowest scores were given regarding the anatomical form of the crowns, as some minor chipping was reported. Relatively low scores were also given for the periodontal response and the adjacent mucosa. Overall, patient satisfaction was high. CONCLUSIONS: At the three-year follow-up, the zirconia-core crowns appeared to be an effective clinical solution as they had favorable aesthetic and functional properties. Only the marginal fit of the prostheses should be improved upon.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Coroas , Porcelana Dentária , Falha de Restauração Dentária , Prótese Dentária Fixada por Implante/métodos , Zircônio , Desenho Assistido por Computador , Prótese Dentária Fixada por Implante/efeitos adversos , Seguimentos , Prática Privada , Estudos Prospectivos , Resultado do TratamentoRESUMO
Introducción: la amalgama de plata es un material restaurador para uso en dientes posteriores. El propósito de este estudio fue observar las características de trabajo de la amalgama dental Nu Alloy dp® en dientes de ivorina y, posteriormente, evaluar algunas cualidades clínicas de este material restaurador, dieciocho meses después de ser colocado en boca. Métodos: se realizaron 153 restauraciones de amalgama dental Nu Alloy dp® en dientes de ivorina en el laboratorio y se registró la percepción de los odontólogos. Posteriormente se realizaron 306 obturaciones en pacientes para evaluar el comportamiento clínico del material restaurador. Resultados: en el estudio de laboratorio se reportó una evaluación buena de los odontólogos para las variables condensación, tallado, bruñido y pulido con porcentajes de respuesta favorables entre el 68 y 86%. En el estudio clínico se revisaron 92 obturaciones al final del estudio, dieciocho meses de seguimiento, con los siguientes resultados: evaluación excelente para las variables desgaste oclusal, falla cohesiva y evaluación radiográfica; buena valoración para las variables de integridad marginal, textura superficial y decoloración. Conclusiones: de la fase de laboratorio se puede decir que la amalgama dental Nu Alloy dp® presentó buena valoración de sus características de manipulación, las cuales se reflejan posteriormente en los resultados obtenidos en la evaluación clínica. Con los resultados encontrados en la revisión clínica a dieciocho meses se concluye que el comportamiento clínico de la amalgama fue excelente.
Introduction: silver amalgam is a dental material which is used in restorative clinical dentistry for posterior teeth. The purpose of this study was to evaluate the preclinical performance of the Nu Alloy dp® dental amalgam in plastic teeth, and, then to evaluate the clinical performance of the restorative material after eighteen months of being placed in the mouth. Methods: 153 NuAlloy dp® dental amalgam restorations were made in the preclinical phase and the dentists perception was recorded. Subsequently 306 restorations were made in patients in order to evaluate the clinical performance of the restorative material. Results: a good evaluation was reported by the dentists in the preclinical study regarding the following variables: cohesion, carving, burnishing and polishing, with favorable answer percentages between 68% and 86%. Ninety two restorations were examined at the end of the clinical study with following results: excellent evaluation for oclusal wear, cohesive failure of the material, and radiographic evaluation variables; and good evaluation for marginal integrity, surface texture and discoloration variables. Conclusions: good performance results were obtained with Nu Alloy dp® dental amalgam in the preclinical phase which are reflected subsequently in the clinical evaluation results. The results found in the evaluation at eighteen months allowed us to conclude that the clinical performance was excellent. Dental amalgam requires maintenance appointments in order to carry out its polishing every six months and to keep its surface texture and brightness which were obtained in the first appointments.
Assuntos
Humanos , Amálgama Dentário , Restauração Dentária PermanenteRESUMO
Quality control and management systems have gradually been incorporated into Spanish health care system. Ambulatory dialysis centers have been pioneers of this kind of systems in nephrology, on the one hand, due to professional needs to establish the utmost control of each process of the activity, and on the other, urged by the requirements of government services. This has given rise to the recent creation of a multidisciplinary task force for Quality Management fostered by the Sociedad Española de Nefrología (Spanish Nephrology Association). Work started by receiving information of the initial stages of nephrology services and dialysis units in the country by means of a survey regarding the use of quality management systems and a follow up of the indicators. In addition, the goal was to stimulate hospital units and peripheral dialysis centers so as to incorporate proper tools for quality management in their practices and to define health care procedures and their indicators. This work also aimed at establishing consensual monitoring plans to allow comparisons of the results between different centers that might become a reference for future areas of improvement bridging the gap between the development of guides and their later follow up. In this article the advances made in this regard are reviewed.
Los sistemas de control y gestión de la calidad se han incorporado progresivamente al mundo sanitario en España y los centros de hemodiálisis extrahospitalarios concertados han sido pioneros en este campo en el terreno de la Nefrología; por un lado, por una necesidad profesional de asegurar al máximo el control de cada proceso de la actividad que realizan, y por otro, impulsados por los requerimientos de la administración pública. Todo esto ha motivado la reciente creación de un grupo de trabajo multidisciplinario sobre Gestión de la Calidad, impulsado por la Sociedad Española de Nefrología, el cual inició su andadura evaluando, mediante una encuesta, la situación de partida en los servicios de Nefrología y las unidades de hemodiálisis de ámbito nacional, con respecto a la utilización de sistemas de gestión de calidad y al seguimiento de indicadores. Además, tenía como objetivo estimular a las unidades hospitalarias y a los centros de diálisis periféricos a incorporar las herramientas de gestión de la calidad en su práctica, definir los diferentes procesos asistenciales y sus indicadores, y establecer planes de monitorización consensuados que permitieran comparar resultados entre diferentes centros y que sirvieran como punto de referencia para futuras áreas de mejora, dando el salto entre la elaboración de guías y su monitorización posterior. En este trabajo se resumen los avances realizados en este sentido.