Indicadores para a avaliação do processo transfusional: revisão integrativa

Objective: to identify transfusion-related indicators. Method: an integrative literature review carried out between March and May 2022, in nine sources of information from 2001 to 2021. As a search strategy, the descriptors “Quality Indicators in Health Care”, “Service Indicators”, “Basic Health Indicators”, “Hemotherapy Service”, “Blood Transfusion”, “Blood Safety” were used, with Boolean operators “AND” and “OR” in three languages, with 49 articles being analyzed. Results: a total of 53 indicators were identified, which were grouped for: blood component stock management, transfusion process production, transfusion process assessment and transfusion process support. Conclusion: the identified indicators make it possible to assess the transfusion process, although activities, such as care assessment, present few indicators, highlighting the need for studies on the subject and the construction of new indicators to support a more improved transfusion process assessment.Objetivo: identificar indicadores relacionados con el proceso de transfusión. Método: revisión integrativa de la literatura, realizada entre marzo y mayo de 2022, en nueve fuentes de información de 2001 a 2021. Como estrategia de busca, se utilizaron los descriptores “Indicadores de Calidad en la Atención de Salud”, “Indicadores de Servicio”, “Indicadores Básicos de Salud”, “Servicio de Hemoterapia”, “Transfusión de Sangre”, “Seguridad de la Sangre”, con operadores booleanos “AND” y “OR” en tres idiomas, analizando 49 artículos. Resultados: se identificaron 53 indicadores, los cuales fueron agrupados en: gestión del stock de hemocomponentes, producción del proceso transfusional, evaluación del proceso transfusional y apoyo al proceso transfusional. Conclusión: los indicadores identificados posibilitan la evaluación del proceso transfusional, aunque actividades, como la evaluación del cuidado, presenten pocos indicadores, destacando la necesidad de estudios sobre el tema y la construcción de nuevos indicadores que apoyen una evaluación más perfeccionada del proceso de transfusión.Objetivo: identificar os indicadores relacionados ao processo transfusional. Método: revisão integrativa de literatura realizada entre março e maio de 2022, em nove fontes de informação no período de 2001 a 2021. Como estratégia de busca, utilizaram-se os descritores "Indicadores de Qualidade em Assistência à Saúde", "Indicadores de Serviços", "Indicadores Básicos de Saúde", “Serviço de Hemoterapia", "Transfusão de Sangue", "Segurança do Sangue”, com os operadores boleanos “AND” e “OR” em três idiomas, sendo analisados 49 artigos. Resultados: foram identificados 53 indicadores, os quais se agruparam para: gestão do estoque de hemocomponentes, de produção do processo transfusional, para avaliação do processo transfusional e de suporte do processo transfusional. Conclusão: os indicadores identificados possibilitam avaliação do processo transfusional, apesar de atividades, como a avaliação do cuidado, apresentarem poucos indicadores, evidenciando a necessidade de estudos sobre a temática e construção de novos indicadores para dar sustentação à avaliação mais aprimorada do processo transfusional

Analyzing recommender systems for health promotion using a multidisciplinary taxonomy: A scoping review

Background: Recommender systems are information retrieval systems that provide users with relevant items (e.g., through messages). Despite their extensive use in the e-commerce and leisure domains, their application in healthcare is still in its infancy. These systems may be used to create tailored health interventions, thus reducing the cost of healthcare and fostering a healthier lifestyle in the population. Objective: This paper identifies, categorizes, and analyzes the existing knowledge in terms of the literature published over the past 10 years on the use of health recommender systems for patient interventions. The aim of this study is to understand the scientific evidence generated about health recommender systems, to identify any gaps in this field to achieve the United Nations Sustainable Development Goal 3 (SDG3) (namely, “Ensure healthy lives and promote well-being for all at all ages”), and to suggest possible reasons for these gaps as well as to propose some solutions. Methods: We conducted a scoping review, which consisted of a keyword search of the literature related to health recommender systems for patients in the following databases: ScienceDirect, PsycInfo, Association for Computing Machinery, IEEExplore, and Pubmed. Further, we limited our search to consider only English-lan-guage journal articles published in the last 10 years. The reviewing process comprised three researchers who filtered the results simultaneously. The quantitative synthesis was conducted in parallel by two researchers, who classified each paper in terms of four aspects—the domain, the methodological and procedural aspects, the health promotion theoretical factors and behavior change theories, and the technical aspects—using a new multidisciplinary taxonomy. Results: Nineteen papers met the inclusion criteria and were included in the data analysis, for which thirty-three features were assessed. The nine features associated with the health promotion theoretical factors and behavior change theories were not observed in any of the selected studies, did not use principles of tailoring, and did not assess (cost)-effectiveness. Discussion: Health recommender systems may be further improved by using relevant behavior change strategies and by implementing essential characteristics of tailored interventions. In addition, many of the features required to assess each of the domain aspects, the methodological and procedural aspects, and technical aspects were not reported in the studies. Conclusions: The studies analyzed presented few evidence in support of the positive effects of using health recommender systems in terms of cost-effectiveness and patient health outcomes. This is why future studies should ensure that all the proposed features are covered in our multidisciplinary taxonomy, including integration with electronic health records and the incorporation of health promotion theoretical factors and behavior change theories. This will render those studies more useful for policymakers since they will cover all aspects needed to determine their impact toward meeting SDG3.European Union's Horizon 2020 No 68112

Discordant Increases in CD4+ T Cells in Human Immunodeficiency Virus-Infected Patients Experiencing Virologic Treatment Failure: Role of Changes in Thymic Output and T Cell Death

Some patients infected with human immunodeficiency virus (HIV) who are experiencing antiretroviral treatment failure have persistent improvement in CD4+ T cell counts despite high plasma viremia. To explore the mechanisms responsible for this phenomenon, 2 parameters influencing the dynamics of CD4+ T cells were evaluated: death of mature CD4+ T cells and replenishment of the CD4+ T cell pool by the thymus. The improvement in CD4+ T cells observed in patients with treatment failure was not correlated with spontaneous, Fas ligand-induced, or activation-induced T cell death. In contrast, a significant correlation between the improvement in CD4+ T cell counts and thymic output, as assessed by measurement of T cell receptor excision circles, was observed. These observations suggest that increased thymic output contributes to the dissociation between CD4+ T cell counts and viremia in patients failing antiretroviral therapy and support a model in which drug-resistant HIV strains may have reduced replication rates and pathogenicity in the thymu

Opening the Black Box: Explaining the Process of Basing a Health Recommender System on the I-Change Behavioral Change Model

Recommender systems are gaining traction in healthcare because they can tailor recommendations based on users' feedback concerning their appreciation of previous health-related messages. However, recommender systems are often not grounded in behavioral change theories, which may further increase the effectiveness of their recommendations. This paper's objective is to describe principles for designing and developing a health recommender system grounded in the I-Change behavioral change model that shall be implemented through a mobile app for a smoking cessation support clinical trial. We built upon an existing smoking cessation health recommender system that delivered motivational messages through a mobile app. A group of experts assessed how the system may be improved to address the behavioral change determinants of the I-Change behavioral change model. The resulting system features a hybrid recommender algorithm for computer tailoring smoking cessation messages. A total of 331 different motivational messages were designed using 10 health communication methods. The algorithm was designed to match 58 message characteristics to each user pro le by following the principles of the I-Change model and maintaining the bene ts of the recommender system algorithms. The mobile app resulted in a streamlined version that aimed to improve the user experience, and this system's design bridges the gap between health recommender systems and the use of behavioral change theories. This article presents a novel approach integrating recommender system technology, health behavior technology, and computer-tailored technology. Future researchers will be able to build upon the principles applied in this case study.European Union's Horizon 2020 Research and Innovation Programme under Grant 68112

Testing a Dutch web-based tailored lifestyle programme among adults: a study protocol

<p>Abstract</p> <p>Background</p> <p>Smoking, high alcohol consumption, unhealthy eating habits and physical inactivity often lead to (chronic) diseases, such as cardiovascular diseases and cancer. Tailored online interventions have been proven to be effective in changing health behaviours. The aim of this study is to test and compare the effectiveness of two different tailoring strategies for changing lifestyle compared to a control group using a multiple health behaviour web-based approach.</p> <p>Methods</p> <p>In our Internet-based tailored programme, the five lifestyle behaviours of smoking, alcohol intake, fruit consumption, vegetable consumption, and physical activity are addressed. This randomized controlled trial, conducted among Dutch adults, includes two experimental groups (i.e., a sequential behaviour tailoring condition and a simultaneous behaviour tailoring condition) and a control group. People in the sequential behaviour tailoring condition obtain feedback on whether their lifestyle behaviours meet the Dutch recommendations. Using a step-by-step approach, they are stimulated to continue with a computer tailored module to change only one unhealthy behaviour first. In the course of the study, they can proceed to change a second behaviour. People in the simultaneous behaviour tailoring condition receive computer tailored feedback about all their unhealthy behaviours during their first visit as a stimulation to change all unhealthy behaviours. The experimental groups can re-visit the website and can then receive ipsative feedback (i.e., current scores are compared to previous scores in order to give feedback about potential changes). The (difference in) effectiveness of the different versions of the programme will be tested and compared to a control group, in which respondents only receive a short health risk appraisal. Programme evaluations will assess satisfaction with and appreciation and personal relevance of the intervention among the respondents. Finally, potential subgroup differences pertaining to gender, age and socioeconomic status regarding the behaviour effects and programme evaluation will be assessed.</p> <p>Discussion</p> <p>Research regarding multiple behaviour change is in its infancy. We study how to offer multiple behaviour change interventions optimally. Using these results could strengthen the effectiveness of web-based computer-tailoring lifestyle programmes. This study will yield new results about the need for differential lifestyle approaches using Internet-based expert systems and potential differences in subgroups concerning the effectiveness and appreciation.</p> <p>Trial registration</p> <p>Dutch Trial Register <a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2168">NTR2168</a>.</p

Improving completeness of electronic problem lists through clinical decision support: a randomized, controlled trial

Background: Accurate clinical problem lists are critical for patient care, clinical decision support, population reporting, quality improvement, and research. However, problem lists are often incomplete or out of date. Objective: To determine whether a clinical alerting system, which uses inference rules to notify providers of undocumented problems, improves problem list documentation. Study Design and Methods: Inference rules for 17 conditions were constructed and an electronic health record-based intervention was evaluated to improve problem documentation. A cluster randomized trial was conducted of 11 participating clinics affiliated with a large academic medical center, totaling 28 primary care clinical areas, with 14 receiving the intervention and 14 as controls. The intervention was a clinical alert directed to the provider that suggested adding a problem to the electronic problem list based on inference rules. The primary outcome measure was acceptance of the alert. The number of study problems added in each arm as a pre-specified secondary outcome was also assessed. Data were collected during 6-month pre-intervention (11/2009–5/2010) and intervention (5/2010–11/2010) periods. Results: 17,043 alerts were presented, of which 41.1% were accepted. In the intervention arm, providers documented significantly more study problems (adjusted OR=3.4, p<0.001), with an absolute difference of 6,277 additional problems. In the intervention group, 70.4% of all study problems were added via the problem list alerts. Significant increases in problem notation were observed for 13 of 17 conditions. Conclusion: Problem inference alerts significantly increase notation of important patient problems in primary care, which in turn has the potential to facilitate quality improvement

Effects of zinc transporters on Cryptococcus gattii virulence

Zinc is an essential nutrient for all living organisms because it is a co-factor of several important proteins. Furthermore, zinc may play an essential role in the infectiousness of microorganisms. Previously, we determined that functional zinc metabolism is associated with Cryptococcus gattii virulence. Here, we characterized the ZIP zinc transporters in this human pathogen. Transcriptional profiling revealed that zinc levels regulated the expression of the ZIP1, ZIP2 and ZIP3 genes, although only the C. gattii zinc transporter Zip1 was required for yeast growth under zinc-limiting conditions. To associate zinc uptake defects with virulence, the most studied cryptococcal virulence factors (i.e., capsule, melanin and growth at 37 °C) were assessed in ZIP mutant strains; however, no differences were detected in these classical virulence-associated traits among the mutant and WT strains. Interestingly, higher levels of reactive oxygen species were detected in the zip1Δ and in the zip1Δ zip2Δ double mutants. In line with these phenotypic alterations, the zip1Δ zip2Δ double mutant displayed attenuated virulence in a murine model of cryptococcosis. Together, these results indicate that adequate zinc uptake is necessary for cryptococcal fitness and virulence

Ambientes de ocorrência do porífero Oncosclera jewelli no Parque Estadual Do Tainhas, Planalto Meridional do RS: uma análise geomorfométrica

Tainhas State Park embraces locations of occurrence of freshwater sponge Oncosclera jewelli. Our objective is to indicate the areas of potential occurrence of the species from factors related to the geomorphometric signature of the occurance points along the Tainhas River in the Park and its buffer zone. Connections and data analysis were performed from the construction and manipulation of a geographic database, in SIGs SPRING-5.4.3 and QGIS-2.18, containing: a) MDEs from Topodata, Embrapa and Alos bases, obtained by remote orbitals sensors for the entire study area, and MDE obtained by drone-generated aerial images of the geomorphometric variables: slope, aspect and topographic position index; b) geological map of Rio Grande do Sul; c) land use and coverage map, based on images from the GeoEye satellite. The results demonstrated that the species occurs exclusively on the lithological unit of Serra Geral Formation. The plain is marked by terrain of low slope and south and east orientation and flattened plains. The Potential Occurrence Map of the species was generated, demonstrating that approximately 4.5% of the total length of watercourse stretches in the study area meet the analyzed geomorphometric conditions.O Parque Estadual do Tainhas abrange ambientes de ocorrência do porífero Oncosclera jewelli. Nosso objetivo é indicar as áreas de potencial ocorrência da espécie a partir de fatores relacionados à assinatura geomorfométrica dos pontos de ocorrência ao longo do Rio Tainhas no Parque e sua zona de amortecimento. Foram realizados cruzamentos e análises de dados a partir da construção e manipulação de um banco de dados geográficos, nos SIGs SPRING-5.4.3 e QGIS-2.18, contendo: a) MDEs oriundos das bases Topodata, Embrapa e Alos, obtidos por sensores remotos orbitais para toda a área de estudo, e MDE obtido por imagens aéreas geradas por Drone e as variáveis geomorfométricas produzidas: declividade, aspecto e índice de posição topográfica; b) mapa geológico do Rio Grande do Sul; c) mapa de uso e cobertura do solo, com base em imagens do satélite GeoEye. Os resultados demonstraram que a espécie ocorre exclusivamente sobre a unidade litológica da Formação Serra Geral. O relevo é marcado por terrenos de baixa declividade e orientação sul e leste e em relevo aplainado. Foi gerado o Mapa de Potencial Ocorrência da espécie, demonstrando que aproximadamente 4,5% do comprimento total dos trechos de cursos d’água na área de estudo reúnem as condicionantes geomorfométricas identificadas como de potencial ocorrência da espécie

Transcriptomic analysis reveals that mTOR pathway can be modulated in macrophage cells by the presence of cryptococcal cells

Cryptococcus neoformans and Cryptococcus gattii are the etiological agents of cryptococcosis, a high mortality disease. The development of such disease depends on the interaction of fungal cells with macrophages, in which they can reside and replicate. In order to dissect the molecular mechanisms by which cryptococcal cells modulate the activity of macrophages, a genome-scale comparative analysis of transcriptional changes in macrophages exposed to Cryptococcus spp. was conducted. Altered expression of nearly 40 genes was detected in macrophages exposed to cryptococcal cells. The major processes were associated with the mTOR pathway, whose associated genes exhibited decreased expression in macrophages incubated with cryptococcal cells. Phosphorylation of p70S6K and GSK-3β was also decreased in macrophages incubated with fungal cells. In this way, Cryptococci presence could drive the modulation of mTOR pathway in macrophages possibly to increase the survival of the pathogen

Severe Obesity and Selected Risk Factors in a Sixth Grade Multiracial Cohort: The HEALTHY Study

To document the prevalence of severe obesity and associated risk in the HEALTHY cohort