bluuebunny/crossref_metadata_2025 huggingface dataset:
SOSYAL BİLGİLER ÖĞRETMEN ADAYLARININ FAKÜLTEYE UYUM SÜREÇLERİNİN YARATICI DRAMA İLE DESTEKLENMESİ
Authors: Akhan Nadire Emel , Demir Kenan
Published: January 2020

Bu
araştırmanın amacı, Sosyal Bilgiler öğretmenliği birinci sınıfına yeni başlayan
öğrencilerin okula uyum süreçlerini yaratıcı drama yöntemi ile desteklemenin
etkisini belirlemektir. Araştırmanın çalışma grubunu, Akdeniz Üniversitesinde
2017-2018 eğitim öğretim sosyal bilgiler eğitimi birinci sınıflarına yeni
başlayan 57 öğrenci oluşturmuştur. Araştırmada ön test - son test kontrol
gruplu deneysel desen kullanılmıştır. Ayrıca çalışmada sürecin
değerlendirilmesi ile elde nitel veriler nicel bulguları desteklemek için
kullanılmıştır. Çalışmada araştırmacılar tarafından geliştirilen 9 oturumluk
(her atölye 180 dakika) yaratıcı drama etkinlikleri uygulanmıştır. Uzman
görüşleri alınarak her atölyenin kazanımları yazılmış ve bu kazanımlar ışığında
öğrenme-öğretme etkinlikleri hazırlanmıştır. Çalışmanın başında ve sonunda
çalışmanın kazanımları ve uzman görüşlerine göre likert tipi 40 maddelik
“Oryantasyon Çalışmasını Değerlendirme Formu” geliştirilmiş ve uygulanmıştır. Toplanan
nicel veriler SPSS 21.0 programı ile analiz edilmiştir. Oryantasyon eğitiminin
bitiminde deney grubu öğrencilerinin oryantasyon çalışmasını değerlendirme
formlarına verdikleri cevaplar, atölye eğitmenine yazdıkları değerlendirme
mektupları ve yine çalışmaları değerlendirmek için açık uçlu sorulara
verdikleri yazılı cevaplar betimsel analiz yöntemiyle irdelenmiştir. Nicel ve nitel verilerin analizi sonucunda yaratıcı drama
etkinlikleriyle yürütülen oryantasyon eğitiminin deney grubundaki öğrencilerin
kişisel, mesleki, sosyal alanlarda gelişimleri ile okulu, öğretmenlerini ve
arkadaşlarını daha iyi tanımaları konusunda anlamlı derece olumlu etkilediği
belirlenmiştir.
KADIN ÖĞRETMENLERİN YÖNETİCİLİĞE BAKIŞ AÇILARININ İNCELENMESİ
Authors: Ercoşkun Muhammet Hanifi , Yıldırım Ahmet
Published: January 2020

Toplum
tarafından kendilerine sosyal rolleri gerekçesiyle öğretmenlik, hemşirelik ve
sekreterlik gibi meslekleri seçme algısı yüklenen kadınlar, artık birçok iş
sektörünün yönetim kademesinde yer edinmişlerdir. Bu çalışmanın amacı, kadın
öğretmenlerin yöneticiliğe bakış açılarının incelenmesidir. Çalışmanın
evrenini, Erzincan il merkezi ve ilçelerinde çalışan 1700 kadın öğretmen
oluşturmaktadır. Bu evrenden seçkisiz örnekleme yöntemi ile belirlenen 339
kadın öğretmen seçilmiştir. Araştırmaya katılan öğretmen sayısı 241’dir.
Betimsel tarama yöntemi ile yapılan araştırmada, kadın öğretmenlerin
yöneticiliğe bakış açılarını ölçen “Kadın Öğretmenlerin Yöneticiliğe Bakış
Açıları Ölçeği” uygulanmıştır. Verilerin çözümlenmesinde SPSS paket programı
kullanılarak demografik özelliklerinin frekans ve yüzde değerleri
incelenmiştir. Medeni durum, mezun olduğu okul türü ve öğretmenlik mesleğini
sevip sevmeme durumu değişkenlerine göre bağımsız t testi uygulanmıştır. Kıdem
ve yöneticilik yapabilme düzeyi değişkenleri için ise tek yönlü varyans analizi
(ANOVA) yapılmıştır. Araştırmada; kadın öğretmenlerin önemli bir bölümünün 1-5
yıl mesleki kıdeme sahip olduğu, eğitim fakültesi mezunu olduğu, öğretmenlik
mesleğini sevdiği ve yöneticilik yapabilmek için eğitime ihtiyaç duydukları
bulgularına ulaşılmıştır. Araştırma sonuçlarına göre, kadın öğretmenlerin
yöneticiliğe bakış açıları çeşitli faktörlerden etkilenmiştir. Kadın
öğretmenler, okul yöneticilerinin yönetimle ilgili kurumsal yaklaşımları iyi
bilmesi gerektiğine inanmaktadırlar. Ayrıca kadın öğretmenler, okul yönetiminin
okulla ilgili alacağı kararlarda öğrenci ve öğretmenler ile birlikte ortak bir
paydada buluşmaları gerektiğini düşünmektedirler.
Online EFL Assignments and Success
Authors: Yalçın Ahmet , Şevik Mustafa
Published: January 2020

Giving homework is a common practice at all levels of education, yet its
impact as a pedagogical tool on the learning process is still a matter of
debate. The past decade has seen the rapid development of web-based tools
created for educational purposes. In parallel with these developments,
researchers and educators have begun to show an increased interest in online
homework systems in recent years in order to evaluate learning and to overcome
the drawbacks of pen-and-paper homework. This study aims to investigate the
effects of online English as a Foreign Language (EFL) assignments on student
success  in a university vocational
school context. Participants of this experimental study were 49 first-grade
students studying at Burdur Mehmet Akif Ersoy University (MAKU) Gölhisar
Vocational School (GVS). Of these students, 28 constituted the experimental
group and 21 constituted the control group. The study was conducted in the
spring term of the 2016-2017 academic year for a 12-week period. At the
beginning of the study, a pre-test was applied to both groups. Next, five
weekly assignments were given for the experimental group via Edmodo and for the
control group as pen-and-paper homework. The effect of the assignments on
student success was determined by comparing the two groups’ pre-test and
post-test results using quantitative methods. The findings revealed that
assignments whether online or pen-and-paper increased students' success significantly.
Moreover, the success improvement of the students who did online assignments
was about double that of the students who were responsible for doing
pen-and-paper assignments. The study concluded with suggestions that EFL
teachers should give assignments in university vocational schools and that
these assignments should be given as online since they are more effective on
student success.
Street Design and Human Behaviour Factors towards a Safe Urban Environment for Women
Authors: Abdul Rahman Norhafizah , Ali Maimon , Ghani Izham
Published: January 2020

Integrating women safety in the urban street environment is critical in creating good quality living to improve living standard. This paper discusses women’s needs and characteristics of urban streets that can affect women’s behaviour. The objectives of this paper are to identify the characters of urban environment in making streets safe for women and establishing the characteristics of safe urban street environment for women. This study is conducted using mixed methodology to identify the relationship between urban street design and women’s behaviour. This paper will contribute towards safe urban street design with an excellent urban environment and dynamic economic activities. Keywords: women safety; urban design; safe cities; behavioural study eISSN: 2398-4295 © 2019. The Authors. Published for AMER, ABRA & cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.DOI:http://dx.doi.org/10.21834/ajbes.v4i17.184
The Most-Cited Authors Who Published Papers in JMIR mHealth and uHealth Using the Authorship-Weighted Scheme: Bibliometric Analysis
Authors: Kan Wei-Chih , Chou Willy , Chien Tsair-Wei , Yeh Yu-Tsen , Chou Po-Hsin
Published: January 2020

Background

Many previous papers have investigated most-cited articles or most productive authors in academics, but few have studied most-cited authors. Two challenges are faced in doing so, one of which is that some different authors will have the same name in the bibliometric data, and the second is that coauthors’ contributions are different in the article byline. No study has dealt with the matter of duplicate names in bibliometric data. Although betweenness centrality (BC) is one of the most popular degrees of density in social network analysis (SNA), few have applied the BC algorithm to interpret a network’s characteristics. A quantitative scheme must be used for calculating weighted author credits and then applying the metrics in comparison.

Objective

This study aimed to apply the BC algorithm to examine possible identical names in a network and report the most-cited authors for a journal related to international mobile health (mHealth) research.

Methods

We obtained 676 abstracts from Medline based on the keywords “JMIR mHealth and uHealth” (Journal) on June 30, 2018. The author names, countries/areas, and author-defined keywords were recorded. The BCs were then calculated for the following: (1) the most-cited authors displayed on Google Maps; (2) the geographical distribution of countries/areas for the first author; and (3) the keywords dispersed by BC and related to article topics in comparison on citation indices. Pajek software was used to yield the BC for each entity (or node). Bibliometric indices, including h-, g-, and x-indexes, the mean of core articles on g(Ag)=sum (citations on g-core/publications on g-core), and author impact factor (AIF), were applied.

Results

We found that the most-cited author was Sherif M Badawy (from the United States), who had published six articles on JMIR mHealth and uHealth with high bibliometric indices (h=3; AIF=8.47; x=4.68; Ag=5.26). We also found that the two countries with the highest BC were the United States and the United Kingdom and that the two keyword clusters of mHealth and telemedicine earned the highest indices in comparison to other counterparts. All visual representations were successfully displayed on Google Maps.

Conclusions

The most cited authors were selected using the authorship-weighted scheme (AWS), and the keywords of mHealth and telemedicine were more highly cited than other counterparts. The results on Google Maps are novel and unique as knowledge concept maps for understanding the feature of a journal. The research approaches used in this study (ie, BC and AWS) can be applied to other bibliometric analyses in the future.
Impact of Age on Patients’ Communication and Technology Preferences in the Era of Meaningful Use: Mixed Methods Study
Authors: Clarke Martina A , Fruhling Ann L , Sitorius Marilyn , Windle Thomas A , Bernard Tamara L , Windle John R
Published: January 2020

Background

Identifying effective means of communication between patients and their health care providers has a positive impact on patients’ satisfaction, adherence, and health-related outcomes.

Objective

This study aimed to identify the impact of patients’ age on their communication and technology preferences when managing their health. We hypothesize that a patient’s age affects their communication and technology preferences when interacting with clinicians and managing their health.

Methods

A mixed methods study was conducted to identify the preferences of patients with cardiovascular diseases. Results were analyzed based on the patients’ age. Grounded theory was used to analyze the qualitative data. Patients were recruited based on age, gender, ethnicity, and zip code.

Results

A total of 104 patients were recruited: 34 young adults (19-39 years), 33 middle aged (40-64), and 37 senior citizens (>65). Young adults (mean 8.29, SD 1.66) reported higher computer self-efficacy than middle-aged participants (mean 5.56, SD 3.43; P<.05) and senior citizens (mean 47.55, SD 31.23; P<.05). Qualitative analysis identified the following three themes: (1) patient engagement (young adults favored mobile technologies and text messaging, middle-aged patients preferred phone calls, and senior citizens preferred direct interactions with the health care provider); (2) patient safety (young adults preferred electronic after-visit summaries [AVS] and medication reconciliation over the internet; middle-aged patients preferred paper-based or emailed AVS and medication reconciliation in person; senior citizens preferred paper-based summaries and in-person medication reconciliation); (3) technology (young adults preferred smartphones and middle-aged patients and senior citizens preferred tablets or PCs). Middle-aged patients were more concerned about computer security than any other group. A unique finding among senior citizens was the desire for caregivers to have access to their personal health record (PHR).

Conclusions

Patients of different ages have different communication and technology preferences and different preferences with respect to how they would like information presented to them and how they wish to interact with their provider. The PHR is one approach to improving patient engagement, but nontechnological options need to be sustained to support all patients.
Factors Related to User Ratings and User Downloads of Mobile Apps for Maternal and Infant Health: A Cross-Sectional Study
Authors: Biviji Rizwana , Vest Joshua R , Dixon Brian E , Cullen Theresa , Harle Christopher A
Published: January 2020

Background

Mobile health apps related to maternal and infant health (MIH) are prevalent and frequently used. Some of these apps are extremely popular and have been downloaded over 5 million times. However, the understanding of user behavior and user adoption of these apps based on consumer preferences for different app features and categories is limited.

Objective

This study aimed to examine the relationship between MIH app characteristics and users’ perceived satisfaction and intent to use.

Methods

The associations between app characteristics, ratings, and downloads were assessed in a sample of MIH apps designed to provide health education or decision-making support to pregnant women or parents and caregivers of infants. Multivariable linear regression was used to assess the relationship between app characteristics and user ratings, and ordinal logistic regression was used to assess the relationship between app characteristics and user downloads.

Results

The analyses of user ratings and downloads included 421 and 213 apps, respectively. The average user rating was 3.79 out of 5. Compared with the Apple App Store, the Google Play Store was associated with high user ratings (beta=.33; P=.005). Apps with higher standardized user ratings (beta=.80; P<.001), in-app purchases (beta=1.12; P=.002), and in-app advertisements (beta=.64; P=.02) were more frequently downloaded. Having a health care organization developer as part of the development team was neither associated with user ratings (beta=−.20; P=.06) nor downloads (beta=−.14; P=.63).

Conclusions

A majority of MIH apps are developed by non–health care organizations, which could raise concern about the accuracy and trustworthiness of in-app information. These findings could benefit app developers in designing better apps and could help inform marketing and development strategies. Further work is needed to evaluate the clinical accuracy of information provided within the apps.
Performance of Computer-Aided Diagnosis in Ultrasonography for Detection of Breast Lesions Less and More Than 2 cm: Prospective Comparative Study
Authors: Yongping Liang , Zhou Ping , Juan Zhang , Yongfeng Zhao , Liu Wengang , Shi Yifan
Published: January 2020

Background

Computer-aided diagnosis (CAD) is used as an aid tool by radiologists on breast lesion diagnosis in ultrasonography. Previous studies demonstrated that CAD can improve the diagnosis performance of radiologists. However, the optimal use of CAD on breast lesions according to size (below or above 2 cm) has not been assessed.

Objective

The aim of this study was to compare the performance of different radiologists using CAD to detect breast tumors less and more than 2 cm in size.

Methods

We prospectively enrolled 261 consecutive patients (mean age 43 years; age range 17-70 years), including 398 lesions (148 lesions>2 cm, 79 malignant and 69 benign; 250 lesions≤2 cm, 71 malignant and 179 benign) with breast mass as the prominent symptom. One novice radiologist with 1 year of ultrasonography experience and one experienced radiologist with 5 years of ultrasonography experience were each assigned to read the ultrasonography images without CAD, and then again at a second reading while applying the CAD S-Detect. We then compared the diagnostic performance of the readers in the two readings (without and combined with CAD) with breast imaging. The McNemar test for paired data was used for statistical analysis.

Results

For the novice reader, the area under the receiver operating characteristic curve (AUC) improved from 0.74 (95% CI 0.67-0.82) from the without-CAD mode to 0.88 (95% CI 0.83-0.93; P<.001) at the combined-CAD mode in lesions≤2 cm. For the experienced reader, the AUC improved from 0.84 (95% CI 0.77-0.90) to 0.90 (95% CI 0.86-0.94; P=.002). In lesions>2 cm, the AUC moderately decreased from 0.81 to 0.80 (novice reader) and from 0.90 to 0.82 (experienced reader). The sensitivity of the novice and experienced reader in lesions≤2 cm improved from 61.97% and 73.23% at the without-CAD mode to 90.14% and 97.18% (both P<.001) at the combined-CAD mode, respectively.

Conclusions

S-Detect is a feasible diagnostic tool that can improve the sensitivity for both novice and experienced readers, while also improving the negative predictive value and AUC for lesions≤2 cm, demonstrating important application value in the clinical diagnosis of breast cancer.

Trial Registration

Chinese Clinical Trial Registry ChiCTR1800019649; http://www.chictr.org.cn/showprojen.aspx?proj=33094
Sexual Behaviors and Violence in Pornography: Systematic Review and Narrative Synthesis of Video Content Analyses
Authors: Carrotte Elise R , Davis Angela C , Lim Megan SC
Published: January 2020

Background

Owing to increasing access to Web-based pornography and concerns about its impact on viewers, many researchers have attempted to systematically analyze the content of pornography.

Objective

We aimed to systematically review the results of quantitative content analyses of video-based pornography and identify the degree to which the following behaviors are depicted: (1) sexual behaviors and themes, (2) condom use during sexual behaviors, and (3) aggression and violence.

Methods

Inclusion criteria for article eligibility were (1) peer-reviewed publications, (2) articles in the English language, (3) articles describing a quantitative content analysis of video pornography, and (4) articles quantitatively examining at least one variable of interest.

Results

A total of 23 studies met the eligibility criteria. Studies varied in scope and definitions of behavioral variables. Condom use was rare, although more commonly depicted in gay male pornography (36%-64% videos) compared with heterosexual pornography (2%-3% videos). Normative sexual behaviors were most frequently depicted in pornography samples (eg, vaginal intercourse in 48%-90% and fellatio in 52%-90% of heterosexual videos; fellatio in 66%-100% and anal intercourse in 70%-80% of gay male videos). Extreme acts of violence (1%-3% videos) and rape (0%-6% videos) were relatively rare. However, more subtle forms of aggression, such as spanking (5%-75% videos), were more common, and unequal sexual relations (eg, domination) were also common. Although estimates varied by study, dominating and violent behaviors were nearly always directed toward women.

Conclusions

Condom nonuse and gender inequalities are common in pornography, which has implications for the development of healthy sexual relationships among pornography viewers. Higher quality research, including study replication and consistent methodological choices, is needed.
An App for Detecting Bullying of Nurses Using Convolutional Neural Networks and Web-Based Computerized Adaptive Testing: Development and Usability Study
Authors: Ma Shu-Ching , Chou Willy , Chien Tsair-Wei , Chow Julie Chi , Yeh Yu-Tsen , Chou Po-Hsin , Lee Huan-Fang
Published: January 2020

Background

Workplace bullying has been measured in many studies to investigate its effects on mental health issues. However, none have used web-based computerized adaptive testing (CAT) with bully classifications and convolutional neural networks (CNN) for reporting the extent of individual bullying in the workplace.

Objective

This study aims to build a model using CNN to develop an app for automatic detection and classification of nurse bullying-levels, incorporated with online Rasch computerized adaptive testing, to help assess nurse bullying at an earlier stage.

Methods

We recruited 960 nurses working in a Taiwan Ch-Mei hospital group to fill out the 22-item Negative Acts Questionnaire-Revised (NAQ-R) in August 2012. The k-mean and the CNN were used as unsupervised and supervised learnings, respectively, for: (1) dividing nurses into three classes (n=918, 29, and 13 with suspicious mild, moderate, and severe extent of being bullied, respectively); and (2) building a bully prediction model to estimate 69 different parameters. Finally, data were separated into training and testing sets in a proportion of 70:30, where the former was used to predict the latter. We calculated the sensitivity, specificity, and receiver operating characteristic curve (area under the curve [AUC]), along with the accuracy across studies for comparison. An app predicting the respondent bullying-level was developed, involving the model’s 69 estimated parameters and the online Rasch CAT module as a website assessment.

Results

We observed that: (1) the 22-item model yields higher accuracy rates for three categories, with an accuracy of 94% for the total 960 cases, and accuracies of 99% (AUC 0.99; 95% CI 0.99-1.00) and 83% (AUC 0.94; 95% CI 0.82-0.99) for the lower and upper groups (cutoff points at 49 and 66 points) based on the 947 cases and 42 cases, respectively; and (2) the 700-case training set, with 95% accuracy, predicts the 260-case testing set reaching an accuracy of 97. Thus, a NAQ-R app for nurses that predicts bullying-level was successfully developed and demonstrated in this study.

Conclusions

The 22-item CNN model, combined with the Rasch online CAT, is recommended for improving the accuracy of the nurse NAQ-R assessment. An app developed for helping nurses self-assess workplace bullying at an early stage is required for application in the future.
Follow-Up Investigation on the Promotional Practices of Electric Scooter Companies: Content Analysis of Posts on Instagram and Twitter
Authors: Dormanesh Allison , Majmundar Anuja , Allem Jon-Patrick
Published: January 2020

Background

Electric scooters (e-scooters) have become a popular mode of transportation in both the United States and Europe. In the wake of this popularity, e-scooters have changed the commuting experience in many metropolitan areas. Although e-scooters offer an efficient and economical way to travel short distances in traffic-congested areas, recent studies have raised concerns over their safety. Bird and Tier Mobility are 2 popular e-scooter companies in the United States and Europe, respectively. Both companies maintain active social media accounts with hundreds of posts and tens of thousands of followers. Recent studies have shown that consumer behavior may be influenced by the content posted to popular social media platforms, such as Instagram and Twitter.

Objective

This study aimed to examine the official Instagram and Twitter accounts of Bird and Tier Mobility to determine whether these companies promote and demonstrate the use of safety gear in their posts to their consumers.

Methods

Posts to Bird’s (n=287) and Tier Mobility’s (n=190) official Instagram accounts, as well as Bird’s (n=313) and Tier Mobility’s (n=67) official Twitter accounts, were collected from November 9, 2018, to October 7, 2019. Rules for coding content of posts were informed by previous research.

Results

Among posts to Bird’s Instagram account, 69.3% (199/287) had a person visible with an e-scooter, 9.1% (26/287) contained persons wearing protective gear, and there were no mentions of protective gear in captions corresponding to the post. Among posts to Tier Mobility’s Instagram account, 84.7% (161/190) contained a person visible with an e-scooter, 36.3% (69/190) contained persons wearing protective gear, and 4.2% (8/190) of captions corresponding to posts mentioned protective gear. Among posts to Bird’s Twitter account, 71.9% (225/313) had an image, of which 44.0% (99/225) contained a person visible with an e-scooter and 15.1% (34/225) contained persons wearing protective gear. Among posts to Tier Mobility’s Twitter account, 78% (52/67) had an image, of which 52% (27/52) contained a person with an e-scooter and 21% (11/52) contained persons wearing protective gear.

Conclusions

Findings show that modeling and promoting safety is rare on Bird’s and Tier Mobility’s official social media accounts, which may contribute to the normalization of unsafe riding practices. Social media platforms may offer a potential avenue for public health officials to intervene with rider safety campaigns for public education.
Longitudinal Risk Prediction of Chronic Kidney Disease in Diabetic Patients Using a Temporal-Enhanced Gradient Boosting Machine: Retrospective Cohort Study (Preprint)
Authors: Song Xing , Waitman Lemuel R , Yu Alan SL , Robbins David C , Hu Yong , Liu Mei
Published: January 2020

BACKGROUND

Artificial intelligence–enabled electronic health record (EHR) analysis can revolutionize medical practice from the diagnosis and prediction of complex diseases to making recommendations in patient care, especially for chronic conditions such as chronic kidney disease (CKD), which is one of the most frequent complications in patients with diabetes and is associated with substantial morbidity and mortality.

OBJECTIVE

The longitudinal prediction of health outcomes requires effective representation of temporal data in the EHR. In this study, we proposed a novel temporal-enhanced gradient boosting machine (GBM) model that dynamically updates and ensembles learners based on new events in patient timelines to improve the prediction accuracy of CKD among patients with diabetes.

METHODS

Using a broad spectrum of deidentified EHR data on a retrospective cohort of 14,039 adult patients with type 2 diabetes and GBM as the base learner, we validated our proposed Landmark-Boosting model against three state-of-the-art temporal models for rolling predictions of 1-year CKD risk.

RESULTS

The proposed model uniformly outperformed other models, achieving an area under receiver operating curve of 0.83 (95% CI 0.76-0.85), 0.78 (95% CI 0.75-0.82), and 0.82 (95% CI 0.78-0.86) in predicting CKD risk with automatic accumulation of new data in later years (years 2, 3, and 4 since diabetes mellitus onset, respectively). The Landmark-Boosting model also maintained the best calibration across moderate- and high-risk groups and over time. The experimental results demonstrated that the proposed temporal model can not only accurately predict 1-year CKD risk but also improve performance over time with additionally accumulated data, which is essential for clinical use to improve renal management of patients with diabetes.

CONCLUSIONS

Incorporation of temporal information in EHR data can significantly improve predictive model performance and will particularly benefit patients who follow-up with their physicians as recommended.
Adequate Management of Phosphorus in Patients Undergoing Hemodialysis Using a Dietary Smartphone App: Prospective Pilot Study (Preprint)
Authors: Fakih El Khoury Cosette , Crutzen Rik , Schols Jos MGA , Halfens Ruud JG , Karavetian Mirey
Published: January 2020

BACKGROUND

The renal diet is complex and requires alterations of the diet and careful monitoring of various nutrients. Elevated serum phosphorus is common among patients undergoing hemodialysis, and it is associated with many complications. Smartphone technology could be used to support both dietitians and patients by providing a source of accessible and reliable information.

OBJECTIVE

The aim of this pilot is to assess the potential efficacy of an intervention using the educational and self-monitoring mobile app KELA.AE on the phosphorous management in hemodialysis patients. Results will be used to improve both the app and a planned, rigorous large-scale trial intended to assess app efficacy.

METHODS

This is a prospective pilot study performed at the hemodialysis unit of Al Qassimi Hospital (Emirate of Sharjah, United Arab Emirates). All patients were assessed for eligibility and, based on inclusion criteria, considered for enrollment. Participants met with a dietitian once a week and used the mobile app regularly for 2 weeks. Outcomes (knowledge, self-reported nonadherence, dietary intake, anthropometry, and biochemical data) were measured. This pilot is reported as per guidelines for nonrandomized pilot and feasibility studies and in line with the CONSORT (Consolidated Standards of Reporting Trials) 2010 checklist for reporting pilot or feasibility trials.

RESULTS

Of 26 subjects, 23 successfully completed the pilot. Patient dietary knowledge about phosphorous management improved from 51.4% (SD 13.9) to 68.1% (SD 13.3) after intervention with a large effect size (d=1.22, 95% CI 0.59 to 1.85). Dietary protein intake increased from a mean of 0.9 g/kg (SD 0.3) per day to a mean of 1.3 g/kg (SD 0.5) per day with a large effect size (d=1.07, 95% CI 0.45 to 1.69). Phosphorus to protein ratio dropped from a mean of 18.4 mg/g protein to 13.5 mg/g protein with a large effect size (d=0.83, 95% CI 0.22 to 1.43). There was no evidence of change in phosphorous intake, self-reported nonadherence, and serum phosphorus.

CONCLUSIONS

The findings of this prospective pilot reveal the potential efficacy of a smartphone app as a supportive nutrition education tool for phosphorus management in patients undergoing hemodialysis. This pilot study showed that the KELA.AE app has the potential to improve knowledge and dietary choices. A rigorous randomized controlled trial should be performed to evaluate the efficacy, assessing app use of a long-term intervention.
Building Information Modeling (BIM) for Dams-Literature Review and Future Needs
Authors: Sari Yunitta Chandra , Wahyuningrum Catur Ayu , Kresnanto Nindyo Cahyo
Published: January 2020

Dam is a structure with high beneficial values and these include, serving as the source of raw water supply and electrical energy, ensuring flood reduction, tourist attractions, and habitat protection. It is, however, associated with a very complex development process ranging from the planning/design, construction, as well as operation and maintenance. Therefore, there is a need for special attention, accuracy, and good coordination at every stage from the parties involved as well as the integration of all fields starting from the Architecture, Engineering, and Construction (AEC) elements. Moreover, ensuring an effective and efficient construction process presents a serious challenge for the owner/government, designers, consultants and contractors which is now being resolved through the use of a technological innovation known as the Building Information Modeling (BIM).This study was conducted to determine the scientific developments of BIM for dam management and also to identify further related areas to be researched in the future. Moreover, the analysis was concentrated on the potential added value of the technological innovations on dams, explained its advantages, and assesses the potential challenges hampering its effectiveness in Indonesia. It was discovered that the use of BIM for dam projects is possible as long as there are adequate government regulations and the availability of qualified human resources while the consequence would be an increase in the investment cost. The findings of this research are expected to encourage the use of BIM in dam construction and management in Indonesia and also to increase efficiency and effectiveness in all aspects.
Por que 1.000 simulações? convergência na análise de sensibilidade probabilística de modelos de custo-efetividade
Authors: Zimmermann Ivan , Santos Marisa
Published: January 2020

Introdução: Os modelos de simulação de Monte Carlo (MC) representam uma ferramenta importante na construção de cenários e avaliação de incertezas em análises de custo-efetividade em saúde. A definição do número mínimo de iterações é um dos critérios essenciais na sua construção. Objetivos: Apresentar um método simples e didático para a avaliação da convergência de modelos de MC em análises de custo-efetividade em saúde. Métodos: Ao se discutirem os critérios de convergência de modelos de MC, destaca-se que uma amostra de MC consiste em todas as observações virtuais da primeira à última iteração (i e j, respectivamente), de onde pode ser obtida a média amostral e os quadrados médios das distâncias de cada média amostral, ou seja, as variações amostrais para cada nova simulação computada ( j = 1, 2, 3...). Por definição, a sequência de médias amostrais de MC e suas variâncias amostrais até um número suficientemente grande é a própria demonstração do Teorema Central do Limite (TCL). Isto é, conforme aumentamos o tamanho da amostra de MC, o erro do parâmetro µ (média populacional) se aproxima de zero. Ao adotarmos as estatísticas relativas, como desvio padrão relativo (RSD) e erro padrão relativo (RSE), retiramos a influência das unidades específicas das variáveis, tornando possível a comparação da convergência de uma ou mais variáveis em um mesmo contexto. Dessa forma, com base nos Resultados: de um modelo hipotético de custo-efetividade e cenários alternativos com 100, 500, 1.000 e 10.000 iterações, foram avaliados os comportamentos de convergência das estatísticas amostrais centrais, RSD e RSE dos Resultados: de custo (R$) e efetividade (QALY) incremental. Resultados: Após conduzidas as simulações, os valores das medianas do custo incremental e seus intervalos de confiança, baseados nos percentis de 0,025 e 0,975, de acordo com o número de simulações foram R$ 2.067.632,38 (IC95%: R$ 1.446.805,65 a R$ 2.744.200,11; n = 100), R$ 2.035.269,97 (IC95%: R$ 1.412.984,40 a R$ 2.756.363,98; n = 500), R$ 2.038.087,13 (IC95%: R$ 1.411.004,72 a R$ 2.786.176,35; n = 1.000) e R$ 2.041.674,90 (IC95%: R$ 1.397.900,90 a R$ 2.825.205,43; n = 10.000). Da mesma forma, os valores medianos de efetividade incremental foram 15,2501 (IC95%: 3,9505 a 34,8218; n = 100), 15,5633 (IC95%: 4,5604 a 33,4819; n = 500), 15,7413 (IC95%: 4,2368 a 33,8800; n = 1.000) e 16,0274 (IC95%: 4,6348 a 33,8281; n = 10.000). Em relação às estatísticas relativas para avaliação da convergência, os valores de RSD de custo e efetividade foram 16,84% e 50,58%, 17,02% e 45,98%, 17,47% e 45,98%, 17,72% e 44,74% e de RSE foram 1,68% e 5,06%, 0,76% e 2,06%, 0,55% e 1,45%, 0,18% e 0,45%, respectivamente nos cenários de 100, 500, 1.000 e 10.000 iterações. Conclusões: De acordo com os Resultados:, conclui-se que a instabilidade do modelo no cenário de 100 simulações começa a ser reduzida já no cenário de 500 iterações e apresenta mínimas mudanças entre 1.000 e 10.000 iterações.
Acompanhamento farmacoterapêutico no tratamento com Sofosbuvir e Daclatasvir em paciente com Hepatite C e Câncer Metastático: um relato de caso.
Authors: Dos Santos Teles Cardoso Amanda , Tavares Pereira Marcelo , Vasconcelos da Silva Cinara , Laignier Cazedey Edith Cristina
Published: January 2020

Introdução: O medicamento tem natureza híbrida, ou seja, promove benefícios à saúde, mas também portam riscos. O acompanhamento farmacoterapêutico, atividade ofertada aos pacientes em tratamento da Hepatite C, beneficiários de um plano de saúde para servidores públicos conveniado com a Farmácia da Universidade, tem se revelado uma ferramenta importante para o uso racional de medicamentos e o alcance de bons resultados com a farmacoterapia, principalmente em pacientes com condições crônicas. Objetivo: Descrever o perfil do paciente e os problemas relacionados com medicamento, identificando as intervenções propostas pela equipe de farmacêuticos os resultados alcançados. Métodos: As informações foram obtidas dos formulários de acompanhamento farmacoterapêutico utilizados no atendimento ao paciente no ano de 2017. Todo registro clínico foi feito nos moldes da metodologia SOAP, com adaptações. Resultados: Paciente do sexo feminino, 54 anos, diagnosticada com Hepatite C (F1), câncer de crânio com metástase óssea e câncer de pulmão primário, em uso de 10 (dez) medicamentos prescritos, incluindo medicamentos paliativos, anticonvulsivante, quimioterapia e chá por automedicação, com indicação tratamento da Hepative C com daclatasvir e sofosbovir. A partir da análise dos medicamentos utilizados foi identificado 1 (um) problema relacionado ao medicamento, 1 (uma) interação medicamentosa importante, 1 (um) problema de adesão aos medicamentos e reações adversas medicamentosas decorrentes do uso do anticonvulsivante e da quimioterapia. O aprazamento dos medicamentos em uso pela paciente foi readequado, sendo também sugeridas ao prescritor e acatadas duas substituições do medicamento anticonvulsivante (uma por interação medicamentosa e outra por reação adversa). DISCUSSÃO: O conhecimento sobre interação das drogas antivirais de ação direta com as utilizadas no tratamento paliativo do câncer metastático são pouco robustos. A revisão do aprazamento facilitou da administração dos medicamentos, a substituição do anticonvulsivante e suspensão do uso de chá preveniu a ocorrência de interação medicamentosa e contribuiu no aumento da adesão. Conclusão: o acompanhamento farmacoterapêutico dispensado à paciente demonstrou-se relevante, pois possibilitou prevenir a ocorrência de problemas relacionados aos medicamentos como eventos adversos e interações medicamentosas, evidenciando a importância da relação farmacêutico/paciente.
Análise da qualidade de vida de pacientes com artrite reumatoide em uso dos medicamentos biológicos
Authors: Souza Carvalho da Silva Deyse , Barbosa De Jesus Elen , Moreira Cerqueira Oliveira Priscila , Almeida Neta Maria Carmélia , Nunes Wildemberg Brauer Alline Mikaele , Tupina Alcantara de Moreira Aramis , Assunção Costa Lindemberg , De Moura Santos Pablo
Published: January 2020

Introdução: A artrite reumatoide (AR) é uma doença crônica e autoimune que afeta as articulações, especialmente das extremidades do corpo. Tem prevalência mundial de 0.5% a 1% na população, atingindo majoritariamente as mulheres entre 30 e 50 anos de idade. O tratamento é ofertado gratuitamente através do Sistema Único de Saúde (SUS) que disponibiliza as drogas modificadoras do curso da doença (DMCD) sintéticas e biológicas. A qualidade de vida relacionada à saúde (QVRS) é uma medida que leva em consideração as consequências da doença e de seu tratamento associados com limitações físicas, psicológicas ou sociais, decorrentes da condição do paciente. Alguns dos instrumentos para avaliar a QVRS comumente utilizados são o Health Assessment Questionnaire (HAQ) e a Escala Visual analógica (EVA). O HAQ é capaz de fornecer o Índice de Deficiência (ID) e apresenta uma escala que varia de 0 a 3, sendo que valores mais próximos de três são associados a pior qualidade de vida. A EVA avalia a intensidade de dor nas últimas semanas, apresentando uma escala de 0 a 10, no qual valores próximos de dez são considerados como dor mais intensa. Objetivo: Esse trabalho teve como objetivo avaliar a qualidade de vida de pacientes portadores da Artrite reumatoide que fazem uso dos medicamentos biológicos. Métodos: Trata-se de um corte transversal com abordagem quantitativa, tendo como público-alvo pacientes com AR atendidos em um polo de infusão de um Hospital Universitário. Durante consulta farmacêutica, os pacientes foram entrevistados utilizando um formulário estruturado. Foram aplicados os questionários de domínio público EVA e HAQ. Para análise estatística foi utilizada análise de frequências absolutas, percentuais e médias. Resultados: Dos 30 pacientes entrevistados, a predominância foi de mulheres (83%), acima de 51 anos. Das 26 pessoas que apresentaram algum tipo de comorbidade associada, 53,8% possuíam Hipertensão Arterial Sistêmica (HAS). A EVA apresentou uma média de 6. Em relação à qualidade de vida, 27% apresentaram HAQ de 0 a 1, 44% HAQ de 1 a 2 e 29% HAQ de 2 a 3. Dos pacientes que apresentaram uma melhor qualidade de vida, 60% faziam uso de Infliximabe, sendo seguido por Tocilizumabe, Rituximabe e Abatacepte com 17%, 13% e 10%, respectivamente. Conclusão: Com este estudo foi possível determinar a QVRS em pacientes com AR em uso de medicamentos biológicos e contribuir para entender a sua correlação com o uso dos diversos medicamentos biológicos.
Caracterização e custos gerados pelas demandas judiciais para acesso ao brometo de tiotrópio no Estado Do Paraná
Authors: Szpak Renata , Chipon Strapasson Giovanna , Dantas Rattmann Yanna , Carneiro Gomes Eliane
Published: January 2020

Introdução: O Brometo de Tiotrópio (BT), medicamento utilizado no tratamento da Doença Pulmonar Obstrutiva Crônica (DPOC), entre os anos de 2010 – 2016 foi o medicamento mais solicitado via demanda judicial no estado do Paraná. A terapia da DPOC no Brasil está prevista no Protocolo Clínico e Diretrizes Terapêuticas (PCDT) aprovado pela Portaria do Ministério da Saúde nº 609, de 6 de junho de 2013. Entretanto, nenhum medicamento da classe dos broncodilatadores anticolinérgicos de longa duração, a qual pertence o BT, faz parte deste protocolo. Por este motivo, não são encontrados na Relação Nacional de Medicamentos Essenciais (RENAME) do Sistema Único de Saúde (SUS), portanto, recorre-se à judicialização para se obter este medicamento. Objetivos: Realizar um levantamento dos tipos de ações ajuizadas para o medicamento BT no Paraná, regionais de saúde que mais solicitaram o medicamento, custos gerados com essa demanda bem como o impacto financeiro para o paciente que arca com o tratamento no estado do Paraná. Métodos: Trata-se de um estudo retrospectivo de caráter exploratório descritivo, que aborda o período de 2010 a 2016, com a coleta de dados realizada por meio dos sistemas gerenciais SISMEDEX e SYSMED viabilizados pela parceria com o Centro de Medicamentos do Paraná (CEMEPAR). Resultados: As ações judicias mais frequentes foram as civis públicas (75,3% dos processos totais), seguidas de ações de procedimento comum (23,5% do total). As regionais Londrina e Umuarama foram responsáveis por 53,1% dos processos de demandas judiciais para obtenção do medicamento, fato relacionado por mais de 40% dos processos pertencerem a uma única ação civil pública ajuizada na Vara Federal de Londrina, identificada pelo n° 2009.70.01.001743-9. Em resposta às demandas judiciais de pacientes com DPOC, o CEMEPAR forneceu mensalmente 56.120 unidades do Brometo de Tiotrópio da marca Spiriva®Respimat® 2,5 mcg/4 mL (60 doses), no período do estudo, com o custo de R$ 11.714.443,01, para o estado. Este valor corresponde a menos que 3% do orçamento gasto com medicamentos no estado. O preço de aquisição foi em média R$ 153,91 por frasco. Foi realizada uma média de valores do medicamento para compra individual, pelo paciente, considerando valor mínimo e máximo determinados pela Agência Nacional de Vigilância Sanitária (ANVISA), o valor médio correspondeu a 38,04% do salário mínimo. O poder de compra no ano de 2016 foi de -35%, o menor dos anos estudados. Conclusão: Neste estudo, foi possível observar a necessidade da revisão do protocolo clínico da DPOC (ainda de 2013), para inserir novas opções terapêuticas na RENAME, justificadas pelo número de demandas judiciais pelo medicamento, gastos gerados de forma pública e a inviabilidade de compra privada por pacientes assalariados.
Conflito entre direito à saúde e direito à propriedade intelectual: o caso do sofosbuvir
Authors: Jesus dos Santos Jaqueline , Sodré Araújo Patricia , Bomfim Mariluce Karla , Oyram Yara , Souto Ana Cristina , Alves Costa Ediná , Souza Gisélia
Published: January 2020

INTRODUÇÃO: A hepatite C é um dos maiores problemas de saúde pública no mundo, afetando principalmente países de baixa renda ou em desenvolvimento. As tecnologias mais recentes proporcionaram melhores índices de adesão aos tratamentos, contudo, os custos destas tecnologias para os sistemas de saúde são desafiadores. OBJETIVO: Identificar as notícias relacionadas ao medicamento sofosbuvir e discutir o conflito entre direito à saúde e direito à propriedade intelectual a partir do acesso à esta tecnologia.Metodologia: Estudo integra o Observatório de Análise de Política em Saúde (OAPS) do Eixo temático Políticas de Medicamentos, Assistência Farmacêutica e Vigilância Sanitária do ISC/UFBA e em parceria com a UNEB. Foram utilizados dados do banco de notícias do Ministério da Saúde (MS), ANVISA, Médicos Sem Fronteiras (MSF) e entidades representativas da saúde no período de 2015-2018, relacionadas ao medicamento sofosbuvir. As notícias foram organizadas e posteriormente discutidas e analisadas. Resultados: e DISCUSSÃO: Em 2015 a ANVISA registrou o sofosbuvir. A Fiocruz e o Consórcio BMK, assinaram acordo de cooperação técnico-científica para desenvolver o Sofosbuvir. Tal fato motivou a farmacêutica norte-americana Gilead Sciences a solicitar um pedido de patente ao Instituto Nacional da Propriedade Industrial (INPI). No contexto internacional, oMSF apresentou contestação legal na China contra o pedido de patente da Gilead e em 2018 a China considerou inválidas as principais reivindicações do pedido de patente para o sofosbuviro que permitiu produzir e exportar versões genéricas do medicamento neste país. Em setembro de 2018 a Justiça Federal brasileira proferiu decisão liminar que anulou a concessão da patente à Gilead, sob justificativas epidemiológicas da hepatite C no Brasil e dos custos elevados para o SUS de tratamentos com esse medicamento que poderia representar limitação ao acesso da população. Conclusão:Apesar de o Brasil ter elevada dependência externa da produção de tecnologias inovadoras, existem laboratórios oficiais com condições de produzir o genérico do sofosbuvir, e assegurar economia para o SUS ampliando o acesso a tais tratamentos.Questiona-se qual a prioridade para o Brasil: garantir o direito a saúde ou priorizar o direito à propriedade intelectual?É preciso definir o ponto de equilíbrio entre o direito das indústrias farmacêuticas e o direito ao acesso a medicamentos para a população.
Controle glicêmico no mundo real de diabéticos acompanhados por 7 anos em grupos terapêuticos
Authors: Castano Silva Thales Brendon , M. Diniz Leonardo , H. R. F. Almeida Paulo , J. de Queiroz Mariana , de Assis Acurcio Francisco , Alvares Teodoro Juliana
Published: January 2020

Introdução: Grandes estudos demonstraram que manter um controle glicêmico com HbA1c abaixo de 7% previne ou retarda o desenvolvimento de complicações micro e macrovasculares, mas apesar dos avanços na compreensão do diabetes e da disponibilidade de novos medicamentos e tecnologias, o gerenciamento glicêmico ideal continua sendo um desafio no tratamento. Objetivos: Avaliar o controle metabólico no tratamento de pacientes diabéticos acompanhados em longo prazo em um serviço de endocrinologia. Métodos: Coorte não-concorrente que avaliou retrospectivamente formulários de acompanhamentos em grupos terapêuticos de pacientes acometidos por DM tipos 1 e 2 em tratamento no segmento ambulatorial do Hospital das Clínicas da UFMG que tiveram um tempo de acompanhamento maior ou igual a seis meses. Resultados: Foram acompanhados 74 pacientes, sendo 54 DM2 e 20 DM1, idade média de 54 ± 13,37 anos, duração média de DM 16,7 ± 7,2 anos, alta prevalência de comorbidades e complicações crônicas do DM. Comparando-se valores das variáveis basais e finais do acompanhamento, Glicemia de jejum (mg/dL), Creatinina, PA Sistólica (mmHg) e PA Diastólica (mmHg) para pacientes com DM2 diminuíram significativamente, enquanto Colesterol HDL (mg/dL) para DM1 (Tabela 2) aumentou significativamente. As incidências cumulativas de complicações relacionadas aos olhos, coração, rins, sistema nervoso e arterial foram de 30%, 29%, 70%, 63% e 42% respectivamente, no grupo DM1 e 11%, 25%, 31%, 4% e 22% no grupo DM2. Apenas 4,9% dos resultados de HbA1c foram explicados pela correlação das variáveis. Conclusão: Não houve diferenças clinicamente significativas nas variáveis de controle glicêmico entre início e o final do acompanhamento. Observamos uma incidência maior de complicações crônicas no grupo DM1 do que DM2 durante o acompanhamento. Apesar das múltiplas variáveis avaliadas, não foram observadas correlações fortes com HbA1c. Os resultados desta análise comprovam à complexidade em elucidar os determinantes do controle glicêmico e a influência da continuidade do cuidado no tratamento de indivíduos com DM.