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Genisca, Alicia E., Esther M. Sampayo, Joy M. Mackey, Lisa Johnson, and Heather L. Crouse. "Assessment of Attitudes Toward the Emergency Triage System in Belize." Global Pediatric Health 7 (January 2020): 2333794X2091158. http://dx.doi.org/10.1177/2333794x20911581.
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Objective. Triage in resource-limited settings (RLS) improves outcomes. Emergency Triage Assessment and Treatment (ETAT) is a simple triage algorithm that improves assessment and initial management of children in RLS. In Belize, pediatric triage varies with setting, from a 5-level Emergency Severity Index (ESI) used at the National Referral Hospital to a lack of triage at government health centers (GHC). Most data on ETAT implementation are in settings where no triage system existed; data on how to integrate ETAT into existing, heterogeneous triage systems are lacking. The aim of this study is to explore health care providers’ (HCPs) attitudes toward the current triage system prior to national pediatric triage process implementation. Methods. A qualitative study was performed via convenience sampling of HCPs who participated in an ETAT training course using focus groups immediately and 1 year after an initial ETAT training. Focus groups were digitally recorded and transcribed. Three coders analyzed all transcripts to identify emerging themes. Constant comparison analysis was performed until achieving thematic saturation. Results. The following principal themes emerged: (1) importance of triage education and implementation to standardize and improve communication; (2) major limitations of ESI include its complexity, lack of pediatric-specific criteria, and dependence on equipment not consistently available; and (3) desire to implement a simple, low-resource pediatric-specific triage system. Conclusions. Participants believe triage education and process implementation is essential to improve communication and pediatric emergency care. Simple, low-resource pediatric-specific triage systems, like ETAT, may improve utilization by providing faster recognition and improved care for acutely ill children.
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Horton, Michael, Rebecca V. Harris, and Robert S. Ireland. "The Development and Use of a Triage Protocol for Patients with Dental Problems Contacting an Out-of-hours General Medical Practitioner Cooperative." Primary Dental Care os8, no. 3 (2001): 93–97. http://dx.doi.org/10.1308/135576101322561886.
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Purpose of the study The number of patients contacting general medical practitioner (GMP) out-of-hours services with dental problems is perceived to be a significant problem by the medical profession. This study was undertaken to design and pilot a triage protocol that could be used by non-dental staff to refer callers with dental complaints for appropriate treatment. Basic procedures A triage protocol was designed to address the patient conditions considered to be relevant to emergency dental care. The triage protocol was piloted for three months at a GMP cooperative in North Wales, which provided an out-of-hours service for 61 GMPs. Baseline data were collected for three months prior to the introduction of the triage protocol. Main findings The study showed that the number of dental callers contacting the out-of-hours service was not as great as GMPs imagined, and was similar to other studies. The introduction of the triage protocol resulted in a rise in the number of callers asked to call the general dental practitioner (GDP) support line. The number of unregistered patients given the name of a dentist also increased. The need to make a second telephone call seemed not to affect patient satisfaction since when patients were later questioned on their experience, those who had used the service since the introduction of the triage protocol were more likely to be satisfied with the service. Principal conclusions This study provides some evidence that a triage protocol can be used successfully by non-dental staff to sift requests for out-of-hours emergency dental care.
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Yoon, Philip, Ivan Steiner, and Gilles Reinhardt. "Analysis of factors influencing length of stay in the emergency department." CJEM 5, no. 03 (2003): 155–61. http://dx.doi.org/10.1017/s1481803500006539.
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ABSTRACTObjectives:Length of stay (LOS) is a key measure of emergency department (ED) throughput and a marker of overcrowding. Time studies that assess key ED processes will help clarify the causes of patient care delays and prolonged LOS. The objectives of this study were to identify and quantify the principal ED patient care time intervals, and to measure the impact of important service processes (laboratory testing, imaging and consultation) on LOS for patients in different triage levels.Methods:In this retrospective review, conducted at a large urban tertiary care teaching hospital and trauma centre, investigators reviewed the records of 1047 consecutive patients treated during a continuous 7-day period in January 1999. Key data were recorded, including patient characteristics, ED process times, tests performed, consultations and overall ED LOS. Of the 1047 patient records, 153 (14.6%) were excluded from detailed analysis because of incomplete documentation. Process times were determined and stratified by triage level, using theCanadian Emergency Department Triage and Acuity Scale(CTAS). Multiple linear regression analysis was performed to determine which factors were most strongly associated with prolonged LOS.Results:Patients in intermediate triage Levels III and IV generally had the longest waiting times to nurse and physician assessment, and the longest ED lengths of stay. CTAS triage levels predicted laboratory and imaging utilization as well as consultation rate. The use of diagnostic imaging and laboratory tests was associated with longer LOS, varying with the specific tests ordered. Specialty consultation was also associated with prolonged LOS, and this effect was highly variable depending on the service consulted.Conclusions:Triage level, investigations and consultations are important independent variables that influence ED LOS. Future research is necessary to determine how these and other factors can be incorporated into a model for predicting LOS. Improved information systems will facilitate similar ED time studies to assess key processes, lengths of stay and clinical efficiency.
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Rega, Paul P., Christopher E. Bork, Kelly Burkholder-Allen, Michael S. Bisesi, and Jeffrey P. Gold. "Single-Breath-Count Test: An Important Adjunct in the Triaging of Patients in a Mass-Casualty Incident Due to Botulism." Prehospital and Disaster Medicine 25, no. 3 (2010): 219–22. http://dx.doi.org/10.1017/s1049023x00008062.
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AbstractClostridium botulinum toxins, the most poisonous substance known to humankind, are considered to be a [US] Centers for Disease Control and Prevention Category A bioterrorist agent. Despite this concern, little has been published with regard to the tactical aspects of triaging a mass-casualty event involving botulism victims arriving at an emergency department. Because neuromuscular-ventilatory failure is a principal reason for botulism's early morbidity and mortality, using a quick and sensitive test to evaluate this possibility is imperative. The purpose of this article is to propose the adoption of the Single-Breath-Count Test (SBCT). The ease and validity of the use of the SBCT in evaluating complications associated with various neuromuscular disorders make it an attractive adjunct for triage during a mass-casualty incident due to botulism. While education, immune globulin, antitoxin, and invasive airway techniques are well-recognized steps in treating botulism, incorporating a time-honored technique such as the SBCT, will be an important addition to the triage process.
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La Rochelle, P., S. Lavoie, V. Boucher, M. Émond, and J. Perry. "P042: Pilot study for the inter-arm blood pressure systematic measurement during the diagnosis of transient ischemic attack in the emergency department." CJEM 21, S1 (2019): S78. http://dx.doi.org/10.1017/cem.2019.233.
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Introduction: Our principal aim was to document the feasibility of the systematic measurement of the inter-arm blood pressure difference (IABPD) during an episode of transient ischemic attack (TIA) or mild stroke diagnosed in the Emergency Department (ED). As secondary goal was to compare the systolic blood pressure (BP) at triage with the systolic BPs measured during the IABPD. Methods: This is a single center pilot study. Patients presenting in the ED for a diagnosis of TIA were recruited. Once patient has been triaged and diagnosed of TIA, a research assistant made sure that the patient lay on a stretcher for at least 5 minutes. Two automated sphygmomanometers were applied, on each arm. No specific device or device calibration were required. Three consecutive simultaneous BP readings were performed, inverting cuffs arm to arm between each reading. Only the last two set of readings were used to calculate the mean IABPD. This method enables to minimize the error coming from the potential sphygmomanometers’ inaccuracies. Results: 32 patients were recruited from June to September 2017 and all had a successful IABPD measurement. Four patients had an IABPD >10 mmHg, varying from 1.5 to 13 mmHg when the left arm was higher and from 1 to 61 mmHg when the right arm was higher. Of the 22 patients where the triage BP arm side selection was recorded, only 11 were congruent with the arm presenting the highest BP during the IABPD measurement. Selecting of the arm with the highest BP value may better reflect cerebrovascular risk exposition. The mean systolic BP at triage was 159.3 mmHg (95%CI: 144.9-173.7) compared to144.8 mmHg (95%CI: 132.9-156.7) if the arm with the highest value during the IABPD measurement is selected and 142.4 mmHg (95%CI: 130.8-154.0) if the same arm as triage is selected. The p-value for these differences were 0.003 and 0.001 respectively. The patient which presented the IABPD of 61 mmHg, had a stroke 3 days after its ED visit which subsequently led to her death 10 days later. Conclusion: Our results show that the systematic IABPD measurement using a pragmatic approach in the ED is feasible and is ready to investigate its use in the context of a new TIA or mild stroke. This information may contribute to a better discrimination of the short-term risk of stroke and may help to diagnose acute aortic dissection, monitor more accurately BP during hyperacute stroke or estimate intracerebral hemorrhage risk if systemic thrombolysis is considered.
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Zhang, Xingyu, Joyce Kim, Rachel E. Patzer, Stephen R. Pitts, Aaron Patzer, and Justin D. Schrager. "Prediction of Emergency Department Hospital Admission Based on Natural Language Processing and Neural Networks." Methods of Information in Medicine 56, no. 05 (2017): 377–89. http://dx.doi.org/10.3414/me17-01-0024.
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SummaryObjective: To describe and compare logistic regression and neural network modeling strategies to predict hospital admission or transfer following initial presentation to Emergency Department (ED) triage with and without the addition of natural language processing elements.Methods: Using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), a cross-sectional probability sample of United States EDs from 2012 and 2013 survey years, we developed several predictive models with the outcome being admission to the hospital or transfer vs. discharge home. We included patient characteristics immediately available after the patient has presented to the ED and undergone a triage process. We used this information to construct logistic regression (LR) and multilayer neural network models (MLNN) which included natural language processing (NLP) and principal component analysis from the patient’s reason for visit. Ten-fold cross validation was used to test the predictive capacity of each model and receiver operating curves (AUC) were then calculated for each model.Results: Of the 47,200 ED visits from 642 hospitals, 6,335 (13.42%) resulted in hospital admission (or transfer). A total of 48 principal components were extracted by NLP from the reason for visit fields, which explained 75% of the overall variance for hospitalization. In the model including only structured variables, the AUC was 0.824 (95% CI 0.818-0.830) for logistic regression and 0.823 (95% CI 0.817-0.829) for MLNN. Models including only free-text information generated AUC of 0.742 (95% CI 0.7310.753) for logistic regression and 0.753 (95% CI 0.742-0.764) for MLNN. When both structured variables and free text variables were included, the AUC reached 0.846 (95% CI 0.839-0.853) for logistic regression and 0.844 (95% CI 0.836-0.852) for MLNN.Conclusions: The predictive accuracy of hospital admission or transfer for patients who presented to ED triage overall was good, and was improved with the inclusion of free text data from a patient’s reason for visit regardless of modeling approach. Natural language processing and neural networks that incorporate patient-reported outcome free text may increase predictive accuracy for hospital admission.
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VanRooyen, Michael J., Edward P. Sloan, John A. Barrett, Robert F. Smith, and Hernan M. Reyes. "Outcome in an Urban Pediatric Trauma System with Unified Prehospital Emergency Medical Services Care." Prehospital and Disaster Medicine 10, no. 1 (1995): 19–23. http://dx.doi.org/10.1017/s1049023x00041601.
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AbstractHypothesis:Pediatric mortality is predicted by age, presence of head trauma, head trauma with a low Glasgow Coma Scale (GCS) score, a low Pediatric Trauma Score (PTS), and transport directly to a pediatric trauma center.Population:Studied were 1,429 patients younger than 16 years old admitted to or declared dead on arrival (DOA) in a pediatric trauma center from January through October, 1988. The trauma system, which served 3-million persons, included six pediatric trauma centers.Methods:Data were obtained by a retrospective review of summary statistics provided to the Chicago Department of Health by the pediatric trauma centers.Results:Overall mortality was 4.8% (68 of 1429); 32 of the patients who died (47.1%) were DOA. The in-hospital mortality rate was 2.6%. Head injury was the principal diagnosis in 46.2% of admissions and was a factor in 72.2% of hospital deaths. The mortality rate was 20.3% in children with a GCS≤10 and 0.4% when the GCS was >10 (odds ratio [OR] = 67.0, 95% CI = 15.0–417.4). When the PTS was ≤ 5, mortality was 25.6%; with a PTS > 5, the mortality was 0.2% (OR = 420.7, 95% CI = 99.3–2,520). Although transfers to a pediatric trauma center accounted for 73.6% of admissions, direct field triage to a pediatric trauma center was associated with a 3.2 times greater mortality risk (95% CI = 1.58–6.59). Mortality rates were equal for all age groups. Pediatric trauma center volume did not influence mortality rates.Conclusions:Head injury and death occur in all age groups, suggesting the need for broad prevention strategies. Specific GCS and PTS values that predict mortality can be used in emergency medical services (EMS) triage protocols. Although the high proportion of transfers mandates systemwide transfer protocols, the lower mortality in these patients suggests appropriate EMS field triage. These factors should be considered as states develop pediatric trauma systems.
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Carvalho, Anna-Maria, Marie-Elaine Delvin, Carolyn Rosenczweig, Sujit Sivarman, and Raghu Venugopal. "Helping at Ground Zero: the experience of four Canadian emergency medicine residents and an emergency department nurse." CJEM 4, no. 02 (2002): 115–18. http://dx.doi.org/10.1017/s1481803500006242.
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SOMMAIRE Le 11 septembre 2001, le monde a été témoin d’une des pires attaques terroristes de l’histoire de l’humanité dirigée contre les deux Tours du World Trade Center à New York, et contre le Pentagone à Washington, DC. En tant que contingent canadien non officiel formé de quatre résidents en médecine d’urgence et d’une infirmière d’urgence, nous nous sommes joints au personnel médical américain pour offrir notre aide au cours de la phase de sauvetage à New York. Nous présentons un compte-rendu de notre expérience en tant que bénévoles au centre principal de triage de «Ground Zero.» Nous dressons le bilan des leçons que nous avons tirées de l’expérience et discutons du rôle du résident dans une situation de désastre.
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Fitzgerald, Janna, Martin Lum, and Ann Dadich. "Scheduling unplanned surgery: a tool for improving dialogue about queue position on emergency theatre lists." Australian Health Review 30, no. 2 (2006): 219. http://dx.doi.org/10.1071/ah060219.
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Theatre use is heavily influenced by the presentation and scheduling of emergency cases for unplanned surgery. This research guided the development of a triage standard for scheduling emergency surgery in New South Wales public hospitals and aimed to contribute to a better understanding of decisionmaking practices. An emergency-surgery survey asked questions about urgency of a set of clinical conditions and appropriate time frames for patients to receive surgical treatment for these conditions. Surveys were distributed via 71 NSW public hospitals. A total of 198 decision makers responded: surgeons (42.8%), anaesthetists (24.7%), and nurses (32.5%). Principal component analysis was applied to reduce the data to three urgency classifications, and analysis of variance was used to assess variance of opinions between professional groups. The data suggested that the parameters that distinguish the codes (1, very urgent; 2, semi-urgent; 3, least urgent) were not unequivocally apparent. Although there was a consistent approach to the ?urgency 1? and ?urgency 3? categories, there were significant differences between responses when determining ?urgency 2?. The data indicated that when making decisions, anaesthetists act as intermediaries between surgeons and nurses. There was significant disparity between individuals when respondents were asked to state an ideal time for the commencement of surgery and the maximum length of time that the surgery could wait. This presented a need for a risk assessment tool to be incorporated when developing a dynamic prototype triage instrument.
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Fiestas Solórzano, Victor Edgar, Nieli Rodrigues da Costa Faria, Caroline Fernandes dos Santos, et al. "Different Profiles of Cytokines, Chemokines and Coagulation Mediators Associated with Severity in Brazilian Patients Infected with Dengue Virus." Viruses 13, no. 9 (2021): 1789. http://dx.doi.org/10.3390/v13091789.
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The incidence of dengue in Latin America has increased dramatically during the last decade. Understanding the pathogenic mechanisms in dengue is crucial for the identification of biomarkers for the triage of patients. We aimed to characterize the profile of cytokines (IFN-γ, TNF-α, IL-1β, IL-6, IL-18 and IL-10), chemokines (CXCL8/IL-8, CCL2/MCP-1 and CXCL10/IP-10) and coagulation mediators (Fibrinogen, D-dimer, Tissue factor-TF, Tissue factor pathway inhibitor-TFPI and Thrombomodulin) during the dengue-4 epidemic in Brazil. Laboratory-confirmed dengue cases had higher levels of TNF-α (p < 0.001), IL-6 (p = 0.005), IL-10 (p < 0.001), IL-18 (p = 0.001), CXCL8/IL-8 (p < 0.001), CCL2/MCP-1 (p < 0.001), CXCL10/IP-10 (p = 0.001), fibrinogen (p = 0.037), D-dimer (p = 0.01) and TFPI (p = 0.042) and lower levels of TF (p = 0.042) compared to healthy controls. A principal component analysis (PCA) distinguished between two profiles of mediators of inflammation and coagulation: protective (TNF-α, IL-1β and CXCL8/IL-8) and pathological (IL-6, TF and TFPI). Lastly, multivariate logistic regression analysis identified high aspartate aminotransferase-to-platelet ratio index (APRI) as independent risk factors associated with severity (adjusted OR: 1.33; 95% CI 1.03–1.71; p = 0.027), the area under the receiver operating characteristics curve (AUC) was 0.775 (95% CI 0.681–0.869) and an optimal cutoff value was 1.4 (sensitivity: 76%; specificity: 79%), so it could be a useful marker for the triage of patients attending primary care centers.
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Gradela, Adriana, Thamyris Oliveira Carneiro Santiago, Isabelle Caroline Pires, et al. "Sexual Dimorphism in Red-Eared Sliders (Trachemys scripta elegans) from the Wild Animal Triage Center of the Tiete Ecological Park, São Paulo, Brazil." Acta Scientiae Veterinariae 45, no. 1 (2017): 10. http://dx.doi.org/10.22456/1679-9216.80442.
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Background: Trachemys scripta elegans is an aquatic turtle native to North America and distributed geographically from the eastern United States to northeastern Mexico. In Brazil, it is an exotic and invasive species and the most illegally traded pet animal. When these turtles grow and they cease to be attractive as pets, they are released clandestinely in lakes, ponds, rivers, and other bodies of water, where they threaten biodiversity and native populations. The present study aimed to characterize specimens of T. s. elegans from the Centro de Triagem de Animais Silvestres do Parque Ecológico do Tiete by analyzing body biometrics, sexual dimorphism, and structure of specimens for sex ratio and size classes.Materials, Methods & Results: Trachemys scripta elegans turtles (39 females and 30 males) were anesthetized, euthanized and frozen. After being thawed, the turtles were sexed according to measurements on secondary sex characters such as claw length (CWL) of the third finger of the right forearm and length of the tail from the tip to the beginning of the cloacal opening (postcloacal tail length, PTL); subsequently, sex was confirmed through dissection. Subsequently, body mass (BM, g) and maximum carapace length (MCL, cm), maximum carapace width (MCW, cm), maximum plastron length (MPL, cm), maximum plastron width (MPW) and shell height (HGT, cm, measured laterally until obtaining the greatest value) were evaluated and the sexual dimorphism index (SDI) was also calculated. All analyses were performed using SAS v. 9.4 software. The results indicate a sex ratio of 1.3 females per male. The identification of males by secondary sex characteristics was performed using only claw length (CWL), which was related to sex and not to maximum carapace length (MCL). The most discriminatory variables were CWL in males and body mass (BM) in females. With the exception of CWL, the sexual dimorphism index (SDI) values all favored females and varied from 1.21 to 2.49, with the greatest value for BM and the lowest value for postcloacal tail length (PTL). Males exhibited a unimodal tendency at a classification interval of 15.0 cm MCL, and females exhibited a bimodal tendency at 21.0- and 22.0 cm MCL. Sexual maturity was identified at 12.0 cm MCL in males and at 12.5 cm MCL in females. The rate of CWL growth in males was higher at the beginning of sexual maturity and subsequently decreased, whereas in females, the rate of CWL escalated after 19.0 cm MCL. In both sexes, principal component 1 (PC1) was composed of the variables related to size and BM, and principal component 2 (PC2) and principal component 3 (PC3) were composed of variables related to secondary sex characteristics (CWL and PTL).Discussion: In members of the genus Trachemys, several secondary sex characteristics can be used to differentiate between the sexes, however, in the present study, recognition of males was performed only by claw length, as it was confirmed by the discriminate analysis and the principal components analysis (PCA) which showed that CWL was the variable that was most discriminatory in males (approximately 76.0%), followed by BM (approximately 50%) in females. The results reinforcing the claim that the degree of development of secondary sex characteristics varies between species as well as between distinct populations of the same species and establish that even under unnatural habitat, sexual dimorphism of size in favor of females is maintained for variables related to mass and size.
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He, Katherine, Peng Zhang, and Stewart C. Wang. "Crash Telemetry-Based Injury Severity Prediction is Equivalent to or Out-Performs Field Protocols in Triage of Planar Vehicle Collisions." Prehospital and Disaster Medicine 34, no. 04 (2019): 356–62. http://dx.doi.org/10.1017/s1049023x19004515.
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AbstractIntroduction:With the increasing availability of vehicle telemetry technology, there is great potential for Advanced Automatic Collision Notification (AACN) systems to improve trauma outcomes by detecting patients at-risk for severe injury and facilitating early transport to trauma centers.Methods:National Automotive Sampling System Crashworthiness Data System (NASS-CDS) data from 1999-2013 were used to construct a logistic regression model (injury severity prediction [ISP] model) predicting the probability that one or more occupants in planar, non-rollover motor vehicle collisions (MVCs) would have Injury Severity Score (ISS) 15+ injuries. Variables included principal direction of force (PDOF), change in velocity (Delta-V), multiple impacts, presence of any older occupant (≥55 years old), presence of any female occupant, presence of right-sided passenger, belt use, and vehicle type. The model was validated using medical records and 2008-2011 crash data from AACN-enabled Michigan (USA) vehicles identified from OnStar (OnStar Corporation; General Motors; Detroit, Michigan USA) records. To compare the ISP to previously established protocols, a literature search was performed to determine the sensitivity and specificity of first responder identification of ISS 15+ for MVC occupants.Results:The study population included 924 occupants in 836 crash events. The ISP model had a sensitivity of 72.7% (95% Confidence Interval [CI] 41%-91%) and specificity of 93% (95% CI 92%-95%) for identifying ISS 15+ occupants injured in planar MVCs. The current standard 2006 Field Triage Decision Scheme (FTDS) was 56%-66% sensitive and 75%-88% specific in identifying ISS 15+ patients.Conclusions:The ISP algorithm comparably is more sensitive and more specific than current field triage in identifying MVC patients at-risk for ISS 15+ injuries. This real-world field study shows telemetry data transmitted before dispatch of emergency medical systems can be helpful to quickly identify patients who require urgent transfer to trauma centers.
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Curotto, Mariana, Julieta Zalacaín-Colombo, Melisa Paolino, and Silvina Arrossi. "Adopción e implementación del ofrecimiento de la autotoma VPH por agentes sanitarios en Jujuy, Argentina." Salud Pública de México 60, no. 6, nov-dic (2018): 674. http://dx.doi.org/10.21149/8854.
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Objetivo. Evaluar la adopción e implementación en escala de la estrategia orientada a ofrecer puerta a puerta la autotoma de la prueba del virus del papiloma humano (AT-VPH), por parte de agentes sanitarios (AS), en Jujuy, Argentina. Material y métodos. Se aplicó una encuesta autoadministrada a 478 AS. Las dimensiones de adopción e implementación fueron evaluadas con el modelo RE-AIM. Resultados. Adopción: 81.8% de los AS ofreció la AT-VPH y 86.4% expresó gratificación con la estrategia. Implementación: los problemas encontrados fueron la demora en la entrega de tubos (61.3%) y resultados (70.0%); falta de recursos humanos (28.3%), y dificultades al obtener turnos para realizar el triage (26.1%). El principal obstáculo fue la sobrecarga de trabajo (50.2%), mientras que la capacitación (38.0%) y el listado de mujeres a contactar (28.7%) fueron los elementos facilitadores. Conclusiones. La adopción de la AT-VPH fue alta entre los AS. Deben reforzarse las estrategias programáticas para motivar a los AS y reducir su carga de trabajo al implementar la AT-VPH.
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Longmore, Sally K., Gough Y. Lui, Ganesh Naik, Paul P. Breen, Bin Jalaludin, and Gaetano D. Gargiulo. "A Comparison of Reflective Photoplethysmography for Detection of Heart Rate, Blood Oxygen Saturation, and Respiration Rate at Various Anatomical Locations." Sensors 19, no. 8 (2019): 1874. http://dx.doi.org/10.3390/s19081874.
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Monitoring of vital signs is critical for patient triage and management. Principal assessments of patient conditions include respiratory rate heart/pulse rate and blood oxygen saturation. However, these assessments are usually carried out with multiple sensors placed in different body locations. The aim of this paper is to identify a single location on the human anatomy whereby a single 1 cm × 1 cm non-invasive sensor could simultaneously measure heart rate (HR), blood oxygen saturation (SpO2), and respiration rate (RR), at rest and while walking. To evaluate the best anatomical location, we analytically compared eight anatomical locations for photoplethysmography (PPG) sensors simultaneously acquired by a single microprocessor at rest and while walking, with a comparison to a commercial pulse oximeter and respiration rate ground truth. Our results show that the forehead produced the most accurate results for HR and SpO2 both at rest and walking, however, it had poor RR results. The finger recorded similar results for HR and SpO2, however, it had more accurate RR results. Overall, we found the finger to be the best location for measurement of all three parameters at rest; however, no site was identified as capable of measuring all parameters while walking.
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Mayorga Mayorga, Jairo Israel, Juan Israel Acurio Pérez, Fernando Sebastián Andrade Borja, and Mónica Alexandra Ocaña Guevara. "Predictor de mortalidad, utilidad de trauma score revisado. (RTS)." ConcienciaDigital 3, no. 2 (2020): 34–54. http://dx.doi.org/10.33262/concienciadigital.v3i2.1205.
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La principal causa de muertes y discapacidad en la población adulta joven es el trauma. A nivel mundial se estimó 278,6 millones de personas sufrieron traumas en especial relación con accidentes de tránsito. En países latinoamericanos las estadísticas se duplican versus con las potencias mundiales y que del 20% al 40% de la ocupación hospitalaria fue relacionada a esta causa. La presente investigación se realizó con el objetivo de valorar como predictor de mortalidad a la escala Trauma Score Revisado (RTS) en el servicio de emergencias del hospital General Docente Ambato (HGDA). Fue de carácter observacional-documentado de enfoque cuali-cuantitativo, de diseño no experimental, analítico sintético y de corte retrospectivo tranversal. Se definió que las variables de las constantes vitales se encontraron en un porcentaje normal en la mayoría de pacientes atendidos y en lis que no se pudo realizar el cálculo de la escala fue por la limitación de falta de información por un llenado incompleto de las historias clínicas, además que en la atención pre-hospitalaria como en el triage hace falta la implementación de RTS para mejorar el tiempo en la atención que influirá en el pronóstico de estos pacientes críticos.
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Saegerman, Claude, Allison Gilbert, Anne-Françoise Donneau, et al. "Clinical decision support tool for diagnosis of COVID-19 in hospitals." PLOS ONE 16, no. 3 (2021): e0247773. http://dx.doi.org/10.1371/journal.pone.0247773.
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Background The coronavirus infectious disease 19 (COVID-19) pandemic has resulted in significant morbidities, severe acute respiratory failures and subsequently emergency departments’ (EDs) overcrowding in a context of insufficient laboratory testing capacities. The development of decision support tools for real-time clinical diagnosis of COVID-19 is of prime importance to assist patients’ triage and allocate resources for patients at risk. Methods and principal findings From March 2 to June 15, 2020, clinical patterns of COVID-19 suspected patients at admission to the EDs of Liège University Hospital, consisting in the recording of eleven symptoms (i.e. dyspnoea, chest pain, rhinorrhoea, sore throat, dry cough, wet cough, diarrhoea, headache, myalgia, fever and anosmia) plus age and gender, were investigated during the first COVID-19 pandemic wave. Indeed, 573 SARS-CoV-2 cases confirmed by qRT-PCR before mid-June 2020, and 1579 suspected cases that were subsequently determined to be qRT-PCR negative for the detection of SARS-CoV-2 were enrolled in this study. Using multivariate binary logistic regression, two most relevant symptoms of COVID-19 were identified in addition of the age of the patient, i.e. fever (odds ratio [OR] = 3.66; 95% CI: 2.97–4.50), dry cough (OR = 1.71; 95% CI: 1.39–2.12), and patients older than 56.5 y (OR = 2.07; 95% CI: 1.67–2.58). Two additional symptoms (chest pain and sore throat) appeared significantly less associated to the confirmed COVID-19 cases with the same OR = 0.73 (95% CI: 0.56–0.94). An overall pondered (by OR) score (OPS) was calculated using all significant predictors. A receiver operating characteristic (ROC) curve was generated and the area under the ROC curve was 0.71 (95% CI: 0.68–0.73) rendering the use of the OPS to discriminate COVID-19 confirmed and unconfirmed patients. The main predictors were confirmed using both sensitivity analysis and classification tree analysis. Interestingly, a significant negative correlation was observed between the OPS and the cycle threshold (Ct values) of the qRT-PCR. Conclusion and main significance The proposed approach allows for the use of an interactive and adaptive clinical decision support tool. Using the clinical algorithm developed, a web-based user-interface was created to help nurses and clinicians from EDs with the triage of patients during the second COVID-19 wave.
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Widyaningrum, Rahmah, Mei Neni Sitaresmi, and Lely Lusmilasari. "Analisis Pelaksanaan Trias Usaha Kesehatan Sekolah (UKS) dan Perilaku Hidup Bersih dan Sehat (PHBS) di SLB C di Bantul." Berita Kedokteran Masyarakat 32, no. 9 (2018): 309. http://dx.doi.org/10.22146/bkm.8579.
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Evaluation of triage programs school health unit and clean and health living behavior in school for children with special educational needs BantulPurposeThis study aimed to get an overview of school health unit and implementation of clean and health living behavior in school for children with special educational needs. MethodsThis research used qualitative methods with a case study approach. Participants of the study included the principal, the teacher, students and public health center staff, the senior managers of the school, and the Yogyakarta provincial youth and sports education department. Qualitative data were obtained through in-depth interviews, observations, and documentation studies. ResultsThe implementation of trias school health unit program was in the good category. Some clean and health living indicators were still in low category. The obstacles of the school health unit and clean and health living behavior program implementation were limited understanding of students, low coverage of teacher and school training, economic conditions and parental attitudes, school readiness, and involvement of relevant agencies. Factors affecting school health unit implementation included curriculum, school organization, and partnership. ConclusionThe implementation of school health unit and clean and health can be enhanced through partnership optimization with community health centers, related offices, non-governmental organizations, and education and health universities.
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Picón Silva, Erich Steve, Julián Hernando Salgado Hernández, and Migel Ángel Saavedra Ortiz. "Perfil epidemiológico del servicio de urgencias según motivo de consulta. Hospital de San José de Bogotá, Septiembre 2011 a Febrero 2012." Revista Repertorio de Medicina y Cirugía 22, no. 3 (2013): 197–203. http://dx.doi.org/10.31260/repertmedcir.v22.n3.2013.771.
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Introducción: el servicio de urgencias del Hospital de San José de Bogotá DC adelanta la implementación de un programa de registros clínicos con fines estadísticos y propósitos de investigación. Objetivo: establecer el perfil epidemiológico del servicio de urgencias de adultos con base en la información del software e-salud en un período de seis meses. Métodos: se obtuvieron 18.519 registros de septiembre 2011 a febrero 2012. Las variables consideradas fueron edad, género, responsable del pago de la atención, clasificación triage, tiempo de espera para la atención y motivo de consulta; los datos fueron procesados con frecuencias, medidas de tendencia central y dispersión en Stata 10. Resultados: la población atendida en su mayoría fue menor de 50 años (65%), 52.6% fueron hombres, la edad promedio 43 años, el principal pagador corresponde a la aseguradora (EPS 90.3%), los motivos de consulta más frecuentes fueron dolor abdominal (61.2%), trauma (14.2%) y cefalea (10,2%). El tiempo de espera para la atención fue menor de quince minutos en el 85% de los casos. Conclusión: no existieron diferencias entre el perfil epidemiológico obtenido con la información arrojada por el sistema de registro e-Salud y el previo del personal de facturación. Los hallazgos sugieren ajustar y ampliar las guías trazadoras del servicio.
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Ross, Emily J., Chelsea H. Wiener, Diane Robinson, and Jeffrey E. Cassisi. "Optimizing Community and Hospital Services Using the Cancer Support Source Program." Journal of Patient Experience 7, no. 1 (2018): 96–104. http://dx.doi.org/10.1177/2374373518808309.
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Background: The Cancer Support Community developed the Cancer Support Source (CSS) to assess the needs of cancer patients with distress. Each item on this self-administered questionnaire represents an area of concern which the patient rates and indicates their need for action with a “staff person,” but no details about the category of staff is given. Objective: To examine the factor structure of the CSS and to increase its utility to triage patients for referral to services based on a needs assessment. Methods: Data from 690 patients who completed the CSS over a 1-year period were analyzed. In study 1, an exploratory principal component analysis was conducted. In study 2, the fit of this proposed model was evaluated with confirmatory factor analysis (CFA). Results: Three factors were retained in the final CFA: emotional distress, physical health concerns, and resource needs. This model demonstrated adequate fit, Root Mean Square Error of Approximation (RMSEA)= 0.056, Comparitive Fit Index (CFI) = .907, Standardized Root Mean Square Residual (SRMR) = 0.050. Conclusions: Three factors are proposed as CSS subscales to guide referral and coordinate services: Emotional Distress/Patient and Family Counselor, Physical Health Concerns/Medical Care Provider, and Resource Needs/Case Management-Clinical Social Worker. The clinical utility of these referral subscales should be established with additional research.
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Kornblau, Steven M., Raoul Tibes, Yi Hua Qiu, et al. "Functional proteomic profiling of AML predicts response and survival." Blood 113, no. 1 (2009): 154–64. http://dx.doi.org/10.1182/blood-2007-10-119438.
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Abstract Because protein function regulates the phenotypic characteristics of cancer, a functional proteomic classification system could provide important information for pathogenesis and prognosis. With the goal of ultimately developing a proteomic-based classification of acute myeloid leukemia (AML), we assayed leukemia-enriched cells from 256 newly diagnosed AML patients, for 51 total and phosphoproteins from apoptosis, cell-cycle, and signal-transduction pathways, using reverse-phase protein arrays. Expression in matched blood and marrow samples were similar for 44 proteins; another 7 had small fold changes (8%-55%), suggesting that functional proteomics of leukemia-enriched cells in the marrow and periphery are similar. Protein expression patterns were independent of clinical characteristics. However, 24 proteins were significantly different between French-American-British subtypes, defining distinct signatures for each. Expression signatures for AML with cytogenetic abnormalities involving −5 or −7 were similar suggesting mechanistic commonalities. Distinct expression patterns for FMS-like tyrosine kinase 3–internal tandem duplication were also identified. Principal component analysis defined 7 protein signature groups, with prognostic information distinct from cytogenetics that correlated with remission attainment, relapse, and overall survival. In conclusion, protein expression profiling patterns in AML correlate with known morphologic features, cytogenetics, and outcome. Confirmation in independent studies may also provide pathophysiologic insights facilitating triage of patients to emerging targeted therapies.
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Schober, Patrick, Sebastiaan M. Bossers, and Lothar A. Schwarte. "Intracranial Hematoma Detection by Near Infrared Spectroscopy in a Helicopter Emergency Medical Service: Practical Experience." BioMed Research International 2017 (2017): 1–6. http://dx.doi.org/10.1155/2017/1846830.
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In (helicopter) emergency medical services, (H)EMS, the prehospital detection of intracranial hematomas should improve patient care and the triage to specialized neurosurgical hospitals. Recently, noninvasive detection of intracranial hematomas became possible by applying transcranial near infrared spectroscopy (NIRS). Herein, second-generation devices are currently available, for example, the Infrascanner 2000 (Infrascan), that appear suited also for prehospital (H)EMS applications. Since (H)EMS operations are time-critical, we studied the Infrascanner 2000 as a “first-time-right” monitor in healthy volunteers (n=17, hospital employees, no neurologic history). Further, we studied the implementation of the Infrascanner 2000 in a European HEMS organization (Lifeliner 1, Amsterdam, The Netherlands). The principal results of our study were as follows: The screening for intracranial hematomas in healthy volunteers with first-time-right intention resulted in a marked rate of virtual hematomas (false positive results, i.e., 12/17), rendering more time consuming repeat measurements advisable. The results of the implementation of the Infrascanner in HEMS suggest that NIRS-based intracranial hematoma detection is feasible in the HEMS setting. However, some drawbacks exist and their possible solutions are discussed. Future studies will have to demonstrate how NIRS-based intracranial hematoma detection will improve prehospital decision making in (H)EMS and ultimately patient outcome.
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Isomura, Takuya, Koji Sakai, Kiyoshi Kotani, and Yasuhiko Jimbo. "Linking Neuromodulated Spike-Timing Dependent Plasticity with the Free-Energy Principle." Neural Computation 28, no. 9 (2016): 1859–88. http://dx.doi.org/10.1162/neco_a_00862.
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The free-energy principle is a candidate unified theory for learning and memory in the brain that predicts that neurons, synapses, and neuromodulators work in a manner that minimizes free energy. However, electrophysiological data elucidating the neural and synaptic bases for this theory are lacking. Here, we propose a novel theory bridging the information-theoretical principle with the biological phenomenon of spike-timing dependent plasticity (STDP) regulated by neuromodulators, which we term mSTDP. We propose that by integrating an mSTDP equation, we can obtain a form of Friston’s free energy (an information-theoretical function). Then we analytically and numerically show that dopamine (DA) and noradrenaline (NA) influence the accuracy of a principal component analysis (PCA) performed using the mSTDP algorithm. From the perspective of free-energy minimization, these neuromodulatory changes alter the relative weighting or precision of accuracy and prior terms, which induces a switch from pattern completion to separation. These results are consistent with electrophysiological findings and validate the free-energy principle and mSTDP. Moreover, our scheme can potentially be applied in computational psychiatry to build models of the faulty neural networks that underlie the positive symptoms of schizophrenia, which involve abnormal DA levels, as well as models of the NA contribution to memory triage and posttraumatic stress disorder.
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Bayram, Jamil D., and Shawki Zuabi. "Disaster Metrics: A Proposed Quantitative Model for Benchmarking Prehospital Medical Response in Trauma-Related Multiple Casualty Events." Prehospital and Disaster Medicine 27, no. 2 (2012): 123–29. http://dx.doi.org/10.1017/s1049023x12000416.
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AbstractIntroductionQuantitative benchmarking of trauma-related prehospital response for Multiple Casualty Events (MCE) is complicated by major difficulties due to the simultaneous occurrences of multiple prehospital activities.Hypothesis/ProblemAttempts to quantify the various components of prehospital medical response in MCE have fallen short of a comprehensive model. The objective of this study was to model the principal parameters necessary to quantitatively benchmark the prehospital medical response in trauma-related MCE.MethodsA two-step approach was adopted for the methodology of this study: an extensive literature search was performed, followed by prehospital system quantitative modeling. Studies on prehospital medical response to trauma injuries were used as the framework for the proposed model. The North Atlantic Treaty Organization (NATO) triage categories (T1-T4) were used for the study.ResultsTwo parameters, the Injury to Patient Contact Interval (IPCI) and Injury to Hospital Interval (IHI), were identified and proposed as the principal determinants of the medical prehospital response in trauma-related MCE. IHI is the time interval from the occurrence of injury to the completion of transfer of care of critical (T1) and moderate (T2) patients. The IHI for each casualty is compared to the Maximum Time Allowed described in the literature (golden hour for T1 and Friedrich's time for T2). In addition, the medical rescue factor (R) was identified as the overall indicator for the prehospital medical performance for T1 and T2, and a numerical value of one (R = 1) was proposed to be the quantitative benchmark.ConclusionA new quantitative model for benchmarking prehospital response to MCE in trauma-related MCE is proposed. Prospective studies of this model are needed to validate its applicability.Bayram J, Zuabi S. Disaster metrics: a proposed quantitative model for benchmarking prehospital medical response in trauma-related multiple casualty events. Prehosp Disaster Med. 2012;27(2):-7.
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Dippenaar, Enrico. "An epidemiological study of a patient population, triage category allocations and principal diagnosis within the emergency centres of a private healthcare group in the Emirate of Dubai, United Arab Emirates." Nursing Open 7, no. 5 (2020): 1468–74. http://dx.doi.org/10.1002/nop2.518.
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Medipally, Dinesh K. R., Daniel Cullen, Valérie Untereiner, et al. "Vibrational spectroscopy of liquid biopsies for prostate cancer diagnosis." Therapeutic Advances in Medical Oncology 12 (January 2020): 175883592091849. http://dx.doi.org/10.1177/1758835920918499.
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Background: Screening for prostate cancer with prostate specific antigen and digital rectal examination allows early diagnosis of prostate malignancy but has been associated with poor sensitivity and specificity. There is also a considerable risk of over-diagnosis and over-treatment, which highlights the need for better tools for diagnosis of prostate cancer. This study investigates the potential of high throughput Raman and Fourier Transform Infrared (FTIR) spectroscopy of liquid biopsies for rapid and accurate diagnosis of prostate cancer. Methods: Blood samples (plasma and lymphocytes) were obtained from healthy control subjects and prostate cancer patients. FTIR and Raman spectra were recorded from plasma samples, while Raman spectra were recorded from the lymphocytes. The acquired spectral data was analysed with various multivariate statistical methods, principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA) and classical least squares (CLS) fitting analysis. Results: Discrimination was observed between the infrared and Raman spectra of plasma and lymphocytes from healthy donors and prostate cancer patients using PCA. In addition, plasma and lymphocytes displayed differentiating signatures in patients exhibiting different Gleason scores. A PLS-DA model was able to discriminate these groups with sensitivity and specificity rates ranging from 90% to 99%. CLS fitting analysis identified key analytes that are involved in the development and progression of prostate cancer. Conclusions: This technology may have potential as an alternative first stage diagnostic triage for prostate cancer. This technology can be easily adaptable to many other bodily fluids and could be useful for translation of liquid biopsy-based diagnostics into the clinic.
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Hubáček, Petr, Radka Filipčíková, Drahomíra Vrzalová, et al. "MTS - Triage patients with internal issues - principles and effectiveness." Interní medicína pro praxi 20, no. 2 (2018): e6-e8. http://dx.doi.org/10.36290/int.2018.017.
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Thibon, E., X. Bobbia, B. Blanchard, et al. "Association entre mortalité et attente aux urgences chez les adultes à hospitaliser pour étiologies médicales." Annales françaises de médecine d’urgence 9, no. 4 (2019): 229–34. http://dx.doi.org/10.3166/afmu-2019-0151.
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Introduction: Notre objectif principal est de comparer, dans un centre hospitalier universitaire (CHU) français et chez les patients hospitalisés pour étiologies médicales à partir de la structure des urgences (SU), le taux de mortalité intrahospitalière entre ceux qui n’attendent pas faute de place en service et ceux en attente (boarding).Méthode: Il s’agit d’une étude quasi expérimentale, monocentrique, observationnelle, rétrospective, par recueil d’informations à partir des dossiers patients informatisés. Nous avons appliqué un score de propension pour ajuster les critères de jugement aux variables mesurées dans les deux groupes, c’est-à-dire les données : 1) démographiques (âge et sexe) ; 2) médicales (niveau de triage) ; 3) biologiques (numération leucocytaire, hémoglobinémie, natrémie, kaliémie, taux sérique de CRP, créatininémie) ; 4) d’imageries (réalisation ou non de radiographie, d’échographie, d’imagerie par résonance magnétique, de tomodensitométrie).Résultats: En 2017, la SU du CHU a admis 60 062 patients adultes. Sur les 15 496 patients hospitalisés après admission en SU, 6 997 l’ont été pour une étiologie médicale, dont 2 546 (36 %) sans attente et 4 451 (64 %) après une attente. Après pondération, le taux de mortalité intrahospitalière était plus important dans le groupe en attente : 7,8 vs 6,3 % ;p< 0,05. De même, la durée médiane d’hospitalisation était plus importante dans le groupe en attente : 7,6 [4,7– 12,0] vs 7,1 j [4,3–11,5] ;p< 0,01.Discussion: Les taux de mortalité et de la durée de séjour intrahospitaliers sont plus importants chez les patients étudiés qui attendent en SU faute de place en service. Nos résultats sont concordants avec la littérature internationale. Il est nécessaire de trouver des solutions pour réduire cette surmortalité.
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Huang, Sheng-Wen, Huey-Pin Tsai, Su-Jhen Hung, Wen-Chien Ko, and Jen-Ren Wang. "Assessing the risk of dengue severity using demographic information and laboratory test results with machine learning." PLOS Neglected Tropical Diseases 14, no. 12 (2020): e0008960. http://dx.doi.org/10.1371/journal.pntd.0008960.
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Background Dengue virus causes a wide spectrum of disease, which ranges from subclinical disease to severe dengue shock syndrome. However, estimating the risk of severe outcomes using clinical presentation or laboratory test results for rapid patient triage remains a challenge. Here, we aimed to develop prognostic models for severe dengue using machine learning, according to demographic information and clinical laboratory data of patients with dengue. Methodology/Principal findings Out of 1,581 patients in the National Cheng Kung University Hospital with suspected dengue infections and subjected to NS1 antigen, IgM and IgG, and qRT-PCR tests, 798 patients including 138 severe cases were enrolled in the study. The primary target outcome was severe dengue. Machine learning models were trained and tested using the patient dataset that included demographic information and qualitative laboratory test results collected on day 1 when they sought medical advice. To develop prognostic models, we applied various machine learning methods, including logistic regression, random forest, gradient boosting machine, support vector classifier, and artificial neural network, and compared the performance of the methods. The artificial neural network showed the highest average discrimination area under the receiver operating characteristic curve (0.8324 ± 0.0268) and balance accuracy (0.7523 ± 0.0273). According to the model explainer that analyzed the contributions/co-contributions of the different factors, patient age and dengue NS1 antigenemia were the two most important risk factors associated with severe dengue. Additionally, co-existence of anti-dengue IgM and IgG in patients with dengue increased the probability of severe dengue. Conclusions/Significance We developed prognostic models for the prediction of dengue severity in patients, using machine learning. The discriminative ability of the artificial neural network exhibited good performance for severe dengue prognosis. This model could help clinicians obtain a rapid prognosis during dengue outbreaks. However, the model requires further validation using external cohorts in future studies.
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Chin, Caroline N., Kate Sullivan, and Stephen F. Wilson. "A 'snap shot' of the health of homeless people in inner Sydney: St Vincent's Hospital." Australian Health Review 35, no. 1 (2011): 52. http://dx.doi.org/10.1071/ah09824.
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Objectives. The poor health profile of people who are homeless results in a disproportionate use of health resources by these people. An in-hospital count of demographic and health data of homeless patients was conducted on two occasions at St Vincent’s Hospital in Sydney as an indicator of health resource utilisation for the Sydney region. Methods. Two in-hospital counts were conducted of homeless patients within the boundaries of St Vincent’s Hospital to coincide with the inaugural City of Sydney homeless street counts in winter 2008 and summer 2009. Data collected included level of homelessness, principal diagnosis, triage category, bed occupancy and linkages to services post hospital discharge. Results. Homeless patients at St Vincent’s utilised over four times the number of acute ward beds when compared with the state average. This corresponds to a high burden of mental health, substance use and physical health comorbidities in homeless people. There was high utilisation of mental health and drug and alcohol services by homeless people, and high levels of linkages with these services post-discharge. There were relatively low rates of linkage with general practitioner and ambulatory care services. Conclusion. Increasing knowledge of the health needs of the homeless community will assist in future planning and allocation of health services. What is known about the topic? The poor health status of people who are homeless has been previously noted in the USA, Canada and Scotland. What does this paper add? Homeless people living in Sydney also have a poor health profile and a disproportionate use of health resources when compared to people in the general population. What are the implications for practitioners? Health services for homeless people should be equipped to deal with mental health, substance use and physical health comorbidities.
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Kline, Jeffrey, David Adler, Naomi Alanis, et al. "Study protocol for a multicentre implementation trial of monotherapy anticoagulation to expedite home treatment of patients diagnosed with venous thromboembolism in the emergency department." BMJ Open 10, no. 10 (2020): e038078. http://dx.doi.org/10.1136/bmjopen-2020-038078.
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IntroductionIn the USA, many emergency departments (EDs) have established protocols to treat patients with newly diagnosed deep vein thrombosis (DVT) as outpatients. Similar treatment of patients with pulmonary embolism (PE) has been proposed, but no large-scale study has been published to evaluate a comprehensive, integrated protocol that employs monotherapy anticoagulation to treat patients diagnosed with DVT and PE in the ED.Methods and analysisThis protocol describes the implementation of the Monotherapy Anticoagulation To expedite Home treatment of Venous ThromboEmbolism (MATH-VTE) study at 33 hospitals in the USA. The study was designed and executed to meet the requirements for the Standards for Reporting Implementation Studies guideline. The study was funded by investigator-initiated awards from industry, with Indiana University as the sponsor. The study principal investigator and study associates travelled to each site to provide on-site training. The protocol identically screens patients with both DVT or PE to determine low risk of death using either the modified Hestia criteria or physician judgement plus a negative result from the simplified PE severity index. Patients must be discharged from the ED within 24 hours of triage and treated with either apixaban or rivaroxaban. Overall effectiveness is based upon the primary efficacy and safety outcomes of recurrent VTE and bleeding requiring hospitalisation respectively. Target enrolment of 1300 patients was estimated with efficacy success defined as the upper limit of the 95% CI for the 30-day frequency of VTE recurrence below 2.0%. Thirty-three hospitals in 17 states were initiated in 2016–2017.Ethics and disseminationAll sites had Institutional Review Board approval. We anticipate completion of enrolment in June 2020; study data will be available after peer-reviewed publication. MATH-VTE will provide information from a large multicentre sample of US patients about the efficacy and safety of home treatment of VTE with monotherapy anticoagulation.
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Bhoyar, Ankit D. "Design Construction and Performance Test of a Low-Cost Pandemic Ventilator for Breathing Support." International Journal for Research in Applied Science and Engineering Technology 9, no. 8 (2021): 2374–80. http://dx.doi.org/10.22214/ijraset.2021.37771.
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Abstract: Mass casualty incidents such as those that are being experienced during the novel coronavirus disease (COVID-19) pandemic can overwhelm local healthcare systems, where the number of casualties exceeds local resources and capabilities in a short period of time. The introduction of patients with worsening lung function as a result of COVID-19 has strained traditional ventilator supplies. Mechanical ventilator is a medical device which is usually utilized to ventilate patients who cannot breathe adequately on their own. Among many types of ventilators Bag Valve Mask (BVM) is a manual ventilator in which a bag is pressed to deliver air into the lungs of the patient. In present work, a mechanical system along with speed controller has been developed to automate the operation of BVM. The constructed prototype contains crank, powered by servo motor, supported by wooden frame. To bridge the gap during ventilator shortages and to help clinicians triage patients, manual resuscitator devices can be used to deliver respirations to a patient requiring breathing support. With principal dimensions of 0.54*0.64 m2 , bvm weighs 0.9 kg and DC power convertor for supplying power for a continuous operation, the prototype can be moved easily. The dimensions of the frame are selected as such to be compatible with the physical dimension of Ambu bag. The performance of the device was tested using Airflow meter which illustrates that the Tidal Volume vs. Time graph of the automated system is similar to the graph produced by manual operation of the BVM, but with a mean deviation of 0.182 Litres with manual operation and 0.1 Litres with prototype. For patients who require ventilatory support, manual ventilation is a vital procedure. It has to be performed by experienced healthcare providers that are regularly trained for the use of bag-valve-mask (BVM) in emergency situations. Keywords: Mechanical Ventilator, Automated BVM, BPM, COVID-19, Ventilator design, Airflow meter
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Frolov, V., S. Hendy, and A. L. Larsen. "Stationary strings and principal Killing triads in 2 + 1 gravity." Nuclear Physics B 468, no. 1-2 (1996): 336–52. http://dx.doi.org/10.1016/0550-3213(96)00140-x.
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Silva, Luzia Poliana Anjos da, Fernanda Queiros, and Isabela Lima. "Fatores etiológicos da deficiência auditiva em crianças e adolescentes de um centro de referência APADA em Salvador-BA." Revista Brasileira de Otorrinolaringologia 72, no. 1 (2006): 33–36. http://dx.doi.org/10.1590/s0034-72992006000100006.
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A audição representa a principal fonte para aquisição das habilidades de linguagem e fala da criança. A criança portadora de deficiência auditiva nos primeiros meses de vida é privada de estimulação sonora no período mais importante de seu desenvolvimento, e conseqüentemente, poderá apresentar alterações emocionais, sociais, e lingüísticas. Neste contexto é de suma relevância conhecer os principais fatores etiológicos que ocasionam a lesão auditiva para se traçar um perfil nosológico fidedigno, e serem tomadas as medidas cabíveis de prevenção e orientação as famílias sobre as repercussões da deficiência auditiva na infância. OBJETIVOS: Caracterizar o perfil etiológico da deficiência auditiva em um centro de referência para atendimento a crianças e adolescentes deficientes auditivos. METODOLOGIA: Foram realizadas entrevistas, triagem fonoaudiológica e avaliação de prontuários de 87 crianças deficientes auditivas cadastradas na Associação de Pais e Amigos dos Deficientes Auditivos do Estado da Bahia(APADA-BA), buscando-se determinar a etiologia, distribuição por sexo, idade do diagnóstico, grau de deficiência, idade de protetização e da reabilitação fonoaudiológica. RESULTADOS: Dentre as 87 crianças e adolescentes que passaram pela triagem fonoaudiológica, selecionamos uma amostra de 53 sujeitos, cujos pais compareceram as três sessões de anamnese e avaliação. O principal fator etiológico responsável pela deficiência auditiva na população avaliada foi a rubéola materna responsável por 32% dos casos de surdez, seguida pela meningite piogênica com 20%, causa idiopática com 15%, prematuridade com 9%, hereditariedade (pai ou mãe surdo) e icterícia neonatal também apresentaram incidência de 6%; otite média crônica representou 4%, uso de misoprostol na gestação, sarampo, ototoxicidade e caxumba apareceram na amostra, cada fator, com 2%. CONCLUSÃO: O presente estudo demonstrou a heterogeneidade de fatores que ocasionam o comprometimento auditivo, e como as duas principais causas (rubéola e meningite piogênica) ainda apresentam uma incidência alta na população em estudo. Acreditamos que medidas de prevenção devem ser tomadas, principalmente na profilaxia da rubéola materna e na vacinação ampliada de neonatos e lactentes contra a meningite bacteriana.
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César Fernandes, Bruno, Raquel Borges de Barros Primo, Anny Karoliny das Chagas Bandeira, Mariella Rodrigues da Silva, and Carolina Calixto de Souza Andrade. "IMPORTÂNCIA DO RECONHECIMENTO PRECOCE DA HIPERTENSÃO ARTERIAL EM CRIANÇAS E ADOLESCENTES." Revista Interdisciplinar em Ciências da Saúde e Biológicas 4, no. 2 (2020): 89–101. http://dx.doi.org/10.31512/ricsb.v4i2.297.
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A hipertensão arterial é considerada uma epidemia, mantendo-se como a principal causa de morte e incapacitação global. Como a hipertensão arterial na infância é altamente preditiva de hipertensão arterial na idade adulta, tem havido um crescente interesse no reconhecimento precoce dessa condição na população pediátrica, por meio de uma triagem ambulatorial em crianças acima de três anos. Este estudo foi realizado com o intuito de enfatizar a importância do monitoramento rotineiro de aferição da pressão arterial em crianças e adolescentes nas consultas de puericultura. Trata-se de uma revisão de literatura em artigos publicados, pesquisados através das bases de dados PubMed e Biblioteca Virtual em Saúde. O estudo concluiu que a aferição da pressão arterial em todas as consultas de crianças é importante, tendo em vista que sua triagem precoce nessa população vem sendo preconizada pelos principais institutos e organizações de saúde do mundo, para direcionar as políticas de vigilância em saúde e prevenção de doenças crônicas associadas na idade adulta. Caso seja identificada a doença, é preciso instaurar um tratamento, o que irá variar entre terapêuticas não farmacológicas e farmacológicas, que devem ser introduzidas para todos os pacientes pediátricos com valores de pressão arterial acima do percentil aceitável para idade.
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Zucato, Barbara, and Mara Suzana Behlau. "Índice de sintomas do refluxo Faringo-Laríngeo: relação com os principais sintomas de refluxo gastresofágico, nível de uso de voz e triagem vocal." Revista CEFAC 14, no. 6 (2012): 1197–203. http://dx.doi.org/10.1590/s1516-18462012005000078.
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OBJETIVO: relacionar o Índice de Sintomas do Refluxo Faringo-Laríngeo - ISRFL com os principais sintomas do refluxo gastresofágico - RGE (azia/queimação e dor retroesternal), com o nível de uso da voz e com uma triagem vocal. MÉTODO: participaram deste estudo 179 voluntários maiores de 18 anos, 107 mulheres e 72 homens, classificados em dois grupos de acordo com o escore total do ISRFL, grupo positivo (escore total igual ou maior a 13 pontos) e negativo (abaixo deste). Os participantes foram questionados sobre a presença dos sinais característicos do refluxo gastresofágico (azia/queimação e/ou dor retroesternal), sobre a demanda de uso da voz (baixa/alta demanda) e submetidos à triagem vocal durante a entrevista. RESULTADOS: quanto ao ISRFL, 35 (19,6%) indivíduos compuseram o grupo positivo (escore médio de 20) e 144 (80,4%) o grupo negativo (média de 4,34 pontos). Os sintomas característicos do RGE foram maiores no grupo positivo: azia/queimação em 54,2% (19) verso 30,5% (44), dor retroesternal em 51,4% (18) verso 20,1% (29), sendo que 74,3% dos indivíduos do grupo positivo e apenas 43,1% do negativo apresentaram algum dos sintomas. Quanto à triagem vocal, 37,1% do grupo positivo e 13% do negativo falharam. Não houve diferença de demanda vocal auto-relatada entre os grupos. Foi encontrada associação estatística entre IRFL positivo, os sintomas de refluxo gastresofágico e fracasso na triagem vocal (p< 0,001). Não houve associação quanto ao uso da voz. CONCLUSÃO: o ISRFL positivo pode estar relacionado com os sinais do RGE e com a alteração na qualidade vocal percebida em triagem.
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Coelho Paraguassu, Eber, and Anneli Mercedes Celis de Cárdenas. "Atualizações dos estudos atuais sobre medicamentos para combater a COVID-19." Brazilian Journal of Implantology and Health Sciences 2, no. 11 (2020): 01–09. http://dx.doi.org/10.36557/2674-8169.2020v2n11p01-09.
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Uma campanha de triagem em grande escala rendeu dezenas de estruturas cristalinas de pequenos fragmentos de moléculas que se ligam à protease principal do SARS-CoV-2. A comunidade de pesquisa global é encorajada a persegui-los como pontos de partida para a descoberta de medicamentos para COVID-19.
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Suguimoto, Juliana Coutinho de Paula, Emiliana Bittencourt Sureto, and Raquel Rodrigues Machado. "Elaboração da triagem pré-quimioterapia por profissionais de enfermagem." Sínteses: Revista Eletrônica do SIMTEC, no. 6 (October 27, 2016): 143. http://dx.doi.org/10.20396/sinteses.v0i6.8541.
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Agentes antineoplásicos administrados por via endovenosa tem ação sistêmica, atingindo todos os tecidos do organismo e não apenas no tumor, ocasionando efeitos adversos que podem ser agravados de acordo com o quadro clínico do paciente antes do início da terapêutica1-2. Recomenda-se a realização de uma triagem3 que identifique alterações clínicas que possam alterar o tratamento proposto. Objetivo: Prevenir e identificar situações que possam comprometer a saúde e a segurança do paciente antes da sessão de quimioterapia. Estudo descritivo, documental. Construiu-se instrumento baseado em artigo sobre critérios de toxicidade4 contendo principais toxicidades provocadas pelos quimioterápicos e registro de sinais vitais para a tomada de decisão do enfermeiro quanto a necessidade de avaliação médica e da suspensão ou prorrogação do tratamento. O instrumento é aplicado antes do início de cada sessão de quimio pelo enfermeiro ou técnico de enfermagem em consultório privativo antes da entrada no ambulatório de quimioterapia. O enfermeiro também verifica os resultados de exames solicitados pela equipe médica. Em junho de 2015, iniciou-se a triagem pré-quimioterapia, e observou-se: uma redução nas queixas e eventos adversos durante a infusão de medicamentos; estreitamento e fortalecimento do vínculo entre paciente, acompanhantes e equipe de enfermagem. Em Junho/2016 foram suspensas 33 sessões após a triagem e no mês 07/2016, houve 48 suspensões. Conclusão: A avaliação do paciente antes da quimioterapia guiada pelo instrumento elaborado possibilitou melhora na assistência e com menor possibilidade de ocorrência de complicações durante a infusão e piora do quadro clínico em decorrência das toxicidades provocadas pelos agentes antineoplásicos.
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Smanio, Paola. "Doença cardiovascular em mulheres diabéticas assintomáticas." Arquivos Brasileiros de Endocrinologia & Metabologia 51, no. 2 (2007): 305–11. http://dx.doi.org/10.1590/s0004-27302007000200021.
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A doença cardiovascular é a principal causa de morbi-mortalidade em pacientes diabéticos. A isquemia do miocárdio é freqüentemente assintomática, levando a um diagnóstico tardio e prejudicando o prognóstico. Como o risco de eventos cardiovasculares pode ser modificado pela triagem apropriada, a identificação precoce da doença arterial coronária é de grande benefício, em particular no sexo feminino. Ainda não há consenso sobre que paciente deve ser investigada e quando deve ser iniciada a investigação diagnóstica. A decisão sobre qual método diagnóstico não-invasivo deva ser o empregado na triagem inicial é complexa, devendo conhecer-se a prevalência da doença para justificar a investigação de rotina.
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Scacabarossi, Haroldo, and Yasnara Silveira de Medeiros. "A triagem e catação de recicláveis dentro do aterro sanitário, como condicionante de vulnerabilização social de excluídos em Boa Vista-RR." Revista Brasileira de Gestão Ambiental e Sustentabilidade 3, no. 5 (2016): 239. http://dx.doi.org/10.21438/rbgas.030513.
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A triagem e a catação de recicláveis dentro do Aterro Sanitário do Município de Boa Vista, capital do Estado de Roraima estão se tornando as condicionantes principais no processo de vulnerabilização social dos já excluídos, oriundos de diversas regiões do Estado. Assim, esta pesquisa teve como objetivo apresentar o delineamento conceitual da problemática da triagem de recicláveis no Município de Boa Vista, no que diz respeito aos atores principais dos processos de catação e triagem praticados no interior do Aterro Sanitário de Boa Vista e propiciar uma discussão acerca da abordagem teórico-metodológica das variáveis dos processos, frente às recentes transformações socioambientais ligadas ao tema. As atividades ilegais de catação e triagem de recicláveis dentro de uma área pertencente ao município gera uma série de questionamentos, uma vez que o acesso ao interior do aterro é feito de forma clandestina e irregular. A problemática não está por se resolver em curto espaço de tempo, como tenta fazer o executivo municipal, entendendo que disponibilizar alternativas de melhoria na condição social e de renda para os que ali atuam seria o primeiro passo. As medidas propostas pelo Guia de Atuação Ministerial para o encerramento de lixões, enfatizadas na pesquisa, contemplam, quase em sua totalidade, as inúmeras medidas necessárias à inclusão desses trabalhadores em uma melhor condição social.
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Medina, Prudencia, and Katty Arrieta. "Simulación de eventos discretos para optimizar recursos restrictivos del servicio de urgencias de un hospital. Cartagena, Colombia." Teknos revista científica 13, no. 1 (2013): 55. http://dx.doi.org/10.25044/25392190.425.
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Aunque cada país tiene una cultura diferente, los servicios de urgencias en general no escapan a una realidad común: la congestión. El objetivo de la investigación es simular los eventos discretos presentes en el servicio de urgencias de un hospital en Cartagena de Indias, Colombia, luego de identificar las causas principales de la congestión y hacer un análisis del sistema a través de las medidas de rendimientos de la teoría de líneas de espera; se simulan escenarios para establecer el recurso restrictivo en el sistema de urgencias y hacer una propuesta de mejora. Los resultados obtenidos muestran que el recurso restrictivo es el triage, con un porcentaje de ocupación del 99%; esto ocasiona el tiempo de espera de los pacientes, que es de 82 minutos, y un alto número de pacientes que esperan para ser atendidos; por lo tanto, se sugiere poner otro servidor en el triage.
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Moncada Mora, Luis Fabian, José Fernando Negrete Zambrano, Max Alejandro Arias Monteros, and Pablo Ramiro Armijos Valdivieso. "Análisis de la triada: integración académica, permanencia y dispersión geográfica." RIED. Revista Iberoamericana de Educación a Distancia 22, no. 1 (2019): 271. http://dx.doi.org/10.5944/ried.22.1.22001.
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Este artículo examina la relación que existe entre la decisión de permanecer o abandonar los estudios universitarios y el rendimiento académico inmediato, siguiendo el patrón de dispersión geográfica de la población estudiantil, que es una de las principales fortalezas de la educación a distancia. La información, base de la investigación, corresponde a una cohorte de estudiantes matriculados en una carrera de grado a distancia de la Universidad Técnica Particular de Loja (UTPL). Usando técnicas estadísticas y econométricas – principalmente modelos de probabilidad multinivel - se logró determinar que existe un efecto positivo del rendimiento académico inmediato en la decisión que toman los estudiantes de permanecer en los estudios. Este patrón de comportamiento se mantuvo en todos los centros de apoyo que tiene la UTPL, independientemente de su tamaño y distancia de la sede; es decir, la dispersión geográfica del centro de matrícula o lugar de vivienda del estudiante, no es un factor que influye en las decisiones que éste toma. La aversión a la pérdida es el principal factor de explicación del comportamiento, el hecho de no ser eficiente genera un efecto directo e inmediato, como es natural, no lo encuentra sentido a su permanencia ya que no ha logrado integrarse adecuadamente.
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Vasconcelos, Rosângela Melo, Lucieny Silva Martins Serra, and Vânia Maria de Farias Aragão. "Emissões otoacústicas evocadas transientes e por produto de distorção em escolares." Revista Brasileira de Otorrinolaringologia 74, no. 4 (2008): 503–7. http://dx.doi.org/10.1590/s0034-72992008000400004.
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Após os cinco anos de idade, a principal queixa em crianças que não ouvem normalmente é a dificuldade de aprendizagem. OBJETIVOS: Comparar os resultados suspeitos de perda auditiva pela triagem com os exames de emissões otoacústicas evocadas (EOAE) transientes (EOAT) e por produto de distorção (EOAPD), com dados dos exames audiométricos; observar qual dos dois procedimentos de EOAE responde melhor para triagem em escolares. MATERIAL E MÉTODOS: Avaliar 451 escolares da 1ª série do ensino fundamental, em escolas públicas de São Luís. Foram feitos, na própria escola, os exames otoscópicos com remoção de cerume quando necessário e os exames de EOAT e EOAPD em todos os escolares. Nas crianças que apresentaram alteração em algum dos exames de EOAT e/ou EOAPD foram realizadas a audiometria e imitanciometria. FORMA DE ESTUDO: Prospectivo Transversal. RESULTADOS: Freqüência de 18,6% de rolhas de cerume. Após triagem com EOAT e EOAPD não foi encontrada diferença estatisticamente significante quando comparamos os resultados dos exames que falharam somente nas EOAT e EOAPD com dados dos exames audiométricos, no entanto quando comparado esses dados com falha nos dois exames houve diferença significante (p<0,05). CONCLUSÃO: Os dois procedimentos de EOAE respondem bem á triagem auditiva em escolares.
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Filho, Laerte de Paiva Viana, João Pedro Costa Apolinário, Daniela Teixeira Ribeiro, et al. "O uso da tomografia computadorizada de baixa dose (TCBD) no rastreio de câncer de pulmão: revisão narrativa." Revista Eletrônica Acervo Saúde 12, no. 9 (2020): e3998. http://dx.doi.org/10.25248/reas.e3998.2020.
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Objetivo: Avaliar o uso da tomografia computadorizada de baixa dose (TCBD) no rastreamento do câncer de pulmão (CP). Revisão bibliográfica: O CP representa a neoplasia com maior incidência e mortalidade no mundo e caracteriza-se por rápida progressão e diagnóstico tardio, fatores que limitam as opções terapêuticas e contribuem para a baixa sobrevida dos pacientes. Medidas de rastreio mostram-se favoráveis em pacientes assintomáticos com alto risco de neoplasia, contribuindo com um prognóstico favorável. A TCBD revela-se como a principal ferramenta de rastreio, apresentando maior sensibilidade na detecção precoce de neoplasia de pulmão e de câncer em estágio I, quando comparada à triagem por radiografia torácica. Entretanto, fatores como a relação custo-benefício, a alta exposição à radiação ionizante e risco de falsos positivos representam empecilhos que devem ser analisados e considerados antes da implementação da triagem generalizada por TCBD. Considerações finais: A TCBD é objeto de estudo devido à grande relevância de seu uso na triagem de câncer de pulmão, decorrente de análises bibliográficas e pesquisas anteriores.
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Hernandes, Luana de Oliveira, Priscila Gramata da Silva Vitorino, Judith Victoria Castillo Mejía, et al. "Cuidados de enfermagem ao paciente oncológico acometido pela Covid-19." Research, Society and Development 10, no. 9 (2021): e26410918099. http://dx.doi.org/10.33448/rsd-v10i9.18099.
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Os pacientes oncológicos foram muito afetados pela pandemia por covid-19, pois devido à sua condição de saúde debilitada, estes pacientes podem apresentar um risco elevado para desenvolver formas mais graves da infecção pela covid-19, devido ao comprometimento do sistema imunológico causado pelo tratamento com quimioterapia e radioterapia. O objetivo principal deste estudo foi identificar os principais cuidados de enfermagem ao paciente oncológico com covid-19 e de forma mais específica, descrever os principais problemas de saúde desencadeados pela covid-19 e identificar os problemas de saúde em pacientes oncológicos que podem ser potencializados pela covid-19. Este estudo é uma pesquisa descritiva, com busca de artigos realizada em bibliotecas digitais. A equipe de enfermagem precisou se adaptar à nova rotina de EPIs para proteção de todos, incluindo os próprios profissionais. Houveram mudanças significativas no atendimento da enfermagem para pacientes oncológicos, que consistiram principalmente no aumento do número de consultas via telemedicina e telefone, o que diminuiu o número de pacientes nas clínicas e hospitais, já que o enfermeiro realizava triagem e direcionava os pacientes conforme o quadro clínico de cada um. Quanto aos cuidados direcionados aos pacientes oncológicos, de acordo com os estudos, todos foram mantidos, com a diferença de que alguns foram revisados e adaptados para atender a nova demanda imposta pelo coronavírus.
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Nascimento, Marilza Leal. "Situação atual da triagem neonatal para hipotireoidismo congênito: críticas e perspectivas." Arquivos Brasileiros de Endocrinologia & Metabologia 55, no. 8 (2011): 528–33. http://dx.doi.org/10.1590/s0004-27302011000800005.
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O hipotireoidismo congênito (HC) é uma das causas mais frequentes de deficiência mental passível de prevenção. Esforços devem ser utilizados na sua detecção e no tratamento precoces. O atraso no diagnóstico e no tratamento resultará em sequela neurocognitiva. A triagem neonatal mudou a evolução natural dessa enfermidade. O nível de corte do TSH utilizado é 10 mUI/l. No Brasil, a triagem neonatal é realizada há três décadas. Atualmente todos os estados brasileiros e o Distrito Federal a realizam. Analisando os últimos dados do Programa Nacional de Triagem Neonatal (PNTN), observamos que existe uma diferença enorme entre os Serviços de Referência nos vários estados. A cobertura do PNTN é de 81,61% dos recém-nascidos. Apenas 56,94% colheram a amostra até sete dias de vida. Os tempos médios da coleta até a chegada da amostra ao laboratório, da realização da dosagem do TSH, da liberação do resultado e reconvocação das crianças suspeitas estão fora do preconizado, culminando numa idade média de início de tratamento muito acima da ideal. Isso resulta na impossibilidade de cumprimento do principal objetivo da triagem, que é o início precoce do tratamento para a prevenção de sequelas. Estudos recentes têm sugerido mudança do nível de corte do TSH para 6 mUI/l para reduzir os falso-negativos. Medidas devem ser adotadas para que os índices ideais do PNTN sejam atingidos.
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Szklo, Moysés, and Liz Maria de Almeida. "Rastreamento como Estratégia de Controle do Câncer." Revista Brasileira de Cancerologia 64, no. 2 (2018): 251–57. http://dx.doi.org/10.32635/2176-9745.rbc.2018v64n2.85.
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Além da prevenção primária, o rastreamento (detecção precoce) é uma estratégia importante para o controle do câncer. Neste artigo, resumimos os principais princípios da triagem em geral e usamos o câncer de próstata e colorretal como exemplos da aplicação desses princípios.
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Carvalho Rocha Alves da Silva, Juliana, Rafael Santos Santana, Cecília Menezes Farinasso, Dayde Lane Mendonça Silva, and Helaine Carneiro Capucho. "Ensaios clínicos com medicamentos no Brasil: uma análise das principais características." Vigilância Sanitária em Debate: Sociedade, Ciência & Tecnologia 8, no. 4 (2020): 74–82. http://dx.doi.org/10.22239/2317-269x.01514.
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Introdução: Os resultados de ensaios clínicos são utilizados pelas agências regulatórias de todo o mundo para fins de registro e comercialização de medicamentos. A Agência Nacional de Vigilância Sanitária (Anvisa) é a responsável pelos registros de tecnologias em saúde no Brasil e regras para análises técnicas de ensaios clínicos. A Anvisa vem atuando para atualizar seu arcabouço regulatório a respeito de ensaios clínicos com medicamentos no país, para reduzir tempo de análise e harmonizar conforme regras internacionais. Objetivo: Caracterizar os ensaios clínicos de fase III, com medicamentos, realizados no Brasil a partir da publicação da RDC n° 9, de 20 de fevereiro de 2015, da Anvisa. Método: Estudo exploratório e descritivo realizado em três etapas: (1) análise quantitativa pré e pós RDC n° 9/2015; (2) análise da população participante de ensaio clínico que embasou registros de medicamentos; (3) caracterização dos ensaios clínicos realizados no Brasil. Resultados: Houve redução em 20% de ensaios clínicos realizados no Brasil quando se compara o período anterior e posterior à publicação da RDC n° 9/2015 da Anvisa; apenas 33% dos ensaios clínicos que embasaram registros de medicamentos no país foram realizados com população brasileira; os medicamentos sintéticos e biológicos somam 96% da intervenção estudada nos ensaios clínicos; placebo ainda é muito utilizado como comparador (37%); a indústria farmacêutica é majoritariamente o patrocinador dos ensaios clínicos (86%). Conclusões: Diante deste cenário, é imperativo que se fortaleçam as ações de farmacovigilância no Brasil, a fim de conhecer os perfis de efetividade e segurança dos medicamentos após exposição da população brasileira.
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Silva, George Sobrinho, Daisy de Rezende Figueiredo Fernandes, and Cláudia Regina Lindgren Alves. "Avaliação da assistência à saúde da criança na Atenção Primária no Brasil: revisão sistemática de métodos e resultados." Ciência & Saúde Coletiva 25, no. 8 (2020): 3185–200. http://dx.doi.org/10.1590/1413-81232020258.27512018.
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Resumo Essa revisão sistemática objetivou analisar os métodos e instrumentos, bem como os principais resultados, das avaliações de qualidade da assistência à saúde da criança na APS no Brasil. Estudo realizado de acordo com as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), em consulta às bases de dados MEDLINE, LILACS, IBECS e BDENF, PUBMED, PsycNET, Cochrane e CINAHL (1994-2016), com foco em crianças de 0 a 5 anos. Foram identificados 3.004 artigos. Após a triagem inicial e a aplicação dos critérios STROBE e SRQR, 21 artigos foram incluídos na revisão. Cerca de 52% dos artigos foram realizados na região sudeste e 95,2% publicados a partir de 2010. O principal instrumento de avaliação utilizado foi o Primary Care Assessment Tool (52,4%). A qualidade da assistência a criança mostrou-se deficitária, com limitações no acesso aos serviços, carência de infraestrutura e baixa qualificação de profissionais. Houve aumento significativo dos estudos avaliativos nos últimos anos no Brasil. Apesar dos avanços na assistência à saúde no país, os limitados índices de qualidade apontam a necessidade de superação de desafios para garantia da atenção integral à saúde da criança.
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Panza, Graziela Bizin, and Marcelo Tsuguio Okano. "O PAPEL DA COOPERATIVA DE RECICLAGEM NA LOGÍSTICA REVERSA DE UM SISTEMA PRODUTIVO." South American Development Society Journal 4, Esp01 (2018): 104. http://dx.doi.org/10.24325/issn.2446-5763.vespi1p104-123.
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Os objetivos desta pesquisa são mapear a cadeia produtiva de logística reversa de uma cooperativa de reciclagem, verificar as características sociais e econômicas das cooperativas através do Social Business Model Canvas e quais são os benefícios para a logística reversa do acordo entre as cooperativas e empresas e associações de fabricantes. A abordagem qualitativa será utilizada nesta pesquisa, e o método a ser empregado é o estudo de caso múltiplos, onde serão considerados mais de um objeto de estudo, com caráter exploratório e descritivo. Os objetivos foram alcançados, a cadeia produtiva de logística reversa de uma cooperativa de reciclagem pode ser mapeada. As principais características sociais são realizar o descarte correto de lixo para os grandes geradores; limpeza, descarte correto, coleta e triagem do lixo para os municípios e renda, trabalho, educação, resgate da cidadania e autoestima para os cooperados. As características econômicas são que as cooperativas têm convênios ou parcerias com as prefeituras que provem galpões, caminhões para coletas, agua e luz; a principal fonte de receita é a venda de material reciclável; prestação de serviços para os grandes geradores é outra fonte de receita e as parcerias são importantes para as cooperativas.
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Panza, Graziela Bizin, and Marcelo Tsuguio Okano. "O PAPEL DA COOPERATIVA DE RECICLAGEM NA LOGÍSTICA REVERSA DE UM SISTEMA PRODUTIVO." South American Development Society Journal 4, Esp01 (2018): 82. http://dx.doi.org/10.24325/issn.2446-5763.vespi1p82-101.
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Os objetivos desta pesquisa são mapear a cadeia produtiva de logística reversa de uma cooperativa de reciclagem, verificar as características sociais e econômicas das cooperativas através do Social Business Model Canvas e quais são os benefícios para a logística reversa do acordo entre as cooperativas e empresas e associações de fabricantes. A abordagem qualitativa será utilizada nesta pesquisa, e o método a ser empregado é o estudo de caso múltiplos, onde serão considerados mais de um objeto de estudo, com caráter exploratório e descritivo. Os objetivos foram alcançados, a cadeia produtiva de logística reversa de uma cooperativa de reciclagem pode ser mapeada. As principais características sociais são realizar o descarte correto de lixo para os grandes geradores; limpeza, descarte correto, coleta e triagem do lixo para os municípios e renda, trabalho, educação, resgate da cidadania e autoestima para os cooperados. As características econômicas são que as cooperativas têm convênios ou parcerias com as prefeituras que provem galpões, caminhões para coletas, agua e luz; a principal fonte de receita é a venda de material reciclável; prestação de serviços para os grandes geradores é outra fonte de receita e as parcerias são importantes para as cooperativas.