Search

Objetivo: Identificar, na literatura nacional e internacional, os cuidados ofertados aos idosos no final de vida por equipes de instituições de longa permanência. Metodologia: Revisão integrativa da literatura realizada nas bases de dados Scientific Electronic Library Online (SciELO) e Medical Literature and Retrieval System Online (Medline), via Pubmed, utilizando a estratégia PICO para a construção da questão de pesquisa. Utilizou-se a combinação de Medical Subject Headings (Mesh Terms) e os descritores em ciências da saúde (DeCS) associados ao operador booleano AND, incluindo artigos originais em inglês, espanhol, português e francês, publicados entre 2013 e 2023, disponíveis online na íntegra. Foi utilizado o aplicativo Rayyan para gerenciar a identificação e seleção dos documentos, totalizando dez artigos como corpus da pesquisa. Os achados foram submetidos à análise por temas. Resultados: Os resultados foram organizados em duas principais categorias – ações de cuidado centradas ao idoso residente de instituições de longa permanência e ações de cuidado (in)diretas: intervenções junto às equipes de instituições de longa permanência. Os cuidados prestados pelas equipes ora são diretamente aos idosos, como a higiene, a hidratação, a alimentação, ora se desenvolvem de maneira indireta, por meio de reuniões e capacitação das equipes que com eles atuam. Conclusão: Os cuidados ofertados aos idosos em instituições de longa permanência priorizam um final de vida com qualidade, respeito, alívio do sofrimento, redução dos sintomas depressivos e da morte no ambiente hospitalar. Além disso, a presença de equipes multiprofissionais e de cuidados paliativos nas instituições pode assegurar a dignidade, a qualidade de (final de) vida e o conforto dos idosos.

Objetivo: Identificar as estratégias disponíveis na literatura internacional que forneça métodos de autoajuda para pacientes em cuidados paliativos e seus familiares. Método: Trata-se de uma revisão integrativa da literatura, realizada entre abril e maio de 2022, utilizando as bases de dados e bibliotecas online Medline, Scielo, Scopus, CINAHL e Web of Science. Os estudos foram selecionados de forma rigorosa, através da utilização de diferentes combinações dos MESH’s e palavras chaves self-help, groups, palliative care, medicine in literature, literature, health, disease com o operador booleano AND. Foi utilizado um aplicativo online de gerenciamento de revisões, Rayyan - Intelligent Systematic Review, sendo realizada a dupla verificação cega. Na busca primária foram encontrados 3259 estudos, após a aplicação dos critérios de exclusão 16 artigos compuseram o corpus de análise que usou como forma de apreciação a metodologia descritiva. Resultados: Obteve-se como principais achados a utilização de grupos de autoajuda como uma importante estratégia para auxiliar pacientes e familiares em situações desafiadoras que cernem o final de vida, outras estratégias foram vislumbradas como o uso de cartilhas, espaços e programas, que tendem a auxiliar nos momentos em que é necessário a comunicação de más notícias ou passar por situações de perda antecipatória e luto. Houve a predominância de estudos de abordagem qualitativa, e em maioria realizados na Suécia. Conclusão: Evidenciou-se que a estratégia dominante foi os grupos de autoajuda, que demonstraram ser um espaço de troca de conhecimento e experiências pessoais, entre os indivíduos participantes.

Immigration is an important and contemporary topic in management education given its impact on labor, wages, innovation, and diversity. However, extant research offers few insights into the antecedents to student immigration attitudes. Survey data from undergraduate students taking business courses at two large public universities in the southeast U.S. reveal that while student attitudes toward immigration are more moderate than the general U.S. population, these attitudes differ by gender, political affiliation, and immigration background. Following realistic conflict theory and social identity theory, these student immigration attitudes are a function of both fear and competition. First, their attitudes are confounded by conflicting antecedents in perceived personal competition for resources with immigrants (e.g., jobs, wages) versus immigration benefits (e.g., costs, labor base, innovation). Second, xenophobia (fear of immigrants) is a remarkably powerful influencer of one's immigration attitude and its antecedents. With these points, management educators must engage students in critical thinking about immigration to prepare them to effectively work with diverse colleagues and business partners while leading global organizations. We, therefore, present four cross-disciplinary areas of intersection between immigration and management education, including diversity and cultural intelligence, human resource management and ethics, entrepreneurship and innovation, and finally, economic and socioeconomic impacts.

O objetivo deste estudo foi descrever os cuidados realizados por profissionais de equipes da atenção primária à saúde visando a dignidade de pessoas em final de vida no domicílio e conhecer os aspectos facilitadores e dificultadores. Trata-se de uma pesquisa qualitativa com 12 profissionais de cinco Estratégias de Saúde da Família. Foram realizadas entrevistas semiestruturadas, entre outubro e novembro de 2022, cujos resultados foram organizados no programa Atlas.ti e submetidos à análise de conteúdo. As participantes foram enfermeiras, médicas, técnicas de enfermagem e agente comunitária de saúde, as quais relataram não atender com frequência pessoas em final de vida. A identificação dessas pessoas no serviço ocorre pelos agentes comunitários de saúde, prontuários e busca direta do serviço por pacientes e familiares. Para tentar promover dignidade, visitas domiciliares e encaminhamentos para serviços de saúde são estratégias para assegurar a longitudinalidade do cuidado, assim como o acolhimento, acesso a equipes especializadas e comunicação efetiva com os envolvidos no cuidado. O diálogo, a equipe qualificada, a inserção da família nos cuidados e o acompanhamento da equipe são fatores facilitadores do cuidado centrado na dignidade. A sobrecarga de trabalho, a limitação de recursos, as fragilidades na comunicação e os vínculos familiares enfraquecidos dificultam a manutenção da dignidade das pessoas em final de vida no domicílio.

Abstract Background The Federal Ministry of Education and Research of Germany (BMBF) funds a network of university medicines (NUM) to support COVID-19 and pandemic research at national level. The “COVID-19 Data Exchange Platform” (CODEX) as part of NUM establishes a harmonised infrastructure that supports research use of COVID-19 datasets. The broad consent (BC) of the Medical Informatics Initiative (MII) is agreed by all German federal states and forms the legal base for data processing. All 34 participating university hospitals (NUM sites) work upon a harmonised infrastructural as well as legal basis for their data protection-compliant collection and transfer of their research dataset to the central CODEX platform. Each NUM site ensures that the exchanged consent information conforms to the already-balloted HL7 FHIR consent profiles and the interoperability concept of the MII Task Force “Consent Implementation” (TFCI). The Independent Trusted Third-Party (TTP) of the University Medicine Greifswald supports data protection-compliant data processing and provides the consent management solutions gICS. Methods Based on a stakeholder dialogue a required set of FHIR-functionalities was identified and technically specified supported by official FHIR experts. Next, a “TTP-FHIR Gateway” for the HL7 FHIR-compliant exchange of consent information using gICS was implemented. A last step included external integration tests and the development of a pre-configured consent template for the BC for the NUM sites. Results A FHIR-compliant gICS-release and a corresponding consent template for the BC were provided to all NUM sites in June 2021. All FHIR functionalities comply with the already-balloted FHIR consent profiles of the HL7 Working Group Consent Management. The consent template simplifies the technical BC rollout and the corresponding implementation of the TFCI interoperability concept at the NUM sites. Conclusions This article shows that a HL7 FHIR-compliant and interoperable nationwide exchange of consent information could be built using of the consent management software gICS and the provided TTP-FHIR Gateway. The initial functional scope of the solution covers the requirements identified in the NUM-CODEX setting. The semantic correctness of these functionalities was validated by project-partners from the Ludwig-Maximilian University in Munich. The production rollout of the solution package to all NUM sites has started successfully.

The Woven Endobridge (WEB) device serves as an endosaccular flow-disruptor in the treatment of wide-necked cerebral aneurysms. Despite the varying availability of different WEB sizes, there are still limitations. Especially aneurysms with an width and height larger than 10 mm and 10.4 mm pose a particular challenge. Here we present a case report and technical note in the treatment of a large middle cerebral artery (MCA) aneurysm using the WEB device and adjunctive coiling. WEB-assisted coiling (WAC) of large aneurysms is a rarely described technique that allows intrasaccular embolization alone without the need for intracerebral stenting. Accurate sizing of the WEB device is very important in such cases. However, aneurysm recurrence must be considered and may require further treatment. More research is needed to further evaluate the safety and success of this technique.

The use of strobilurin fungicides in agriculture has increased steadily during the past 25 years, and although strobilurins have minimal water solubility, they regularly appear in surface waters, at times in concentrations approaching toxic levels for aquatic life. The present study examined concentrations of strobilurin fungicides in designated trout streams draining an agricultural watershed in southeastern Minnesota, USA, where fungicides may have contributed to a recent fish kill. Water samples (n = 131) were analyzed for the presence of five different strobilurin fungicides (azoxystrobin, fluoxastrobin, picoxystrobin, pyraclostrobin, trifloxystrobin). Samples were collected via grab and automated sampling during baseflow and stormflow events throughout an entire crop-growing season from sites on each of the three forks of the Whitewater River. Detection frequencies for the five strobilurins ranged from 44 to 82%. Fluoxastrobin and pyraclostrobin concentrations were above known toxic levels in 3% and 15% of total samples analyzed, respectively. The highest concentrations were detected in mid-summer (mid-June to mid-August) samples, coincident with likely strobilurin applications. Lower concentrations were present in water samples collected during the nonapplication periods in spring and fall, suggesting groundwater–stream interactions or steady leaching of fungicides from watershed soils or stream sediments. Further study is required to determine strobilurin concentrations in sediments, soils, and groundwater. Better tracking and guidance regarding strobilurin use is necessary to adequately protect aquatic life as fungicide use continues to increase.

Abstract Background Medical data from family doctors are of great importance to health care researchers but seem to be locked in German practices and, thus, are underused in research. The RADAR project (Routine Anonymized Data for Advanced Health Services Research) aims at designing, implementing and piloting a generic research architecture, technical software solutions as well as procedures and workflows to unlock data from family doctor’s practices. A long-term medical data repository for research taking legal requirements into account is established. Thereby, RADAR helps closing the gap between the European countries and to contribute data from primary care in Germany. Methods The RADAR project comprises three phases: (1) analysis phase, (2) design phase, and (3) pilot. First, interdisciplinary workshops were held to list prerequisites and requirements. Second, an architecture diagram with building blocks and functions, and an ordered list of process steps (workflow) for data capture and storage were designed. Third, technical components and workflows were piloted. The pilot was extended by a data integration workflow using patient-reported outcomes (paper-based questionnaires). Results The analysis phase resulted in listing 17 essential prerequisites and guiding requirements for data management compliant with the General Data Protection Regulation (GDPR). Based on this list existing approaches to fulfil the RADAR tasks were evaluated—for example, re-using BDT interface for data exchange and Trusted Third Party-approach for consent management and record linkage. Consented data sets of 100 patients were successfully exported, separated into person-identifying and medical data, pseudonymised and saved. Record linkage and data integration workflows for patient-reported outcomes in the RADAR research database were successfully piloted for 63 responders. Conclusion The RADAR project successfully developed a generic architecture together with a technical framework of tools, interfaces, and workflows for a complete infrastructure for practicable and secure processing of patient data from family doctors. All technical components and workflows can be reused for further research projects. Additionally, a Trusted Third Party-approach can be used as core element to implement data privacy protection in such heterogeneous family doctor’s settings. Optimisations identified comprise a fully-electronic consent recording using tablet computers, which is part of the project’s extension phase.

Abstract Background Defining and protecting participants’ rights is the aim of several ethical codices and legal regulations. According to these regulations, the Informed Consent (IC) is an inevitable element of research with human subjects. In the era of “big data medicine”, aspects of IC become even more relevant since research becomes more complex rendering compliance with legal and ethical regulations increasingly difficult. Methods Based on literature research and practical experiences gathered by the Institute for Community Medicine (ICM), University Medicine Greifswald, requirements for digital consent management systems were identified. Results To address the requirements, the free-of-charge, open-source software “generic Informed Consent Service” (gICS®) was developed by ICM to provide a tool to facilitate and enhance usage of digital ICs for the international research community covering various scenarios. gICS facilitates IC management based on IC modularisation and supports various workflows within research, including (1) electronic depiction of paper-based consents and (2) fully electronic consents. Numerous projects applied gICS and documented over 336,000 ICs and 2400 withdrawals since 2014. Discussion Since the consent’s content is a prerequisite for securing participants’ rights, application of gICS is no guarantee for legal compliance. However, gICS supports fine-granular consents and accommodation of differentiated consent states, which can be directly exchanged between systems, allowing automated data processing. Conclusion gICS simplifies and supports sustained IC management as a major key to successfully conduct studies and build trust in research with human subjects. Therefore, interested researchers are invited to use gICS and provide feedback for further improvements.

Abstract Background The identity management is a central component in medical research. Patients are recruited from various sites, which requires an error tolerant record linkage method, to ensure that patients are registered only once. In large research projects or institutions, the identity management has to deal with several thousands or millions of patients. In environments with large numbers of patients the register process could lead to high runtimes caused by record linkage. The Central Biomaterial Bank of the Charité (ZeBanC) searched for an identity management solution, which can handle millions of patients in large research projects with an acceptable performance. The goal of this paper was to simulate the registration of several million patients using the E-PIX service at Charité – Universitätsmedizin Berlin. The E-PIX service was evaluated in terms of needed runtimes, memory requirements, and processor utilization. A total of at least 20 million patients had to be registered. The runtimes to register patients into databases with various sizes should be examined, and the maximum number of patients, which the E-PIX service could handle, should be determined. Methods Tools were set up or developed to measure the needed runtimes, the memory used and the processor usage to register patients into various sizes of databases. To generate runtimes close to reality, modified patient data based on transposed real patient data were used for the simulation. The transposed patient data were sent to E-PIX to measure the runtimes of the registration process. This measurement was repeated for various database sizes. Results E-PIX is suitable to manage multi-million patients within a dataset. With the given hardware, it was possible to register a total of more than 30 million patients. It was possible to register more than 16 thousand patients per day into this database. Conclusions The E-PIX tool fulfills the requirements of the Charité to be used for large research projects. The use of E-PIX is intended for the research context in the Charité.

Introduction Medical research studies which involve electronic data capture of sensitive data about human subjects need to manage medical and identifying participant data in a secure manner. To protect the identity of data subjects, an independent trusted third party should be responsible for pseudonymization and management of the identifying data. Methods We have developed a web-based integrated solution that combines REDCap as an electronic data capture system with the trusted third party software tools of the University Medicine Greifswald, which provides study personnel with a single user interface for both clinical data entry and management of identities, pseudonyms and informed consents. Results Integration of the two platforms enables a seamless workflow of registering new participants, entering identifying and consent information, and generating pseudonyms in the trusted third party system, with subsequent capturing of medical data in the electronic data capture system, while maintaining strict separation of medical and identifying data in the two independently managed systems. Conclusion Our solution enables a time-efficient data entry workflow, provides a high level of data protection by minimizing visibility of identifying information and pseudonym lists, and avoids errors introduced by manual transfer of pseudonyms between separate systems. [ABSTRACT FROM AUTHOR]

Brown rot decay removes cellulose and hemicellulose from wood?residual lignin contributing up to 30percent of forest soil carbon?and is derived from an ancestral white rot saprotrophy in which both lignin and cellulose are decomposed. Comparative and functional genomics of the ?dry rot? fungus Serpula lacrymans, derived from forest ancestors, demonstrated that the evolution of both ectomycorrhizal biotrophy and brown rot saprotrophy were accompanied by reductions and losses in specific protein families, suggesting adaptation to an intercellular interaction with plant tissue. Transcriptome and proteome analysis also identified differences in wood decomposition in S. lacrymans relative to the brown rot Postia placenta. Furthermore, fungal nutritional mode diversification suggests that the boreal forest biome originated via genetic coevolution of above- and below-ground biota

BACKGROUND: An often assumed advantage of polycentric knee joints compared to monocentric ones is the improved ground clearance during swing phase due to the geometric shortening of the lower leg segment (LLS). OBJECTIVE: To investigate whether polycentric knee joints considerably improve ground clearance and to evaluate the influence of prosthetic alignment on the extent of ground clearance. METHODOLOGY: 11 polycentric and 2 monocentric knee joints were attached to a rigid, stationary testing device. Shortening of the LLS and the resulting ground clearance during knee flexion were measured. Prosthetic components were mounted at the same height and the anterior-posterior position was in accordance with the manufacturer's alignment recommendations. FINDINGS: Shortening of up to 14.7 (SD=0.0) mm at the instance of minimal ground clearance during swing phase was measured. One knee joint elongated by 4.4 (SD=0.0) mm. Measurements of the ground clearance demonstrated differences up to 25.4 (SD=0.0) mm. One monocentric knee joint provided more ground clearance when compared to 8 of the polycentric knee joints investigated. CONCLUSION: Only some polycentric knee joints shorten appreciably during swing phase. With an optimized prosthetic alignment and a well-designed swing phase control, a monocentric knee joint may generate greater ground clearance compared to a polycentric knee joint. LAYMAN’S ABSTRACT Tripping is a safety risk for amputees and it is mainly affected by ground clearance during swing phase. An often assumed advantage of polycentric knee joints compared to monocentric ones is the improved ground clearance during swing phase due to the geometric shortening of the lower leg segment (LLS). Based on this statement safety benefits for above knee-amputees due to reduced danger of stumbling are discussed commonly for the entire group of polycentric knee joints. We believe that this statement is not true for all polycentric knee joint designs. Therefore, we analyzed 11 polycentric and two monocentric knee joints in a rigid, stationary testing device with their individual prosthetic alignments according to the manufacturer’s alignment recommendations. Shortening of the LLS and the resulting ground clearance during knee flexion were measured. The results showed shortening effects of up to 15 mm. One knee joint elongated by 4 mm. One monocentric knee joint provided more ground clearance when compared to 8 of the polycentric knee joints investigated. We conclude, that only some polycentric knee joints shorten appreciably during swing phase. With an optimized prosthetic alignment a monocentric knee joint may generate greater ground clearance compared to a polycentric knee joint. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/33768/26547 How To Cite: Köhler T.M, Bellmann M, Blumentritt S. Polycentric Exoprosthetic Knee Joints – Extent of Shortening during Swing Phase. Canadian Prosthetics & Orthotics Journal. 2020;Volume3, Issue1, No.5. https://doi.org/10.33137/cpoj.v3i1.33768 Corresponding Author: Thomas Maximilian Köhler, MSc Ottobock: Hermann-Rein-Straße 2a, 37075, Göttingen. E-mail: thomasmaximilian.koehler@ottobock.de ORCID: https://orcid.org/0000-0002-5063-121X

Abstract Background The use of medical data for research purposes requires an informed consent of the patient that is compliant with the EU General Data Protection Regulation. In the context of multi-centre research initiatives and a multitude of clinical and epidemiological studies scalable and automatable measures for digital consent management are required. Modular form, structure, and contents render a patient’s consent reusable for varying project settings in order to effectively manage and minimise organisational and technical efforts. Results Within the DFG-funded project “MAGIC” (Grant Number HO 1937/5-1) the digital consent management service tool gICS was enhanced to comply with the recommendations published in the TMF data protection guideline for medical research. In addition, a structured exchange format for modular consent templates considering established standards and formats in the area of digital informed consent management was designed. Using the new FHIR standard and the HAPI FHIR library, the first version for an exchange format and necessary import-/export-functionalities were successfully implemented. Conclusions The proposed exchange format is a “work in progress”. It represents a starting point for current discussions concerning digital consent management. It also attempts to improve interoperability between different approaches within the wider IHE-/HL7-/FHIR community. Independent of the exchange format, providing the possibility to export, modify and import templates for consents and withdrawals to be reused in similar clinical and epidemiological studies is an essential precondition for the sustainable operation of digital consent management.

Abstract Background In most research projects budget, staff and IT infrastructures are limiting resources. Especially for small-scale registries and cohort studies professional IT support and commercial electronic data capture systems are too expensive. Consequently, these projects use simple local approaches (e.g. Excel) for data capture instead of a central data management including web-based data capture and proper research databases. This leads to manual processes to merge, analyze and, if possible, pseudonymize research data of different study sites. Results To support multi-site data capture, storage and analyses in small-scall research projects, corresponding requirements were analyzed within the MOSAIC project. Based on the identified requirements, the Toolbox for Research was developed as a flexible software solution for various research scenarios. Additionally, the Toolbox facilitates data integration of research data as well as metadata by performing necessary procedures automatically. Also, Toolbox modules allow the integration of device data. Moreover, separation of personally identifiable information and medical data by using only pseudonyms for storing medical data ensures the compliance to data protection regulations. This pseudonymized data can then be exported in SPSS format in order to enable scientists to prepare reports and analyses. Conclusions The Toolbox for Research was successfully piloted in the German Burn Registry in 2016 facilitating the documentation of 4350 burn cases at 54 study sites. The Toolbox for Research can be downloaded free of charge from the project website and automatically installed due to the use of Docker technology.