RESUMO
Objetivo: una tecnología médica es el conjunto de técnicas, medicamentos, equipos y procedimientos utilizados por los profesionales de la salud en la atención médica. Este estudio busca identificar los criterios de evaluación de nuevas tecnologías en salud que utilizan algunos hospitales. Metodología: estudio observacional de corte transversal. Se incluyeron todos los directores de hospitales y clínicas del departamento de Antioquia que estuvieran interesados en participar en la investigación. Se aplicó una encuesta de 21 preguntas. Resultados: el 60 % de los encuestados dio la máxima importancia a la capacidad de producción de daños en la atención de los pacientes; el 90 % tiene en cuenta el criterio de seguridad clínica (éticos y jurídicos) y el 100 % lo hace con la evaluación de costo efectividad. En cuanto al orden de relevancia para la toma de decisiones en la adquisición de nuevas tecnologías, el perfil epidemiológico institucional tuvo mayor calificación. Conclusiones: las instituciones de salud encuestadas tienen protocolos establecidos para la evaluación de tecnologías. Se identificaron los temas a los que se les da mayor priorización, como son la producción de daños a la atención de pacientes, la seguridad clínica, aspectos éticos y jurídicos, y la evaluación de costo efectividad
Introduction: A medical technology is the set of techniques, drugs, equipment, and procedures used by health professionals in the delivery of medical care. Objective: to identify the criteria for evaluating new health technologies used by some hospitals. Methodology: An observational cross-sectional study was carried out. All the directors of Hospitals and Clinics of the department of Antioquia who belonged to one and who were interested in participating in the research were included. A survey of 21 questions was applied. Results: 60 % of the respondents gave the maximum importance to the capacity to produce damages in the care of patients, 90 % consider the criteria of clinical, ethical, and legal safety; and 100 % do it with the evaluation of cost effectiveness. In relation to the order of relevance for decision-making in the acquisition of new health technologies, it was evidenced that the institutional epidemiological profile had a higher rating. Conclusions: The surveyed health institutions have established protocols in the evaluation of new health technologies. Likewise, the issues that are given the highest priority were identified, such as the issue of harm to patient care, clinical safety, ethical and legal aspects, and cost-effectiveness evaluation.
Objetivo: uma tecnologia médica é o conjunto de técnicas, medicamentos, equipamentose procedimentos utilizados pelos profissionais da saúde na atenção médica. Este estudobusca identificar os critérios de avaliação de novas tecnologias na saúde que utilizam alguns hospitais. Metodologia: estudo observacional de corte transversal. Se incluíram todos os diretoresde hospitais e clínicas do Departamento de Antioquia que estiveram interessados em participar na investigação. Se aplicou uma enquete de 21 perguntas. Resultados: 60 % dos entrevistados deram a máxima importância na capacidade de produção de danos na atenção dos pacientes; 90% têm em conta o critério de segurançaclínica (éticos e jurídicos) e 100% o fazem com a avaliação de custo efetividade. Enquantoà ordem de relevância para a toma de decisões na aquisição de novas tecnologias, o perfil epidemiológico institucional teve maior qualificação. Conclusões: as instituições de saúde entrevistadas têm protocolos estabelecidos para a avaliação de tecnologias. Se identificaram os temas aos quais se deve dar maior priorização, como são a produção de danos à atenção de pacientes, a segurança clínica, aspectos éticos jurídicos, a avaliação de custo efetividade.
Assuntos
Humanos , Análise Custo-Benefício , Avaliação da Tecnologia Biomédica , Organização Mundial da Saúde , Custos e Análise de Custo , Economia , Equipamentos e ProvisõesRESUMO
BACKGROUND: Musculoskeletal Ultrasonography (MSUS) is an important tool for the clinical assessment in Juvenile Idiopathic Arthritis (JIA). The objective of this study was to evaluate the reliability of MSUS to detect elementary lesions: synovitis, tenosynovitis, cartilage damage and bone erosions in the wrist and metacarpal (MCP) joints of patients with JIA. METHODS: Thirty children in various subgroups of JIA according to ILAR criteria, were included in this cross-sectional study. Clinical data including painful, swollen and limited joints were recorded. Five rheumatologist ultrasonographers, blinded to the clinical evaluation, evaluated the presence of elementary lesions in the wrist and MCP 2 and 3 joints bilaterally. The synovitis was graded in B-Mode and Power Doppler (PD). In addition to descriptive statistics intra- and inter-observer reliability was calculated using Cohen's kappa according to Landis and Koch. RESULTS: US detected more synovitis than the clinical examination (62% vs 28%, 30% vs 23% and 22% vs 17% in the wrist, second and third MCP joints respectively). The intra-observer concordance for synovitis in all joints was excellent in B-Mode (k 0.84 .63-1.0 p = 0.001), except for MCP 2, where it was good (0.61, IC 95% .34-89, p = 0.001). For both modalities (PD, B-Mode) tenosynovitis, cartilage damage and bone erosions it was also excellent. Regarding synovitis grading the concordance was excellent for all grades (0.83-1.0, IC 95% 0.51.1.0, p = 0.001), except for grade 1 where it was good (0.61, IC 95% 0.43-.83, p = 0.001). Reliability inter-observer for grayscale synovitis (0.67-0.95, IC 95% 0.67-1.0, p = 0.001), tenosynovitis grayscale (0.89, IC 95% 0.78-0.99, p.001), damage cartilage (0.89, IC 95% 0.78-0.99, p = 0.001), PD (0.66, IC 95% 0.39-1.0, p = 0.001). The concordance for grading synovitis was excellent, but for grayscale grade 1 and 2 (.66, IC 95% .53-.74, p = 0.007) and PD grade 1 and 2 (0.63, IC 95% .58-.91, p = 004) was good. CONCLUSIONS: The intra- and inter-observer reliability of MSUS for inflammatory and structural lesions is good to excellent for the wrist and MCP in patients with JIA.
Assuntos
Artrite Juvenil/diagnóstico por imagem , Articulação Metacarpofalângica/diagnóstico por imagem , Ultrassonografia/métodos , Articulação do Punho/diagnóstico por imagem , Artrite Juvenil/patologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Articulação Metacarpofalângica/patologia , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Articulação do Punho/patologiaRESUMO
La rápida evolución de la tecnología y con ella la de los diferentes métodos diagnósticos y terapéuticos ha traído consigo un creciente interés por los profesionales de la salud en disponer de los últimos avances y las mejores tecnologías para atender a los pacientes puesto que, a través de estos recursos, se espera reducir la incertidumbre clínica en cuanto a los diagnósticos y tratamientos. Se reconoce que los avances tecnológicos son, en parte, responsables de mejorar la salud de las comunidades y, en consecuencia, de aumentar la expectativa de vida de la población. Sin embargo, el gran número de innovaciones emergentes hace pensar que debe haber un proceso de selección apropiado por parte de los sistemas de salud para garantizar que se logren en la práctica los beneficios y los propósitos planteados. La selección de las nuevas tecnologías debe incluir tanto el análisis de la tecnología en sí como la comparación con otras; este proceso se denomina Evaluación de tecnologías en salud y tiene un enfoque principalmente macro, es decir, desde agencias de evaluación de carácter nacional que evalúan con el objetivo de regular las inclusiones de tecnologías en los sistemas de salud en Colombia. Se trata de un Plan de beneficios; sin embargo, la disponibilidad de las nuevas tecnologías está en las instituciones de salud e implica una evaluación que regule las tecnologías en este nivel. Internacionalmente esto se reconoce como Evaluación de tecnologías basada en hospitales. Este artículo hace una descripción de las evaluaciones de tecnologías, pero con énfasis en metodologías hospitalarias.
The rapid evolution of technology and subsequent growth of diagnostic and therapeutic methods has brought about a growing interest in health professionals for having the latest and best technologies to serve patients as these resources are expected to reduce clinical uncertainty regarding diagnosis and treatment. Technological advances are acknowledged in part as being responsible for the improvement in the health of communities and the increase in life expectancy of the population. However, the large number of emerging innovations suggests that health systems must implement an appropriate selection process to ensure that the benefits and objectives are in fact achieved. The selection process of new technologies should include both the analysis of the technology itself as well as how it compares to others. This process is known as health technology assessment. These evaluations focus on the macro level, mainly from national assessment agencies, which evaluate with the aim of regulating the implementation of technologies in the Colombian health systems, which is a benefit plan. However, new technologies are only available in health institutions, which involves an assessment that regulates technologies at that level and is internationally known as hospital-based health technology assessment. This document provides a description of technology assessment with an emphasis on hospital methodologies.
A rápida evolução da tecnologia e com ela a dos diferentes métodos diagnósticos e terapêuticos há traído consigo um crescente interesse pelos profissionais da saúde em dispor dos últimos avances e as melhores tecnologias para atender aos pacientes posto que, através destes recursos, se espera reduzir a incerteza clínica em quanto aos diagnósticos e tratamentos. Se reconhece que os avances tecnológicos são, em parte, responsáveis de melhorar a saúde das comunidades e, em consequência, de aumentar a expectativa de vida da população. Mas, o grande número de inovações emergentes faz pensar que deve haver um processo de seleção apropriado por parte dos sistemas de saúde para garantir que se consigam na prática os benefícios e os propósitos levantados. A seleção das novas tecnologias deve incluir tanto a análise da tecnologia em si como a comparação com outras; este processo se denomina Avaliação de tecnologias em saúde e tem um enfoque principalmente macro, ou seja, desde agências de avaliação de carácter nacional que avaliam com o objetivo de regular as inclusões de tecnologias nos sistemas de saúde na Colômbia. Se trata de um Plano de benefícios; mas, a disponibilidade das novas tecnologias está nas instituições de saúde e implica uma avaliação que regula as tecnologias neste nível. Internacionalmente isto se reconhece como Avaliação de tecnologias baseada em hospitais. Este artigo faz uma descrição das avaliações de tecnologias, mas com ênfase em metodologias hospitalares.
Assuntos
Avaliação da Tecnologia Biomédica , Tecnologia , Avaliação em Saúde , Desenvolvimento Tecnológico , Tecnologia Biomédica , Tomada de Decisões , Recursos em Saúde , Administração Hospitalar , HospitaisRESUMO
Equine coital exanthema (ECE), caused by equid herpesvirus 3 (EHV-3), has been recognized as an economically significant venereal disease for years. However, no infection models on the natural host have been established. In order to set up an experimental infection protocol, seronegative and seropositive mares were topically inoculated in the perineal region with 4 × 10(6)TCID(50)/ml of EHV-3. Clinical signs were then evaluated by means of a designed scoring system, and body temperature was recorded daily. Virological, and serological studies were also performed. Typical ECE lesions, with clinical scores of 90, 92, 160 and 172, were observed in the four seronegative animals. Only mild ECE lesions were observed in the two seropositive mares, being the clinical scores 53 and 41. Both groups of mares shed the virus, but the duration of virus shedding was shorter and its intensity was lower in seropositive mares than in seronegative ones. Moreover, EHV-3 antibody response was detected in both seronegative and seropositive mares after experimental infection and re-infection, being more moderate in seropositive ones. As a conclusion, EHV-3 infection of mares was experimentally achieved in a reproducible manner. The typical lesions of ECE were observed after topical EHV-3 infection in seronegative mares, in association with virus excretion and neutralizing antibody kinetics.
Assuntos
Infecções por Herpesviridae/veterinária , Herpesvirus Equídeo 3/fisiologia , Doenças dos Cavalos/imunologia , Doenças dos Cavalos/patologia , Infecções Sexualmente Transmissíveis/veterinária , Animais , Anticorpos Antivirais/sangue , Formação de Anticorpos , Sequência de Bases , Feminino , Genótipo , Infecções por Herpesviridae/imunologia , Infecções por Herpesviridae/patologia , Infecções por Herpesviridae/virologia , Doenças dos Cavalos/virologia , Cavalos , Dados de Sequência Molecular , Alinhamento de Sequência , Infecções Sexualmente Transmissíveis/imunologia , Infecções Sexualmente Transmissíveis/patologia , Infecções Sexualmente Transmissíveis/virologia , Fatores de Tempo , Proteínas do Envelope Viral/genética , Eliminação de Partículas ViraisRESUMO
BACKGROUND: Cerebral venous thrombosis (CVT) is a rare form of cerebrovascular disease that is usually not mentioned in multicenter registries on all-type acute stroke. We aimed to describe the experience on hospitalized patients with CVT in a Mexican multicenter registry on acute cerebrovascular disease. METHODS: CVT patients were selected from the RENAMEVASC registry, which was conducted between 2002 and 2004 in 25 Mexican hospitals. Risk factors, neuroimaging, and 30-day outcome as assessed by the modified Rankin scale (mRS) were analyzed. RESULTS: Among 2000 all-type acute stroke patients, 59 (3%; 95% CI, 2.3-3.8%) had CVT (50 women; female:male ratio, 5:1; median age, 31 years). Puerperium (42%), contraceptive use (18%), and pregnancy (12%) were the main risk factors in women. In 67% of men, CVT was registered as idiopathic, but thrombophilia assessment was suboptimal. Longitudinal superior sinus was the most frequent thrombosis location (78%). Extensive (>5 cm) venous infarction occurred in 36% of patients. Only 81% of patients received anticoagulation since the acute phase, and 3% needed decompressive craniectomy. Mechanical ventilation (13.6%), pneumonia (10.2%) and systemic thromboembolism (8.5%) were the main in-hospital complications. The 30-day case fatality rate was 3% (2 patients; 95% CI, 0.23-12.2%). In a Cox proportional hazards model, only age <40 years was associated with a mRS score of 0 to 2 (functional independence; rate ratio, 3.46; 95% CI, 1.34-8.92). CONCLUSIONS: The relative frequency of CVT and the associated in-hospital complications were higher than in other registries. Thrombophilia assessment and acute treatment was suboptimal. Young age is the main determinant of a good short-term outcome.
Assuntos
Veias Cerebrais , Acidente Vascular Cerebral/complicações , Trombose Venosa/complicações , Adulto , Fatores Etários , Transtornos Cerebrovasculares , Feminino , Hospitalização , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , México/epidemiologia , Neuroimagem , Gravidez , Complicações Cardiovasculares na Gravidez , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Trombose Venosa/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Cardiac allograft vasculopathy (CAV) is a major factor limiting long-term survival after heart transplantation (HT). The purpose of this study was to characterize the coronary artery structure and to determine the prevalence of vasculopathy after HT, comparing the sensitivity of coronary angiography with that of intravascular ultrasound (IVUS) and virtual histology (VH). METHODS: A prospective recruitment cross-sectional study was performed in 31 adult HT recipients including 22 men and, 9 women of overall mean age of 45.2 ± 12.6 years at an average of 3.7 ± 3.7 years after transplantation. They underwent simultaneously coronary angiography and IVUS assessment of the left anterior descending coronary artery. We investigated histological composition of the intima. Final data were analyzed using parametric and nonparametric tests. RESULTS: IVUS discovered the presence of CAV among 17/31 (54.8%) patients versus coronary angiography in 10 (32.3%; P = .009). The histological composition of the intima as assessed with IVUS VH was 26.1% fiber, 8.7% necrotic core, 5.7% calcium, and 4.3% lipid. There was no significant association between preexistent risk factors and the presence of CAV. There was a correlation between time elapsed since HT and CAV development. CONCLUSION: Time elapsed since HT is the most important risk factor for the development of CAV. Its prevalence almost doubled when measured with IVUS in contrast with angiography. IVUS was thus shown to be a more sensitive diagnostic tool compared with coronary angiography.
Assuntos
Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Transplante de Coração/efeitos adversos , Ultrassonografia de Intervenção , Adulto , Chile , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/patologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Transplante Homólogo , Resultado do TratamentoRESUMO
The temporary disruption of reproductive activities due to equine coital exanthema (ECE), caused by equid herpesvirus 3 (EHV-3), at thoroughbred breeding facilities and embryo transfer centres, has an appreciable economic impact. The aim of the present study was to estimate the prevalence of excretion of EHV-3 in mares without clinical symptoms under field conditions and the re-excretion patterns of the virus in two seropositive (presumably latently infected) mares maintained in isolation for 11 mo. The EHV-3 virus was detected in perineal-vaginal swabs by real time PCR in 14 (6%) of 220 thoroughbred mares without clinical symptoms at the time of breeding. In the two isolated mares, re-excretion of EHV-3 was demonstrated on two occasions, 3 mo apart (each for a 3 d interval) in one mare, and on only 1 d in the other mare. Antibodies against EHV-3 were identified by seroneutralization in 105 (48%) of the thoroughbred mares, and during the entire period in the two isolated mares. Therefore, the present study provided evidence of EHV-3 shedders in a healthy mare population under both field and isolation conditions. Furthermore, at least two periods of spontaneous EHV-3 reactivation and re-excretion in the presence of serum antibodies occurred in one mare in an 11 mo interval. These findings could assist in the design and implementation of measures to minimize the spread of EHV-3 and control ECE outbreaks.
Assuntos
Infecções por Herpesviridae/veterinária , Herpesvirus Equídeo 3/isolamento & purificação , Doenças dos Cavalos/virologia , Eliminação de Partículas Virais , Animais , Infecções por Herpesviridae/virologia , Herpesvirus Equídeo 3/fisiologia , Doenças dos Cavalos/imunologia , Cavalos , Periodicidade , Ativação ViralRESUMO
State of latency, well known for several herpesviruses, has been proposed for equine herpesvirus-3 (EHV-3) and supported by epidemiological observations. No detailed assessment about reactivation, patterns of excretion and reexcretion has been formally reported. An experimental reactivation study by corticosteroid treatment in previously naturally infected horses was therefore carried out. Two polo mares with clinical and virologically confirmed history of equine coital exanthema were injected with dexamethasone and prednisolone on 3 successive days. Clinical signs, body temperature and clinical samples for virological and serological studies were obtained daily. Mares did not show any systemic clinical signs or hyperthermia. EHV-3 shedding, seroconversion and the presence of a small lesion were observed in one of the mares under study 2 weeks after corticosteroid treatment. The results demonstrate that this virus exhibits a latency-reactivation behaviour similar to that of other alpha herpesviruses. Reactivation of latency may have an important bearing on the appearance of clinical signs in mares and/or stallions during the breeding season without the actual evidence of transfer from mare to stallion or vice versa.
Assuntos
Corticosteroides/farmacologia , Infecções por Herpesviridae/veterinária , Herpesvirus Equídeo 3/fisiologia , Doenças dos Cavalos/virologia , Latência Viral , Animais , DNA Viral/análise , Dexametasona/farmacologia , Feminino , Infecções por Herpesviridae/virologia , Cavalos , Reação em Cadeia da Polimerase/métodos , Reação em Cadeia da Polimerase/veterinária , Prednisolona/farmacologia , Latência Viral/efeitos dos fármacosRESUMO
Forty two cases of advanced gestational choriocarcinoma were examined, with 4 of these patients being hospitalized for less than 24 hours. Given the non specific and atypical nature of the symptomatology, it was correctly diagnosed in 20 of these cases. In the other 22 cases where the predominant clinical status was established as a result of the localized invasion of neighboring structures or through metastasis, a variety of diagnoses were given, including uterine cervical carcinoma, endometrial carcinoma, pulmonary metastasis, brain tumor, bleeding of the gastrointestinal tract. The 20 patient diagnosed with choriocarcinoma were treated in the following manner: nine were operated for hysterectomies, with one of these also receiving an omentectomy, seven more were given chemotherapy treatment based upon methotrexate, and the remaining for were simply stabilized, which produced unfavorable results in that they survived from one to twenty weeks longer, with an average on only five weeks.