Desenvolvimento de ferramenta computacional, em modelo conceitual e prático, para a elaboração e gestão dos projetos de pesquisa clínica com recursos privados

Introdução: A previsão e o controle financeiro são essenciais para a saúde financeira da instituição que desenvolve um projeto de pesquisa clínica. O papel da gestão financeira é maximizar os recursos e, para tal, é preciso o uso de ferramentas que proporcionem informações precisas e rápidas, uma vez que planejar e controlar são medidas indispensáveis para a sustentabilidade da organização. Métodos: Com revisão de literatura e os dados coletados de questionário realizados com os responsáveis pela gestão financeira no centro de pesquisa, foram elaborados os documentos de requisitos do sistema para previsão orçamentária e controle financeiro de projetos. Baseado nestes, foi desenvolvida uma ferramenta, no Microsoft Access, para a elaboração e análise da previsão orçamentária do projeto de pesquisa, assim como um módulo para o acompanhamento da gestão e controle financeiro. A usabilidade do sistema foi validada pelo método System Usability Scale (SUS). Resultados: O estudo identificou entre os problemas e dificuldades na realização da avaliação financeira de protocolos de pesquisas destacam-se a falta de conhecimento e envolvimento dos pesquisadores, a falta de conhecimento técnico da equipe para a realização das tarefas o que retarda e fragiliza a análise da previsão orçamentária de um projeto. A elaboração dos documentos de requisitos do sistema permitiu o design e qualificação na construção da ferramenta, utilizando por base o guia PMBOK e as respostas dos usuários. A validação da usabilidade da ferramenta permite inferir um conceito A baseado na experiência do usuário quanto à sua utilização no processo de trabalho. Conclusão: A fim de que esse controle seja efetivo, é imprescindível o registro e a organização do planejado para a realização do projeto, assim como do que foi efetivamente utilizado até sua conclusão. O produto permite avaliação orçamentária e controle financeiro, visualizando o processo de forma simples, rápida e auditável, auxiliando a mensuração da margem financeira de sua execução, bem como na decisão de sua realização, por parte do pesquisador ou da instituição, a partir de relatórios de previsão e controle financeiro. O produto poderá beneficiar os Hospitais da rede EBSERH aprimorando a gestão e controle dos processos financeiros em consonância com a legislação vigente e as boas práticas na gestão de projetos.Introduction: Financial forecasting and control are important to the financial health of the institution developing a clinical research project. The role of financial and financial resource management is an accurate and timely information evaluation resource, as programming and monitoring are indispensable to the sustainability of the organization. Methods: Based on the review of data and data on financial management data at the research center, the requirements documents for the budget system and project financial control were prepared. In this example, a tool, not in Microsoft Access, has been developed for the preparation and analysis of the weather forecast as a module for monitoring financial management. System usability was validated by the System Usability Scale (SUS) method. Results: The study identified among the problems and difficulties in conducting financial evaluation of research groups, the lack of knowledge and involvement of researchers, the lack of knowledge of the team to perform the tasks they take and the weakening of the forecast analysis. budget of a project. Creation of project and work system requirements documents in the construction of the machine, based on the PMBOK guide and user responses. The experience of using the machine allows us to infer a concept. Conclusion: In order to achieve this control, it is essential to record and organize the plan for carrying out the project, as well as its completion. The product allows the budget evaluation and financial control, visualizing the process in a simple, fast and auditable way, helping the financial margin measurement of its execution, as well as its own realization, by the researcher or the institution, from forecasting reports and financial control. EBSERH enhancing the management and control of financial processes in line with current legislation and best practices in project management

Osteoporosis in Parkinson’s disease and the role of lean body mass: a cross-sectional study in a Brazilian tertiary center

BackgroundParkinson’s disease (PD) is the second most common neurodegenerative illness and has the highest increase rate in recent years. There is growing evidence to suggest that PD is linked to higher osteoporosis rates and risk of fractures.ObjectiveThis study aims to estimate the prevalence and factors associated with osteoporosis as defined by the National Osteoporosis Foundation (NOF) and World Health Organization in patients with mild to moderate PD.MethodsWe performed a cross-sectional study at a tertiary public hospital in Fortaleza, Brazil, dating from May 2021 until April 2022. The study sample was comprised of patients with mild to moderate PD who were at least 40 years old and who had the ability to walk and stand unassisted. Bone Mineral Density (BMD) of both the hip (neck of the femur) and the lumbar spine were obtained via properly calibrated Dual Energy X-ray Absorptiometry (DXA) scanning. The FRAX (Fracture Risk Assessment Tool) score was used to determine a person’s 10-year risk of major osteoporotic fracture. The Revised European Working Group on Sarcopenia in Older People (EWGSOP 2) was used as a basis to confirm a sarcopenia diagnosis with the following parameters: low muscle strength gauged by handgrip strength and low muscle quantity by DXA. Physical performance was carefully evaluated by using the Short Physical Performance Battery test. Osteoporosis and osteopenia were diagnosed following the NOF guidelines and WHO recommendations.ResultsWe evaluated 107 patients in total, of whom 45 (42%) were women. The group’s mean age was 68 ± 9 years, and the mean disease time span was 9.9 ± 6.0 years and mean motor UPDRS was 43 ± 15. We found that 42.1% and 34.6% of the sample had osteopenia and osteoporosis following NOF criteria, respectively, and 43% and 33.6% following the WHO recommendations. Lower lean appendicular mass was associated to osteopenia and osteoporosis in multinomial logistic regression analysis in both diagnostic criteria.ConclusionOur findings provide additional evidence for the protective role of lean mass against osteoporosis in patients with PD

Desenvolvimento de ferramenta computacional, em modelo conceitual e prático, para a elaboração e gestão dos projetos de pesquisa clínica com recursos privados

Introdução: A previsão e o controle financeiro são essenciais para a saúde financeira da instituição que desenvolve um projeto de pesquisa clínica. O papel da gestão financeira é maximizar os recursos e, para tal, é preciso o uso de ferramentas que proporcionem informações precisas e rápidas, uma vez que planejar e controlar são medidas indispensáveis para a sustentabilidade da organização. Métodos: Com revisão de literatura e os dados coletados de questionário realizados com os responsáveis pela gestão financeira no centro de pesquisa, foram elaborados os documentos de requisitos do sistema para previsão orçamentária e controle financeiro de projetos. Baseado nestes, foi desenvolvida uma ferramenta, no Microsoft Access, para a elaboração e análise da previsão orçamentária do projeto de pesquisa, assim como um módulo para o acompanhamento da gestão e controle financeiro. A usabilidade do sistema foi validada pelo método System Usability Scale (SUS). Resultados: O estudo identificou entre os problemas e dificuldades na realização da avaliação financeira de protocolos de pesquisas destacam-se a falta de conhecimento e envolvimento dos pesquisadores, a falta de conhecimento técnico da equipe para a realização das tarefas o que retarda e fragiliza a análise da previsão orçamentária de um projeto. A elaboração dos documentos de requisitos do sistema permitiu o design e qualificação na construção da ferramenta, utilizando por base o guia PMBOK e as respostas dos usuários. A validação da usabilidade da ferramenta permite inferir um conceito A baseado na experiência do usuário quanto à sua utilização no processo de trabalho. Conclusão: A fim de que esse controle seja efetivo, é imprescindível o registro e a organização do planejado para a realização do projeto, assim como do que foi efetivamente utilizado até sua conclusão. O produto permite avaliação orçamentária e controle financeiro, visualizando o processo de forma simples, rápida e auditável, auxiliando a mensuração da margem financeira de sua execução, bem como na decisão de sua realização, por parte do pesquisador ou da instituição, a partir de relatórios de previsão e controle financeiro. O produto poderá beneficiar os Hospitais da rede EBSERH aprimorando a gestão e controle dos processos financeiros em consonância com a legislação vigente e as boas práticas na gestão de projetos.Introduction: Financial forecasting and control are important to the financial health of the institution developing a clinical research project. The role of financial and financial resource management is an accurate and timely information evaluation resource, as programming and monitoring are indispensable to the sustainability of the organization. Methods: Based on the review of data and data on financial management data at the research center, the requirements documents for the budget system and project financial control were prepared. In this example, a tool, not in Microsoft Access, has been developed for the preparation and analysis of the weather forecast as a module for monitoring financial management. System usability was validated by the System Usability Scale (SUS) method. Results: The study identified among the problems and difficulties in conducting financial evaluation of research groups, the lack of knowledge and involvement of researchers, the lack of knowledge of the team to perform the tasks they take and the weakening of the forecast analysis. budget of a project. Creation of project and work system requirements documents in the construction of the machine, based on the PMBOK guide and user responses. The experience of using the machine allows us to infer a concept. Conclusion: In order to achieve this control, it is essential to record and organize the plan for carrying out the project, as well as its completion. The product allows the budget evaluation and financial control, visualizing the process in a simple, fast and auditable way, helping the financial margin measurement of its execution, as well as its own realization, by the researcher or the institution, from forecasting reports and financial control. EBSERH enhancing the management and control of financial processes in line with current legislation and best practices in project management

Associação entre a capacidade funcional, transtorno do sono e nível de atividade física em indivíduos com doença de Parkinson durante o período de pandemia de covid-19: um estudo transversal

Resumo Objetivo Avaliar o nível de atividade física, considerando as condições sociodemográficas, clínicas e funcionais, de pessoas idosas com Doença de Parkinson (DP). Método Foi realizado um estudo transversal a partir dos seguintes dados: nível de atividade física (International Physical Activity Questionnaire versão curta - IPAQ curto), transtornos do sono, queixa cognitiva, tempo de doença, grau de dependência para realizar atividades básicas do dia a dia pela escala Schwab & England (S & E) de indivíduos idosos com DP atendidos em um serviço de saúde terciário, durante a pandemia da covid-19. Regressão de Poisson, teste U de Mann-Whitney e teste t de Student foram utilizados para análise estatística. Resultados A cada 10 pontos de elevação na escala de S & E, a razão de prevalência de ser ativo foi maior em 1,04 (IC 95% 1,01 – 1,08) e quem não referiu transtorno de sono teve razão de prevalência de 1,17 (IC95% 1,02-1,34) vez maior de ser ativo. Indivíduos com DP inativos eram mais velhos e tinham maior tempo de doença. Conclusão Ênfase deve ser dada a capacidade funcional e ao sono de indivíduos com DP para o manejo adequado do nível de AF em períodos de restrição social

Avaliação de uma ferramenta nutricional como preditor de prognóstico do paciente gravemente enfermo

Objetivos: Avaliar o escore de risco nutricional NUTRIC como preditor prognóstico e compará-lo com outros escores de gravidade. Método: estudo observacional, retrospectivo, com avaliação dos registros de 80 pacientes internados em uma unidade de terapia intensiva adulto, de março a junho de 2017. Foi estimado o risco nutricional através do escore NUTRIC. Resultados: foram construídas curvas ROC: as áreas sob a curva do escore APACHE II, SOFA no primeiro e no terceiro dia foram de 0,711; 0,701 e 0,809; respectivamente, e a do NUTRIC de 0,713. Foi encontrado um ponto de corte do NUTRIC de 5, com acurácia de 73,6% (IC 95%: 0,628-0,844). Os pacientes foram divididos em 2 subgrupos: G1, com pontuação ³5 e G2 com pontuação < 5. O subgrupo G1 apresentou mais disfunções orgânicas, mensuradas pelo SOFA do terceiro dia (8,8±4,8 x 4,2±4,3; p<0,001) e maior taxa de mortalidade na UTI (66,0 x 26,7%; p=0,002). Conclusão: o escore NUTRIC pode predizer um desfecho desfavorável, semelhante aos escores APACHE II e o SOFA. Parece ser útil em prever a ocorrência de novas disfunções e mortalidade.  Palavras-chaves: Avaliação Nutricional. Prognóstico. Unidade de Terapia Intensiva. Mortalidade. Índice de Gravidade de Doença

Pregnancies with an outcome of fetal death present higher risk of delays in obstetric care: A case-control study.

The objective of this study was identify the association between delays in the care provided to pregnant women and the fetal death outcome, in a tertiary reference maternity hospital in the Northeastern Brazil. A case-control study, with 72 cases of fetal death and 144 controls (live births) in women admitted to the Obstetrics Service of the Assis Chateaubriand Teaching Maternity Hospital, in Fortaleza, Ceará. Controls were matched (2:1) by the approximate gestational age of the case. The groups were compared using the three delays model of obstetric care. The Pearson's Chi-square test and the Fisher's exact test were used to compare the groups. P 6 consultations: 27.8% in cases, 40.3% in controls, p = 0.003), less risk classification of pregnancy (41.7% vs 55.9%, p = 0.048), less guidance about the health facility for delivery (44.5% vs 64%, p = 0.009), lower frequency of cesarean sections (25.4% vs 65.7%) and higher frequency of hemorrhagic syndromes (33.3% vs 19.4%, p = 0.024) and syphilis (15.3% vs 4.2%, p = 0·004). Variables that persisted significantly associated with fetal death in the logistic regression were: Refusal of assistance (OR = 4.07, IC 95%: 1.08-15.3), Absence or inadequacy of prenatal care (OR = 2.69, IC 95%: 1.07-6.75), Delay in diagnosis (OR = 10.3, IC 95%: 2.58-41.4) and Inadequate patient conduct (OR = 4.88; IC 95%: 1.43-16.6). Despite of having a higher frequency of obstetric complications, gestations with fetal death are more prone to delays in obstetric care

Prevalence of COVID-19 in children, adolescents and adults in remote education situations in the city of Fortaleza, Brazil

Objectives: A retrospective study was conducted to identify the prevalence of COVID-19 through serology and RT-PCR in children, adolescents and adults. A database of the COVID-19 Tracking Program in school children was used. Methods: The data comprised sociodemographic and clinical variables, results of serological tests (IgM and IgG), and real-time-polymerase chain reaction (RT-PCR) results of IgM-positive individuals. The statistical analysis was performed with a 5% significance level. Results: Among 423 children, 107 (25.3%) exhibited seroprevalence with IgG, IgM or IgG/IgM; among 854 adolescents, 250 (29.2%) had positive serology; and among 282 adults, 59 (20.9%) were positive. The frequency of positivity on RT-PCR for SARS-CoV-2 was 3.5%, 3.6% and 6.0% in children, adolescents and adults, respectively. Children had a lower incidence of symptoms than adolescents (p = 0.001) and adults (p = 0.003); the most frequent were fever, ageusia, anosmia, headache, dry cough, sore throat, muscle pain, runny nose, dyspnoea, and diarrhoea. Conclusions: The prevalence rate for all groups was 26.7% in serology and 4.04% in RT-PCR. Children had lower rates of IgM and fewer symptoms compared with adolescents and adults. The data suggest the potential for transmissibility in all age groups

Feasibility indicators of telemedicine for patients with dementia in a public hospital in Northeast Brazil during the COVID-19 pandemic.

BackgroundThe use of telemedicine has become a fundamental tool in healthcare in recent years, especially at times of Covid-19 pandemic. Currently, there are several telemedicine tools that are simple, inexpensive, and effective means of communication. This article aims to describe indicators of feasibility including patient recruitment, attendance, discomfort (internet connection issues and/or noncompliant patient behavior), satisfaction, and travel time and cost savings of virtual telemedicine consultations for patients with dementia.MethodsThe study was conducted at the Geriatrics Department of Hospital Universitário Walter Cantídio (HUWC) in Fortaleza, Brazil, between May 1st and December 31, 2020. The eligibility criteria included previous diagnosis of dementia syndrome and receiving care at the hospital's dementia outpatient clinic in face-to-face consultations in the preceding 12 months. Patients were excluded if they did not feel comfortable with virtual consultations, did not have the required communication technology available or their caregiver was not available to attend the remote consultation. The patients were recruited from the outpatient dementia clinic's medical appointment scheduling list. The intervention was designed as a one-time consultation and it included treatment approaches and health promotion recommendations.ResultsPatient recruitment, attendance and discomfort rates were 85.5%, 97.7% and 9.4%, respectively. To attend face-to-face visits, they reported an average travel time (including the consultation) of 233.21 minutes and average total cost of 60.61 reais (around USD 11). The study intervention was well accepted among the patients and their caregivers with 97.6% being satisfied. Many were happy to avoid long waits in crowded medical waiting rooms and the risk of covid-19 contagion.ConclusionsWe found good recruitment, attendance, and acceptance rates of remote care for the follow-up of dementia patients as well as low discomfort rates.Trial registrationBrazilian Trial Registry (REBEC) RBR-9xs978

Clinical correlates of sarcopenia and falls in Parkinson's disease.

BACKGROUND:Sarcopenia is a complex and multifactorial geriatric condition seen in several chronic degenerative diseases. This study aimed to screen for sarcopenia and fall risk in a sample of Parkinson's disease (PD) patients and to investigate demographic and clinical factors associated. METHODS:This is a cross-sectional study. We evaluated 218 PD patients at the Movement Disorders Clinic in Fortaleza, Brazil, and collected clinical data including experiencing falls in the six months prior to their medical visit. Probable sarcopenia diagnosis was confirmed by using a sarcopenia screening tool (SARC-F questionnaire) and the presence of low muscle strength. RESULTS:One hundred and twenty-one patients (55.5%) were screened positive for sarcopenia using the SARC-F and 103 (47.4%) met the criteria for probable sarcopenia. Disease duration, modified Hoehn and Yahr stage, Schwab and England Activities of Daily Living Scale score, levodopa equivalent dose, probable sarcopenia and positive SARC-F screening were all associated with experiencing falls. Disease duration, lower quality of life and female gender were independently associated with sarcopenia. Experiencing falls was significantly more frequent among patients screened positive in the SARC-F compared to those screened negative. CONCLUSIONS:Sarcopenia and PD share common pathways and may affect each other's prognosis and patients' quality of life. Since sarcopenia is associated with lower quality of life and increased risk of falls, active case finding, diagnosis and proper management of sarcopenia in PD patients is essential