Legal actions in Brazilian air transport: A machine learning and multinomial logistic regression analysis

In Brazil, one of the most harmful costs for airlines is the number of lawsuits filed against them. It is a problem that can affect its operations, reduce the entry of new competitors and create legal uncertainty in the country. This work seeks to highlight the factors which most contribute to the rise of judicial indemnities, discuss the most relevant issues and identify the best techniques to predict the indemnified values. The objective is to provide subsidies for airlines to mitigate the number of legal actions by using machine learning models. This research contributes by discussing one of the most relevant subjects in Brazilian air transport and comparing the machine learning models’ performance. The study is based on lawsuits between 2016 and 2021 using the companies’ data. The performance of Naive Bayes, Random Forest, Support Vector Machines, and Multinomial Logistic Regression models are evaluated through the accuracy, area under the ROC curve, and confusion matrix. The results showed better predictive power for Random Forest and Logistic Regression. The latter showed that flight delays, cancellations, and airline faults have a negative effect on indemnities. The above-average compensation is a tendency in some states, being the moral damage awarded to customers the main cause of higher compensation

Perfil clínico-epidemiológico das lesões traumáticas em adultos atendidos no Hospital Universitário Sul-Fluminense (HUSF) em Vassouras-RJ

Segundo a Organização Mundial da Saúde (OMS), cerca de 1 milhão de pessoas morrem no mundo a cada ano vítima de acidentes de trânsito, ocasionando impactos negativos na família das vítimas e na saúde da população. Nossa população carece de estudos mais específicos sobre o perfil clínico-epidemiológico dos pacientes vítimas de trauma, desse modo, faz-se de suma importância à realização de estudos que definam melhor essas variáveis relativas ao público-alvo atendido diuturnamente em nosso sistema público de saúde de emergência. O objetivo deste estudo é descrever o perfil clínico-epidemiológico de pacientes vítimas de trauma atendidos no Hospital Universitário Sul-Fluminense – Vassouras-RJ. Foi realizado um estudo retrospectivo e prospectivo através da analise de prontuários de 100 pacientes atendidos no ambulatório de ortopedia e nas enfermarias de clínica cirúrgica no período de janeiro de 2015 a setembro de 2015 no Hospital Universitário Sul-Fluminense (HUSF) em Vassouras/RJ. Os dados foram coletados através de questionário semi-estruturado e analisados estatisticamente. Os resultados encontrados foram: a principal causa delesão traumática foram os acidentes motociclísticos (24%), 64% dos pacientes que sofreram algum trauma eram do sexo masculino, a maioria das vítimas (40%) está na faixa etária de 18 a 30 anos e 42,95% dos pacientes apresentaram lesões em membros superiores. Após análise dos dados coletados, pode-se observar que o presente estudo se assemelha ao cenário nacional. O investimento na formação de profissionais da área de urgência e emergência e o incentivo para exercer seu papel de educador na prevenção das causas que contribuem para o aumento desta estatística serão de grande importância

Generalidades sobre o quadro clínico da Rinossinusite: uma revisão narrativa de literatura: Generalities about the clinical picture of Rhinosinusitis: a narrative literature reviewv

A rinossinusite é um processo inflamatório da mucosa dos seios paranasais e da cavidade nasal. O sistema nasossinusal é responsável pelo balanço adequado entre a fabricação e o clearence de muco nas cavidades paranasais. A fisiologia deste é de vital importância para a proteção das vias aéreas superiores. No advém, determinados fatores podem acarretar um desbalanço nesse complexo, consequentemente um processo inflamatório. Qualquer fator que altere a drenagem, seja por obstrução, maior produção ou espessamento do muco, como processo infecciosos ou alérgicos, haverá uma impactação de secreções e a facilitação de colonização bacteriana, dando início ao processo infeccioso. A identificação da inflamação do nariz e seios paranasais é basicamente clínica. A suspeição desta ocorre através da manifestação de dois ou mais sintomatologias. As quais são o bloqueio ou obstrução nasal, a descarga nasal, pressão ou dor facial e redução ou perda do olfato. De modo geral, é essencial à prevenção básica das rinossinusites agudas é barrar a infecção viral. O suporte inclui medidas gerais de higiene, alimentação e hidratação, imunização para o combate de vírus respiratórios , administração de fármacos para turbinar o sistema imune se necessário

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Epidemiology of femur fractures at the Nova Iguaçu general hospital.

Fractures of the proximal femur and their management remain a matter of great attention for doctors. Osteoporosis and the high incidence of comorbidities in the elderly can lead to an increased risk of complications and mortality. This study aims to  analyze the epidemiological profile of fractures of the proximal third of the femur in patients treated at the orthopedics department of the Hospital Geral de Nova Iguaçu. A retrospective, analytical and observational study was carried out at the General Hospital of Nova Iguaçu. Data were collected by analyzing 94 medical records from July 2018 to September 2018. After being organized in spreadsheets, the information was analyzed statistically with the R-project software, version 3.5.3. The test to verify the association between the variables was Pearson's Chi-Square test. There was a prevalence of males, with 52.13% of cases. Of the 94 patients, 87 were aged over 41 years and 74.47% of the patients arrived at the hospital on their own. Falling from height was the main type of trauma with 86.18% and 53.20% of patients were diagnosed with a transtrochanteric fracture. This study reinforces the social importance of femur fractures in the elderly and the need to implement health actions that reinforce the need for public policies so that there is specific attention for this group.Fraturas do fêmur proximal e seu manejo continuam sendo um assunto de grande atenção para os médicos. A osteoporose e a alta incidência de comorbidades na população de idosos pode levar a um maior risco de complicações e mortalidade. O objetivo deste estudo é analisar o perfil epidemiológico das fraturas do terço proximal do fêmur em pacientes tratados no Departamento de Ortopedia do Hospital Geral de Nova Iguaçu. Foi realizado um estudo retrospectivo, analítico e observacional, desenvolvido no Hospital Geral de Nova Iguaçu. Os dados foram coletados mediante análise de 94 prontuários no período de julho de 2018 a setembro de 2018. Após organizadas em planilhas, as informações foram analisadas estatisticamente com o auxílio do software R-project, versão 3.5.3. O teste para verificar a associação entre as variáveis foi o teste de Qui-Quadrado de Pearson. Houve prevalência do sexo masculino, com 52,13% dos casos. Dos 94 pacientes, 87 tinham idade acima de 41 anos e 74,47% dos pacientes, chegaram ao hospital por meios próprios. A queda da própria altura foi o principal tipo de trauma com 86,18% e 53,20% dos pacientes foram diagnosticados com fratura transtrocanteriana. Este estudo reforça a importância social da fratura de fêmur em idosos e a necessidade de implementação de ações em saúde que reforcem a necessidade políticas públicas para que haja uma atenção específica para este grupo

Red blood cell transfusions worsen the outcomes even in critically ill patients undergoing a restrictive transfusion strategy

CONTEXT AND OBJECTIVE: Anemia and blood transfusions are common in intensive care. This study aimed to evaluate epidemiology and outcomes among critically ill patients under a restrictive transfusion strategy. DESIGN AND SETTING: Prospective observational cohort study in an intensive care unit (ICU) at a tertiary hospital. METHODS: All adults admitted to the ICU over a one-year period who remained there for more than 72 hours were included, except those with acute coronary syndrome, ischemic stroke, acute hemorrhage, prior transfusion, pregnant women and Jehovah's Witnesses. The restrictive strategy consisted of transfusion indicated when hemoglobin levels were less than or equal to 7.0 g/dl. RESULTS: The study enrolled 167 patients; the acute physiology and chronic health evaluation II (APACHE II) score was 28.9 ± 6.5. The baseline hemoglobin level was 10.6 ± 2.2 g/dl and on day 28, it was 8.2 ± 1.3 g/dl (P < 0.001). Transfusions were administered to 35% of the patients. In the transfusion group, 61.1% did not survive, versus 48.6% in the non-transfusion group (P = 0.03). Transfusion was an independent risk factor for mortality (P = 0.011; odds ratio, OR = 2.67; 95% confidence interval, CI = 1.25 to 5.69). ICU stay and hospital stay were longer in the transfusion group: 20.0 (3.0-83.0) versus 8.0 (3.0-63.0) days (P < 0,001); and 24.0 (3.0-140.0) versus 14.0 (3.0-80.0) days (P = 0.002), respectively. CONCLUSIONS: In critically ill patients, there was a reduction in hemoglobin with increasing length of ICU stay. Moreover, transfusion was associated with worse prognoses