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OBJECTIVE: KPIs have been employed for internal quality control (IQC) in ART. However, clinical KPIs (C-KPIs) such as age, AMH and number of oocytes collected are never added to laboratory KPIs (L-KPIs), such as fertilization rate and morphological quality of the embryos for analysis, even though the final endpoint is the evaluation of clinical pregnancy rates. This paper analyzed if a KPIs-score strategy with clinical and laboratorial parameters could be used to establish benchmarks for IQC in ART cycles. METHODS: In this prospective cohort study, 280 patients (36.4±4.3years) underwent ART. The total KPIs-score was obtained by the analysis of age, AMH (AMH Gen II ELISA/pre-mixing modified, Beckman Coulter Inc.), number of metaphase-II oocytes, fertilization rates and morphological quality of the embryonic lot. RESULTS: The total KPIs-score (C-KPIs+L-KPIs) was correlated with the presence or absence of clinical pregnancy. The relationship between the C-KPIs and L-KPIs scores was analyzed to establish quality standards, to increase the performance of clinical and laboratorial processes in ART. The logistic regression model (LRM), with respect to pregnancy and total KPIs-score (280 patients/102 clinical pregnancies), yielded an odds ratio of 1.24 (95%CI = 1.16-1.32). There was also a significant difference (p<0.0001) with respect to the total KPIs-score mean value between the group of patients with clinical pregnancies (total KPIs-score=20.4±3.7) and the group without clinical pregnancies (total KPIs-score=15.9±5). Clinical pregnancy probabilities (CPP) can be obtained using the LRM (prediction key) with the total KPIs-score as a predictor variable. The mean C-KPIs and L-KPIs scores obtained in the pregnancy group were 11.9±2.9 and 8.5±1.7, respectively. Routinely, in all cases where the C-KPIs score was ≥9, after the procedure, the L-KPIs score obtained was ≤6, a revision of the laboratory procedure was performed to assess quality standards. CONCLUSION: This total KPIs-score could set up benchmarks for clinical pregnancy. Moreover, IQC can use C-KPIs and L-KPIs scores to detect problems in the clinical-laboratorial interface.
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Benchmarking/normas , Laboratorios/normas , Indicadores de Calidad de la Atención de Salud/normas , Técnicas Reproductivas Asistidas/normas , Adulto , Femenino , Humanos , Modelos Estadísticos , Embarazo , Índice de Embarazo , Estudios Prospectivos , Control de CalidadRESUMEN
METHODS: All 16 KPIs were analyzed, including the percentage of patients admitted to the stroke unit, venous thromboembolism prophylaxis in the first 48 hours after admission, pneumonia and hospital mortality due to stroke, and hospital discharge on antithrombotic therapy in patients without cardioembolic mechanism. RESULTS: Both centers admitted over 80% of the patients in their stroke unit. The incidence of venous thromboembolism prophylaxis was > 85%, that of in-hospital pneumonia was < 13%, the hospital mortality for stroke was < 15%, and the hospital discharge on antithrombotic therapy was > 70%. CONCLUSION: Our results suggest using the parameters of all of the 16 KPIs required by the Ministry of Health of Brazil, and the present results for the two stroke units for future benchmarking.
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Benchmarking/normas , Mortalidad Hospitalaria , Evaluación de Procesos y Resultados en Atención de Salud/normas , Indicadores de Calidad de la Atención de Salud/normas , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia , Benchmarking/estadística & datos numéricos , Brasil , Adhesión a Directriz , Humanos , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Estudios Retrospectivos , Accidente Cerebrovascular/mortalidadRESUMEN
ABSTRACT The present study aimed to analyze the stroke units in two centers for the key performance indicators (KPIs) required by the Ministry of Health in Brazil. Methods All 16 KPIs were analyzed, including the percentage of patients admitted to the stroke unit, venous thromboembolism prophylaxis in the first 48 hours after admission, pneumonia and hospital mortality due to stroke, and hospital discharge on antithrombotic therapy in patients without cardioembolic mechanism. Results Both centers admitted over 80% of the patients in their stroke unit. The incidence of venous thromboembolism prophylaxis was > 85%, that of in-hospital pneumonia was < 13%, the hospital mortality for stroke was < 15%, and the hospital discharge on antithrombotic therapy was > 70%. Conclusion Our results suggest using the parameters of all of the 16 KPIs required by the Ministry of Health of Brazil, and the present results for the two stroke units for future benchmarking.
RESUMO O objetivo do presente estudo é analisar os indicadores de qualidade (IQ) exigidos pelo Ministério da Saúde no Brasil em duas unidades de AVC. Métodos Foram analisados os 16 IQ, incluindo a percentagem de pacientes internados na unidade de AVC, profilaxia de tromboembolismo venoso (TEV) nas primeiras 48 horas após a admissão; pneumonia e mortalidade hospitalar e alta hospitalar em terapia antitrombótica (TAT) em pacientes sem mecanismo cardioembólico. Resultados Ambos os centros admitiram mais de 80% dos pacientes na unidade de AVC. A profilaxia do TEV foi realizada em mais de 85% dos casos; a pneumonia hospitalar foi inferior a 13%; a mortalidade hospitalar foi menor que 15% e a alta hospitalar em uso de TAT foi acima de 70%. Conclusão O presente estudo sugere os parâmetros dos 16 IQ exigidos pelo Ministério da Saúde do Brasil e os resultados obtidos em duas unidades de AVC para avaliação comparativa futura
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Humanos , Evaluación de Procesos y Resultados en Atención de Salud/normas , Mortalidad Hospitalaria , Benchmarking/normas , Indicadores de Calidad de la Atención de Salud/normas , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Brasil , Estudios Retrospectivos , Benchmarking/estadística & datos numéricos , Adhesión a Directriz , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Accidente Cerebrovascular/mortalidadRESUMEN
BACKGROUND: Despite efforts to define metrics assessing hospital-level quality for renal cell carcinoma (RCC) surgical care there remains a paucity of real-world data validating their ability to benchmark performance. Consequently, whether poor performance on hospital-level quality indicators is associated with inferior patient outcomes remains unknown. OBJECTIVES: To determine hospital-level variations in RCC surgical quality after adjusting for differences in patient- and tumor-specific factors. Further, to determine associations between hospital-level quality performance and surgical volume, academic affiliation, and patient mortality. DESIGN, SETTING, AND PARTICIPANTS: RCC patients undergoing surgery in the USA and Puerto Rico (2004-2014) were identified from the National Cancer Database. OUTCOME MEASURES AND STATISTICAL ANALYSIS: Hospital-level quality of care was assessed according to disease-specific process and outcome quality indicators. Case-mix adjusted hospital benchmarking was performed using indirect standardization methodology and multivariable regression models. A composite measure of quality, the Renal Cancer Quality Score (RC-QS), was subsequently derived and associations between RC-QS and surgical volume, academic affiliation, and patient mortality were determined. RESULTS AND LIMITATIONS: Over 1100 hospitals were benchmarked for quality, with 10-31% identified as providing poor care for a given quality indicator. Lower RC-QS hospitals had smaller referral volumes and were less academic compared with higher RC-QS hospitals (p<0.001). Higher RC-QS was independently associated with lower 30-d, 90-d, and overall mortality (adjusted odds ratio [confidence interval]: 0.92 [0.90-0.95], odds ratio: 0.94 [0.91-0.96], hazard ratio: 0.97 [0.96-0.98] per unit increase, respectively). These data are retrospective and it is unknown whether improvement in the RC-QS improves outcomes. CONCLUSIONS: Widespread hospital-level variations in RCC surgical quality exist, as captured by the RC-QS. Superior quality is associated with improved patient outcomes, including mortality benefit. The RC-QS serves as a benchmarking tool for RCC quality that can provide audit level feedback to hospitals and policymakers for quality improvement. PATIENT SUMMARY: We benchmarked hospital performance across quality indicators for kidney cancer surgical care. Overall, large variations in quality exist, with high volume academic hospitals demonstrating superior performance and improved patient survival. These data can inform hospitals and policymakers for quality improvement initiatives.
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Carcinoma de Células Renales/cirugía , Disparidades en Atención de Salud/normas , Neoplasias Renales/cirugía , Nefrectomía/normas , Evaluación de Procesos, Atención de Salud/normas , Indicadores de Calidad de la Atención de Salud/normas , Anciano , Benchmarking/normas , Carcinoma de Células Renales/mortalidad , Carcinoma de Células Renales/patología , Bases de Datos Factuales , Femenino , Hospitales/normas , Humanos , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Modelos Lineales , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Nefrectomía/efectos adversos , Nefrectomía/mortalidad , Oportunidad Relativa , Modelos de Riesgos Proporcionales , Puerto Rico , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Estados UnidosRESUMEN
BACKGROUND: It is not clear whether Magnet recognition by the American Nurses Credentialing Center (nursing excellence program) is associated with improved patient outcomes. We investigated whether hospitalization in a Magnet hospital is associated with improved outcomes for patients with ischemic stroke. METHODS AND RESULTS: We performed a cohort study of patients with ischemic stroke from 2009 to 2013, who were registered in the New York Statewide Planning and Research Cooperative System database. Propensity-score-adjusted multivariable regression models were used to adjust for known confounders, with mixed effects methods to control for clustering at the facility level. An instrumental variable analysis was used to control for unmeasured confounding and simulate the effect of a randomized trial. During the study period, 176 557 patients were admitted for ischemic stroke, and met the inclusion criteria. Of these, 32 092 (18.2%) were hospitalized in Magnet hospitals, and 144 465 (81.8%) in non-Magnet institutions. Instrumental variable analysis demonstrated that hospitalization in Magnet hospitals was associated with lower case-fatality (adjusted difference, -23.9%; 95% CI, -29.0% to -18.7%), length of stay (adjusted difference, -0.4; 95% CI, -0.8 to -0.1), and rate of discharge to a facility (adjusted difference, -16.5%; 95% CI, -20.0% to -13.0%) in comparison to non-Magnet hospitals. The same associations were present in propensity-score-adjusted mixed effects models. CONCLUSIONS: Using a comprehensive all-payer cohort of patients with ischemic stroke in New York State, we identified an association of treatment in Magnet hospitals with lower case-fatality, discharge to a facility, and length of stay. Further research into the factors contributing to the superiority of Magnet hospitals in stroke care is warranted.
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Benchmarking , Isquemia Encefálica/terapia , Habilitación Profesional , Personal de Enfermería en Hospital , Admisión del Paciente , Indicadores de Calidad de la Atención de Salud , Accidente Cerebrovascular/terapia , Anciano , Anciano de 80 o más Años , Benchmarking/normas , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidad , Habilitación Profesional/normas , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Análisis Multivariante , New York , Personal de Enfermería en Hospital/normas , Admisión del Paciente/normas , Alta del Paciente , Puntaje de Propensión , Indicadores de Calidad de la Atención de Salud/normas , Accidente Cerebrovascular/diagnóstico , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the perceived usefulness of publicly reported nursing home quality indicators. STUDY SETTING: Primary data were collected from October 2013 to August 2014 among a convenience sample of persons (or family member) recently admitted or anticipating admission to a nursing home within 75 miles of the city of Philadelphia. STUDY DESIGN: Structured interviews were conducted to assess the salience of data on the Medicare Nursing Home Compare website, including star ratings, clinical quality measures, and benchmarking of individual nursing home quality with state and national data. DATA COLLECTION: Interviews were transcribed verbatim, independently coded by two reviewers, and agreement determined. A thematic analysis of transcripts was undertaken. PRINCIPAL FINDINGS: Thirty-five interviews were completed. Eighty-three percent (n = 29) were caregivers and 17 percent (n = 6) were residents. Star ratings, clinical quality measures, and benchmarking information were salient to decision making, with preferred formats varying across participants. Participants desired additional information on the source of quality data. Confusion was evident regarding the relationship between domain-specific and overall star quality ratings. CONCLUSIONS: The Nursing Home Compare website provides salient content and formats for consumers. Increased awareness of this resource and clarity regarding the definition of measures could further support informed decision making regarding nursing home choice.
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Cuidadores/psicología , Conducta de Elección , Casas de Salud/normas , Pacientes/psicología , Indicadores de Calidad de la Atención de Salud/normas , Benchmarking/normas , Femenino , Humanos , Entrevistas como Asunto , Masculino , Medicare , Persona de Mediana Edad , Philadelphia , Estados UnidosRESUMEN
OBJECTIVES: The objective was to review and update key definitions and metrics for emergency department (ED) performance and operations. METHODS: Forty-five emergency medicine leaders convened for the Third Performance Measures and Benchmarking Summit held in Las Vegas, February 21-22, 2014. Prior to arrival, attendees were assigned to workgroups to review, revise, and update the definitions and vocabulary being used to communicate about ED performance and operations. They were provided with the prior definitions of those consensus summits that were published in 2006 and 2010. Other published definitions from key stakeholders in emergency medicine and health care were also reviewed and circulated. At the summit, key terminology and metrics were discussed and debated. Workgroups communicated online, via teleconference, and finally in a face-to-face meeting to reach consensus regarding their recommendations. Recommendations were then posted and open to a 30-day comment period. Participants then reanalyzed the recommendations, and modifications were made based on consensus. RESULTS: A comprehensive dictionary of ED terminology related to ED performance and operation was developed. This article includes definitions of operating characteristics and internal and external factors relevant to the stratification and categorization of EDs. Time stamps, time intervals, and measures of utilization were defined. Definitions of processes and staffing measures are also presented. Definitions were harmonized with performance measures put forth by the Centers for Medicare and Medicaid Services (CMS) for consistency. CONCLUSIONS: Standardized definitions are necessary to improve the comparability of EDs nationally for operations research and practice. More importantly, clear precise definitions describing ED operations are needed for incentive-based pay-for-performance models like those developed by CMS. This document provides a common language for front-line practitioners, managers, health policymakers, and researchers.
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Benchmarking/normas , Servicio de Urgencia en Hospital/normas , Competencia Profesional/normas , Indicadores de Calidad de la Atención de Salud/normas , Benchmarking/estadística & datos numéricos , Congresos como Asunto , Consenso , Eficiencia Organizacional , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Relaciones Interprofesionales , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Estados UnidosRESUMEN
BACKGROUND: Several organizations seek to address the growing burden of arthritis in developing countries by providing total joint replacements (TJR) to patients with advanced arthritis who otherwise would not have access to these procedures. Because these mission trips operate in resource poor environments, some of the features typically associated with high quality care may be difficult to implement. In the U.S., many hospitals that perform TJRs use the Blue Cross/Shield's Blue Distinction criteria as benchmarks of high quality care. Although these criteria were designed for use in the U.S., we applied them to Operation Walk (Op-Walk) Boston's medical mission trip to the Dominican Republic. Evaluating the program using these criteria illustrated that the program provides high quality care and, more importantly, helped the program to find areas of improvement. METHODS: We used the Blue Distinction criteria to determine if Op-Walk Boston achieves Blue Distinction. Each criterion was grouped according to the four categories included in the Blue Distinction criteria--"general and administrative", "structure", "process", or "outcomes and volume". Full points were given for criteria that the program replicates entirely and zero points were given for criteria that are not replicated entirely. Of the non-replicated criteria, Op-Walk Boston's clinical and administrative teams were asked if they compensate for failure to meet the criterion, and they were also asked to identify barriers that prevent them from meeting the criterion. RESULTS: Out of 100 possible points, the program received 71, exceeding the 60-point threshold needed to qualify as a Blue Distinction center. The program met five out of eight "required" criteria and 11 out of 19 "informational" criteria. It scored 14/27 in the "general" category, 30/36 in the "structure" category, 17/20 in the "process" category, and 10/17 in the "outcomes and volume" category. CONCLUSION: Op-Walk Boston qualified for Blue Distinction. Our analysis highlights areas of programmatic improvement and identifies targets for future quality improvement initiatives. Additionally, we note that many criteria can only be met by hospitals operating in the U.S. Future work should therefore focus on creating criteria that are applicable to TJR mission trips in the context of developing countries.
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Artritis/cirugía , Artroplastia de Reemplazo de Cadera/normas , Artroplastia de Reemplazo de Rodilla/normas , Planes de Seguros y Protección Cruz Azul/normas , Países en Desarrollo , Misiones Médicas/normas , Evaluación de Procesos y Resultados en Atención de Salud/normas , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Artritis/diagnóstico , Benchmarking/normas , Boston , República Dominicana , Accesibilidad a los Servicios de Salud/normas , Humanos , Evaluación de Programas y Proyectos de Salud , Resultado del TratamientoRESUMEN
A aterosclerose é classificada como enfermidade crônica não transmissível e é considerada uma das principais causas de morte e morbidade em vários países, incluindo o Brasil. Entre as possíveis causas de sua gênese está o hábito alimentar, especificamente o consumo de ácidos graxos, principalmente saturados e trans. Ácidos graxos saturados possuem características biológicas e fisico-químicas diferentes dos insaturados. Os mais abundantes na dieta humana são o palmítico e esteárico. Sua associação com acometimentos cardiovasculares vem sendo cada vez mais investigada, principalmente os que possuem mais de dez carbonos em sua cadeia interferindo no metabolismo de lipoproteínas podendo desencadear todo o processo aterosclerótico. A indústria de alimentos vem desenvolvendo algumas tecnologias opcionais para reduzir ou eliminar ácidos graxos trans, em especial, o elaídico, dentre elas a modificação no processo de hidrogenação que aumenta a quantidade de ácidos graxos saturados. Alguns alimentos industrializados necessitam de uma grande quantidade de ácidos graxos saturados promovendo um aumento no teor de ácido palmítico e esteárico, sendo este último considerado um ácido graxo saturado neutro, mas dependendo da concentração utilizada, pode contribuir no decréscimo da HDL-c (High Density Lipoprotein), dentre outras alterações deletérias. Desta forma, investigar as alterações de determinados parâmetros biológicos diante da mudança da proporção de ácidos graxos saturados, respeitando o teor total de lipídios de uma dieta é a base deste estudo. Foram realizados ensaios em material biológico para a determinação dos seguintes parâmetros: 1) Atividade de enzimas antioxidantes; 2) Peroxidação lipídica em tecidos; 3) Lipidograma; 4) Determinação do perfil de ácidos graxos de tecidos e rações e 5) Expressão de genes relacionados com o processo aterosclerótico (ICAM-1, VCAM-1, CD36 e MCP-1). A determinação da atividade de enzimas antioxidantes foi realizada considerando somente as enzimas Catalase (CAT) e Superóxido Dismutase (SOD), por se tratarem de enzimas com alteração expressiva no processo aterogênico, na ocorrência de disfunção endotelial. Neste trabalho, foi analisada a atividade das referidas enzimas no tecido hepático e cardíaco, onde não foram constatadas alterações. O mesmo processo biológico que estimula a produção excessiva de espécies reativas pode levar ao aumento da peroxidação lipídica, principalmente de ácidos graxos polinsaturados das membranas celulares, em tecidos como fígado, cérebro e coração. A peroxidação lipídica apresentou diferenças significativas no tecido hepático. O grupo alimentado com ração enriquecida com tripalmitato apresentou peroxidação lipídica aumentada em relação ao grupo controle. Correlacionando com o perfil de ácidos graxos do tecido hepático, notamos que houve maior incorporação de ácido palmítico nesse tecido, que por apresentar configuração linear, quando incorporado à membrana celular, pode levar à disfunção e possível suscetibilidade a danos, como a peroxidação. No tecido cardíaco e no tecido cerebral não foram observadas alterações e diferenças entre os tratamentos. O lipidograma consiste na quantificação de lipoproteínas e frações lipídicas, compondo o perfil lipídico no plasma sanguíneo. Os resultados obtidos mostraram que o colesterol total foi significativamente menor no grupo controle, assim como triacilglicerol e LDL colesterol (LDL-c). Já HDL colesterol (HDL-c) está reduzida no grupo que recebeu ração suplementada com ácido palmítico, assim como este grupo apresentou parâmetros aumentados nas dosagens de triacilglicerol e colesterol total. Os grupos alimentados com ração suplementada com triestearato e trioleato apresentaram resultados intermediários para a dosagem de HDL-c, com valores tendendo ao grupo suplementado com tripalmitato. Em relação à dosagem de LDL-c, foi constatada diferença entre os grupos suplementados e o grupo controle. Destaca-se que não houve diferença entre a dosagem entre os grupos suplementados. Portanto, o grupo alimentado com dieta enriquecida com ácido oleico (monoinsaturado) equipara-se aos grupos alimentados com dietas enriquecidas com ácido esteárico e palmítico (saturados). O perfil de ácidos graxos do tecido hepático mostrou uma porcentagem elevada de ácido palmítico no grupo alimentado com ração enriquecida com o mesmo ácido graxo, com diferença estatística em relação aos demais grupos. Já em relação ao ácido esteárico, não houve diferenças significativas entre os grupos. Em compensação, o teor de ácido oleico no grupo suplementado com este mesmo ácido graxo e com ácido palmítico foi significativamente diferente em relação aos demais, com valores superiores. Este resultado demonstra que não houve dessaturação do ácido esteárico a oleico, ao menos neste modelo. No tecido cardíaco, foi observado o mesmo comportamento. No tecido cardíaco não houve diferença estatística significativa da concentração de ácidos graxos, indicando que não houve incorporação ou dessaturação. Ressalta-se que de acordo com determinação realizada utilizando a técnica de cromatografia gasosa, as rações apresentavam em sua composição o teor de lipídios adequado ao modelo animal e as proporções de ácidos graxos alteradas como proposto no objetivo deste trabalho. Em relação às moléculas de adesão e quimiocinas (VCAM-1, ICAM-1, CD-36 e MCP-1) relacionadas com o processo aterosclerótico, houve somente alteração na molécula CD-36 no grupo alimentado com ração enriquecida com trioleato, com redução em relação aos demais. Mas, as moléculas de adesão relacionadas com o processo inicial da aterogênese, a expressão gênica realizada através da técnica de q-RT-PCR não foi relevante, não apresentando diferença entre os tratamentos. Conclui-se, portanto, que os tratamentos aplicados ao modelo animal selecionado possui o potencial de alterar lipoproteínas plasmáticas, mas não de manter a continuidade e desencadear o processo inflamatório relacionado à aterogênese
Atherosclerosis is chronic a non-communicable disease considered one of a major cause of morbidity and mortality in several countries, including Brazil. Among all the possible causes of their genesis the dietary habit of high fatty acid intake, especially saturated and trans fatty acids is the most important. Saturated and unsaturated fatty acids possess different biological and physicochemical characteristics. The most abundant fatty acid in the human diet are palmitic and stearic and they association with cardiovascular events has been increasingly investigated, especially those one with more than ten carbons in its chain which interfers in the lipoproteins metabolism and can initiate the atherosclerotic process. The food industry has developed some optional technologies to reduce or eliminate the presence of trans fatty acids in foods, in particular elaidic, which after the hydrogenation process increases the saturated fatty acids content. Some industrialized foods requires a large amount of saturated fatty acids that promote an increase of palmitic and stearic content, the last fatty acid mentioned is considered a neutral saturated fatty acid that can contribute to the decrease in HDL-c (High Density lipoprotein), depending on the concentration used, among other deleterious changes. Thus, investigate changes of specifics biological parameters in response to consumption of different saturated fatty acids, respecting the total content of lipids in a normolipidic diet is the aim of this study. Assays were conducted to determine the following parameters in the tissues: 1) Activity of antioxidant enzymes, 2) Lipid peroxidation, 3) Lipidogram; 4) Fatty acid composition 5) Expression of genes related the atherosclerotic process (ICAM-1, VCAM-1, CD36 and MCP- 1). The determination of the activity of antioxidant enzymes was carried out considering only the enzymes Catalase (CAT) and Superoxide Dismutase (SOD), because they are enzymes more sensitive and readily available in changes resulted of an atherosclerotic process with endothelial dysfunction. In the study, no changes were observed in activity of these enzymes in the liver and heart. The same biological process that stimulates the overproduction of reactive species can lead to increased lipid peroxidation, especially of polyunsaturated fatty acids present in cell membranes of tissues such as liver, brain and heart. The group fed with diet enriched with tripalmitate showed increased lipid peroxidation compared to control group. Correlating this information with the fatty acid profile in liver tissue, we noted that there was a greater incorporation of palmitic acid, which exhibit linear configuration when incorporated into the cell membrane and can lead to dysfunction and higher susceptibility to damages such as oxidation. No differences were observed in the others tissues analyzed. The lipidogram is the quantification of lipoprotein and lipid fractions, composing the lipid profile in blood plasma. The results showed that total cholesterol was significantly lower in the control group, as well triglyceride and LDL cholesterol (LDL-c). HDL cholesterol (HDL-C) concentration is reduced and triacylglycerol and cholesterol increased n the group fed with diet supplemented with palmitic. The groups fed with diets supplemented with tristearate and trioleate presented intermediate results for the measurement of HDL-c, with values tending to the group supplemented with tripalmitate. Regarding LDL-c levels, significant differences were observed between the supplemented groups and the control group. Emphasis that there was no difference between the dosage between the supplemented groups. Therefore, the group fed with oleic acid (monounsaturated) supplemented diet equates to the groups fed with diets enriched with stearic and palmitic acid (saturated). The fatty acid profile of liver tissue showed a high percentage of palmitic acid in the group fed with diet enriched with the same fatty acid, with a statistical difference compared to the other groups. In relation to stearic acid, there were no significant differences between groups. As compensation, the oleic acid content in the group supplemented with the same fatty acid and palmitic acid was significantly higher when compared to the others. This result demonstrates that no desaturation of stearic acid to oleic happened in this experimental model. In cardiac tissue there was no statistically significant difference in the concentration of fatty acids, indicating no incorporation or desaturation. Regarding adhesion molecules and chemokines (VCAM-1, ICAM- 1, CD-36 and MCP-1) related to the atherosclerotic process, there was only change in the gene expression of CD-36 molecule in the group fed diet enriched with trioleate, with reduction in relation to others. No other alterations were observed. In conclusion, we verified that the consumption of the different fatty acids in this experimental model has potential to alter lipoproteins levels but not to iniciate or maintain the inflammatory process associated with atherogenesis
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Animales , Masculino , Femenino , Biomarcadores/análisis , Ácido Palmítico , Ácido Oléico/efectos adversos , Aterosclerosis , Ácidos Grasos/efectos adversos , Ácidos Esteáricos/efectos adversos , Ácido Palmítico/efectos adversos , Benchmarking/normas , Biomarcadores Farmacológicos/análisisRESUMEN
OBJECTIVE: We conducted a systematic review of HIV progression models to identify the mathematical structures used, the main research questions and key model aspects in terms of quality and robustness. METHODS: We searched for articles published before February 2009 that described models of HIV progression in humans. We included two strategies of search with and without MeSH terms. We classified the models by their mathematical structure and research question. We created a checklist of desirable features of the models, reviewed and classified the articles to inform our conclusions. RESULTS: Among 3491 articles found, 93 met the inclusion criteria. Among the selected articles, 60 used transition models, 25 applied differential equations, and eight had other structures. We did not find a relation between the type of question explored and the modeling method used. None of the studies complied with the complete set of items in the checklist, but 6.5% cover at least 90% of them. CONCLUSION: There is an enormous heterogeneity of HIV modeling exercises in terms of methods used and topics addressed, as well as in the presentation of key aspects of the articles in terms of quality and robustness.
Asunto(s)
Benchmarking/normas , Infecciones por VIH , Modelos Teóricos , Sesgo , Progresión de la Enfermedad , Humanos , Control de Calidad , Reproducibilidad de los ResultadosRESUMEN
STUDY OBJECTIVES: To analyze the accuracy and linearity of different CPAP devices outside of the manufacturers' own quality control environment. METHODS: Accuracy (how well readings agree with the gold standard) and linearity were evaluated by comparing programmed pressure to measured CPAP pressure using an instrument established as the gold standard. Comparisons were made centimeter-by-centimeter (linearity) throughout the entire programming spectrum of each device (from 4 to 20 cm H2O). RESULTS: A total of 108 CPAP devices were tested (1836 measurements); mean use of the devices was 956 hours. Twenty-two of them were new. The intra-class correlation coefficient (ICC) decreased from 0.97 at pressures programmed between 4 and 10 cm H2O, to 0.84 at pressures of 16 to 20 cm H2O. Despite this high ICC, the 95% agreement limit oscillated between -1 and 1 cm H2O. This same behavior was observed in relation to hours of use: the ICC for readings taken on devices with < 2,000 hours of use was 0.99, while that of the 50 measurements made on devices with > 6,000 hours was 0.97 (the agreement limit oscillated between -1.3 and 2.5 cm H2O). "Adequate adjustments" were documented in 97% of measurements when the definition was +/- 1 cm H2O of the programmed pressure, but this index of adequate adjustment readings decreased to 85% when the +/- 0.5 cm H2O criterion was applied. CONCLUSIONS: In general, the CPAP devices were accurate and linear throughout the spectrum of programmable pressures; however, strategies to assure short- and long-term equipment reliability are required in conditions of routine use.