INTEROPERABILITY OF PUBLIC HEALTH INFORMATION SYSTEMS IN THE STATE OF AMAPÁ

Interoperability in public health has major advantages over agility gains throughout the state bureaucratic logistics system. This agility is fundamental to help relieve the highest demand in all areas of health sciences in the Brazilian public service. This short communication aims to inform the population of Amapa and the academic community about the implementation of interoperability of public health services in the state of Amapá. The service is already in its implementation phase and is expected to end and be fully used by early 2020.A interoperabilidade em saúde pública tem grandes vantagens sobre os ganhos de agilidade em todo o sistema de logística burocrática do estado. Essa agilidade é fundamental para ajudar a aliviar a maior demanda em todas as áreas das ciências da saúde no serviço público brasileiro. Esta breve comunicação visa informar a população do Amapá e a comunidade acadêmica sobre a implementação da interoperabilidade dos serviços públicos de saúde no estado do Amapá. O serviço já está em sua fase de implementação e deve terminar e ser totalmente utilizado no início de 2020

Extra short 4mm implants used to rehabilitation of atrophic posterior mandible. A serial case reports

Rehabilitation of patients through implants in areas with severe bone resorption in the posterior mandible is a challenge in implant dentistry. In this context, extra short implants configure a treatment option for this type of patient, as they can avoid increased financial cost, treatment time and patient morbidity. The present study evaluated the marginal bone stability in individualized extra-short implants for masticatory function in the posterior mandible. Using digitized periapical radiographs of 13 extra-short implants performed on 7 patients. The mesial and distal regions of each implant were selected, from the bone crest to the region parallel to the apex, and the bone stability of this crest was measured using the Image J software immediate T1 and 1 year after rehabilitation (T2). The height of the bone crest remained stable, showing no statistically significant difference between T1 and T2 (p> 0.005) for both the mesial bone crest and the distal bone crest in individual or united crowns rehabilitation. Marginal bone stability was observed in extra short implants, corroborating the biological and biomechanical stability of these implants presented in the literature. Despite the limited sample size and proservation time, extra-short implants are predictive treatment options for patients with severe bone atrophy in the posterior mandible

Peri-implantite e mucosite peri-implantar. Fatores de risco, diagnóstico e tratamento.

Introduction: The aim of this paper is to deepen the knowledge of peri-implant disease and existing treatments described in the literature. Material and methods: Literature review of peri-implant disease based on a search in databases like PubMed and Medline using keywords "periimplantitis, mucositis, tabaquism, oral microbiota, occlusal overload, surgical treatment, antimicrobial therapy, detoxification, regenerative therapy, bone defects". Development and discussion: Analysis of risk factors, diagnosis and treatment of peri-implant disease. Conclusions: Factors such as tabaquism or a history of periodontitis, along with poor oral hygiene are the main causes of peri-implant disease. A correct diagnosis of the cause and the appropriate choice of therapy may stop the progression of peri-implant disease. Following treatment done, it will be very important to do the periodic controls and maintenance of proper oral hygiene.Introdução: O objetivo deste trabalho é aprofundar o conhecimento da doença peri-implantar e os tratamentos existentes descritos na literatura. Material e método: Revisão bibliográfica das doenças peri-implantares, com base em uma pesquisa nos indexadores Pubmed, Medline e Cochrane Library, utilizando os uni termos " peri-implantite, mucosite, dependência de tabaco, microbiota oral, sobrecarga oclusal, tratamento cirúrgico, terapia antimicrobiana, desintoxicação,  terapia regenerativa, defeitos ósseos ". Desenvolvimento e discussão: Análise de fatores de risco, diagnóstico e tratamento de doenças peri-implantares. Conclusões: Fatores como tabaco ou histórico de periodontite, juntamente com falta de higiene bucal, são as principais causas da doença peri-implantar. Um diagnóstico correto da etiologia, bem como a escolha apropriada da terapêutica, pode interromper o avanço da doença peri-implantar. Após o tratamento realizado, será muito importante o monitoramento e manutenção regulares da higiene bucal adequada

Tração necessária para a remoção de copings de coroa fundida cimentada em pilares de implante dentário.

Introduction: Implant-supported fixed prostheses are alternative treatments increasingly common in dental clinics. They can be screwed or cemented depending on the surgical planning. Screwed prostheses are reversible, have greater bacterial infiltrate, aesthetics impaired by the screw hole. Cemented prostheses have reversal difficulties, loss of the prosthesis in case of screw loosening and better aesthetics due to the lack of screw hole. Objectives: In this context, the present study aims to evaluate the tensile strength levels of cemented copping´s by 2 different types of cement for fixation of cemented implant-supported crowns. Methodology: Three specimens were made with implants and crowns cemented with different materials, where each of these specimens was submitted to a traction test. Results: Zinc phosphate cemented copping's (CP1 and CP4) required a tensile strength of 118.02 N and 213.63 N respectively, while resin cemented copping's (C2 and C3) required a tensile strength of 258.93 N and 228.87 N respectively. Conclusion: Within the limitations of the current in vitro conditions employed in this study, retention of cemented crown copping's in the resin abutment and zinc phosphate cement implant abutments was significantly affected by the cement type. Resin cement required significantly higher tensile strength than zinc phosphate cement for removal of copipngs.  Introdução: As próteses fixas implanto-suportadas são alternativas de tratamentos cada dia mais frequente nas clinicas odontológicas. Elas podem ser parafusadas ou cimentadas dependendo do planejamento cirúrgico. As próteses parafusadas são reversíveis, tem maior infiltrado bacteriano, estética prejudicada pelo orifício dos parafusos. As próteses cimentadas têm dificuldades de reversão, perda da prótese em caso de afrouxamento de parafuso e uma melhor estética por não ter orifício do parafuso. Objetivos: Nesse contexto, o presente estudo, pretender avaliar os níveis de resistência a tração dos copping´s cimentados por 2 diferentes tipos de cimentos para fixação de coroas implanto-suportadas cimentadas. Metodologia: Foram confeccionados três corpos de prova com implantes e coroas cimentadas com diferentes matérias, onde cada um desses corpos de prova foi submetido a um teste de tracionamento. Resultados: Os copping´s cimentados com cimento fosfato de zinco (CP1 e CP4) exigiram uma força de tração de 118.02 kgf e 213.63 kgf respectivamente, enquanto os copping´s cimentados com cimento resinoso (C2 e C3) exigiram uma força de tração de 258.93 kgf e 228.87 kgf respectivamente. Conclusão: Dentro das limitações das atuais condições in vitro empregadas neste estudo, a retenção de copping’s de coroa cimentada nos pilares de implantes com cimento resinoso e cimento fosfato de zinco foi significativamente afetada pelo tipo de cimento. O cimento resinoso exigiu uma força de tração significativamente maior que o cimento fosfato de zinco para a remoção dos copipng’s

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)