RESUMEN
OBJECTIVES: To analyze activities involving veteran resource parents and patients in a family partnership program; their perspectives were also explored. STUDY DESIGN: The multiple roles assumed by family stakeholders in neonatal initiatives were reviewed. Quality control questionnaires were distributed to resource parents and patients and providers who worked with them. Mixed methods were used to analyze results. RESULTS: Thirty resource parents and patients were involved in a total of 653 activities related to clinical care (n = 413), teaching (n = 31), and research (n = 209); 7 initiatives were described to illustrate the positive impact of family stakeholders on clinical care, teaching, and/or research. Resource parents and patients had different degrees and intensity of involvement: all were involved in low-risk initiatives and 9 in more complex activities. In the questionnaire, family stakeholders all described positive impacts associated with their participation and benefits to themselves, such as meaning making. Three resource parents reported traumatic memories that occurred during medical simulations. The majority of providers report that resource parents and patients improved their projects, but some also report this new collaboration is complex. CONCLUSIONS: Although stakeholder participation increasingly is recommended, practical knowledge and the impact of their participation is scarce. Having several resource parents and patients bring their contributions may be more valuable than a few "expert stakeholders." Recruiting and orienting resource parents and patients toward different types of activities should take into account the complexity and risks of the tasks. Family stakeholders are appreciated and have a positive impact on projects in which they are involved.
Asunto(s)
Investigación sobre la Eficacia Comparativa/métodos , Educación Médica/normas , Investigación sobre Servicios de Salud/normas , Unidades de Cuidado Intensivo Neonatal/organización & administración , Neonatología/organización & administración , Evaluación del Resultado de la Atención al Paciente , Participación de los Interesados , Investigación sobre Servicios de Salud/economía , Humanos , Recién Nacido , Neonatología/educación , Quebec , Estudios RetrospectivosRESUMEN
Comparative effectiveness research (CER) is imperative for objective and balanced assessment of treatment outcomes. CER that uses administrative databases (AD-CER) affords unique opportunities for large scale data analyses that potentially transcend limitations of small institutional datasets. Prostate cancer has received much attention from the AD-CER research community, whereas non-prostate genitourinary malignancies are less well-studied. The objective of this article is to review the currently available AD-CER that has been published in the non-prostate genitourinary malignancies space.
Asunto(s)
Investigación sobre la Eficacia Comparativa/métodos , Conjuntos de Datos como Asunto , Sistema de Registros/estadística & datos numéricos , Neoplasias Urogenitales/terapia , Humanos , Masculino , Resultado del Tratamiento , Neoplasias Urogenitales/mortalidadRESUMEN
Introduction: The study of the final elongation values produced by 45º, 60º, 75º, and 90º-angle z-plasties performed on the skin of the lower abdomen of fresh cadavers were compared with the theoretical mathematical data published in the literature. Methods: Four z-plasties with 2-cm main and secondary branches each, and with 45º, 60º, 75º, and 90º angles were performed on the skin of the lower abdomen in 11 fresh cadavers to evaluate the final elongation produced. Results: The mean elongation at their respective angles was lower than that found in the literature, with a p value of <0.01. Conclusion: The elongation values obtained from the present study showed a significant difference from the published values.
Introdução: O estudo do alongamento final produzido por zetaplastias com ângulos de 45, 60, 75 e 90 graus na pele do abdome inferior de cadáveres frescos foi comparado com os dados matemáticos teóricos apresentados pela literatura. Métodos: Foram realizadas quatro zetaplastias com ramos principais e secundários de 2 cm cada um deles e ângulos de 45, 60, 75 e 90 graus na pele do abdome inferior de 11 cadáveres frescos para avaliar o alongamento final produzido. Resultados: A média dos alongamentos para os respectivos ângulos foi inferior ao encontrado na literatura, com valor de p < 0,01. Conclusão: Existiu diferença significativa entre os valores da literatura e os encontrados no presente estudo.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Historia del Siglo XXI , Colgajos Quirúrgicos , Antropometría , Abdomen , Investigación sobre la Eficacia Comparativa , Modelos Teóricos , Colgajos Quirúrgicos/cirugía , Antropometría/métodos , Investigación sobre la Eficacia Comparativa/métodos , Abdomen/cirugíaRESUMEN
Abstract This study aimed to isolate and evaluate the cellulase activity of cellulolytic bacteria in hot springs of Dehloran, Ilam province, Iran. Water and sludge samples were collected from the hot springs and the bacterial enrichment was performed in a medium containing rice barn and carboxymethyl cellulose (CMC). The cultures were incubated at 50 °C in aerobic conditions. The bacteria were isolated on CMC agar (1%) medium. Cellulase assay of the isolates was measured by the evaluation of endoglucanase enzyme activity, which is also called as carboxymethyl cellulase (CMCase). The isolated thermotolerant bacteria were then identified and optimized for the production of CMCase. Moreover, stabilizing elements of the enzyme were identified with in silico approach. The chosen isolate was identified as Isoptericola variabilis sp. IDAH9. The identified strain produced the most thermostable CMCase at a concentration of 5.6 g/L of ammonium sulfate, 9 g/L CMCase or 12 g/L rice bran, 0/6% Tween-80, and 0.2% sucrose. The produced enzyme showed 80% of the residual activity after 1 h of incubation at 65 °C. In silico data indicated that the remaining residual activity was due to the redundant stabilizing elements in the protein structure. Consequently, I. variabilis can be isolated from the extreme environment and has a thermostable endoglucanase which may be used for various applications after studying them.
Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastorno Depresivo/epidemiología , Diabetes Mellitus/epidemiología , Predicción/métodos , Política de Salud , Tamizaje Masivo/legislación & jurisprudencia , Inteligencia Artificial , Comorbilidad , Investigación sobre la Eficacia Comparativa/métodos , Técnicas de Apoyo para la Decisión , Prestación Integrada de Atención de Salud , Complicaciones de la Diabetes , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/psicología , Modelos Logísticos , Tamizaje Masivo/normas , Formulación de Políticas , Valor Predictivo de las Pruebas , Proveedores de Redes de Seguridad , Autocuidado , Encuestas y CuestionariosRESUMEN
OBJECTIVES: In Brazil, imatinib mesylate is supplied as the first-line therapy for chronic myeloid leukemia in the chronic phase through the public universal healthcare program, Sistema Único de Saúde (SUS). We studied the socio-demographic factors that influenced therapy success in a population in the northeast region of Brazil. METHODS: Patients with chronic myeloid leukemia from the state of Piauí were treated in only one reference center. Diagnosis was based on WHO 2008 criteria. Risk was assessed by Sokal, Hasford and EUTOS scores. Patients received 400 mg imatinib daily. We studied the influence of the following factors on the achievement of complete cytogenetic response within one year of treatment: age, clinical risk category, time interval between diagnosis and the start of imatinib treatment, geographic distance from the patient's home to the hospital, years of formal education and monthly income. RESULTS: Among 103 patients studied, the median age was 42 years; 65% of the patients had 2-9 years of formal education, and the median monthly income was approximately 100 US$. Imatinib was started in the first year after diagnosis (early chronic phase) in 69 patients. After 12 months of treatment, 68 patients had a complete cytogenetic response. The Hasford score, delay to start imatinib and years of formal education influenced the attainment of a complete cytogenetic response, whereas income and the distance from the home to the healthcare facility did not. CONCLUSION: Patients require additional healthcare information to better understand the importance of long-term oral anticancer treatment and to improve their compliance with the treatment. .
Asunto(s)
Investigación sobre la Eficacia Comparativa/métodos , Teorema de Bayes , Desfibriladores Implantables/estadística & datos numéricos , Mamografía/estadística & datos numéricosRESUMEN
OBJECTIVES: Emergency medical services (EMS) providers deliver the initial care for millions of people in the United States each year. The Institute of Medicine noted a deficit in research necessary to improve prehospital care, created by the existence of data silos, absence of long-term outcomes, and limited stakeholder engagement in research. This article describes a regional effort to create a high-performing infrastructure in southwestern Pennsylvania addressing these fundamental barriers. METHODS: Regional EMS records from 33 agencies in January 2011 were linked to hospital-based electronic health records (EHRs) in a single nine-hospital system, with manual review of matches for accuracy. The use of community stakeholder engagement was included to guide scientific inquiry, as well as 2-year follow up for patient-centered outcomes. RESULTS: Local EMS medicine stakeholders emphasized the limits of single-agency EMS research and suggested that studies focus on improving cross-cutting, long-term outcomes. Guided by this input, more than 95% of EMS records (2,675 of 2,800) were linked to hospital-based EHRs. More than 80% of records were linked to 2-year mortality, with more deaths among EMS patients with prehospital hypotension (30.5%) or respiratory distress (19.5%) than chest pain (5.4%) or nonspecific complaints (9.4%). CONCLUSIONS: A prehospital comparative effectiveness research infrastructure composed of patient-level EMS data, EHRs at multiple hospitals, long-term outcomes, and community stakeholder perspectives is feasible and may be scalable to larger regions and networks. The lessons learned and barriers identified offer a roadmap to answering community and policy-relevant research questions in prehospital care.
Asunto(s)
Investigación sobre la Eficacia Comparativa/organización & administración , Registros Electrónicos de Salud/estadística & datos numéricos , Servicios Médicos de Urgencia/organización & administración , Evaluación de Resultado en la Atención de Salud/organización & administración , Garantía de la Calidad de Atención de Salud/organización & administración , Investigación sobre la Eficacia Comparativa/métodos , Investigación sobre la Eficacia Comparativa/estadística & datos numéricos , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Humanos , Masculino , Registro Médico Coordinado , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Pennsylvania , Garantía de la Calidad de Atención de Salud/métodos , Garantía de la Calidad de Atención de Salud/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
OBJECTIVE: To evaluate the performance of manual resuscitators (MRs) used in Brazil in accordance with international standards. METHODS: Using a respiratory system simulator, four volunteer physiotherapists employed eight MRs (five produced in Brazil and three produced abroad), which were tested for inspiratory and expiratory resistance of the patient valve; functioning of the pressure-limiting valve; and tidal volume (VT) generated when the one-handed and two-handed techniques were used. The tests were performed and analyzed in accordance with the American Society for Testing and Materials (ASTM) F920-93 criteria. RESULTS: Expiratory resistance was greater than 6 cmH2O . L-1 . s-1 in only one MR. The pressure-limiting valve, a feature of five of the MRs, opened at low pressures (< 17 cmH2O), and the maximal pressure was 32.0-55.9 cmH2O. Mean VT varied greatly among the MRs tested. The mean VT values generated with the one-handed technique were lower than the 600 mL recommended by the ASTM. In the situations studied, mean VT was generally lower from the Brazilian-made MRs that had a pressure-limiting valve. CONCLUSIONS: The resistances imposed by the patient valve met the ASTM criteria in all but one of the MRs tested. The pressure-limiting valves of the Brazilian-made MRs usually opened at low pressures, providing lower VT values in the situations studied, especially when the one-handed technique was used, suggesting that both hands should be used and that the pressure-limiting valve should be closed whenever possible.
Asunto(s)
Unidades de Cuidados Intensivos , Resucitación/instrumentación , Ventiladores Mecánicos/estadística & datos numéricos , Brasil , Investigación sobre la Eficacia Comparativa/métodos , Simulación por Computador/normas , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Mecánica Respiratoria/fisiología , Volumen de Ventilación Pulmonar , Ventiladores Mecánicos/normasAsunto(s)
Investigación sobre la Eficacia Comparativa/métodos , Estudios Observacionales como Asunto , Proyectos de Investigación , África , Asia , Benchmarking , Conducta Cooperativa , Europa (Continente) , Medicina Basada en la Evidencia/métodos , Humanos , América del Norte , Atención Dirigida al Paciente/métodos , América del SurRESUMEN
OBJECTIVE: To evaluate the performance of manual resuscitators (MRs) used in Brazil in accordance with international standards. METHODS: Using a respiratory system simulator, four volunteer physiotherapists employed eight MRs (five produced in Brazil and three produced abroad), which were tested for inspiratory and expiratory resistance of the patient valve; functioning of the pressure-limiting valve; and tidal volume (VT) generated when the one-handed and two-handed techniques were used. The tests were performed and analyzed in accordance with the American Society for Testing and Materials (ASTM) F920-93 criteria. RESULTS: Expiratory resistance was greater than 6 cmH2O . L−1 . s−1 in only one MR. The pressure-limiting valve, a feature of five of the MRs, opened at low pressures (< 17 cmH2O), and the maximal pressure was 32.0-55.9 cmH2O. Mean VT varied greatly among the MRs tested. The mean VT values generated with the one-handed technique were lower than the 600 mL recommended by the ASTM. In the situations studied, mean VT was generally lower from the Brazilian-made MRs that had a pressure-limiting valve. CONCLUSIONS: The resistances imposed by the patient valve met the ASTM criteria in all but one of the MRs tested. The pressure-limiting valves of the Brazilian-made MRs usually opened at low pressures, providing lower VT values in the situations studied, especially when the one-handed technique was used, suggesting that both hands should be used and that the pressure-limiting valve should be closed whenever possible. .
OBJETIVO: Avaliar o desempenho de reanimadores manuais (RMs) utilizados no Brasil conforme critérios definidos por uma norma internacional. MÉTODOS: Utilizando um simulador do sistema respiratório, oito RMs manuais (cinco produzidos no Brasil e três importados) foram avaliados em relação a resistência inspiratória e expiratória da válvula para o paciente; funcionamento da válvula limitadora de pressão; e volume corrente (VT) gerado por quatro fisioterapeutas voluntários, utilizando uma ou duas mãos. Para a realização e análise dos testes, foram utilizados critérios sugeridos pela norma da American Society for Testing and Materials (ASTM) F920-93. RESULTADOS: A resistência expiratória foi superior a 6 cmH2O . L−1 . s−1 em apenas um dos RMs testados. A válvula limitadora de pressão, presente em cinco RMs, abriu em baixas pressões (< 17 cmH2O), e a pressão máxima variou de 32,0-55,9 cmH2O. Houve grande variação da média de VT obtido pelos diferentes RMs. Os valores médios de VT utilizando uma mão foram inferiores ao sugerido pela ASTM (600 mL). O VT médio, nas situações estudadas, foi geralmente menor nos RMs nacionais com válvula limitadora de pressão. CONCLUSÕES: As resistências impostas pela válvula do paciente estão de acordo com os critérios da ASTM, com exceção de um RM. As válvulas limitadoras de pressão dos RMs nacionais geralmente abrem em baixas pressões, determinando o fornecimento de um menor VT nas situações estudadas, principalmente com o uso de uma mão, o que sugere que a ventilação deva ser feita com as duas mãos e a válvula limitadora de pressão deva ser fechada sempre que possível. .