Percepção dos familiares sobre o processo de doação de órgãos

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina. Curso de Medicina. Departamento de Clinica Medica

Predictive performance for hospital mortality of SAPS 3, SOFA, ISS and new ISS in critically ill trauma patients: a validation cohort study

INTRODUÇÃO: A performance preditiva dos escores anatômicos em comparação com escores de doença crítica, em geral, em pacientes vítimas de trauma, admitidos em unidade de terapia intensiva (UTI) é desconhecida. O objetivo desta análise é realizar a validação externa, comparando a performance preditiva para mortalidade hospitalar de escores de doença crítica em geral (SAPS 3 e SOFA total nas primeiras 24 horas de admissão na UTI) e, de escores anatômicos (ISS e NISS) nessa população. MÉTODOS: Coorte retrospectiva de pacientes vítimas de trauma admitidos em uma UTI especializada de centro terciário de São Paulo entre maio de 2012 e janeiro de 2016. Dados relativos à admissão e primeira evolução para cálculo de SAPS 3 e SOFA foram coletados prospectivamente no banco de dados da unidade. Os escores ISS e NISS foram calculados retrospectivamente com base em resultados de tomografia e prontuário médico. A performance para predição da mortalidade hospitalar foi avaliada pela discriminação, calibração e utilidade clínica pela curva de decisão. RESULTADOS: A coorte incluiu 1.053 pacientes admitidos por trauma na UTI, sendo 84,2% do sexo masculino e com idade média de 40 (±18) anos. O mecanismo principal de trauma foi contuso (90,7%). Traumatismo cranioencefálico esteve presente em 67,8% dos pacientes, sendo grave em 43,3%. No momento da admissão na UTI, 846 pacientes (80,3%) estavam em ventilação mecânica invasiva e 644 (64,3%) em uso de droga vasoativa. Óbito hospitalar ocorreu em 251 pacientes (23,8%). Em relação aos escores prognósticos, a mediana de SAPS 3 foi 41; de SOFA total máximo nas 24 horas de admissão, 7; de ISS, 29; e NISS, 41. AUROCs (IC 95%) foram: SAPS 3 = 0,786 (0,756-0,817), SOFA total máximo em 24 horas de admissão = 0,807 (0,778-0,837), ISS = 0,616 (0,577-0,656) e NISS = 0,689 (0,649-0,729). Em comparações individuais, o SAPS 3 e o SOFA não foram diferentes, mas ambos foram melhores que os escores anatômicos (p <0.001). O SAPS 3 na equação geral e na equação América Central/Sul apresentaram calibração imperfeita. Após recalibração do intercepto e slope da equação, o SAPS 3 recalibrado apresentou melhor calibração ao longo de todo o limiar de risco do desfecho, semelhante ao observado com SOFA. O SOFA total nas primeiras 24 horas de admissão na UTI apresentou calibração próxima de ideal, ao longo de ampla faixa de predição de risco e o maior benefício líquido na curva de decisão. CONCLUSÃO: Os escores anatômicos ISS e NISS têm performances preditivas baixas em pacientes críticos com trauma, sendo superados pelos escores SAPS 3 e SOFA total máximo de 24 horas de admissão. A gravidade de doença crítica em trauma é mais bem caracterizada por disfunção orgânica e variáveis clínicas do que por lesões anatômicasINTRODUCTION: Its not known whether anatomical scores perform better than general critical care scores for trauma patients admitted to the intensive care unit (ICU). We compare the predictive performance for hospital mortality of general critical care scores (SAPS 3 and SOFA) with anatomical injurybased scores (injury severity score [ISS] and new ISS [NISS]). METHODS: Retrospective cohort study of patients admitted to a specialized trauma ICU from a tertiary hospital in São Paulo, Brazil between May, 2012 and January, 2016. We retrieved data from the ICU database for critical care scores and calculated ISS and NISS from chart data and whole body computed tomography results. We compared the predictive performance for hospital mortality of each model through discrimination, calibration, and decisioncurve analysis. RESULTS: The sample comprised 1053 victims of trauma admitted to the ICU, with 84.2% male patients and mean age of 40 (±18) years. Main injury mechanism was blunt trauma (90.7%). Traumatic brain injury (TBI) was present in 67.8% of patients; 43.3% with severe TBI. At the time of ICU admission, 846 patients (80.3%) were on mechanica ventilation and 644 (64.3%) on vasoactive drugs. Hospital mortality was 23.8% (251). Median SAPS 3 was 41; median maximum SOFA within 24 hours of admission, 7; ISS, 29; and NISS, 41. AUROCs (95% CI) were: SAPS 3 = 0.786 (0.756-0.817), SOFA = 0.807 (0.778-0.837), ISS = 0.616 (0.577-0.656) and NISS = 0.689 (0.649-0.729). In pairwise comparisons, SAPS 3 and SOFA did not differ, while both outperformed the anatomical scores (p<0.001). SAPS 3 was miscalibrated for the general equation and for the customized Central, South America equation. After recalibration, SAPS 3 presented a better calibration throughout the entire range of expected risks, like that observed with SOFA. Maximum SOFA within 24 hours of admission presented the best calibration and net benefit in decision-curve analysis. CONCLUSIONS: Trauma-specific anatomical scores have fair performance in critically ill trauma patients and are outperformed by SAPS 3 and SOFA. Illness severity is best characterized by organ dysfunction and physiological variables than anatomical injurie

Septic pelvic thrombophlebitis of unknown origin: an ever threatening entity

Septic pelvic thrombophlebitis (SPT) is a rare and severe entity, which may occur after abortion, delivery, gynecological diseases, or surgeries. Diagnosis is challenging when no risk factor is clearly present, since clinically, symptoms are non-specific. Nowadays, with the aid of imaging methods, diagnosis has become more achievable, but the treatment still bears some uncertainties. The authors present a fatal case of SPT in a young woman who sought medical care already presenting signs of septic shock, referring fever and non-characteristic abdominal pain. The patient evolved rapidly to multiple organ failure and respiratory distress, which was also due to septic pulmonary embolism. The autopsy confirmed the computed tomographic findings of a right ovarian vein septic thrombophlebitis and multiple septic pulmonary embolization foci. The patient did not present any of the recognized risk factors; neither did she present signs of pelvic inflammatory disease on admission or at autopsy. However, an intrauterine device was present. The authors call attention to this entity in the differential diagnosis of a woman with fever and abdominal pain, as well as for an empiric broad-spectrum antibiotic regimen in these cases

sj-docx-1-jic-10.1177_08850666231188051 - Supplemental material for Predictive Performance for Hospital Mortality of SAPS 3, SOFA, ISS, and New ISS in Critically Ill Trauma Patients: A Validation Cohort Study

Supplemental material, sj-docx-1-jic-10.1177_08850666231188051 for Predictive Performance for Hospital Mortality of SAPS 3, SOFA, ISS, and New ISS in Critically Ill Trauma Patients: A Validation Cohort Study by Roberta Muriel Longo Roepke and Bruno Adler Maccagnan Pinheiro Besen, Renato Daltro-Oliveira, Renata Mello Guazzelli, Estevão Bassi, Jorge Ibrain Figueira Salluh, Sérgio Henrique Bastos Damous, Edivaldo Massazo Utiyama, Luiz Marcelo Sá Malbouisson in Journal of Intensive Care Medicine</p

sj-docx-2-jic-10.1177_08850666231188051 - Supplemental material for Predictive Performance for Hospital Mortality of SAPS 3, SOFA, ISS, and New ISS in Critically Ill Trauma Patients: A Validation Cohort Study

Supplemental material, sj-docx-2-jic-10.1177_08850666231188051 for Predictive Performance for Hospital Mortality of SAPS 3, SOFA, ISS, and New ISS in Critically Ill Trauma Patients: A Validation Cohort Study by Roberta Muriel Longo Roepke and Bruno Adler Maccagnan Pinheiro Besen, Renato Daltro-Oliveira, Renata Mello Guazzelli, Estevão Bassi, Jorge Ibrain Figueira Salluh, Sérgio Henrique Bastos Damous, Edivaldo Massazo Utiyama, Luiz Marcelo Sá Malbouisson in Journal of Intensive Care Medicine</p

Efficacy of gamification-based smartphone application for weight loss in overweight and obese adolescents: study protocol for a phase II randomized controlled trial

Background: Overweight and obesity are significant public health concerns that are prevalent in younger age cohorts. Preventive or therapeutic interventions are difficult to implement and maintain over time. On the other hand, the majority of adolescents in the United States have a smartphone, representing a huge potential for innovative digitized interventions, such as weight loss programs delivered via smartphone applications. Although the number of available smartphone applications is increasing, evidence for their effectiveness in weight loss is insufficient. Therefore, the proposed study aims to assess the efficacy of a gamification-based smartphone application for weight loss in overweight and obese adolescents. The trial is designed to be a phase II, single-centre, two-arm, triple-blinded, randomized controlled trial (RCT) with a duration of 6 months. Method: The intervention consists of a smartphone application that provides both tracking and gamification elements, while the control arm consists of an identically designed application solely with tracking features of health information. The proposed trial will be conducted in an urban primary care clinic of an academic centre in the United States of America, with expertise in the management of overweight and obese adolescents. Eligible adolescents will be followed for 6 months. Changes in body mass index z score from baseline to 6 months will be the primary outcome. Secondary objectives will explore the effects of the gamification-based application on adherence, as well as anthropometric, metabolic and behavioural changes. A required sample size of 108 participants (54 participants per group) was calculated. Discussion: The benefits of the proposed study include mid-term effects in weight reduction for overweight and obese adolescents. The current proposal will contribute to fill a gap in the literature on the mid-term effects of gamification-based interventions to control weight in adolescents. This trial is a well-designed RCT that is in line with the Consolidated Standards of Reporting Trials statement