74 research outputs found
Resultados maternos e neonatais em centro de parto normal peri-hospitalar e hospital
OBJETIVO: Comparar os resultados maternos e neonatais em mulheres de baixo risco atendidas em centro de parto normal peri-hospitalar e hospital. MĂTODOS: Estudo transversal com amostra representativa de mulheres de baixo risco atendidas em SĂŁo Paulo, SP, de 2003 a 2006. Foram incluĂdas 991 mulheres que tiveram o parto no centro de parto normal e 325 que deram Ă luz no hospital. Os dados foram obtidos dos prontuĂĄrios. A anĂĄlise comparativa foi realizada para o total de mulheres e estratificada segundo a paridade. Foram aplicados os testes qui-quadrado e exato de Fisher. RESULTADOS: Houve distribuição homogĂȘnea das mulheres segundo a paridade (45,4% nulĂparas e 54,6% mulheres com um ou mais partos anteriores). Foram encontradas diferenças estatisticamente significantes em relação Ă s seguintes intervençÔes: amniotomia (mais freqĂŒente entre nulĂparas do hospital); utilização de ocitocina no trabalho de parto e utilização de analgĂ©sico no pĂłs-parto (mais freqĂŒentes no hospital entre as mulheres de todas as paridades). A taxa de episiotomia foi maior entre as nulĂparas, tanto no centro de parto como no hospital. Houve maior freqĂŒĂȘncia de intervençÔes com o neonato no hospital: aspiração das vias aĂ©reas superiores, aspiração gĂĄstrica, lavagem gĂĄstrica, oxigĂȘnio por mĂĄscara aberta. TambĂ©m ocorreram com mais freqĂŒĂȘncia no hospital bossa serossanguĂnea, desconforto respiratĂłrio e internação na unidade neonatal. NĂŁo houve diferença nos valores de Apgar no quinto minuto nem casos de morte materna ou perinatal. CONCLUSĂES: A assistĂȘncia no centro de parto normal foi realizada com menos intervençÔes e com resultados maternos e neonatais semelhantes aos do hospital
Assessment of ePrescription quality: an observational study at three mail-order pharmacies
<p>Abstract</p> <p>Background</p> <p>The introduction of electronic transfer of prescriptions (ETP) or ePrescriptions in ambulatory health care has been suggested to have a positive impact on the prescribing and dispensing processes. Thereby, implying that ePrescribing can improve safety, quality, efficiency, and cost-effectiveness. In December 2007, 68% of all new prescriptions were transferred electronically in Sweden. The aim of the present study was to assess the quality of ePrescriptions by comparing the proportions of ePrescriptions and non-electronic prescriptions necessitating a clarification contact (correction, completion or change) with the prescriber at the time of dispensing.</p> <p>Methods</p> <p>A direct observational study was performed at three Swedish mail-order pharmacies which were known to dispense a large proportion of ePrescriptions (38â75%). Data were gathered on all ePrescriptions dispensed at these pharmacies over a three week period in February 2006. All clarification contacts with prescribers were included in the study and were classified and assessed in comparison with all drug prescriptions dispensed at the same pharmacies over the specified period.</p> <p>Results</p> <p>Of the 31225 prescriptions dispensed during the study period, clarification contacts were made for 2.0% (147/7532) of new ePrescriptions and 1.2% (79/6833) of new non-electronic prescriptions. This represented a relative risk (RR) of 1.7 (95% CI 1.3â2.2) for new ePrescriptions compared to new non-electronic prescriptions. The increased RR was mainly due to 'Dosage and directions for use', which had an RR of 7.6 (95% CI 2.8â20.4) when compared to other clarification contacts. In all, 89.5% of the suggested pharmacist interventions were accepted by the prescriber, 77.7% (192/247) as suggested and an additional 11.7% (29/247) after a modification during contact with the prescriber.</p> <p>Conclusion</p> <p>The increased proportion of prescriptions necessitating a clarification contact for new ePrescriptions compared to new non-electronic prescriptions indicates the need for an increased focus on quality aspects in ePrescribing deployment. ETP technology should be developed towards a two-way communication between the prescriber and the pharmacist with automated checks of missing, inaccurate, or ambiguous information. This would enhance safety and quality for the patient and also improve efficiency and cost-effectiveness within the health care system.</p
Linear Fidelity in Quantification of Anti-Viral CD8+ T Cells
Enumeration of anti-viral CD8+ T cells to make comparisons between mice, viruses and vaccines is a frequently used approach, but controversy persists as to the most appropriate methods. Use of peptide-MHC tetramers (or variants) and intracellular staining for cytokines, in particular IFNÎł, after a short ex vivo stimulation are now common, as are a variety of cytotoxicity assays, but few direct comparisons have been made. It has been argued that use of tetramers leads to the counting of non-functional T cells and that measurement of single cytokines will fail to identify cells with alternative functions. Further, the linear range of these methods has not been tested and this is required to give confidence that relative quantifications can be compared across samples. Here we show for two acute virus infections and CD8+ T cells activated in vitro that DimerX (a tetramer variant) and intracellular staining for IFNÎł, alone or in combination with CD107 to detect degranulation, gave comparable results at the peak of the response. Importantly, these methods were highly linear over nearly two orders of magnitude. In contrast, in vitro and in vivo assays for cytotoxicity were not linear, suffering from high background killing, plateaus in maximal killing and substantial underestimation of differences in magnitude of responses
Mechanism of cellular rejection in transplantation
The explosion of new discoveries in the field of immunology has provided new insights into mechanisms that promote an immune response directed against a transplanted organ. Central to the allograft response are T lymphocytes. This review summarizes the current literature on allorecognition, costimulation, memory T cells, T cell migration, and their role in both acute and chronic graft destruction. An in depth understanding of the cellular mechanisms that result in both acute and chronic allograft rejection will provide new strategies and targeted therapeutics capable of inducing long-lasting, allograft-specific tolerance
What Is Direct Allorecognition?
Direct allorecognition is the process by which
donor-derived major histocompatibility complex (MHC)-peptide
complexes, typically presented by donor-derived âpassengerâ
dendritic cells, are recognised directly by recipient T cells.
In this review, we discuss the two principle theories which
have been proposed to explain why individuals possess a
high-precursor frequency of T cells with direct allospecificity
and how self-restricted T cells recognise allogeneic MHCpeptide
complexes. These theories, both of which are supported
by functional and structural data, suggest that T cells
recognising allogeneic MHC-peptide complexes focus either
on the allopeptides bound to the allo-MHC molecules or the
allo-MHC molecules themselves. We discuss how direct
alloimmune responses may be sustained long term, the consequences
of this for graft outcome and highlight novel strategies
which are currently being investigated as a potential
means of reducing rejection mediated through this pathway
Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial: study protocol for a multicentre international trial of cardiac output-guided fluid therapy with low-dose inotrope infusion compared with usual care in patients undergoing major elective gastrointestinal surgery.
INTRODUCTION: Postoperative morbidity and mortality in older patients with comorbidities undergoing gastrointestinal surgery are a major burden on healthcare systems. Infections after surgery are common in such patients, prolonging hospitalisation and reducing postoperative short-term and long-term survival. Optimal management of perioperative intravenous fluids and inotropic drugs may reduce infection rates and improve outcomes from surgery. Previous small trials of cardiac-output-guided haemodynamic therapy algorithms suggested a modest reduction in postoperative morbidity. A large definitive trial is needed to confirm or refute this and inform widespread clinical practice. METHODS: The Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial is a multicentre, international, parallel group, open, randomised controlled trial. 2502 high-risk patients undergoing major elective gastrointestinal surgery will be randomly allocated in a 1:1 ratio using minimisation to minimally invasive cardiac output monitoring to guide protocolised administration of intravenous fluid combined with low-dose inotrope infusion, or usual care. The trial intervention will be carried out during and for 4âhours after surgery. The primary outcome is postoperative infection of Clavien-Dindo grade II or higher within 30 days of randomisation. Participants and those delivering the intervention will not be blinded to treatment allocation; however, outcome assessors will be blinded when feasible. Participant recruitment started in January 2017 and is scheduled to last 3âyears, within 50 hospitals worldwide. ETHICS/DISSEMINATION: The OPTIMISE II trial has been approved by the UK National Research Ethics Service and has been approved by responsible ethics committees in all participating countries. The findings will be disseminated through publication in a widely accessible peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER: ISRCTN39653756.The OPTIMISE II trial is supported by Edwards Lifesciences (Irvine, CA) and the UK National Institute for Health Research through RMPâs NIHR Professorship
In vivo administration of artificial antigen-presenting cells activates low-avidity T cells for treatment of cancer
The development of effective antitumor immune responses is normally constrained by low-avidity, tumor-specific CTLs that are unable to eradicate the tumor. Strategies to rescue antitumor activity of low-avidity melanoma-specific CTLs in vivo may improve immunotherapy efficacy. To boost the in vivo effectiveness of low-avidity CTLs, we immunized mice bearing lung melanoma metastases with artificial antigen-presenting cells (aAPC), made by covalently coupling pepMHC-Ig dimers and B7.1-Ig molecules to magnetic beads. aAPC treatment induced significant tumor reduction in a mouse telomerase antigen system, and complete tumor eradication in a mouse TRP-2 antigen system, when low-avidity CTLs specific for these antigens were adoptively transferred. In addition, in an in vivo treatment model of subcutaneous melanoma, aAPC injection also augmented the activity of adoptively transferred CTLs and significantly delayed tumor growth. In vivo tumor clearance due to aAPC administration correlated with in situ proliferation of the transferred CTL. In vitro studies showed that aAPC effectively stimulated cytokine release, enhanced CTL-mediated lysis, and TCR downregulation in low-avidity CTLs. Therefore, in vivo aAPC administration represents a potentially novel approach to improve cancer immunotherap
RemoçÔes maternas da Casa do Parto de Sapopemba para hospital de referĂȘncia
Estudo descritivo com objetivo de caracterizar as remoçÔes maternas da Casa do Parto de Sapopemba, em SĂŁo Paulo, para hospitais de referĂȘncia, entre setembro de 1998 e julho de 2008. A população do estudo compĂŽs-se de 229 casos. Os dados foram obtidos dos prontuĂĄrios e dos livros de registro de remoçÔes. Foi realizada anĂĄlise descritiva. A taxa de remoção materna foi de 5,8% (5,5% intraparto e 0,3% pĂłs-parto). A maioria das mulheres removidas para o hospital era nulĂpara (78,6%). O motivo mais frequente para remoção intraparto foi anormalidade da pĂ©lvis materna ou do feto (22,6%) e para a remoção pĂłs-parto, anormalidade da dequitação (50%). Destacaram-se a nuliparidade, dilatação cervical na admissĂŁo, membranas ovulares rotas e idade gestacional superior a 40 semanas como variĂĄveis importantes para o estudo de fatores de risco para remoção materna
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