Transferência de Responsabilidade de Pacientes: Uma Aplicação da Análise de Redes Sociais

As transferências de informações sobre pacientes ou a transferência de pacientes entre as unidades de serviços de um hospital são áreas críticas para segurança do paciente. Assim como nas organizações em geral, informações adequadas e a comunicação eficaz entre os profissionais envolvidos (atores) são cada vez mais relevantes para a gestão das instituições hospitalares. A análise de redes sociais (ARS) facilita a compreensão de como ocorre a comunicação, as falhas e a atuação dos atores envolvidos. O objetivo desta pesquisa foi verificar o grau de três medidas de centralidade dos atores durante a transferência de responsabilidade de pacientes (TRP), entre setores de um hospital, usando a ARS. A pesquisa tem natureza exploratória, a amostragem foi por conveniência e os atores identificados pela técnica de snowball. Nas TRP analisadas, o paciente e o membro da família do paciente não ocuparam posições de localização central na rede (degree); tiveram pouco acesso às informações (closeness); e não influenciaram nem controlaram as trocas de informações (betweenness). Os enfermeiros surgiram como os papéis categóricos com maior grau de degree, closeness e betweenness. Especulou-se a necessidade de um ator como papel categórico de integração para fomentar a cooperação e o alinhamento entre todos os atores da rede social em torno das TRP.DOI: 10.5585/rgss.v2i2.7

Evolução dos Custos Médico-Hospitalares de Planos Privados de Assistência à Saúde no Brasil

Brazil has achieved a national coverage rate of medical private health plans around 24.5% in June of 2017 (47,383,248). However, it has been observed a slowdown tendency of number of customers, comparing Dec / 2012 (50,409,378). This research reports the evolution of costs in Brazilian healthcare private operators (benefits manager, self-management, medical cooperative, philanthropy, health insurance specialist and group medicine) between 2003 and 2016, from the perspective of the average cost variation and of the resource and services utilization rate. The public data were obtained from websites of the Institute of Supplementary Health Studies (IESS), the National Agency of Supplemental Health (ANS) and the Institute of Applied Economic Research (IPEA). In this period, it was found that the growth of medical inflation in Brazil was higher than the general inflation and that resource and service utilization rates remain at high levels (geometric mean of 81.87%). This indicates that there is an increase in the average cost along with the increase in production.O Brasil alcançou uma taxa de cobertura nacional de planos de saúde privados de assistência médica em torno de 24,5% em junho de 2017 (47.383.248). Entretanto, se observa uma queda de 6,4% no número de beneficiários em relação dez/2014 (50.409.378). Esta pesquisa analisa a evolução dos custos das operadoras médico-hospitalares brasileiras de planos privados de assistência à saúde (administradora de benefícios, autogestão, cooperativa médica, filantropia, seguradora especializada em saúde e medicina de grupo) no período entre 2003 e 2016, sob a perspectiva das variações do custo médio e da sinistralidade (taxa de utilização de recursos e de serviços). Foram usados dados públicos disponíveis nas páginas eletrônicas do Instituto de Estudos de Saúde Suplementar (IESS), da Agência Nacional de Saúde e do Instituto de Pesquisas Econômicas Aplicadas (IPEA). Neste período se observou que o crescimento da inflação médica no Brasil foi superior à inflação geral e que a sinistralidade permanece em níveis elevados (média geométrica de 81,87%). Isto é, houve um crescimento do custo médio junto com a produção

Gross and microscopic morphology of the coati tongue (Nasua nasua)

O quati (Nasua nasua) é um animal que pertence à Família Procyonidae. Foram utilizados três animais ortotanasiados, de ambos os sexos, provenientes do Criatório Científico de Animais Silvestres, Centro Universitário Fundação de Ensino Octávio Bastos (Cecrimpas, Unifeob) autorizado pelo IBAMA (Proc.02027.003731/04-76). Para a análise macroscópica, as línguas foram retiradas, analisadas e foto-documentadas. Para análise microscópica, as línguas foram processadas rotineiramente pela técnica de microscopia eletrônica de varredura e inclusão em Paraplast; pela técnica de microscopia de luz os fragmentos foram cortados em micrótomo, com espessura média de 5mm e corados em HE e Picrosírius com fundo de hematoxilina. Os resultados macroscópicos e microscópicos mostram que a língua do quati apresenta papilas filiformes, fungiformes, valadas e cônicas sendo estas distribuídas nas regiões rostralis, medialis e caudalis. Histologicamente, a língua do quati é revestida por um epitélio pavimentoso estratificado queratinizado apresentando camada basal, espinhosa, granulosa e córnea com fibras de músculos estriados esqueléticos longitudinais e transversais e diversas glândulas. De acordo com os resultados pode-se concluir que a língua do quati possui características macroscópicas e microscópicas semelhantes aos canídeos, tendo como diferença o número de papilas valadas e o grau de queratinização.The coati (Nasua nasua) is an animal that belongs to the Procyonidae family. For this study we used three orthotanasized animals of both sexes, obtained from the Scientific Center for Wild Animal Breeding, University Center Octavio Bastos Educational Foundation (Cecrimpas, Unifeob), authorized by IBAMA (Proc.02027.003731/04-76). For microscopic analysis, tongues were processed routinely through electron microscopy scanning and inclusion in Paraplast; for light microscopy, the fragments were cut by microtome with an average thickness of 5mm and stained with H&E and Picrosirius counterstained with hematoxylin. The macroscopic and microscopic results show that the tongue of coati has filiform, fungiform, vallate and conical papillae distributed in the rostralis, medialis and caudalis regions. Histologically, the tongue is lined by a keratinized stratified squamous epithelium with spinous, granulous and keratin basal layer, with striated longitudinal and transverse skeletal muscles fibers, and several glands. We can conclude that coati's tongue has macroscopic and microscopic features similar to the ones of Canidae, with differences in the number of vallate papillae and degree of keratinization

Thoracic Electrical Impedance Tomography—The 2022 Veterinary Consensus Statement

Electrical impedance tomography (EIT) is a non-invasive real-time non-ionising imaging modality that has many applications. Since the first recorded use in 1978, the technology has become more widely used especially in human adult and neonatal critical care monitoring. Recently, there has been an increase in research on thoracic EIT in veterinary medicine. Real-time imaging of the thorax allows evaluation of ventilation distribution in anesthetised and conscious animals. As the technology becomes recognised in the veterinary community there is a need to standardize approaches to data collection, analysis, interpretation and nomenclature, ensuring comparison and repeatability between researchers and studies. A group of nineteen veterinarians and two biomedical engineers experienced in veterinary EIT were consulted and contributed to the preparation of this statement. The aim of this consensus is to provide an introduction to this imaging modality, to highlight clinical relevance and to include recommendations on how to effectively use thoracic EIT in veterinary species. Based on this, the consensus statement aims to address the need for a streamlined approach to veterinary thoracic EIT and includes: an introduction to the use of EIT in veterinary species, the technical background to creation of the functional images, a consensus from all contributing authors on the practical application and use of the technology, descriptions and interpretation of current available variables including appropriate statistical analysis, nomenclature recommended for consistency and future developments in thoracic EIT. The information provided in this consensus statement may benefit researchers and clinicians working within the field of veterinary thoracic EIT. We endeavor to inform future users of the benefits of this imaging modality and provide opportunities to further explore applications of this technology with regards to perfusion imaging and pathology diagnosis

A Transplantable Phosphorylation Probe for Direct Assessment of G Protein-Coupled Receptor Activation

The newly developed multireceptor somatostatin analogs pasireotide (SOM230), octreotide and somatoprim (DG3173) have primarily been characterized according to their binding profiles. However, their ability to activate individual somatostatin receptor subtypes (sst) has not been directly assessed so far. Here, we transplanted the carboxyl-terminal phosphorylation motif of the sst2 receptor to other somatostatin receptors and assessed receptor activation using a set of three phosphosite-specific antibodies. Our comparative analysis revealed unexpected efficacy profiles for pasireotide, octreotide and somatoprim. Pasireotide was able to activate sst3 and sst5 receptors but was only a partial agonist at the sst2 receptor. Octreotide exhibited potent agonistic properties at the sst2 receptor but produced very little sst5 receptor activation. Like octreotide, somatoprim was a full agonist at the sst2 receptor. Unlike octreotide, somatoprim was also a potent agonist at the sst5 receptor. Together, we propose the application of a phosphorylation probe for direct assessment of G protein-coupled receptor activation and demonstrate its utility in the pharmacological characterization of novel somatostatin analogs

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

The value of mammotomy in diagnosis of nonpalpable breast lesions

Avaliar a acuracia diagnostico da biopsia direcional assistida a vacuo (mamotomia), guiada por ultra-sonografia, no diagnostico das lesoes mamarias nao palpaveis foi o nosso objetivo nesse estudo Foram avaliadas 115 pacientes do ambulatorio de Mastologia da UNIFESP, as quais apresentavam lesoes mamarias nao palpaveis, visiveis a ultra-sonografia. Todas foram submetidas a mamotomia guiada por ultra-sonografia com Mammotome © (BIOSPYS, Irvine, California), com sonda 11 oauge. A biopsia excisional foi realizada com agulhamento previo daquelas pacientes que apresentaram lesao residual apos a mamotomia. Das 115 pacientes, 89 realizaram biopsia excisional. As 26 restantes nao apresentaram lesoes pos-mamotomia, visiveis a ultrasonografia, sendo seguidas por 1 ano sem alteracoes nos exames semestrais, tanto mamograficos quanto ultra-sonograficos. Essas eram lesoes menores do que 1,5cm. Dentre as 89 pacientes submetidas a biopsia excisional, 68 (76,4 por cento) apresentaram lesoes benignas e 21 (23,6 por cento), malignas. A mamotomia diagnosticou 17 das lesoes malignas, com 4 resultados falso-negativos e nenhum falsopositivo. Os falso-resultados ocorreram: nos primeiros casos realizados, mostrando a existencia de uma curva de aprendizagem do metodo; ou por dificuldade tecnica, como o borramento da imagem ultra-sonografica devido hematoma. A sensibilidade e especificidade foram de 81 por cento e 100 por cento, respectivamente, com valores preditivos positivo de 100 por cento, e negativo de 94,4 por cento. A acuracia da mamotomia foi de 95,5 por cento. As complicacoes foram raras como: dois casos de hematomas pos-mamotomias, dos quais nenhum necessitou ...(au)BV UNIFESP: Teses e dissertaçõe

Effects of positive end-expiratory pressure titration on gas exchange, respiratory mechanics and hemodynamics in anesthetized horses.

OBJECTIVE: To assess if positive end-expiratory pressure (PEEP) titration improves gas exchange and respiratory mechanics, without hemodynamic impairment in horses during anesthesia. DESIGN: Prospective, randomized study. ANIMALS: Thirteen isoflurane-anesthetized healthy horses. METHODS: After 60 minutes of anesthesia with spontaneous breathing, mechanical ventilation was initiated with an inspiratory-expiratory ratio of 1:2, PEEP of 5 cmH2O, tidal volume of 10-20 mL kg(-1) and respiratory rate adjusted to maintain normocapnia. Constant PEEP of 5 cmH2O was continued (control group; n = 6) or titrated (PEEP group; n = 7) by increasing and decreasing PEEP from 5 to 20 cmH2O at 15-minute intervals. The horses were instrumented with an arterial catheter to measure blood pressure and allow collection of blood for pH and blood gas analysis and a Swan-Ganz catheter for measurement of cardiac output (CO) using thermodilution. Cardiopulmonary assessment was recorded before PEEP titration and after 15 minutes at each PEEP value. RESULTS: In the PEEP group, static compliance (range) (Cst 278-463 mL cmH2O(-1)) was significantly higher and the shunt fraction (Q.s/Q.t 7-20%) and the alveolar-arterial oxygen difference [P(A-a)O2 95-325 mmHg] were significantly lower than in the control group [Cst of 246-290 mL cmH2O(-1), Q.s/Q.t of 16-19%, P(A-a)O2 of 253-310 mmHg; p < 0.05]. CO (mean +/- SEM) was lower in the PEEP group (23 +/- 2 L minute(-1)) at 20 cmH2O PEEP than in the control group (26 +/- 4 L minute(-1), p < 0.05), with no significant changes in heart rate, blood pressure or central venous pressure. CONCLUSIONS: PEEP titration significantly improved gas exchange and lung compliance, with a small decrease in CO at the highest PEEP level. CLINICAL RELEVANCE: Gas exchange and respiratory mechanics impairment during inhalation anesthesia can be treated using PEEP titration from 5 to 20 cmH2O, without clinically important hemodynamic effects in healthy horses