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INTRODUCTION: Emergency physicians frequently provide care for patients who are experiencing viral illnesses and may be asked to provide verification of the patient's illness (a sick note) for time missed from work. Exclusion from work can be a powerful public health measure during epidemics; both legislation and physician advice contribute to patients' decisions to recover at home. METHODS: We surveyed Canadian Association of Emergency Physicians members to determine what impacts sick notes have on patients and the system, the duration of time off work that physicians recommend, and what training and policies are in place to help providers. Descriptive statistics from the survey are reported. RESULTS: A total of 182 of 1524 physicians responded to the survey; 51.1% practice in Ontario. 76.4% of physicians write at least one sick note per day, with 4.2% writing 5 or more sick notes per day. Thirteen percentage of physicians charge for a sick note (mean cost $22.50). Patients advised to stay home for a median of 4 days with influenza and 2 days with gastroenteritis and upper respiratory tract infections. 82.8% of physicians believe that most of the time, patients can determine when to return to work. Advice varied widely between respondents. 61% of respondents were unfamiliar with sick leave legislation in their province and only 2% had received formal training about illness verification. CONCLUSIONS: Providing sick notes is a common practice of Canadian Emergency Physicians; return-to-work guidance is variable. Improved physician education about public health recommendations and provincial legislation may strengthen physician advice to patients.
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Atitude do Pessoal de Saúde , Medicina de Emergência , Relações Médico-Paciente , Médicos/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Retorno ao Trabalho , Licença Médica , Adulto , Canadá , Tomada de Decisões , Feminino , Mau Uso de Serviços de Saúde , Humanos , Masculino , Inquéritos e QuestionáriosRESUMO
In the context of precision medicine with immunotherapies there is an increasing need for companion diagnostic tests to identify potential therapy responders and avoid treatment coming along with severe adverse events for non-responders. Here, we present a retrospective case study to discover image-based signatures for developing a potential companion diagnostic test for ipilimumab (IPI) in malignant melanoma. Signature discovery is based on digital pathology and fully automatic quantitative image analysis using virtual multiplexing as well as machine learning and deep learning on whole-slide images. We systematically correlated the patient outcome data with potentially relevant local image features using a Tissue Phenomics approach with a sound cross validation procedure for reliable performance evaluation. Besides uni-variate models we also studied combinations of signatures in several multi-variate models. The most robust and best performing model was a decision tree model based on relative densities of CD8+ tumor infiltrating lymphocytes in the intra-tumoral infiltration region. Our results are well in agreement with observations described in previously published studies regarding the predictive value of the immune contexture, and thus, provide predictive potential for future development of a companion diagnostic test.
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Ipilimumab/uso terapêutico , Melanoma/diagnóstico por imagem , Melanoma/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Farmacológicos , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imunoterapia , Linfócitos do Interstício Tumoral/imunologia , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Medicina de Precisão/métodos , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/tratamento farmacológico , Melanoma Maligno CutâneoRESUMO
Resumen Objetivo: Conocer los tipos de cuidados de enfermería y de otros profesionales de la salud para las personas hospitalizadas por fístulas enterocutáneas. Metodología: Se realizó una revisión integrativa de literatura siguiendo los pasos de Ganong (1987) y la guía PRISMA. Se utilizaron las bases de datos MEDLINE, LILACS, BDENF, CINAHL y SCIELO. Se consultaron artículos en inglés y español que estuvieran en texto completo y de acceso gratuito. Los descriptores y palabras claves utilizados fueron: fistula, atención de enfermería, adulto Enterocutaneous fistula, intestinal fistula, therapy, nursing care, adult, hospitalization. Se incluyeron artículos publicados entre los años 2014 a 2020. Resultados: Se encontraron 13 Artículos de los cuáles 8 fueron Guías Clínicas, 3 casos Clínicos y 2 Revisiones Integrativas, los cuales aportan información sobre los cuidados al paciente con fistula enterocutánea distribuidos en cinco pilares, los cuales orientan el manejo interdisciplinario que se da a este tipo de pacientes en el ámbito clínico. Conclusión: Los cuidados a las personas con fístulas enterocutáneas en el ámbito clínico, tiene un abordaje interdisciplinario basado en cinco pilares: prevención y control de sepsis, del desequilibrio hidroelectrolítico, prevención de la desnutrición, el control del efluente y el cuidado de la piel perilesional.Palabras Clave: Fistula, atención de enfermería, adulto.
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Humanos , Mobilidade UrbanaRESUMO
La acatisia aguda es un trastorno del movimiento bastante molesto, caracterizado por sensación subjetiva y signos objetivos de inquietud motora, que se presenta frecuentemente como efecto adverso de los neurolépticos; un tratamiento oportuno es necesario para garantizar una buena adherencia al manejo con antipsicóticos y prevenir recaídas. Se describe el estado actual de los tratamientos disponibles para la acatisia aguda inducida por neurolépticos, valorando efectividad y tolerabilidad. Se realizó una búsqueda electrónica en Pubmed, Science Alert, Springer link, SciELO, Ovid y Elsevier con criterios de selección específicos, obteniendo 87 estudios, de los cuales se escogieron 51 teniendo en cuenta relevancia clínica, nivel de evidencia y actualidad. En este artículo se describen los resultados de la búsqueda. Las benzodiacepinas, los betabloqueadores lipofílicos de acción central y los anticolinérgicos son los fármacos más estudiados para el tratamiento de este trastorno del movimiento; los dos primeros han mostrado superioridad, sin embargo, se necesita aún bastante investigación al respecto.
Acute Akathisia is a movement disorder rather annoying; characterized by subjective feelings and objective signs of restlessness, which often presents as a side effect of neuroleptics, early treatment is necessary to ensure good adherence to treatment with antipsychotics and prevent relapses. To describe the state of the art of available treatments for neuroleptic-induced acute akathisia, taking into account effectiveness and tolerability. An electronic search in Pubmed, Science Alert, Springer link, SciELO, Ovid and Elsevier with specific eligibility criteria, obtaining 87 studies, of which were chosen 51 of them manually, according to their clinical relevance, topicality and level of evidence. In this paper, we describe the results of the search. The benzodiazepines, centrally acting lipophilic beta-blockers and anticholinergics, are the most studied drugs to treat this movement disorder, the first two have shown superiority; however, considerable research is still needed in this regard.
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La inclusión del alumnado con algún tipo de discapacidad es uno de los retos pendientes en el ámbito escolar. El presente estudio tiene como objetivo comprender las experiencias subjetivas de los estudiantes con discapacidad cognitiva leve, padres de familia, pares y docentes, frente al proceso de inclusión escolar en una institución educativa de la ciudad de Neiva. Es un estudio cualitativo-etnográfico que utilizó la observación participante y el dibujo libre en 27 personas distribuidas en 6 grupos (entidades gubernamentales, grupo de apoyo, profesores, padres de familia, estudiantes con discapacidad e iguales). Los resultados evidencian que son las entidades gubernamentales las encargadas de garantizar el derecho a la educación y a la inclusión escolar desde la normatividad reconociendo que existen dificultades en la implementación de estos programas. Las demás personas involucradas en el proceso requieren tener mucho compromiso para que la inclusión pueda realizarse en un ambiente de igualdad que permita la construcción del proyecto de vida. Los estudiantes con discapacidad cognitiva se sienten bien ya que tienen la oportunidad de iniciar un proceso de socialización con los pares los cuales los han aceptado, acogido y establecido un trato con igualdad
Inclusion in schools has been a topic of great interest because the statistics demonstrate a low level of educational inclusion. Therefore, this study aims to understand the subjective experiences of students with Mild Cognitive Disability, parents, peers and teachers to the process of school inclusion in the Educational Institution from the city of Neiva. It is a qualitative ethnographic study, used participant observation and the free drawing in 27 people in 6 groups (government agencies, support groups, teachers, parents, students with disabilities and peers). The results demonstrate that Governmental Entities are responsible for ensuring the right to education and school inclusion from the normativity recognizing that there are difficulties in implementing these programs. The other people involved in the process need to be very commitment to inclusion that can be carried out in an environment of equality that allows the construction of life project. Students with Cognitive Disabilities are feeling good because they have the opportunity to start a process of socialization with peers which have accepted them, welcomed and established equality treatment