Opinions Related to the Potential Application of Artificial Intelligence (AI) by the Responsible in Charge of the Administrative Management Related to the Logistics and Supply Chain of Medical Stock in Health Centers in North of Chile

The research evaluated the opinion of those in charge of the administrative management of the logistics and supply chain of medical and pharmaceutical stocks of health care centers in the north of Chile and a potential improvement of their operations through the use of artificial intelligence (AI). The identification of the problem arose from the empirical analysis, where serious deficiencies in the manual handling and management of the stock of medicines and hospital supplies were evidenced. This deficiency does not allow a timely response to the demand of the logistics and supply chain, causing stock ruptures in health centers. Based on this finding, we asked ourselves how AI was observed as the most efficient tool to solve this difficulty. The results were obtained through surveys of personnel in charge of hospital and pharmacy supplies. The questions focused on the level of training, seniority in positions related to the problem, knowledge of regulations, degree of innovation in the procedures used in logistics and supply chain and procurement. However, a very striking fact was related to the importance of the use of AI, where, very surprisingly, 64.7% considered that it would not help to reduce human errors generated in the areas analyzed.

Estrategias y prácticas culturales que favorecen el desarrollo de niñas y niños mapuche hasta los 4 años. La Araucanía, Chile

Este es un estudio etnográfico realizado durante los años 2017 y 2018, en ocho comunidades rurales Mapuche de la región de La Araucanía. Su objetivo es describir las prácticas y estrategias culturales que utilizan las familias Mapuche para apoyar la estimulación y desarrollo de sus niños/as pequeños. Los datos se obtuvieron mediante observaciones en terreno y entrevistas en profundidad con 16 familias y bajo su consentimiento informado. El análisis fue textual e inductivo, utilizando el programa Atlas.ti8. Las estrategias de estimulación y desarrollo se realizan mediante procesos de participación y colaboración activa de los niños y niñas en la dinámica familiar-comunitaria, observando, escuchando y practicando con los mayores. También se activan prácticas ancestrales como, realizar ceremonias de protección espiritual, ayudarles a explorar la naturaleza, estimular la imitación de sonidos, escuchar su idioma, practicar juegos tradicionales, escuchar cuentos, historias, adivinanzas, y dichos que les relatan las familias o personas de la comunidad. Las prácticas culturales de cuidado y estimulación del desarrollo de la niñez Mapuche están inmersas en la cotidianidad de la cultura, algunas son adaptaciones que las familias han ido desarrollando para proteger, cuidar, y estimular a sus niños y niñas. La naturaleza y la propia cultura Mapuche otorgan el espacio, ritmo y forma de estimulación para que los niños/as lleguen a ser colaboradores, respetuosos y autónomos.

Towards safe and efficient preoperative planning of transcatheter mitral valve interventions

OBJECTIVE OF THE STUDY

Transcatheter mitral valve interventions are emerging as a viable alternative for patients at high risk. Two key aspects are crucial during the preoperative planning: left ventricular outflow tract assessment and anatomical analysis. Given that the manual anatomical analysis is time-consuming, an automated approach may introduce efficiency during preoperative planning. In this study, we present an automatic method to detect the mitral valve annulus and discuss possible implementation of this method in clinical practice.

PATIENTS

This retrospective study used the data of 71 patients collected from multiple centra. The mean age of this cohort was 74.2±13.1 years, and 56.1% of the patients were female and 43.9% male.

MATERIALS AND METHODS

We trained three deep learning models to segment the area around the mitral valve annulus. In a post-processing step, we extracted the mitral valve annulus from this segmentation. As a final step, clinically relevant measurements such as 2D perimeter, trigone-to-trigone (TT) distance, septal-to-lateral (SL) distance and commissure-to-commissure (IC) distance were derived from the predicted mitral valve annulus. The method was cross-validated with k-folding.

RESULTS

The predicted measurements showed excellent correlation with the manually obtained clinical measurements: 2D perimeter: R²=0.93, TT-distance: R²=0.86, SL-distance: R²=0.86 and IC-distance: R²=0.90. The total analysis time per patient of the automatic method was less than 1 second, which is an enormous speed-up as compared to the manual process (25minutes).

CONCLUSION

The efficiency and accuracy of the proposed method give the confidence to move towards implementation of this technology in clinical practice. We propose a possible implementation of this method in clinical practice, which, in our opinion, will facilitate safe and efficient preoperative planning of transcatheter mitral valve interventions.

Validity and reliability of the modified Tal score in Chilean children. A multicenter study

INTRODUCTION

In pediatrics, it is decisive to assess the severity of bronchial obstruction; to this end, different clinical scoring scales have been developed, including the modified Tal score. The objective of this study was to determine its validity and reliability in children seen at two emergency departments of Concepción, Chile.

POPULATION AND METHODS

Prospective, cohort study. Children younger than 36 months old diagnosed with bronchitis and/or bronchiolitis during the winter and spring months of 2015 were included. Concurrent criterion validity was determined based on the correlation between the score and oxygen saturation, as a reference standard. Predictive validity was assessed based on the association between the score and the probability of a new visit to the emergency department in the following 7 days. The area under the ROC curve was estimated. Reliability between kinesiologists and physicians was established based on the intraclass correlation coefficient (ICC). A p value < 0.05 was considered statistically significant.

RESULTS

A total of 102 children were assessed; a weak correlation between the score and oxygen saturation was observed among kinesiologists (Rho = -0.41). An association was observed between the score and the probability of a new visit to the emergency department. The area under the curve measured by both health care providers was > 0.80. Inter-observer reliability between physicians and kinesiologists showed a weak correlation (ICC = 0.17).

CONCLUSIONS

The modified Tal score shows an adequate predictive validity, but a poor validity when correlated to oxygen saturation, and a weak inter-observer reliability.

[Psychomotor development from 0 to 4 years in indigenous children. A sistematic literature search]

INTRODUCTION

The objective of this study was to evaluate published articles regarding the development of indigenous children aged 0 to four years.

SUBJECTS AND METHOD

Systematic literature search. Parti cipants: Primary studies with populations of indigenous children aged 0 to four years. Type of studies: Primary studies with qualitative or quantitative methodologies published in the last ten years until November 2015. Databases: MEDLINE, Digital Library of the University of Girona: CERCADOR, EMBASE, Scielo.

SEARCH STRATEGY

sensitive and specific. Free terms, MeSH, and Boolean.

RESULTS

Nine articles remain for analysis. There are six central subjects related to intracultural patterns of expected development in indigenous childhood: 1) physical, 2) language, 3) socio-cognitive, 4) emo tional, 5) teaching-learning, 6) psychosocial, which reveal the existence of categories of sociocultural and spiritual contents. There is no defined period of time associated with the education. Learning is through observation and participation. Development is understood as a whole, intertwining the social, cultural, natural and spiritual.

CONCLUSION

Spirituality and nature are at the center. Time as a goal to gain skills does not have a cultural function to demonstrate the acquisition of the inherent va lues to the culture. To base the assessment of development exclusively on psychomotor development as monitoring guide is insufficient to assess the integrality and complexity of the advances, abilities, and skills of indigenous children.

Reliability and validity of measuring scale for postoperative complications in third molar surgery

Background

Third molar removal surgery is the most frequently performed surgery in the oral and maxillofacial field with a wide range of items in the quantification of postoperative complications. For their measure, in 2014 a previous scale design was presented. The aim of this study was to determine the reliability and validity of a scale designed to measure and quantify postoperative complications in third molar surgery (TMS).

Methods

A cross-sectional study of a measurement model was designed. Sixty-two patients (mean age 20.5 ± 6.6 years; 36 women) underwent TMS in three Chilean hospitals. In the postoperative check-up on the 7th day, a maxillofacial surgeon and a surgical resident performed independent postoperative assessments, applying the scale. A confirmatory factor analysis was conducted to obtain validity, internal consistency, interobserver reliability and a score to categorize the severity of complications using structural equation model analysis.

Results

Nine patients (14.5%) had complications. The scale was defined by two components: “Secondary complication” and “Infection” (Cronbach’s alpha 0.71; Interobserver reliability 87.7%) and three categories of postoperative complication: “without or mild”, “moderate” and “severe”.

Conclusion

This study presents a reliability and validity scale called “Surgical complication assessment scale in TMS”.

Psychometric properties of scales used for grading the severity of bronchial obstruction in pediatrics: A systematic review and meta-analysis

INTRODUCTION

In pediatrics, identifying the severity of bronchial obstruction in an early manner is a decisive factor.

OBJETIVE

To assess the psychometric properties of the scales for grading the severity of bronchial obstruction in pediatric patients.

POPULATION AND METHOD

This was a systematic review of studies on the validity and reliability of scales for grading the severity of bronchial obstruction conducted in infants and children younger than 3 years old. The search was conducted in Medline, WoS, EMBASE, SciELO, and Google Scholar. The correlation coefficient corresponding to each article was included in a random effects model to establish the criterion validity and reliability using the weighted averages of coefficients as per the sample size.

RESULTS

A total of 9 articles were included, which accounted for 2699 children; 3 articles had an adequate or excellent methodological quality. Four articles established the concurrent criterion validity considering oxygen saturation, with a weighted correlation coefficient of -0.627 (95% confidence interval [CI]: -0.767 to -0.431, p < 0.001); 2 articles established the convergent criterion validity, with a weighted correlation coefficient of 0.809 (95% CI: 0.721 to 0.871, p < 0.001); 6 articles established the inter-observer reliability, with a weighted correlation coefficient of0.500for kappa and 0.891 for the intraclass correlation coefficient.

CONCLUSION

The assessment of psychometric properties to support the use of scales for grading the construct "severity of bronchial obstruction" showed a moderate to adequate criterion validity. The percentage of agreement among observers in terms of the studied measure (severity of bronchial obstruction) was adequate; however, weaknesses such as the article design should be taken into account since it may affect the internal validity of results.

Wnt signaling and cell-matrix adhesion

Three decades after the beginning of the study of the Wnt signaling pathway, major contributions have been made to elucidate the molecular mechanisms that regulate this signaling pathway and its role in development, homeostasis and disease. However, there is still a lack of understanding about the relationships between Wnt signaling and cell-extracellular matrix (ECM) adhesion. Data gathered in the last years is helping to uncover these relationships. Several ECM proteins are able to regulate components of the Wnt pathway during development and disease, and their misregulation leads to changes in Wnt signaling. Fibronectin, a major ECM protein, regulates non-canonical Wnt signaling during embryogenesis in Xenopus and in muscle regeneration in mouse, whereas it modulates canonical Wnt signaling through modulation of β-catenin. Integrins, which act as Fibronectin receptors, also modulate Wnt activity, and Syndecan-4, a heparan sulphate proteoglycan, is able to regulate canonical and non-canonical Wnt pathways, notably during embryogenesis. Other secreted ECM proteins have been recently associated to the regulation of Wnt signaling, albeit molecular mechanisms are still unclear. The non-canonical Wnt pathway plays a role in the regulation of the ECM assembly, and modulates focal adhesion dynamics through the involvement of Wnt components, whereas Wnt/β-catenin signaling regulates the expression of genes encoding ECM proteins. This evidence indicates that Wnt signaling and cell-ECM adhesion are two closely related processes, and alterations in this cross-talk might be involved in disease.

[Systematic reviews of the literature: what should be known about them]

A systematic review (SR) is an article on the «synthesis of the available evidence», in which a review is performed on the quantitative and qualitative aspects of primary studies, with the aim of summarising the existing information on a particular topic. After collecting the articles of interest the researchers then analyse them and compare the evidence they provide with that from similar ones. The reasons for justifying performing an SR are: when there is uncertainty as regards the effect of an intervention due to there being existing evidence against its real usefulness; when it is desired to know the magnitude of the effect of an intervention; and, when it is desired to analyse the behaviour of an intervention in subject sub-groups. The aim of this article is to perform an update on the basic concepts, indications, strengths and weaknesses of SRs, as well as the development of an SR, the most important potential biases to be taken into account in this type of design, and the basic concepts as regards the meta-analysis. Two examples of SR are also included, of use for surgeons, who often come across this type of design when searching for scientific evidence in biomedical journal bases.

[Evaluation of the risk of the clinical-surgical and pathology study findings in newborns with necrotizing enterocolitis who have received surgical treatment]

INTRODUCTION

Despite advances in neonatal care between 20% and 63% of children with necrotizing enterocolitis (NEC) require surgery. The aim was correlation the risk factors of infants with NEC "IIB / IIIA / IIIB" Bell and the clinical, surgical and pathological findings.

METHOD

In the children with diagnosis of NEC surgically treated, were analyzed of variables: clinical, surgical and pathological findings. We studied two groups: control (n=5) and NEC group (n=12). Comparisons were made between groups using the Mann-Whitney U- and the Spearman coefficient (r). To assess the risk of morbidity / mortality associated with the extent of intestinal resection we applied the Cox regression.

RESULT

We found differences (p < 0.05) between control group and the NEC group regarding Bell, the mean height of villi, Chiu and the number of goblet cells. In the NEC group we find correlations (p < 0.05) from Bell, regarding Chiu (r = 0.761), resection of the colon (r = 0.687), pneumatosis / perforation (r = 1) and the mean height of villi (r = -0.878). The gut reseccion was at 26 cm (3-107). We observed a risk of 1.04 in the neonatal period (p > 0.05) of mortality or consequence post-enterocolitis associated with the extent of bowel resection.

CONCLUSION

The decrease in the average height of villi, the highest level of microscopic intestinal injury and reduced goblet cell population contributes to a greater extent of intestinal resection, which favors the risk of death or developing consequence post-enterocolitis.

Analgesia in patients with acute abdominal pain

BACKGROUND

For decades, the indication of analgesia in patients with Acute Abdominal Pain (AAP) has been deferred until the definitive diagnosis has been made, for fear of masking symptoms, generating a change in the physical exploration or obstructing the diagnosis of a disease requiring surgical treatment. This strategy has been questioned by some studies that have shown that the use of analgesia in the initial evaluation of patients with AAP leads to a significant reduction in pain without affecting diagnostic accuracy.

OBJECTIVES

To determine whether the evidence available supports the use of opioid analgesics in the diagnostic process of patients with AAP.

SEARCH STRATEGY

Trials were identified through searches in Cochrane Controlled Trials Register (CENTRAL) (The Cochrane Library, issue 2, 2009), MEDLINE (1966 to 2009) and EMBASE (1980 to 2009). A randomised controlled trial (RCT) filter for a MEDLINE search was applied (with appropriate modification for an EMBASE search). Trials also were identified through "related articles". The search was not limited by language or publication status.

SELECTION CRITERIA

All published RCTs which included adult patients with AAP, without gender restriction, comparing any opioids analgesia regimen with the non-use of analgesic before any intervention and independent of the results.

DATA COLLECTION AND ANALYSIS

Two independent reviewers assessed the studies identified via the electronic search. Articles that were relevant and pertinent to the aims of the study were selected and their respective full-text versions were collected for subsequent blinded evaluation. The allocation concealment was considered in particular as an option to diminish the biases.The data collected from the studies were reviewed qualitatively and quantitatively using the Cochrane Collaboration statistical software RevMan 5.0. After performing the meta-analysis, the chi-squared test for heterogeneity was applied. In situations of significant clinical heterogeneity, statistical analyses were not applied to the pool of results. In situations of heterogeneity, the random effect model was used to perform the meta-analysis of the results. A sensitivity analysis was also applied based on the evaluation to the methodological quality of the primary studies.

MAIN RESULTS

Eight studies fulfilled the inclusion criteria. Differences with use of opioid analgesia were verified in variables: Change in the intensity of the pain, change in the patients comfort level.

AUTHORS' CONCLUSIONS

The use of opioid analgesics in the therapeutic diagnosis of patients with AAP does not increase the risk of diagnosis error or the risk of error in making decisions regarding treatment.

Analgesia in patients with acute abdominal pain

BACKGROUND

For decades, analgesia for patients with acute abdominal pain was withheld until a definitive diagnosis was established for fear of masking the symptoms, changing physical findings or ultimately delaying diagnosis and treatment of a surgical condition. This non-evidence-based approach has been challenged by recent studies demonstrating that the use of analgesia in the initial evaluation of patients with acute abdominal pain leads to significant pain reduction without affecting diagnostic accuracy. However, early administration of analgesia to such patients can greatly reduce their pain and does not interfere with a diagnosis, which may even be facilitated due to the severity of physical symptoms being reduced.

OBJECTIVES

To determine if the currently available evidence supports the use of opioid analgesia in patient management with acute abdominal pain; and to assess changes in a patient comfort while awaiting definitive diagnosis and final treatment decisions.

SEARCH STRATEGY

Trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, issue 4, 2006), MEDLINE (1966 to 2006) and EMBASE (1980 to 2006). Randomized controlled trial filter for MEDLINE and EMBASE search. Trials will also be identified by "related articles". The searches were not limited by language or publication status.

SELECTION CRITERIA

Randomized controlled trials (RCTs) that include adult patients with acute abdominal pain, without gender restriction, comparing any opioid analgesia regime to no analgesia administered prior to any intervention regardless of outcomes.

DATA COLLECTION AND ANALYSIS

Two authors looked independently at the titles and abstracts of reports. Potentially relevant studies selected by at least one reviewer were retrieved in full text versions for potential inclusion. Allocation concealment was important to avoid bias and was graded using the Cochrane approach. The data from studies included was reviewed qualitatively and quantitatively using the Cochrane Collaborations methodology and statistical software RevMan Analysis 1.0.5. In the case of homogeneity or non- worrying heterogeneity, a random effects model was used. Sensitivity analysis was performed based on quality assessment.

MAIN RESULTS

Six studies fulfilled the inclusion criteria. Improvement with use of opioid analgesia was verified in variables patient comfort, reduction of pain, changes in physical examination.

AUTHORS' CONCLUSIONS

The review provide some evidence to support the notion that the use of opioid analgesics in patients with acute abdominal pain is helpful in terms of patient comfort and does not retard decisions to treat.

[Use of opioid analgesics in diagnosis and decision-making in patients with acute nontraumatic abdominal pain. A systematic review of the literature]

INTRODUCTION

The use of analgesics during the diagnosis and decision-making process in patients with acute nontraumatic abdominal pain is controversial. The aim of the present study was to determine whether the use of opioid analgesics in patients with acute nontraumatic abdominal pain increases the risk of diagnostic error.

METHOD

We performed a systematic review of the literature. Randomized clinical trials (RTCs) comparing the use of opioid analgesics with placebo administered before any procedure in patients with acute nontraumatic abdominal pain were included. There was no restriction on language. RTCs unrelated to this subject were excluded. The variables analyzed were age, gender, and the percentage of adverse effects, appendicitis, changes on physical examination and diagnostic error, modification of pain severity measured by a visual analog scale, and methodological quality of the studies. A search was performed in the MEDLINE and Cochrane databases, using MeSH terms. Each article was analyzed by applying a methodological quality score through which weighted means were applied for each variable. The Chi-square and Student's t-test were applied to compare the groups.

RESULTS

Six articles meeting the selection criteria were found. The mean methodological quality score was 21.6 points. The studies represented a population of 363 patients treated with opioids and 336 patients treated with placebo. There were no differences in the mean age of the patients (39.4 vs 39.6 years), distribution by gender, prevalence of acute appendicitis (23.3% vs 24%) or diagnostic error (15.6% vs 21.1%; p = 0.0637). Differences were found in the variable of pain reduction (27.2 vs 7.2 mm, respectively; p = 0.0167).

CONCLUSIONS

The use of opioid analgesics in patients with acute nontraumatic abdominal pain does not increase the risk of diagnostic error and reduces pain during the decision-making process.

Política de Salud Intercultural: Perspectiva de usuarios mapuches y equipos de salud en la IX región, Chile

BACKGROUND

Intercultural health is becoming an emergent topic in the design of health care programs for Mapuche people of Chile. This process faces important challenges such as the scarce theoretical support about the meaning of intercultural health and their practical consequences for providers and clients.

AIM

To explore the perception in providers and Mapuche clients about intercultural health.

MATERIAL AND METHODS

A survey performed in 11 counties with the highest concentration of Mapuche people, of the IX region of Chile. The perception about the development of a new health policy specially designed for Mapuche patients was surveyed in 399 Mapuche patients and 64 providers of primary health care centers.

RESULTS

Mapuche clients considered, as the main regional challenges, the indifference and discrimination of health care teams towards Mapuche patients, aggravated by the indifference of authorities. Providers considered that the main problem was a lack of knowledge about Mapuche culture and skills to deal with this ethnic group. Patients and providers agreed on the need to use Mapuche dialect in health care attentions, to coordinate actions with traditional healers and to accept ethnical therapeutic practices.

CONCLUSIONS

There is scarce agreement between providers and Mapuche clients about the need for an special intercultural health policy, its contents, and the regional conditions for its implementation and development.

[Brunn's nests as a cause of benign tumor of the bladder in children]

This report concerns the case of a male patient admitted for an operation due to vesicoureteral reflux. During the operation a sessile tumor was discovered in the interior of the bladder at the level of the neck. The tumor corresponded histologically to a mucous polyp with Brunn's nests in the interior. The following are commented on: the extreme rarity of the case, the histopathological characteristics of this abnormal epithelial proliferation which is produced as an exaggerated response to an irritative stimulus and its non-malignant nature.