La Ludomotricidad en la Numeración y Seriación en Estudiantes del Cuarto Grado de Primaria, UGEL 05 2016

El trabajo de investigación, se planteó como objetivo general: Determinar los efectos de la Ludomotricidad en la numeración y seriación en estudiantes del cuarto grado de primaria, de la I.E Francisco Bolognesi – UGEL 05. El tipo de investigación fue aplicada de nivel explicativo, el diseño cuasi experimental con dos grupos: uno experimental y control, aplicando un pre test y un ´post test a ambos grupos. El enfoque es cuantitativo y el método de investigación fue el hipotético deductivo. La muestra estuvo compuesta por 150 estudiantes del cuarto grado de primaria de la institución educativa Francisco Bolognesi, UGEL 05. El tipo de muestreo aplicado fue no probabilístico. El instrumento de recolección de datos fue la prueba de aplicación. Para la validez del instrumento se utilizó el juicio de expertos y para la confiabilidad se utilizó el Kuder y Richardson (KR 20) que salió 0,906 para la numeración y 0,914 para la seriación. Los resultados fueron ordenados en tablas y figuras comparando en cada una de ellas los puntajes y porcentajes obtenidos por el grupo experimental y control. Para las pruebas de hipótesis se aplicó La t de Student cuyo p valor fue de 0,000 menor al nivel a (0, 05) rechazando la hipótesis nula y aceptando la alterna, es decir la Ludomotricidad mejora significativamente el aprendizaje de la numeración y seriación en los estudiantes de cuarto grado de primaria de la institución educativa Francisco Bolognesi, UGEL 05

Cancer Multidisciplinary Team Meetings: Evidence, Challenges, and the Role of Clinical Decision Support Technology

Multidisciplinary team (MDT) model in cancer care was introduced and endorsed to ensure that care delivery is consistent with the best available evidence. Over the last few years, regular MDT meetings have become a standard practice in oncology and gained the status of the key decision-making forum for patient management. Despite the fact that cancer MDT meetings are well accepted by clinicians, concerns are raised over the paucity of good-quality evidence on their overall impact. There are also concerns over lack of the appropriate support for this important but overburdened decision-making platform. The growing acceptance by clinical community of the health information technology in recent years has created new opportunities and possibilities of using advanced clinical decision support (CDS) systems to realise full potential of cancer MDT meetings. In this paper, we present targeted summary of the available evidence on the impact of cancer MDT meetings, discuss the reported challenges, and explore the role that a CDS technology could play in addressing some of these challenges

Data-driven discovery of changes in clinical code usage over time: a case-study on changes in cardiovascular disease recording in two English electronic health records databases (2001-2015)

[EN] Objectives To demonstrate how data-driven variability methods can be used to identify changes in disease recording in two English electronic health records databases between 2001 and 2015. Design Repeated cross-sectional analysis that applied data-driven temporal variability methods to assess month-by-month changes in routinely collected medical data. A measure of difference between months was calculated based on joint distributions of age, gender, socioeconomic status and recorded cardiovascular diseases. Distances between months were used to identify temporal trends in data recording. Setting 400 English primary care practices from the Clinical Practice Research Datalink (CPRD GOLD) and 451 hospital providers from the Hospital Episode Statistics (HES). Main outcomes The proportion of patients (CPRD GOLD) and hospital admissions (HES) with a recorded cardiovascular disease (CPRD GOLD: coronary heart disease, heart failure, peripheral arterial disease, stroke; HES: International Classification of Disease codes I20-I69/G45). Results Both databases showed gradual changes in cardiovascular disease recording between 2001 and 2008. The recorded prevalence of included cardiovascular diseases in CPRD GOLD increased by 47%-62%, which partially reversed after 2008. For hospital records in HES, there was a relative decrease in angina pectoris (-34.4%) and unspecified stroke (-42.3%) over the same time period, with a concomitant increase in chronic coronary heart disease (+14.3%). Multiple abrupt changes in the use of myocardial infarction codes in hospital were found in March/April 2010, 2012 and 2014, possibly linked to updates of clinical coding guidelines. Conclusions Identified temporal variability could be related to potentially non-medical causes such as updated coding guidelines. These artificial changes may introduce temporal correlation among diagnoses inferred from routine data, violating the assumptions of frequently used statistical methods. Temporal variability measures provide an objective and robust technique to identify, and subsequently account for, those changes in electronic health records studies without any prior knowledge of the data collection process.VN is funded by a Public Health England PhD Studentship. RWA is supported by a Wellcome Trust Clinical Research Career Development Fellowship (206602/Z/17/Z). JMGG and CS contributions to this work were partially supported by the MTS4up Spanish project (National Plan for Scientific and Technical Research and Innovation 2013-2016, No. DPI2016-80054-R), the CrowdHealth H2020-SC1-2016-CNECT project (No. 727560) (JMGG) and the Inadvance H2020-SC1-BHC-2018-2020 project (No. 825750). PR and DA did not receive any direct funding for this project. Access to the Clinical Practice Research Datalink was supported by the UK Economic and Social Research Council (ES/P008321/1). Access to aggregated Hospital Episode Statistics was provided by Public Health England. This work was further supported by Health Data Research UK, which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation and the Wellcome Trust.Rockenschaub, P.; Nguyen, V.; Aldridge, RW.; Acosta, D.; Garcia-Gomez, JM.; Sáez Silvestre, C. (2020). Data-driven discovery of changes in clinical code usage over time: a case-study on changes in cardiovascular disease recording in two English electronic health records databases (2001-2015). BMJ Open. 10(2):1-9. https://doi.org/10.1136/bmjopen-2019-034396S19102Hripcsak, G., & Albers, D. J. (2013). Next-generation phenotyping of electronic health records. 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International Journal of Epidemiology, 44(3), 827-836. doi:10.1093/ije/dyv098Herbert, A., Wijlaars, L., Zylbersztejn, A., Cromwell, D., & Hardelid, P. (2017). Data Resource Profile: Hospital Episode Statistics Admitted Patient Care (HES APC). International Journal of Epidemiology, 46(4), 1093-1093i. doi:10.1093/ije/dyx015Chisholm J . The read clinical classification. BMJ 1990;300:1092.doi:10.1136/bmj.300.6732.1092Denaxas, S., Gonzalez-Izquierdo, A., Direk, K., Fitzpatrick, N. K., Fatemifar, G., Banerjee, A., … Hemingway, H. (2019). UK phenomics platform for developing and validating electronic health record phenotypes: CALIBER. Journal of the American Medical Informatics Association, 26(12), 1545-1559. doi:10.1093/jamia/ocz105Department for Communities and Local Government . The English Index of Multiple Deprivation (IMD) 2015 - Guidance. Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/464430/English_Index_of_Multiple_Deprivation_2015_-_Guidance.pdf [Accessed 8 Dec 2019].Sáez, C., Rodrigues, P. P., Gama, J., Robles, M., & García-Gómez, J. M. (2014). Probabilistic change detection and visualization methods for the assessment of temporal stability in biomedical data quality. Data Mining and Knowledge Discovery, 29(4), 950-975. doi:10.1007/s10618-014-0378-6Borg, I., & Groenen, P. (2003). Modern Multidimensional Scaling: Theory and Applications. Journal of Educational Measurement, 40(3), 277-280. doi:10.1111/j.1745-3984.2003.tb01108.xSáez, C., & García-Gómez, J. M. (2018). Kinematics of Big Biomedical Data to characterize temporal variability and seasonality of data repositories: Functional Data Analysis of data temporal evolution over non-parametric statistical manifolds. International Journal of Medical Informatics, 119, 109-124. doi:10.1016/j.ijmedinf.2018.09.015Conrad, N., Judge, A., Tran, J., Mohseni, H., Hedgecott, D., Crespillo, A. P., … Rahimi, K. (2018). Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. The Lancet, 391(10120), 572-580. doi:10.1016/s0140-6736(17)32520-5Herrett E , Shah AD , Boggon R , et al . Completeness and diagnostic validity of recording acute myocardial infarction events in primary care, hospital care, disease registry, and national mortality records: cohort study. BMJ 2013;346:f2350.doi:10.1136/bmj.f2350Pujades-Rodriguez M , Timmis A , Stogiannis D , et al . Socioeconomic deprivation and the incidence of 12 cardiovascular diseases in 1.9 million women and men: implications for risk prediction and prevention. PLoS One 2014;9:e104671.doi:10.1371/journal.pone.0104671Lee S , Shafe ACE , Cowie MR . Uk stroke incidence, mortality and cardiovascular risk management 1999-2008: time-trend analysis from the general practice research database. BMJ Open 2011;1:e000269.doi:10.1136/bmjopen-2011-000269Bhatnagar, P., Wickramasinghe, K., Williams, J., Rayner, M., & Townsend, N. (2015). The epidemiology of cardiovascular disease in the UK 2014. Heart, 101(15), 1182-1189. doi:10.1136/heartjnl-2015-307516Taylor, C. J., Ordóñez-Mena, J. M., Roalfe, A. K., Lay-Flurrie, S., Jones, N. R., Marshall, T., & Hobbs, F. D. R. (2019). Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017: population based cohort study. BMJ, l223. doi:10.1136/bmj.l223Gho JMIH , Schmidt AF , Pasea L , et al . An electronic health records cohort study on heart failure following myocardial infarction in England: incidence and predictors. BMJ Open 2018;8:e018331.doi:10.1136/bmjopen-2017-018331Quint JK , Müllerova H , DiSantostefano RL , et al . Validation of chronic obstructive pulmonary disease recording in the clinical practice research Datalink (CPRD-GOLD). BMJ Open 2014;4:e005540.doi:10.1136/bmjopen-2014-005540Bhaskaran K , Forbes HJ , Douglas I , et al . Representativeness and optimal use of body mass index (BMI) in the UK clinical practice research Datalink (CPRD). BMJ Open 2013;3:e003389.doi:10.1136/bmjopen-2013-003389Booth, H. P., Prevost, A. T., & Gulliford, M. C. (2013). Validity of smoking prevalence estimates from primary care electronic health records compared with national population survey data for England, 2007 to 2011. Pharmacoepidemiology and Drug Safety, 22(12), 1357-1361. doi:10.1002/pds.3537Booth H , Dedman D , Wolf A . CPRD aurum frequently asked questions (FAQs). CPRD 2019.Burns, E. M., Rigby, E., Mamidanna, R., Bottle, A., Aylin, P., Ziprin, P., & Faiz, O. D. (2011). Systematic review of discharge coding accuracy. Journal of Public Health, 34(1), 138-148. doi:10.1093/pubmed/fdr054Marmot, M. 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Common data elements for secondary use of electronic health record data for clinical trial execution and serious adverse event reporting

Background: Data capture is one of the most expensive phases during the conduct of a clinical trial and the increasing use of electronic health records (EHR) offers significant savings to clinical research. To facilitate these secondary uses of routinely collected patient data, it is beneficial to know what data elements are captured in clinical trials. Therefore our aim here is to determine the most commonly used data elements in clinical trials and their availability in hospital EHR systems.Methods: Case report forms for 23 clinical trials in differing disease areas were analyzed. Through an iterative and consensus-based process of medical informatics professionals from academia and trial experts from the European pharmaceutical industry, data elements were compiled for all disease areas and with special focus on the reporting of adverse events. Afterwards, data elements were identified and statistics acquired from hospital sites providing data to the EHR4CR project.Results: The analysis identified 133 unique data elements. Fifty elements were congruent with a published data inventory for patient recruitment and 83 new elements were identified for clinical trial execution, including adverse event reporting. Demographic and laboratory elements lead the list of available elements in hospitals EHR systems. For the reporting of serious adverse events only very few elements could be identified in the patient records.Conclusions: Common data elements in clinical trials have been identified and their availability in hospital systems elucidated. Several elements, often those related to reimbursement, are frequently available whereas more specialized elements are ranked at the bottom of the data inventory list. Hospitals that want to obtain the benefits of reusing data for research from their EHR are now able to prioritize their efforts based on this common data element list.</p

Satisfacción del usuario externo y desgaste laboral del personal de emergencias de un hospital de la sierra del Perú

Introduction: The satisfaction of the external user has a lot to do with the health care provided by the personnel of the health establishments, for which the health personnel must have an ideal mental health without the presence of levels of work burnout, therefore Therefore, the following research was proposed as objective: to determine the relationship between the satisfaction of the external user and work burnout of the health personnel of the emergency service at the Hospital de Pampas in 2011. Materials and methods: the deductive-inductive method was used; The type of research was descriptive, with a non-experimental, retrospective, cross-sectional design. The types of sampling used were intentional non-probabilistic sampling: made up of 8 nurses, 9 doctors and 4 nursing technicians who worked from March to November 2011. And simple probabilistic sampling made up of 71 external users attended from March to November 2011. The data collection techniques were the interview with its self-application questionnaire and survey instruments. The data obtained through the questionnaires were processed with the Excel and SPSS program. Results: It is observed that the majority with 72% of the users think that the degree of satisfaction was Good. The level of the Maslach scale indicates that it is low for the study groups with 89% in men, 88% in nurses and 75% in nursing technicians. It is also observed that there is a negative correlation between the scores of the degree of work burnout of health personnel and the scores of the degree of satisfaction of external users, for which the null hypothesis (Ho) is rejected and the research hypothesis is accepted. (Hi). Conclusion: in the emergency service of the Pampas Hospital, the health personnel mostly have low levels of work burnout and with respect to the external user attended, they mostly have a Good degree of satisfaction.Introducción: La satisfacción del usuario externo tiene mucho que ver en la atención de salud que brinda el personal de los establecimientos de salud, por lo cual el personal de salud debe de poseer una salud mental idónea sin presencia de niveles de desgaste laboral, por lo tanto la siguiente investigación se propuso como objetivo: determinar la relación entre la satisfacción del usuario externo y desgaste laboral del personal de salud del servicio de emergencias en el Hospital de Pampas el 2011. Materiales y métodos: se usó el método deductivo-inductivo; el tipo de investigación fue descriptivo, con diseño no experimental transversal retro prospectivo. Los tipos de muestreo utilizados fueron el no probabilístico intencional: constituido por 8 enfermeras, 9 médicos y 4 técnicos en enfermería que laboraron de marzo a noviembre del 2011. Y el muestreo probabilístico simple conformado por 71 usuarios externos atendidos de marzo a noviembre del 2011. Las técnicas de recolección de datos fue la entrevista con sus instrumentos cuestionario de auto aplicación y encuesta. Los datos obtenidos a través de los cuestionarios fueron procesados con el programa Excel y SPSS. Resultados: Se observa que la mayoría con un 72% de los usuarios opina que el grado de satisfacción fue Bueno, para el 25% fue Regular y sólo el 3% afirma que fue malo. El nivel de la escala de maslach nos indica que el 89% de los médicos tiene un nivel Bajo, el 88% de las enfermeras tiene un nivel Bajo y el 75% de los técnicos en enfermería tienen un nivel Bajo. También se observa que Existe una correlación negativa entre los puntajes del grado de desgaste laboral del personal de salud y los puntajes del grado de satisfacción de los usuarios externos del Hospital de Pampas, por lo cual se rechaza la hipótesis nula (Ho) y se acepta la hipótesis de investigación (Hi). Conclusión: en el servicio de emergencias del Hospital de Pampas el personal de salud en su mayoría tiene niveles bajos de desgaste laboral y respecto al usuario externo atendido tienen en su mayoría un grado de satisfacción Bueno

Classification of brain tumours from MR spectra: the INTERPRET collaboration and its outcomes.

The INTERPRET project was a multicentre European collaboration, carried out from 2000 to 2002, which developed a decision-support system (DSS) for helping neuroradiologists with no experience of MRS to utilize spectroscopic data for the diagnosis and grading of human brain tumours. INTERPRET gathered a large collection of MR spectra of brain tumours and pseudo-tumoural lesions from seven centres. Consensus acquisition protocols, a standard processing pipeline and strict methods for quality control of the aquired data were put in place. Particular emphasis was placed on ensuring the diagnostic certainty of each case, for which all cases were evaluated by a clinical data validation committee. One outcome of the project is a database of 304 fully validated spectra from brain tumours, pseudotumoural lesions and normal brains, along with their associated images and clinical data, which remains available to the scientific and medical community. The second is the INTERPRET DSS, which has continued to be developed and clinically evaluated since the project ended. We also review here the results of the post-INTERPRET period. We evaluate the results of the studies with the INTERPRET database by other consortia or research groups. A summary of the clinical evaluations that have been performed on the post-INTERPRET DSS versions is also presented. Several have shown that diagnostic certainty can be improved for certain tumour types when the INTERPRET DSS is used in conjunction with conventional radiological image interpretation. About 30 papers concerned with the INTERPRET single-voxel dataset have so far been published. We discuss stengths and weaknesses of the DSS and the lessons learned. Finally we speculate on how the INTERPRET concept might be carried into the future.Funding from project MARESCAN (SAF2011-23870) from Ministerio de Economia y Competitividad in Spain. This work was also partially funded by CIBER-BBN, which is an initiative of the VI National R&D&i Plan 2008-2011, CIBER Actions and financed by the Instituto de Salud Carlos III with assistance from the European Regional Development Fund. JRG acknowledges support from Cancer Research UK, the University of Cambridge and Hutchison Whampoa Ltd.This is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1002/nbm.343

Factores que determinan la falta de adherencia de pacientes diabéticos a la terapia medicamentosa

La falta de adherencia al tratamiento es muy frecuente y es un problema global, que impide que la morbi-mortalidad asociada a enfermedades crónicas pueda ser evitada. El objetivo del estudio fue describir los factores que influyen en la adherencia del tratamiento farmacológico en pacientes diabéticos. Se realizó un estudio prospectivo observacional, descriptivo, transversal en el que se entrevistó a pacientes diabéticos atendidos en el Programa Nacional de Diabetes, utilizando un cuestionario diseñado para el estudio que incluía información sobre la adherencia al tratamiento farmacológico, además de los valores de glicemia y hemoglobina glicosilada. Fueron incluidos en el estudio 127 pacientes, de los cuales el 65% era del sexo femenino, la edad promedio fue de 53 años, y tiempo promedio de evolución de la enfermedad de 11 años, el 51,2% tenía grado de instrucción primaria, 60% vivía en pareja, y 28% de los pacientes tenía la hemoglobina glicosilada ≤6,5%. El 13,4% de los pacientes reportó no cumplir, a veces cumplir o no recordar las indicaciones dadas por los prescriptores, siendo los motivos más frecuentes de la falta de cumplimiento: el olvido 58,8%, la utilización de muchos medicamentos 29,4% y la falta de disponibilidad en el programa 29,4%. El olvido y la polimedicación fueron los factores más frecuentes por los cuales los pacientes no se adhieren al tratamiento farmacológico. Esta información permitirá la toma de decisiones para ayudar a los pacientes a mejorar su adherencia al tratamiento farmacológico

Comparación del método de reacción almidón – iodo con la Amplificación por Polimerasa y Recombinasa para el diagnóstico del Huanglongbing (HLB) de los cítricos

Huanglongbing (HLB) is one of the most important citrus diseases worldwide. A field level diagnosis is difficult when it is based on visual symptoms, since they can be confused with similar symptoms of other diseases or nutritional deficiencies of the plant. Molecular methods are used for the diagnosis of the disease, which are laborious, time-consuming and costly, in addition to not allowing rapid detection in the field. In relation to this problem, the method of starch-iodine reaction (RAI) was proposed as a cheap alternative for the diagnosis of HLB by various authors, however, the method has not been widely used, possibly due to lack of diffusion. In the present work the efficacy of the RAI diagnostic method was demonstrated, by comparison with the molecular method of Amplification by recombinase and polymerase (ARP); a molecular method that allows the detection of HLB in the field, but with higher cost. A total of 825 leaf samples were taken from 33 sweet orange (Citrus sinensis L.) plants from orchards of the Department of Caazapá, Paraguay. The samples were analyzed by RAI method, staining and intensity of coloration were observed by optical microscopy. Among these, 33 samples were selected with positive and negative reactions to be analyzed by the ARP method. Results revealed a correlation of 93.6% between both methods. The RAI method, in addition to differentiating HLB symptoms from other diseases and nutritional deficiencies in the plant, is a simple, fast, effective, and economical method for diagnosis if the disease.El Huanglongbing (HLB) es una de las enfermedades más importantes de los cítricos a nivel mundial. Su diagnóstico a nivel de campo es difícil cuando se basa en los síntomas visuales ya que pueden ser confundidos con síntomas similares de otras enfermedades o deficiencias nutricionales de la planta. Métodos moleculares son utilizados para el diagnóstico de la enfermedad, los cuales son laboriosos, requieren tiempo y tienen un costo elevado, además de no permitir una rápida detección en el campo. En relación a esta problemática, el método de diagnóstico de reacción almidón-iodo (RAI) fue propuesto por diversos autores como una alternativa barata para la diagnosis de HLB, sin embargo, el método no ha sido ampliamente utilizado, posiblemente por falta de difusión. En el presente trabajo se demostró la eficacia del método de diagnóstico por RAI, mediante su comparación con el método molecular de Amplificación por recombinasa y polimerasa(ARP), siendo éste un método molecular que permite la detección de HLB a nivel de campo, pero que tiene un costo superior. Fueron extraídas un total de 825 muestras de hojas de 33 plantas de naranjo dulce (Citrus sinensisL.) de plantíos del Departamento de Caazapá, Paraguay. Las muestras fueron analizadas por el método de RAI, la tinción e intensidad de la coloración fueron observadas por microscopia óptica. Entre estas se seleccionaron 33 muestras con reacciones positivas y negativas para ser analizadas por el método de ARP. Resultados revelaron una correlación del 93,6% entre ambos métodos. El método de RAI, además de permitir diferenciar los síntomas de HLB de otras enfermedades y deficiencias nutricionales en la planta, es un método sencillo, rápido, eficaz, y económico para el diagnóstico de la enfermedad

Ginseng in Hair Growth and Viability

The hair follicle is the unique organ that has the capacity of undergoing cyclic transformations following periods of growth (anagen), regression (catagen), and rest (telogen) regenerating itself to restart the cycle. The dynamic capacity of hair to growth and rest enables mammals to control hair growth and length in different body side and to change their coats. Unlike what is observed in many animals in which the pelage synchronously passes from one phase of the cycle to other all stages of growth cycle are simultaneously found in the human pelage, the growth pattern is a mosaic where the hair cycling staging of one hair root is completely independent of it nearest hair follicle, meaning that each follicular unit (FU) can contain follicles in different stages at any given time. A variety of factors, such as nutritional status, hormones, exposure to radiations, chemotherapy or radiotherapy, environmental pollution or drugs may affect hair growth, and affects the number of hairs, this progressive hair loss has a cosmetic and social impact that often significantly affects social and psychological well-being of the patient that suffers from this hair loss. Although a number of therapies, such as finasteride and minoxidil, are approved medications, a wide variety of classes of phytochemicals and natural products, including those present in ginseng are being testing. The purpose of this chapter is to focus on study the potential of ginseng and its metabolites in hair loss