Readmissão de idosos por fratura proximal do fêmur: uma abordagem multinível

OBJETIVO Identificar as características individuais e hospitalares associadas ao risco de readmissão em idosos internados por fratura proximal do fêmur no período de 90 dias após a alta. MÉTODOS Para a obtenção dos registros de óbitos e das readmissões foi realizado linkage dos bancos de dados do Sistema de Informações Hospitalares do Sistema Único de Saúde e do Sistema de Informações sobre Mortalidade do município do Rio de Janeiro dos anos de 2008 a 2011. A população de 3.405 indivíduos com 60 anos ou mais, com internação não eletiva por fratura proximal do fêmur, foi acompanhada por 90 dias após a alta. Foi utilizado o modelo de Cox multinível para o tempo da alta até a readmissão, sendo as características dos pacientes consideradas no primeiro nível e as características dos hospitais no segundo nível. RESULTADOS O risco de readmissão foi maior para os homens (hazard ratio [HR] = 1,37; IC95% 1,08–1,73), indivíduos com mais de 79 anos (HR = 1,45; IC95% 1,06–1,98), pacientes que permaneceram internados por mais que duas semanas (HR = 1,33; IC95% 1,06-1,67) e para os que foram submetidos à artroplastia durante a internação quando comparados aos submetidos à osteossíntese (HR = 0,57; IC95% 0,41–0,79). Além disso, pacientes internados em hospitais estaduais tiveram menor risco para readmissão quando comparados aos internados nos hospitais municipais (HR = 1,71; IC95% 1,09–2,68) e federais (HR = 1,81; IC95% 1,00–3,27). O efeito aleatório dos hospitais no modelo ajustado manteve-se estatisticamente significativo (p < 0,05). CONCLUSÕES Os hospitais apresentam estruturas complexas que refletem na qualidade da assistência. Assim, propõe-se que futuros estudos possam incluir essas complexidades e a gravidade dos pacientes nas análises dos dados, considerando também a correlação existente entre a readmissão e a mortalidade para reduzir vieses.OBJECTIVE To identify individual and hospital characteristics associated with the risk of readmission in older inpatients for proximal femoral fracture in the period of 90 days after discharge. METHODS Deaths and readmissions were obtained by a linkage of databases of the Hospital Information System of the Unified Health System and the System of Information on Mortality of the city of Rio de Janeiro from 2008 to 2011. The population of 3,405 individuals aged 60 or older, with non-elective hospitalization for proximal femoral fracture was followed for 90 days after discharge. Cox multilevel model was used for discharge time until readmission, and the characteristics of the patients were used on the first level and the characteristics of the hospitals on the second level. RESULTS The risk of readmission was higher for men (hazard ratio [HR] = 1.37; 95%CI 1.08–1.73), individuals more than 79 years old (HR = 1.45; 95%CI 1.06–1.98), patients who were hospitalized for more than two weeks (HR = 1.33; 95%CI 1.06-1.67), and for those who underwent arthroplasty when compared with the ones who underwent osteosynthesis (HR = 0.57; 95%CI 0.41–0.79). Besides, patients admitted to state hospitals had lower risk for readmission when compared with inpatients in municipal (HR = 1.71; 95%CI 1.09–2.68) and federal hospitals (HR = 1.81; 95%CI 1.00–3.27). The random effect of the hospitals in the adjusted model remained statistically significant (p < 0.05). CONCLUSIONS Hospitals have complex structures that reflect in the quality of care. Thus, we propose that future studies may include these complexities and the severity of the patients in the analysis of the data, also considering the correlation between readmission and mortality to reduce biases

Construção e validação de um algoritmo para aplicação de laser no tratamento de ferida

Objective: To develop and validate an algorithm for laser wound therapy. Method: Methodological study and literature review. For the development of the algorithm, a review was performed in the Health Sciences databases of the past ten years. The algorithm evaluation was performed by 24 participants, nurses, physiotherapists, and physicians. For data analysis, the Cronbach's alpha coefficient and the chi-square test for independence was used. The level of significance of the statistical test was established at 5% (p<0.05). Results: The professionals' responses regarding the facility to read the algorithm indicated: 41.70%, great41.70%, good16.70%, regular. With regard the algorithm being sufficient for supporting decisions related to wound evaluation and wound cleaning, 87.5% said yes to both questions. Regarding the participants' opinion that the algorithm contained enough information to support their decision regarding the choice of laser parameters, 91.7% said yes. The questionnaire presented reliability using the Cronbach's alpha coefficient test (alpha = 0.962). Conclusion: The developed and validated algorithm showed reliability for evaluation, wound cleaning, and use of laser therapy in wounds.Objetivo: construir e validar um algoritmo para laserterapia em feridas. Método: estudo metodológico e de revisão da literatura. Para a construção do algoritmo, foi realizada revisão junto às bases de dados em Ciências da Saúde dos últimos 10 anos. A avaliação do algoritmo foi feita por 24 participantes, sendo estes fisioterapeutas, médicos e enfermeiros. Para análise dos dados, utilizou-se o Coeficiente Alfa de Cronbach e o teste Qui-quadrado para independência. O nível de significância do teste estatístico foi estabelecido em 5% (p<0,05). Resultados: as respostas dos profissionais sobre a facilidade de leitura do algoritmo indicaram: 41,70% para ótimo; 41,70% para bom; 16,70% para regular. Quanto à opinião dos participantes, se o algoritmo era suficiente para apoiar as suas decisões relacionadas à avaliação da ferida e à limpeza da ferida, 87,5% afirmaram que sim para ambas as questões; sobre a opinião dos participantes se o algoritmo continha informações suficientes para apoiar a sua decisão quanto à escolha dos parâmetros do laser, 91,7% afirmaram que sim. Com relação ao teste de Coeficiente Alfa de Cronbach, observou-se que o questionário apresenta confiabilidade (α=0,962). Conclusão: o algoritmo construído e validado demonstrou confiabilidade para avaliação, limpeza e uso de laserterapia em feridas.Ctr Univ Formiga, Phisiotherapy Dept, Formiga, MG, BrazilUniv Vale Sapucai, Pouso Alegre, MG, BrazilUniv Vale Sapucai, Phisiotherapy Dept, Pouso Alegre, MG, BrazilUniv Fed Sao Paulo, Plast Surg Discipline, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Plast Surg Discipline, Sao Paulo, SP, BrazilWeb of Scienc

Charge Transport Mechanism in Chevron--Graphene Nanoribbons

From the moment atomic precision control of the growth process of graphene was achieved, more elaborated carbon allotropes were proposed opening new channels for flat optoelectronics at the nanoscale. A special type of this material presenting a V-shape (or "kinked" pattern) was recently synthesized and named Chevron-graphene nanoribbons (C-GNRs). To realize the reach of C--GNRs in developing new applications, the formation, and transport of charge carriers in their lattices should be primarily understood. Here, we investigate the static and dynamical properties of quasiparticles in C-GNRs. We study the effects of electron-phonon coupling and doping on the system. We also determine the kind of charge carriers present in C--GNR. It is observed that a phase transition occurs between a delocalized regime of conduction and regimes mediated by charge carriers. Such a phase transition is highly dependent on the doping concentration. Remarkably, crucial differences from the transport in standard graphene nanoribbons are identified. These factors are noted to have a profound impact on the mobility on the system which, in turn, should decisively impact the performance of electronic devices based on C-GNRs.Comment: 12 pages, and 09 figure

Readmission of older patients after hospital discharge for hip fracture: a multilevel approach

ABSTRACT OBJECTIVE To identify individual and hospital characteristics associated with the risk of readmission in older inpatients for proximal femoral fracture in the period of 90 days after discharge. METHODS Deaths and readmissions were obtained by a linkage of databases of the Hospital Information System of the Unified Health System and the System of Information on Mortality of the city of Rio de Janeiro from 2008 to 2011. The population of 3,405 individuals aged 60 or older, with non-elective hospitalization for proximal femoral fracture was followed for 90 days after discharge. Cox multilevel model was used for discharge time until readmission, and the characteristics of the patients were used on the first level and the characteristics of the hospitals on the second level. RESULTS The risk of readmission was higher for men (hazard ratio [HR] = 1.37; 95%CI 1.08–1.73), individuals more than 79 years old (HR = 1.45; 95%CI 1.06–1.98), patients who were hospitalized for more than two weeks (HR = 1.33; 95%CI 1.06-1.67), and for those who underwent arthroplasty when compared with the ones who underwent osteosynthesis (HR = 0.57; 95%CI 0.41–0.79). Besides, patients admitted to state hospitals had lower risk for readmission when compared with inpatients in municipal (HR = 1.71; 95%CI 1.09–2.68) and federal hospitals (HR = 1.81; 95%CI 1.00–3.27). The random effect of the hospitals in the adjusted model remained statistically significant (p < 0.05). CONCLUSIONS Hospitals have complex structures that reflect in the quality of care. Thus, we propose that future studies may include these complexities and the severity of the patients in the analysis of the data, also considering the correlation between readmission and mortality to reduce biases

Síndrome de Mobius: Morbius syndrome

Introdução: A Síndrome de Moebius (SM) é uma desordem neurológica congênita rara cuja principal característica é a paralisia parcial ou completa do nervo facial, podendo ainda, ser acompanhada pela paralisia de outros nervos cranianos. Apresentação do caso: J.F.F.R., 15 meses e 21 dias, sexo masculino, brasileiro, em acompanhamento na Unidade Básica de Saúde Jairo Ferreira de Castro após contra-referência de pediatra particular por apresentar dificuldade em sugar, fechamento incompleto das pálpebras durante o sono, hipomimia da face, desvio de rima à esquerda, estrabismo convergente e hipoplasia da língua. Discussão: De diagnóstico essencialmente clínico, dentre as principais manifestações dessa doença destacam-se: sucção deficiente ou ausente devido ao fechamento incompleto dos lábios; falta de mímica facial; olhar fixo; fechamento incompleto das pálpebras durante o sono e ptose palpebral. A etiologia desta síndrome ainda não está bem estabelecida. Porém, existem algumas hipóteses descritas como lesões hipóxico-isquêmicas no início da gestação, trauma gestacional, exposição a drogas e componentes genéticos. Conclusão: Evidencia-se a importância do manejo interdisciplinar para a introdução precoce e contínua de reabilitação física para os distúrbios do movimento; fonoaudiologia para os déficits das funções motoras orais e intervenção psicomotora devido às dificuldades de coordenação visomotora

Development and validation of an algorithm for laser application in wound treatment

ABSTRACT Objective: To develop and validate an algorithm for laser wound therapy. Method: Methodological study and literature review. For the development of the algorithm, a review was performed in the Health Sciences databases of the past ten years. The algorithm evaluation was performed by 24 participants, nurses, physiotherapists, and physicians. For data analysis, the Cronbach’s alpha coefficient and the chi-square test for independence was used. The level of significance of the statistical test was established at 5% (p<0.05). Results: The professionals’ responses regarding the facility to read the algorithm indicated: 41.70%, great; 41.70%, good; 16.70%, regular. With regard the algorithm being sufficient for supporting decisions related to wound evaluation and wound cleaning, 87.5% said yes to both questions. Regarding the participants’ opinion that the algorithm contained enough information to support their decision regarding the choice of laser parameters, 91.7% said yes. The questionnaire presented reliability using the Cronbach’s alpha coefficient test (α = 0.962). Conclusion: The developed and validated algorithm showed reliability for evaluation, wound cleaning, and use of laser therapy in wounds