APLICAÇÃO DO NET PROMOTER SCORE (NPS) COMO MÉTODO AVALIATIVO NOS ESTÁGIOS DE ODONTOLOGIA: RELATO DE EXPERIÊNCIA

There are several means of evaluation used for clinical practices in the context of health sciences, in order to carry out a translational evaluation, that is, carried out by the professor, the student, the auxiliary student and mainly by the patient, who receives care. A good option for this purpose, given the ease of application and interpretation of data, is the Net Promoter Score (NPS). The objective of this study was to verify the applicability of the NPS, as a means of evaluating students by patients in a Family Health Unit in the context of supervised training. Printed questionnaires, with the question: “On a scale of 0 to 10, how much would you recommend the duo responsible for your care, based on your dental care, being 0 (would not recommend) and 10 (would recommend without a doubt), were delivered and after being filled out, placed in a sealed ballot box to preserve identity. Assessments were carried out for two weeks. Patients are increasingly involved in assessing the quality of care as consumers of health care, and the results of assessments such as the one reported in this study can encourage improvements in access and quality of service. It can be seen from the above that the NPS can be a valid evaluation method in the context of public health internships, given the ease of application and good adherence of patients, associated with its ability to measure satisfaction based on assertive feedback and consequent improvement in practices of health care.Existen varios medios de evaluación utilizados para las prácticas clínicas en el contexto de las ciencias de la salud, con el fin de realizar una evaluación traslacional, principalmente por el paciente, quien recibe la atención. Una buena opción para este fin, dada la facilidad de aplicación , es el Net Promoter Score (NPS). El objetivo de este estudio fue verificar la aplicabilidad del NPS, como medio de evaluación de estudiantes por parte de pacientes en una Unidad de Salud de la Familia en el contexto de formación supervisada. Cuestionarios impresos, con la pregunta: “En una escala de 0 a 10, ¿cuánto recomendaría a la dupla responsable de su cuidado, en función de su cuidado dental, siendo 0 (no recomendaría) y 10 (recomendaría sin lugar a dudas) , fueron entregados y luego de ser llenados, colocados en una urna sellada para preservar la identidad. Las evaluaciones se llevaron a cabo durante dos semanas. Los pacientes participan cada vez más en la evaluación de la calidad de la atención como consumidores de atención sanitaria, y los resultados de evaluaciones como la presentada  pueden fomentar mejoras en el acceso y la calidad del servicio. Se desprende que el NPS puede ser un método de evaluación válido en el contexto de las pasantías en salud pública, dada la facilidad de aplicación y adherencia de los pacientes, asociada a su capacidad para medir la satisfacción a partir de una retroalimentación asertiva y la consecuente mejora en la calidad de vida. prácticas de atención de salud.Diversos são os meios de avaliação utilizados para as práticas clínicas no contexto das ciências da saúde, no intuito de se realizar uma avaliação translacional, ou seja, realizada pelo professor, pelo estudante, pelo estudante auxiliar e principalmente pelo paciente, que recebe os cuidados. Uma boa opção para este fim, dada a facilidade de aplicação e interpretação de dados, é o Net Promoter Score (NPS). O objetivo deste trabalho foi verificar a aplicabilidade do NPS, como meio de avaliação dos estudantes por parte dos pacientes em uma Unidade de Saúde da Família no contexto do estágio supervisionado. Questionários impressos, com a pergunta: “Em uma escala de 0 a 10, quanto você recomendaria a dupla responsável por seus cuidados, baseado em seu atendimento odontológico, sendo 0 (não indicaria) e 10 (indicaria sem nenhuma dúvida), foram entregues e após preenchidos colocados em uma urna lacrada para preservação da identidade. As avaliações foram realizadas por duas semanas. Os pacientes se encontram cada vez mais envolvidos na avaliação da qualidade do atendimento como consumidores de cuidados de saúde, e resultados de avaliações como a relatada nesse estudo podem fomentar melhorias no acesso e na qualidade do serviço. Percebe-se, após o exposto, que a NPS pode ser um método avaliativo válido no contexto dos estágios em saúde coletiva, posto a facilidade de aplicação e boa adesão dos pacientes, associado à sua capacidade de mensurar a satisfação embasando feedbacks assertivos e consequente melhoria nas práticas de atenção em saúde.Diversos são os meios de avaliação utilizados para as práticas clínicas no contexto das ciências da saúde, no intuito de se realizar uma avaliação translacional, ou seja, realizada pelo professor, pelo estudante, pelo estudante auxiliar e principalmente pelo paciente, que recebe os cuidados. Uma boa opção para este fim, dada a facilidade de aplicação e interpretação de dados, é o Net Promoter Score (NPS). O objetivo deste trabalho foi verificar a aplicabilidade do NPS, como meio de avaliação dos estudantes por parte dos pacientes em uma Unidade de Saúde da Família no contexto do estágio supervisionado. Questionários impressos, com a pergunta: “Em uma escala de 0 a 10, quanto você recomendaria a dupla responsável por seus cuidados, baseado em seu atendimento odontológico, sendo 0 (não indicaria) e 10 (indicaria sem nenhuma dúvida), foram entregues e após preenchidos colocados em uma urna lacrada para preservação da identidade. As avaliações foram realizadas por duas semanas. Os pacientes se encontram cada vez mais envolvidos na avaliação da qualidade do atendimento como consumidores de cuidados de saúde, e resultados de avaliações como a relatada nesse estudo podem fomentar melhorias no acesso e na qualidade do serviço. Percebe-se, após o exposto, que a NPS pode ser um método avaliativo válido no contexto dos estágios em saúde coletiva, posto a facilidade de aplicação e boa adesão dos pacientes, associado à sua capacidade de mensurar a satisfação embasando feedbacks assertivos e consequente melhoria nas práticas de atenção em saúde

TRAÇÃO MAXILAR COM ANCORAGEM ESQUELÉTICA POR MINIPLACAS DE TITÂNIO COMO SUBSTITUTO DA MÁSCARA FACIAL NO TRATAMENTO DA CLASSE III – REVISÃO INTEGRATIVA DA LITERATURA

Until the advent of absolute anchorage with titanium plates, the interceptive treatment of skeletal Class III had ideally been conducted through maxillary traction using facial masks, which led to some resistance from specialists towards alternative methods. Therefore, the objective of this study was to conduct a literature review comparing the two treatment approaches, pointing out the advantages and disadvantages of each modality and considering the possibility of using skeletal anchorage devices with titanium miniplates to definitively replace facial mask therapy in Class III patients. The research was carried out using the search platforms PubMed/MEDLINE and SciELO under the eligibility criteria of the PRISMA-ScR strategy for qualitative analysis. Absolute anchorage does not use teeth for support, minimizing dentoalveolar compensations while promoting remarkable maxillary advancement. Therefore, it can be concluded that the possibility of achieving the necessary correction without extraoral devices is encouraging, justifying the search and organization of studies that demonstrate the acceptance and the real capacity to obtain good results with the new therapeutic modality.Hasta el advenimiento del anclaje absoluto con placas de titanio, el tratamiento interceptivo de la Clase III esquelética se llevaba a cabo idealmente mediante tracción maxilar utilizando máscaras faciales, lo que generaba cierta resistencia por parte de los especialistas hacia métodos alternativos. Por lo tanto, el objetivo de este estudio fue realizar una revisión de literatura comparando las dos formas de tratamiento, señalando las ventajas y desventajas de cada modalidad y considerando la posibilidad de que los dispositivos de anclaje esquelético con miniplacas de titanio reemplacen definitivamente la terapia con máscara facial en pacientes con Clase III. Para llevar a cabo esta investigación, se utilizaron las plataformas de búsqueda PubMed/MEDLINE y SciELO bajo los criterios de elegibilidad de la estrategia PRISMA-ScR para el análisis cualitativo. El anclaje absoluto no utiliza los dientes como soporte, minimizando las compensaciones dentoalveolares, al tiempo que promueve un notable avance maxilar. Por lo tanto, se concluye que la posibilidad de lograr la corrección necesaria sin dispositivos extraorales es alentadora, justificando la búsqueda y organización de estudios que demuestren la aceptación y la verdadera capacidad de obtener buenos resultados con la nueva modalidad terapêutica.Até o advento da ancoragem absoluta com placas de titânio, o tratamento interceptativo da Classe III esquelética vinha sendo conduzido idealmente por tração maxilar a partir das máscaras faciais, o que confere uma certa resistência dos especialistas a métodos alternativos. Portanto, o objetivo deste estudo foi realizar uma revisão de literatura comparando as duas formas de tratamento, apontando vantagens e desvantagens de uma e outra modalidade e considerando a possibilidade de a utilização de dispositivos de ancoragem esquelética com miniplacas de titânio substituírem definitivamente a terapia com máscara facial em pacientes portadores de Classe III. Para a realização desse trabalho foram utilizadas as plataformas de busca PubMed/MEDLINE e SciELO sob os critérios de elegibilidade da estratégia PRISMA - ScR para análise qualitativa. A ancoragem absoluta não usa dentes como apoio, minimizando as compensações dentoalveolares, enquanto promove notável avanço maxilar. Conclui-se, portanto, que a possibilidade de se alcançar a correção necessária sem dispositivos extrabucais é alentadora, justificando a busca e ordenação de estudos que demonstrem a aceitação e a real capacidade de obtenção de bons resultados com a nova modalidade terapêutica.Até o advento da ancoragem absoluta com placas de titânio, o tratamento interceptativo da Classe III esquelética vinha sendo conduzido idealmente por tração maxilar a partir das máscaras faciais, o que confere uma certa resistência dos especialistas a métodos alternativos. Portanto, o objetivo deste estudo foi realizar uma revisão de literatura comparando as duas formas de tratamento, apontando vantagens e desvantagens de uma e outra modalidade e considerando a possibilidade de a utilização de dispositivos de ancoragem esquelética com miniplacas de titânio substituírem definitivamente a terapia com máscara facial em pacientes portadores de Classe III. Para a realização desse trabalho foram utilizadas as plataformas de busca PubMed/MEDLINE e SciELO sob os critérios de elegibilidade da estratégia PRISMA - ScR para análise qualitativa. A ancoragem absoluta não usa dentes como apoio, minimizando as compensações dentoalveolares, enquanto promove notável avanço maxilar. Conclui-se, portanto, que a possibilidade de se alcançar a correção necessária sem dispositivos extrabucais é alentadora, justificando a busca e ordenação de estudos que demonstrem a aceitação e a real capacidade de obtenção de bons resultados com a nova modalidade terapêutica

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical science. © The Author(s) 2019. Published by Oxford University Press